Abstract C86: Adapting patient navigation to promote cancer screening in Chicago's Chinatown
Authors: Leung Ivy S. 
Published: May 2016

Women in Chicago's Chinatown experience high rates of breast and cervical cancer. Despite the availability of health services in close proximity to Chinatown, breast and cervical cancer screening and follow-up rates are unacceptably low for Chinese women in this area. However, within this community exist complex barriers to care many women are uninsured or publicly insured, culturally isolated, and are limited English speakers.

The Chinatown Patient Navigation Program is a joint effort by the Chinese American Service League (CASL), Northwestern University, and Mercy Hospital and Medical Center to evaluate a community-based patient navigation program to promote breast and cervical cancer screening and follow-up among Chinatown women. CASL is a trusted community organization in Chinatown for over 35 years; it is where the Chinatown community goes for comprehensive services and cultural events. Mercy Hospital is a community hospital located adjacent to Chinatown with a Cancer Center and Comprehensive Breast and Women's Health Center. Additionally, Mercy Hospital is the largest provider of screening mammograms and Pap tests for the Illinois Breast and Cervical Cancer Program (IBCCP) for uninsured women. Northwestern University brings patient navigation research expertise. Moreover, a Community Advisory Board (CAB) has been established and has been strengthening relationships with the Chinatown community for over five years through CASL's partnership.

In this program, bicultural and multilingual (Cantonese, Mandarin, Toishanese, English speaking) patient navigators guide women through the clinics, specialty referrals, diagnostic/testing sites, and social services necessary for addressing complex barriers to care. Each navigator contributes different strengths to the team and provides cross-training to complement other team member skills with adequate linguistic, cultural, medical, and insurance knowledge.

The community navigation program has comprehensively assisted over four-hundred women in the two years since we've launch the program. Outreach takes place in various community settings, and we regularly host workshops on various topics on women's health and health insurance. In the process of obtaining screenings and timely follow-up, we are helping to build women's trust in the health system and in physicians and staff; increase health coverage for the whole family; create a habit of regular exams; improve women's knowledge in patients' rights and standard clinical care experiences; and decrease fears of hospitals. Our program seeks to not only impact women's health and screening rates, but to positively change the health knowledge and healthcare access of patient's families and friends as well. A large part of the navigators' role has become that of a one-on-one educator on insurance, due to the Affordable Care Act (ACA). The complications of health insurance are compounded by language barriers and lack of knowledge of America's health system. Moreover, systems-level challenges persist, including lack of Chinese-speaking primary-care physicians, shrinking local and state budgets, along with limited cancer education, insurance information and resource availability in Chinese.

The Chinatown Patient Navigation Program has an important research component. This includes focus groups to explore Chinatown women's experiences with the U.S. health care delivery system and individual survey interviews to understand Chinese women's barriers to accessing health care along with their social support and networks. Detailed patient navigation efforts are tracked for a comprehensive process evaluation that can help us better understand service delivery, as well as women's needs and behaviors for obtaining health services independently. In addition, utilization data and medical records will be used to assess changes in community-wide breast and cervical cancer screening rates. Findings from these research activities will help future activities to develop, implement, and disseminate effective and culturally appropriate community-based health programs to eliminate health disparities for Chinese American women. Future directions are to establish a one-stop shop for healthcare services featuring fully integrated Chinese support and to expand navigation services to other chronic diseases and illnesses. This partnership will also serve as a viable model for other community-academic partnerships in underserved communities seeking to improve local health care systems.

Citation Format: Ivy S. Leung. Adapting patient navigation to promote cancer screening in Chicago's Chinatown. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C86.