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Principal Investigator: Rachel C Shelton
Organization: COLUMBIA UNIVERSITY HEALTH SCIENCES
Fiscal Year: 2024
Award: $542,964
Funding agency: National Cancer Institute
Project Summary
Widespread implementation, scale-up, and sustainability of culturally-appropriate, evidence-based programs is
critical to reducing the significant and disproportionate burden of cancer among Black women. Community-
engaged Lay Health Advisor (LHA) programs are highly successful in reducing health inequities for cancer.
One of the most robust evidence-based and nationally disseminated LHA cancer prevention/screening
programs is The National Witness Project (NWP). NWP is one of the few equity-focused LHA programs with
both longevity and evidence of impact in Black communities nationally. Despite its impact, NWP continues to
face challenges to sustainability and the long-term delivery of the program. Advancing the science of
sustainability is urgent, as inequities in cancer and challenges to the sustainability of evidence-based programs
were exacerbated during the COVID pandemic. Research is critically needed on sustainability, particularly
among low-resource settings and communities that face historical and ongoing structural and systemic barriers
to health, to make progress towards racial equity for cancer screening and outcomes. Our team is uniquely
poised to lead and advance research in this area. Building off of our work on sustainability and a long-term
partnership with NWP, we propose a national mixed-methods prospective study with the following aims. First,
in aim 1 we will refine, with a sub-sample of NWP sites nationally (n=6), a package of sustainability strategies
to support the ongoing delivery of NWP at scale, with the long-term goal of addressing cancer screening
inequities among Black women. We will focus on strategies for building capacity and partnerships to enhance
sustained impact and delivery of NWP and support retention of LHAs (e.g. novel curricula/training; tailored
technical assistance; Community of Practice model to share lessons across sites), with the goal of enhancing
capacity for: 1) building partnerships/identifying champions at academic/healthcare centers to leverage
organizational resources; 2) building business case for program’s value; 3) adapting to local community needs
and context. In Aim 2, we propose to deliver and examine the impact of this refined package of sustainability
strategies on multiple sustainability outcomes annually over four years across 16 NWP sites nationally using a
pre-post cluster prospective design. Finally, in aim 3, we plan to apply a concurrent mixed-methods approach
(n=200 surveys and 50-65 in-depth interviews) to examine the uptake, acceptability, appropriateness,
feasibility and impact of sustainability strategies among 16 NWP sites to explore the processes through which
strategies build capacity for and influence sustainability of equity-focused EBIs in community settings over the
4 years. This research is timely, providing a key opportunity to advance scientific understanding of strategies to
promote sustainability among a generalizable, nationally disseminated program. Findings lay the groundwork
for enhancing sustainability of trusted community-led programs and making progress towards racial equity in
cancer and cancer screening.
Terms: <Accountability><Active Follow-up><Address><Area><Behavior><Black><Black race><Breast><Businesses><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cancer Burden><Cancer Center><Cancer Control><Cancer Control Science><Cancer Model><Cancer Survivor><CancerModel><Cancers><Cervical Cancer><Cervical Cancer Screening><Cervix Cancer><Cognitive Discrimination><Collaborations><Communities><Community of Practice><Curriculum><Diagnostic><Discrimination><Early Diagnosis><Education><Educational Curriculum><Educational aspects><Entrepreneurial Skill><Entrepreneurship><Equity><Evaluation><Evidence based program><Face><Goals><Health><Health Inequity><Healthcare><Inequalities in Health><Inequities in Health><Inequity><Infrastructure><Institution><Institutionalization><Interview><Knowledge><Lead><Length of Life><Longevity><Low-resource area><Low-resource community><Low-resource environment><Low-resource region><Low-resource setting><Malignant Cervical Neoplasm><Malignant Cervical Tumor><Malignant Neoplasm of the Cervix><Malignant Neoplasms><Malignant Tumor><Malignant Tumor of the Cervix><Malignant Tumor of the Cervix Uteri><Malignant Uterine Cervix Neoplasm><Malignant Uterine Cervix Tumor><Malignant neoplasm of cervix uteri><Medical><Methods><Modeling><NCI Organization><National Cancer Burden><National Cancer Institute><Outcome><Participant><Pb element><Play><Process><Prospective Studies><Racial Equity><Research><Research Resources><Resource-constrained area><Resource-constrained community><Resource-constrained environment><Resource-constrained region><Resource-constrained setting><Resource-limited area><Resource-limited community><Resource-limited environment><Resource-limited region><Resource-limited setting><Resource-poor area><Resource-poor community><Resource-poor environment><Resource-poor region><Resource-poor setting><Resources><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Science><Scientific Advances and Accomplishments><Screening for cancer><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Site><Survey Instrument><Surveys><Testing><Time><Training><Trust><Underserved Population><Uterine Cervix Cancer><Woman><Work><active followup><black female><black women><cancer prevention><cervical cancer early detection><cervical screening><community partnership><community setting><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><design><designing><disparities in race><disparity due to race><early cancer detection><early detection><evidence base><experience><faces><facial><follow up><follow-up><followed up><followup><health care><health equity><health inequalities><heavy metal Pb><heavy metal lead><implementation science><improved><inequality due to race><inequity due to race><lesson plans><malignancy><neoplasm/cancer><novel><precancer cervical detection><programs><prospective><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial disparity><racial inequality><racial inequity><racially unequal><scale up><scientific accomplishments><scientific advances><screening cancer patients><screening program><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><skills><social><sustainability framework><systemic barrier><systemic hurdle><systemic obstacle><theories><under served group><under served individual><under served people><under served population><underserved group><underserved individual><underserved people><uptake>