Dr. Maxwell is a Professor in the Department of Health Policy and Management, Fielding School of Public Health, at the University of California, Los Angeles. Over the last 20 years, Dr. Maxwell has been engaged in a research program broadly focused on cancer health disparities in diverse populations, including multiple Asian ethnic groups. Asian Americans are a rapidly growing population in California that is underserved. Asian Americans with limited English proficiency are often excluded from research, and many studies that do include Asian Americans combine all Asian subgroups in their analyses due to small numbers. Dr. Maxwell conducted some of the earliest surveys among Filipino and Korean Americans in Los Angeles County that described cancer screening behaviors and related knowledge and attitudes in these communities. She has conducted randomized trials to test the efficacy of interventions to increase the utilization of various cancer screening tests or to improve adherence to diagnostic follow-up procedures. She built strong relationships with many Filipino, Korean and Chinese American community organizations in Los Angeles County who have served as community partners in these studies. Currently, Dr. Maxwell serves as investigator on a number of projects that focus on implementing evidence-based interventions in various settings and on building the capacity of community organizations to promote healthy lifestyles.
Questions & Answers
Our intervention was comprised of a trained peer navigator or lay health worker who assisted individual women to complete a follow-up appointment after an abnormal mammogram. Lay health worker interventions have been used successfully in many ethnic groups – therefore, I strongly feel that our intervention, which was developed for Korean American women, can easily be adapted for other ethnic groups. The key ingredient of this intervention is the lay health worker, who should be a mature female with good communication skills, who really cares about helping women to navigate the health care system, and who can dedicate enough time to the project. Our lay health worker was the wife of a pastor, and I attribute a large part of the success of the intervention to her personality and the way she interacted with women. The type of assistance that women request may be different for different ethnic groups and may have to be adapted. In our Korean sample, for example, we found that women did not like filling -out forms. I don’t know how effective an adapted program would be – that would have to be evaluated.
I think that the initial assessment form is an important tool for the peer navigator to identify the needs of each individual woman and to be able to offer the help that would be most appropriate for each woman. In addition, since we worked with clinics that offered free screening and diagnostic follow-up through the Cancer Detection Program, access was assured. Lack of access to medical services would be a huge challenge that cannot be overcome by a peer navigator intervention.
The ultimate outcome of the peer navigator program is that women receive follow-up exams that were recommended by their physician. This could be determined through a review of charts or electronic medical records. I would also recommend that the peer navigator records the type of assistance that she provided for each woman. We used a log sheet for this.
I am currently involved in several studies that focus on the dissemination of evidence-based interventions, which is very challenging. I am especially interested in organizational factors and intervention characteristics that facilitate dissemination. In one study that is funded by the American Cancer Society, we are working with 22 community organizations that are promoting colorectal cancer screening among their members. They are using an evidence-based, multi-component intervention that we previously developed and tested, which is also posted on the RTIPs site. Please click this link to learn more: http://rtips.cancer.gov/rtips/programDetails.do?programId=1515452. In the ongoing dissemination study, we are comparing two dissemination strategies in a randomized design: a basic dissemination and an organizational dissemination, in which our staff provides technical assistance to facilitate the integration of screening promotion into the organization’s routine practices. I think this study will yield very interesting findings that will inform our future dissemination strategies in community settings.