Problem: The Cancer Resource Centers of Mendocino County (CRC) is a grassroots organization whose mission is to improve the quality of life for those in Mendocino County impacted by cancer. While Latinx residents make up 25.6% of the population in the county1, upon reviewing the demographic data on the cancer patients served at CRC, staff found that only 7% of their client population was Latinx.
PSE Change Solution: CRC staff created a plan to improve outreach to the local Latinx community. In April 2019, staff members attended the Together, Equitable, Accessible, Meaningful (TEAM) training at the GW Cancer Center to build staff capacity in making systems-level changes to improve health equity. CRC staff used the tools provided in the GW Cancer Center TEAM training, including root cause analysis and stakeholder analysis, and created an action plan to assess needs of the Latinx community and improve outreach.
1. United States Census Bureau. (2018). QuickFacts – Mendocino County, California. Retrieved from https://www.census.gov/quickfacts/mendocinocountycalifornia.
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Problem
Research shows that there are racial and ethnic disparities in access to and utilization of health services. For example, individuals who identify as Hispanic/Latinx are more likely to underutilize health care services compared to other populations (Alcalá et al., 2016; Guendelman & Wagner, 2000). Members of Hispanic/Latinx communities also undergo some types of cancer screening less frequently than non-Hispanic/Latinx individuals (American Cancer Society, 2018; Mojica, Flores, & Ketchum, 2017).
The Cancer Resource Centers of Mendocino County (CRC) is a grassroots organization whose mission is to improve the quality of life for those in Mendocino County faced with cancer. Latinx residents make up 25.6% of the population in the county (United States Census Bureau, 2018). However, upon reviewing the demographic data on the cancer patients served at CRC, staff found that only 7% of their client population is Latinx. A sizeable part of this population is Spanish-speaking and consists of Mexican and Central American individuals and families. As a small nonprofit organization, CRC faces some challenges in serving Spanish-speaking cancer patients and their families. For example, the Centers did not have a bilingual (Spanish/English) patient navigator until May 2018. CRC also has faced financial, geographic and economic challenges in promoting CRC’s free cancer services and resources to this community. These include the lack of dedicated outreach staff; a rural, far-flung county; and a large population of seasonal laborers that works long hours.
PSE Solution
With professional guidance, CRC staff created a plan to improve outreach to the local Latinx community. In April 2019, staff members attended the Together, Equitable, Accessible, Meaningful (TEAM) training at the George Washington University (GW) Cancer Center to build staff capacity in making systems-level changes to improve health equity. The goal of TEAM was to help organizations implement quality improvements to advance equitable, accessible and patient-centered cancer care through improved patient-provider communication, cultural sensitivity, shared decision-making, and attention to health literacy. CRC staff used the tools provided in the GW Cancer Center TEAM training, including root cause analysis and stakeholder analysis, and created an action plan to assess needs of the Latinx community and improve outreach.
Actions/Results
Actions/Results
CRC staff developed the following action steps:
- Determine a new metric to measure CRC service utilization by Latinx and Spanish-speaking clients;
- Engage community focus groups to garner suggestions as to services needed by the Latinx community and how to best communicate to the community available CRC services;
- Identify one regularly occurring social support activity for Spanish-speaking cancer patients in CRC’s inland office.
CRC also anticipates the development of both English- and Spanish-language versions of CRC materials and social media postings in 2020.
Success Factors and Key Questions Addressed
Were goals and objectives feasible in the then-current economic and political environment?
Yes, CRC’s goals were feasible. There are no economic barriers to accessing CRC services since these services are free of charge; however, raising awareness among potential clients has been a challenge. In addition, some undocumented clients have expressed apprehension about their citizenship status. Anecdotal evidence from partner agencies suggests that there is heightened concern in the Latinx community that an agency like CRC could be connected to the government and U.S. Immigration and Customs Enforcement (ICE). CRC staff members must work to ease community distrust and reluctance to use services due to suspicion that CRC may share information with ICE, which it does not. To do so, staff has been working to build trust one client at a time. CRC also provides in-depth information to other service agencies so that when those agencies refer clients to CRC, they are able to accurately advise that CRC does not communicate with ICE or any other government agency regarding citizenship status.
What authorizing environment(s)/setting(s) did you work within? Who were the gatekeepers/decisionmakers?
CRC is a small, independent nonprofit, and as such, does not interact with many gatekeepers. The board of directors is very supportive of this project as it is consistent with the organization’s strategic plan.
What resources existed to help implement your efforts?
CRC was able to fit most components of this project into its existing budget and current staff. In addition, early in 2019, CRC received a grant to develop a 4-minute, promotional video which is available both in English and with Spanish closed captioning.
CRC also is rebuilding its website using outside, volunteer support. Since it is not funded, the project is moving slowly. When complete, the website will include information in Spanish.
What resources did you still need to obtain?
Efforts are underway to find a facilitator to lead a cancer support group in Spanish. This will allow CRC to offer a regularly scheduled Spanish-language cancer support group. As a small nonprofit organization, fundraising is an ongoing concern, and a lot of time and effort are dedicated to raising funds to support CRC’s work. One of CRC’s largest resource needs is funding to pay staff and cover indirect costs.
What are the next steps of your PSE change initiative?
CRC expects to evaluate the results of this project in the fourth quarter of 2020 (Step 7: Evaluate). Data will be analyzed to determine whether the percentage of Latinx clients has increased following implementation of this outreach project.
Related Resources
To learn more about the services of the Cancer Resource Center of Mendocino County, click here to see a video (with Spanish subtitles).
To access the GW Cancer Center’s free online TEAM training. Visit the Online Academy and use enrollment code TEAMcare (note: this is case sensitive).
REFERENCES
Alcalá, H. E., Albert, S. L., Trabanino, S. K., Garcia, R.-E., Glik, D. C., Prelip, M. L., & Ortega, A. N. (2016). Access to and use of health care services among Latinos in East Los Angeles and Boyle Heights. Family & Community Health, 39(1), 62-71. doi:10.1097/FCH.0000000000000090
American Cancer Society. (2018). Cancer Facts & Figures for Hispanics/Latinos 2018-2020. Atlanta: American Cancer Society.
Guendelman, S. & Wagner, T. H. (2000). Health services utilization among Latinos and white non-Latinos: Results from a national survey. Journal of Health Care for the Poor and Underserved, 11(2), 279-194. doi:10.1353/hpu.2010.0719
Mojica, C. M., Flores, B., Ketchum, N. S., & Liang, Y. (2017). Health care access, utilization, and cancer screening among low-income Latina women. Hispanic Health Care International 15(4), 160-165. doi: 10.1177/1540415317735343
United States Census Bureau. (2018). QuickFacts – Mendocino County, California. Retrieved from https://www.census.gov/quickfacts/mendocinocountycalifornia
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