Promoting positive health behaviors

Promoting Positive Health Behaviors

Evaluating the Every Woman Matters program and other cancer screening programs

Cancer rates continue to escalate in the U.S.: cancers of the breast, cervical, prostate, and colon are on the rise and despite improvements in screening and treatment, early detection efforts must be improved to reduce healthcare costs as well as to promote healthier lifestyles. Particularly amongst the very poor, screening for cancers is problematic. Often there is a lack of education and access to venues for screening and the poor do not have the financial resources to take time off from work to see physicians for non-emergency care. With these factors in mind, a number of pilot programs have been instituted to expand access to cancer screening for high-risk populations.

Every Woman Matters (EWM)

The Every Woman Matters program was designed to improve the health of low-income woman through increasing access to breast and cervical cancer screening, both of which have been linked to significantly improving positive health outcomes for women. "Eligible women receive a clinical breast examination, mammography, and Papanicolaou smear test at reduced or no cost" (Backer et al. 2005: 401). A qualitative study by Backer (et al. 2005) conducted studies of seven different practice settings offering such services as part of the EWM. All practices that were part of the study set different health-related goals. However, due to a failure of administrative support and physician follow-through, a minority of the participating practices realized their objectives. Overall, the EWM program was determined to be a failure.

According to the results, in Practice 1, "the staff displayed an ability to work as a cooperative team toward goals that they saw as benefiting both themselves and the practice. This was due in large part to the office manager who led the effort, despite a lack of physician leadership" (Backer et al. 20005: 403). But in Practice 2, the physician's staff did not share his enthusiasm for primary care. There was tension between the hospital that owned the practice and clinic staff regarding management and this resulted in a failure to achieve screening benchmarks. In Practice 3, administrative problems stymied care delivery because the nurse manager was overwhelmed. Her responsibilities exceeded her capabilities "and her managerial and leadership skills were underdeveloped" (Backer et al. 2005: 404). This practice also failed to meet its goals.

Interestingly enough, in Practice 4: "The practicing physician's behavior changed very little and he was minimally involved with the change plan. The support staff (primarily the clinic manager) embraced the plan for change with enthusiasm and efficiency, from its development to final implementation" and the practice was successful in meeting its goals (Backer et al. 2005: 405). The lack of physician involvement was less significant than the staff's commitment. However, Practice 5's example showed how a physician's poor leadership could actually inhibit the achievement of meaningful goals. In this instance, the physician's chronic tardiness when seeing patients resulted in a backlog: combined with poor leadership, this became a prescription for disaster. The physician was enthusiastic but disorganized and preventative care was not clearly articulated as a priority (Backer 2005: 405). Practice 6, in contrast, was stymied by the unproductive relationship between the nurse manager and the physician. Once again a failure of leadership and miscommunication resulted in improper care delivery. In Practice 7, although progress had been made in reaching goals, "the office manager and staff passively resisted any efforts to include them in the change plan. The lead physician, although unwilling to drop out of the project, did little to encourage or facilitate staff participation" (Backer 2005: 406).

Although the practices had somewhat different goals and levels of success, certain unifying themes were evident between all seven. Those which were most successful had a 'champion' or a single figure who was instrumental in promoting the success of the venture. Unsuccessful practices, in contrast, had little leadership or leadership dominated by persons who were resistant to change. There had to be a strong sense of vision and mission to create teamwork. Overall, the support staff was more critical than physicians in terms of acting as architects of change (Backer 2005: 406). Newer and less focused practices changed to a greater extent than did those part of entrenched bureaucracies and even in the unsuccessful ventures, at least productive dialogue was generated (Backer 2005: 407).

Black Corals

However, some community-based cancer screening programs have proved to be extremely successful. 'Black Corals,' a program specifically targeting low-income African-American women involved handing out free black coral bracelets "that included an insert with a positive message to African-American women about self-worth and a reminder about breast and cervical cancer screening. Nurses and case managers traveled to local churches in the counties to hand out bracelets, lead workshops about risks and symptoms of breast and cervical cancers, and teach women about early detection" ("Black Corals," 2012). The Black Corals effort was community-based and designed to address the needs of a specific, local population. The program also involved posting notices at community events and leaving flyers at hair salons. It worked in active partnership with a local women's church group to spread further word about the screening. " Within two years of putting Black Corals into action, the number of women at all four of the health center's locations getting Pap tests increased by nearly 17%, mammograms increased by 15%, and the number of women who missed scheduled screening appointments dropped from 31 to 19%" ("Black Corals," 2012 ). This exceeded the initial goals of the program.

Unlike the Backer (et al. 2005) study, this program specifically worked with community members. It did draw upon established leaders but not simply from the realm of healthcare itself but also upon trusted figures, particularly from the local church which was the cornerstone of the small, Southern rural community where the program was piloted. Building trust was critical to communicate to the population group about the urgency of the request. Just as urgency is an important component to motivate healthcare workers themselves to change, individuals must themselves feel a sense of urgency to enjoy the benefits of the program. There are often barriers of fear of the unknown as well as economics regarding the willingness of impoverished persons to avail themselves of health-related services. Self-affirmation and the eye-catching use of a 'beautiful' bracelet was able to overcome this initially, combined with community leader support. Ultimately, the fear of not obtaining screening must be greater than the fear of actually seeking out such screening.