Abstract A018: Community outreach navigation of minority and medically underserved women in rural Arkansas to mammography facilities: Evolution and experiential results of the National Witness Project® from the last decade
Authors: Devonish Julia , Erwin Deborah O. , Johnson Detric , Harfouche Frances , Ross Levi , Maxwell Cynthia 
Published: August 2020

“…intensive, community-based, culturally sensitive educational programs incorporating the spiritual environment of the faith community can positively influence screening behaviors in rural, underserved groups of African American women” Deborah O. Erwin, 1999

The Witness Project is a culturally competent, community-based outreach navigation program founded in Arkansas (AR) where access to mammography screening was especially problematic in certain areas. The (now) National Witness Project® (NWP) has been widely disseminated across the country. Women identify NWP as trusted and familiar providers of breast and cervical cancer education and invaluable assistance.

Objective: Examine the NWP-AR chapter's evolution and past 10 years' experiences navigating rural women.

Methods: NWP-AR provides African-American (AA) and all medically underserved women in rural communities with education and outreach navigation services to mammography as needed. They facilitate implementations of modular or mobile units in areas without facilities (service deserts). In 2007 NWP-AR was implemented in 34 counties and 9 in 2017.

Results: In 2007 there were 1,374 women enrolled in NWP-AR, 84.6% of whom were rural folk. New enrollees (n=1,305) between March 2002-July 2007 were 54.9+/-11.5 years old and mostly AA, Caucasian, or Hispanic (75.7%, 22.1%, 1.7%), married or single (39.9%, 38.2%), and uninsured (82.1%). Medicare or Medicaid use was 31.7%. Initial service location choices were mobile, modular, and freestanding (54.9%, 25.9%, 14.6%). Over time rural women without facilities in their county (n=382) used modular or mobile (62.3%, 30.9%), rural women with facilities in their county (n=725) used mobile or modular (81.5%, 8.7%), and urban women (n=175) used freestanding or modular (61.1%, 19.4%). 2004 AR and national screening rates were 51.0% and 58.3%. In fiscal 2017, NWP-AR held 23 education/outreach events in 9 counties at mostly religious or residential centers (34.8%, 23.9%) and formed 10 new community partnerships in 8 counties. New enrollees (n=446) were ≥40 years of age (78.9%), AA or Caucasian (92.6%, 7.2%, 0.2%), and insured (92.6%). They made 488 contacts with enrollees. Modular units were phased out in favor of mobile units. In the 10 screening events in 8 counties, 138 AA or Caucasian (81.9%, 18.1%) women 40-49 (20.3%), 50-64 (40.6%), and ≥65 (39.1%) years of age were screened. All were insured. Navigation services to screening and later diagnostic testing were used by 67.4% and 2.9%. 2016 AR and national screening rates were 67.8% and 72.4%.

Conclusion: In the 1990s NWP-AR pioneered activations of mobile mammography to rural and underserved areas. They have maintained their positive influences on the screening behavior of AA women. Despite a more focused implementation (34 vs. 9 counties), new enrollment rates almost doubled (~241 in 2007 to 446 in 2017), likely due to the feasibility of the mobile bus units. More work is needed as AR rates remain below average.

Citation Format: Julia Devonish, Deborah O. Erwin, Detric Johnson, Frances Harfouche, Levi Ross, Cynthia Maxwell. Community outreach navigation of minority and medically underserved women in rural Arkansas to mammography facilities: Evolution and experiential results of the National Witness Project® from the last decade [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A018.