Friday, May 3, 2024
5/3/2024
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.
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