Improving North Carolina's Capacity to Prevent Cervical Cancer through Community Engagement, a Needs Assessment, and Resource Strengthening
Creators: name: Clancy, Shannon
name: Mye, Sarah
name: Chao, Catherine
name: Balian, Lara
name: Binder, Adrienne
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2014

description: Background: In 2013, Cervical Cancer-Free North Carolina (CCFNC) identified the South Central and Northeast regions of North Carolina (NC) as disproportionately affected by cervical cancer based on epidemiological surveillance data. Women diagnosed with cervical cancer in NC are often minorities, older, recent immigrants, and/or of lower income. Cervical cancer cases also tend to occur in women who have below average screening rates and HPV vaccination uptake. To address this disparity, CCFNC works with a coalition of partners that deliver and promote cervical cancer prevention services. In 2012, CCFNC developed nine evidenced-based recommendations that could improve cervical cancer prevention. As the CCFNC Capstone team, we worked with stakeholders, who provide cervical cancer prevention services, to identify barriers and encourage the adoption of one of the recommended strategies to increase screening rates and HPV vaccination in high-need regions of NC. Methods: We attended the North Carolina Cervical Cancer Coalition Summit (State Summit) to gather information about the prevailing cervical cancer challenges and stakeholder attitudes towards strategies for improving prevention. We summarized and shared highlights from the event with attendees and coalition members. We then identified and recruited key informants (n=32) from the South Central and Northeast regions of NC using the list of coalition partners and participant referrals. We conducted semi-structured key informant interviews (KIIs) with healthcare providers and educators involved in women's health and immunization to identify challenges and opportunities to improve cervical cancer prevention services in their respective regions. Qualitative data informed the content of the Cervical Cancer Prevention: Strengthening Health Systems and Programs in South Central North Carolina regional meeting. Key informants, coalition members, and other cervical cancer prevention stakeholders attended the regional meeting and participated in community action planning to outline strategies and action steps to implement prioritized recommendations. Following the meeting, our team summarized participant strategies and action steps in the community action plan report, which we distributed to attendees of the meetings. We also updated the NC Cervical Cancer Resource Directory and established a process that can be replicated in the future using our phone survey and web form. Lastly, our team developed an online survey in Qualtrics and analyzed responses to determine recommendations for making the Resource Directory more useful to practitioners and promotional strategies to increase use of the Resource Directory. Results: Participants at the State Summit prioritized two evidence-based recommendations to improve cervical cancer prevention. KIIs identified challenges and opportunities to providing cervical cancer prevention services. They also informed the format and focus of the regional meeting and contributed to its success. At the regional meeting, participants outlined specific strategies and action steps to implement evidence-based recommendations deemed feasible for their organizations. Additionally, our Capstone team identified several barriers that limit use of the Resource Directory, including inaccurate entries, poor Spanish translation, and text with an advanced reading level. Based on these findings and results from the NC Cervical Cancer Resource Directory Survey, the team updated the directory, established a process for revising the directory in the future, and developed specific recommendations for improving utility and awareness of the tool among healthcare professionals. Discussion: Our Capstone project built upon CCFNC's recommendations to improve cervical cancer prevention by facilitating efforts to implement these recommendations. The project contributed to a deeper understanding of the resources, challenges, and opportunities to providing cervical cancer prevention services in South Central and Northeast NC, as well as identified specific ways to help organizations meet their goals and objectives for cervical cancer prevention. We recommend that CCFNC work with Eastern North Carolina Cancer Coalition (ENCCC) to coordinate a Northeast regional meeting, guided by the information obtained from KIIs, that focuses on community action planning to decrease cervical cancer incidence and mortality.