Sustainable strategies for increasing
Cancer Information Service (CIS) use
in African Americans and Hispanics
Cancer Prevention & Control
Research Network
Saint Louis University
University of Texas - Houston
Matthew W. Kreuter, PhD, MPH
Maria E. Fernandez, PhD
Debra J. Pfeiffer, MA
November 1, 2007
Research goal
Increase calls to CIS about HPV
vaccine and cervical cancer
Research design
Study settings
•St. Louis, MO (African American, Intervention)*
•LRGV, TX (Hispanic, Intervention)
•Kansas City, MO (African American, Comparison)
•Laredo, TX (Hispanic, Comparison)
Research audiences
African Americans and Hispanics
•Parents of girls 9-17
•Young women 18-26
•Health care providers that serve them
Summary of key findings
Parents of girls 9-17
Key findings
•Limited knowledge of vaccine
•Ask practical questions
•Ask vaccine safety questions
•HCP leading source of health information
Young women, 18-26
Key findings
•Largely unaware of vaccine
•Ask etiologic questions
•Cancer not perceived as a threat
•HCP leading source of health information
Three part strategy
Part 1: Prime patients in waiting area
•Learn your health information-seeking style in
an interactive quiz
Three part strategy
Part 2: Create conversations
•Simple posters pose provocative questions
•Exposure unavoidable in small exam room
•Intended as a conversation starter
Three part strategy
Part 3: Give provider referral tools
•Patient script with sample questions
Health care providers
Want control of information flow
• HCPs should be the source of health info, not others
• Skeptical of information going to patients from any
source but themselves
• 1-800-numbers: generic, impersonal
• Ideal: local info sources that refer to the HCPs
Health care providers
Want different resources for different clients
• Posters
• Phone script / question card
• Health quiz
Health care providers
Want different options for each resource
• Images
• Design
• Messages
Customization by partners
Young women 18-26
Posters, Young women 18-26
Posters, Young women 18-26
Phone script / question card
Young women 18-26
Phone script / question card
Young women 18-26
Phone script / question card
Young women 19-26
Health quiz
Young women 18-26
Why?
The Collaboration
SLU & UT
• Shared common network partners: CIS
• Cared about low CIS use in our respective
communities
• Interested in health communication
How?
• Explored the problem before we decided to write a
grant
• Collaborative decision about focus
• Equitable distribution of resources
U.T. Development Process
• Conducted interviews with CIS Partners
(from partnership program)
• Conducted 6 focus groups with parents
(fathers and mothers separately), and
young women
• Used Intervention Mapping
• Pilot tested materials with promotoras
CIS Materials
• Provide clinics/community outreach
organizations (from CIS Partnership
Program) with materials
• Community organizations train promotoras to
deliver intervention
• Promotoras use materials in intervention
communities
– One-on-one or in groups of participants
– In English or Spanish as preferred by
participants
U of Texas Materials
ntial and they
1-800-4-CANCER is confide
h if you prefer.
can speak to you in Spanis
• PowerPoint
fotonovela (Photo
stills or embedded
video)
• Fotonovela booklet
• Question cards
• Video
Vivir sin
Why don’t you call
1-800-4-CANCER
That way you can
like I did?
get some of your
questions
answered. Here
’s the card my doct
or gave me.
Thank you so much.
I’ll call when I get home.
Cáncer
Learn ho
w to protec
t
your daug
hter
from cerv
ical cancer
Vivir sin Cáncer
Learn how to protect
from cervical cancer
yourself
“I had no idea that a virus called human
papilloma virus (HPV) caused cervical cancer”
“When I heard 1 out of every 4
women have HPV, I never thought
I would be one of them.”
“The doctor told me I had abnormal changes in
my cervix that could lead to cervical cancer”
“I never thought I could get cervical
cancer, but I was wrong”
26
Hey, I saw this TV commercial for a vaccine for
HPV. Have you heard anything about it?
Yes, my doctor told me about it. Then I
called this free number that she gave me
for the Cancer Information Service or CIS.
27
But, I don’t even have a boyfriend. Why should I get the shot?
Maybe not now, but you might
have one in the future.
28
I’ve never even heard of it.
What is HPV?
HPV is a virus; certain types cause cervical cancer.
The HPV vaccine protects against these types. It
was recently recommended for all girls aged 9-26.
29
1-800-4-CANCER is confidential and they
can speak to you in Spanish if you prefer.
Thank you so much.
I’ll call when I get home.
30
I wonder if it’s safe- I mean it’s a new
shot, right? Are there any side effects?
I’m not really sure… Oh, the doctor did give me a phone
number where we can get more information.
It’s 1-800-4-CANCER from the Cancer Information Service.
31
Program Effectiveness
Study outcome
How measured?
When measured?
Awareness and use of CIS
Interviews with community
partners
Pre- and postintervention
Requests for CIS
information resources
Tracked by Partnership
Program Coordinator
Throughout intervention
period
Use and distribution of CIS
resources
Tracked by Partnership
Program Coordinator
Throughout intervention
period
Calls to 1-800-4-CANCER
CIS call center data
Pre-, during, and postintervention
Next steps
• Final content review by NCI
• Distribute order forms to community partners and HCPs
• Track resource preferences by partner
• Track call volume to CIS
CIS and
Missouri Foundation for Health (MFH)
Linking women to HPV vaccine
• Missourians contact CIS about free vaccine
• Caller matched to nearest facility
• Single campaign creates demand, raises awareness