Abstract IA29: Applying the Transcreation Framework to Address Psychosocial Health Disparities among Latina Breast Cancer Survivors
Authors: Nápoles Anna Maria 
Published: December 2020

Abstract
PURPOSE: Latina breast cancer survivors, especially those who primarily speak Spanish, experience worse symptoms and quality of life than non-Latina survivors. This presentation will describe a new framework, the Transcreation Framework for Community-Engaged Behavioral Interventions to Reduce Health Disparities, and how it was applied to develop a translational research program to address psychosocial health disparities among Spanish-speaking Latina breast cancer survivors (SSBCS). METHODS: Applying the Transcreation Framework (TF), the research program uses community-engaged interventions to equip SSBCS with information and skills to manage their disease. We focus on community-based self-care approaches because many underserved communities have limited access to cancer support services and oncology specialists. Applying the framework, we used rigorous scientific methods in community settings to develop, implement and evaluate the effectiveness of behavioral interventions in reducing psychosocial distress and symptoms among urban and rural SSBCS. RESULTS: We define transcreation as the process of planning, delivering, and evaluating interventions so that they resonate with the community experiencing health disparities, while achieving intended health outcomes. Following the TF’s seven iterative steps, we: 1) engaged community partners; 2) selected a theory to guide intervention development; 3) identified candidate evidence-based interventions and community best practices; 4) designed a new transcreated program prototype; 5) designed studies to test the intervention in community settings; 6) built community capacity to deliver the interventions; and 7) delivered and evaluated intervention implementation processes and outcomes. Formative research identified four general areas of need among SSBCS: fear; loss of control over cancer and life; lack of social support; lack of culturally appropriate care; and lack of cancer information in Spanish that they could understand. Population-based research identified cancer self-efficacy and social support as promising mechanisms to improve quality of life of SSBCS, thus we selected social-cognitive theory as the basis for the intervention prototype. With extensive community involvement, we identified an evidence-based stress management program and a community-based program and incorporated them with our prior research to develop Nuevo Amanecer, a new transcreated 8-week cognitive-behavioral stress management program for delivery by peers (trained SSBCS). Two sequential randomized controlled trials were conducted with urban SSBCS first, then rural SSBCS. The program improved several quality of life domains and decreased breast cancer concerns and depressive and bodily symptoms in the first RCT, and reduced anxiety and improved self-efficacy in performing several stress management skills in the 2nd RCT. Subsequently, we used the TF to develop a survivorship care planning and physical activity intervention (health coach plus mobile app and activity tracker) and tested it in a 2-month pilot study among SSBCS that resulted in reduced fatigue and health distress, improved emotional well-being, increased knowledge of needed follow-up care and resources, and an average increase of 1,313 daily steps. CONCLUSIONS: Engaging underserved communities in the design and implementation of behavioral interventions for cancer survivors leads to programs that are more likely to be effective and sustained because they are embedded and delivered in the communities experiencing cancer health disparities. Peer- and community health worker-delivered cancer support programs could be a low-cost, effective method for meeting the psychosocial needs of and increasing inclusion of underrepresented groups in cancer research. Research Implications: The TF can guide development and testing of behavioral interventions for communities experiencing cancer health disparities. The TF results in interventions that balance fidelity to evidence with fit to the setting because they are designed with community.
Citation Format: Anna Maria Nápoles. Applying the Transcreation Framework to Address Psychosocial Health Disparities among Latina Breast Cancer Survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA29.