Center for Health Promotion and Prevention Research

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UTHealth, 2-1-1 collaboration improves cancer control, prevention outcomes

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Maria E. Fernandez, Ph.D.
Maria E. Fernandez, Ph.D.

HOUSTON – A partnership that added health navigation services to 2-1-1 call centers helped a significant number of underserved Texans receive cancer control or prevention measures such as Pap tests and smoking cessation help, according to research from The University of Texas Health Science Center at Houston (UTHealth).

The research results were presented recently at the Ninth American Association for Cancer Research Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.

“There are many programs available to help low-income people receive health care, but they don’t always know about them,” said the study’s lead author, Maria E. Fernandez, Ph.D., a professor and director of the Center for Health Promotion and Prevention Research at UTHealth School of Public Health. “We wondered if we could use the helpline structure to ask people about their health and, if we were able to assess their risk, if we could connect them to programs in their community.”

The 2-1-1 helpline is a nationwide program that connects low-income and minority callers to community-based services. For this study, UTHealth School of Public Health formed a partnership with 2-1-1 call centers in the Houston area, the El Paso area and the Lower Rio Grande Valley area, adding Cancer Control Navigation (CCN) intervention to the helpline’s existing services. CCN services included discussion of the barriers patients faced in receiving health care. Examples include negative attitudes about screening, lack of transportation or difficulty taking time off work—and suggestions for overcoming them.

If the callers needed cancer-related health interventions, some callers were assigned to receive referrals. Others were assigned to receive referrals plus the more detailed CCN services.

Navigators continued contact with the callers until the participants had either completed the needed services or chose not to continue to participate. The final sample included 1,736 callers, with follow-up interviews conducted after the initial contact.

The study showed that the CCN intervention increased completion of any needed cancer control behavior by 27 percent compared with those who received only a referral. Considering individual behaviors, the CCN intervention significantly increased Pap test screening by 37 percent compared to those who received a referral only. Several other cancer prevention behaviors were also higher in the CNN group compared with the referral-only group, but Fernandez cautioned that these findings were not statistically significant, likely due to smaller sample sizes.

Nevertheless, the trend of higher completion of cancer control behaviors among participants who received navigation was clear. For example, colorectal cancer screening increased by 40 percent; mammography increased by 19 percent, HPV vaccination of daughters increased by 43 percent and participation in smoking cessation programs increased by 50 percent.

Fernandez said the study results indicate that there is strong potential to reach the poor and the medically underserved with lifesaving cancer control services by partnering with existing programs aimed at helping the poor and the medically underserved such as the 2-1-1 helpline.

“This study was designed and implemented in the real world,” she said. “This type of collaboration has great potential to connect large numbers of medically underserved individuals to cancer control and prevention services and decrease the burden of cancer in underserved populations including the poor, ethnic minorities and rural residents.”

Fernandez said the main limitation of this study was how difficult it was to follow up with participants. Many used short-term cellphones and did not have phone numbers where they could be reached at later dates. Fernandez said the difficulty in tracking participants resulted in certain sample sizes being smaller than she expected. Next steps include expanding the program to other 2-1-1 call centers and testing various approaches for increasing the impact of the program.

This study was funded by the Cancer Prevention Research Institute of Texas and by a training grant from the National Cancer Institute.

-adapted from a press release by the American Association for Cancer Research

—Written by Hannah RhodesMedia Contact: 713-500-3030