Lorena Verdugo, Dr. Julie Armin, and Juanita Trejo

Addressing Language and Education Barriers in Southern Arizona

Two University of Arizona researchers presented posters at a local research fair highlighting interventions underway at UACC aimed at improving patient-centered cancer care for underserved populations.

[featured image – Left to Right: Lorena Verdugo, Dr. Julie Armin, and Juanita Trejo]

On May 2nd, The University of Arizona’s Juanita Trejo, MPH and Yvonne Bueno, MPH, OTR/L, presented posters at the 3rd Annual El Rio Research Fair “Innovations in Community Health”. Juanita Trejo, a recent graduate from the University of Arizona Master of Public Health program, presented a poster on the process of training Community Health Workers (CHWs) for The University of Arizona Cancer Center’s (UACC) expansion of Dr. Catherine A. Marshall’s Un Abrazo Para La Familia™ (Abrazo) program, Embracing the Family. She was awarded 2nd place in the innovation category. Yvonne Bueno, a 4th year Doctor of Public Health (DrPH) student at the University of Arizona’s College of Public Health, presented the results of qualitative survivorship care interviews, an important research tool in the expansion of UACC’s patient navigation program. She was recognized in the relevance category, earning 3rd place.

Each program presented is an integral part of UACC’s work with the Alliance to Advance Patient-Centered Cancer Care. Under the guide of Principal Investigator Heidi A. Hamann, PhD, the University of Arizona is working to increase access to high-quality cancer care and decrease health disparities in Southern Arizona, collaborating with local community groups to deliver their interventions. The Arizona Community Health Outreach Workers’ Network (AzCHOW) will serve as a training partner on Abrazo, a family-focused supportive care intervention to increase knowledge and reduce distress for underserved cancer patients and their families. The network will provide training to the CHWs who will deliver the program. El Rio Health will be a community partner on the patient navigation expansion, helping to incorporate culturally appropriate, bilingual navigators into UACC’s existing program.

The National Program Office reached out to Juanita and Yvonne to find out more about their work with the Alliance and discuss research progress.

Juanita Trejo, MPH

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“Dr. Catherine A. Marshall [Associate Professor, Research, College of Education] is the creator of Un Abrazo Para La Familia™; the intervention was shaped with a focus on low-income families facing cancer because of the limited resources available to them. The communities that we are focusing on include families that live within the catchment area of the UA Cancer Center (Pima, Pinal, Santa Cruz, Cochise, and Yuma). Specifically, we are focusing on the families of UACC patients who are of low-socioeconomic status.

Abrazo is an educational and supportive program that aims at reducing stress and anxiety by educating families about the disease, the treatment process, and how to navigate the system. The focus of this program is on the co-survivors of the patients, whom can be family members, caregivers, or anyone that has been deeply affected by the diagnosis. Abrazo is a 3-hour long intervention and is available in English or Spanish, facilitated by trained Community Health Workers (CHWs) [who are meeting with co-survivors] in their respective counties at a time and location that is most convenient for the family. Every family receives a BagIT, which is a bag that contains cancer related materials that are used to facilitate Abrazo. Each hour is dedicated to different topics, incorporating cancer prevention information. The topics include Cancer Information and Navigating Cancer-Related Systems, Communicating and Problem Solving in Cancer-Related Systems, and Building Socio-Emotional Support and Reinforcing Skills Development.”

“When CHWs were recruited to be part of this project and arrived to the training, we knew they had prior cancer experience through other projects. What we learned was how important the topics covered were to them and how they related to the information provided through their personal experience with cancer. The training not only helped the CHWs learn the material and understand their role in the project but we, as the research team, fully grasped how important the CHWs will be when they work with families similar to their own.

One of the greatest barriers to care in general and one of the simplest ways to be culturally appropriate is through language. We know that the leading cause of death among the Latino population in the U.S. is cancer1. In Southern Arizona specifically, the Latino population accesses cancer care at a lower rate and are diagnosed at later stages due to their barriers to care- language being one of them. What Abrazo brings to the table is an intervention available in English and Spanish that incorporates the importance of family, which in the Latino population is culturally appropriate and relevant. Having CHWs with work and life experience with cancer allows for a stronger connection with the families we will be working with.”

Yvonne Bueno, MPH, OTR/L

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“One of our research goals is to increase cancer care coordination between primary care providers (PCPs) and other specialties.  The mechanism UACC is using to achieve this is by expanding an evidence based, peer led navigation program.  We are working with our community partner, El Rio Community Health Center on this goal, which entails qualitative research for understanding barriers to cancer care coordination for the patients they serve.  Those qualitative results were then used to develop the community navigator role based on care coordination needs identified by our community partner.

Yvonne

Yvonne Bueno

Care coordination is a critical issue in oncology, especially when patients and survivors move between settings, have multiple procedures, see specialty providers, and transition back to primary care. Care coordination at the UACC is also complicated by geography (patients may travel long distances for their cancer care), language (patients may have needs for Spanish-speaking providers and instructions), and access (patients may have limited access to primary care providers). To ameliorate these problems, we aim to focus on culturally and linguistically appropriate patient navigation. Ultimately, through these increased navigation services, we aim to improve access of UACC patients to cancer and survivorship care, increased receipt and utilization of survivorship care plans for UACC patients and primary care providers, and enhanced linkage of cancer survivors to PCPs.”

“The potential impact of this program will be to improve patient-centered quality cancer care and reduce health care access disparities among vulnerable and underserved cancer patients in Southern Arizona. So far, two community navigators have been hired, trained, and have been implemented at UACC. They are currently serving patients who have been identified with high social needs.  They assist patients in overcoming barriers to care, negotiate health care systems, and access quality care. More specifically, roles of the community navigators include: connecting patients to resources and support systems; assisting with interactions between health care providers; streamlining appointment scheduling; helping patients access financial services; helping patients arrive at scheduled appointments on time and prepared; assuaging patients’ fear and anxiety; identifying appropriate social services; and tracking outcomes and interventions.  Patient navigators offer a promising approach to decrease cancer disparities, both by optimizing existing resources and by compensating for the lack of resources on behalf of low-income, minority patients.”

The University of Arizona Cancer Center’s Un Abrazo Para La Familia™ and patient navigation programs show promising potential, and are on track to positively impact underserved communities in Southern Arizona. After their successful poster sessions, Juanita and Yvonne will be working on project implementation. Abrazo is due to enter the patient recruitment stage, with the hope that families served will share the information learned with their extended families and their local communities, amplifying the impact of the intervention.


Yvonne Bueno, MPH, OTR/L, is a 4th year Doctor of Public Health (DrPH) student in the College of Public Health at the University of Arizona, with a concentration in Maternal and Child Health. She is a graduate research assistant (GRA) working primarily on Increasing Oncology/Primary Care coordination, or Goal 1 of the University of Arizona’s Alliance. She works with Alliance Co-Investigator Dr. Julie Armin, who is the community liaison co-lead, and the process outcome specialist on the project. Responsibilities include conducting pre-intervention needs assessment in partnership with their community partner, El Rio Community Health Center, and assist with expansion of evidence-based, culturally appropriate, peer-led navigation program.

Juanita Trejo, MPH is a recent graduate of the University of Arizona Master of Public Health program, specializing in Health Behavior and Health Promotion. She has been working in her role as Project Coordinator for Un Abrazo Para La Familia™ for a little over a year, and recently started working as a Depression Care Manager in the COPE-D program. Her research interests include how interpersonal relationships in minority populations affect their overall health and barriers to health. Juanita joined the Alliance intervention bringing a wealth of professional experience in project coordination, research design, and engaging diverse populations; she has worked as Clinic Manager for a free non-profit health clinic in Tucson (Clínica Amistad), she was Research Assistant in the ANIMO lab with Dr. David Garcia and was a volunteer with the Peace Corps.

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