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Native Navigation across the Cancer Continuum in Comanche Nation

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The Southern Plains (Oklahoma, Texas, and Kansas) Native Americans (NAs) have excessive cancer incidence and mortality rates. Despite the implementation of educational strategies that have successfully reached many racial/ethnic groups in the United States to decrease cancer incidence and mortality, this is not the case among NA people living in the Southern Plains. The proposed project seeks to meet National Institutes of Health missions to eliminate health disparities among a minority population, and to understand the role of human behavior across the cancer continuum. Patient navigation is an emerging strategy of employing trained individuals to assist others to navigate the health care system to receive needed education and services. It is a process by which an individual-a patient navigator-provides outreach and education, ensures access to screening examinations, and guides patients with a suspicious finding through and around barriers in the complex cancer care system to help ensure timely diagnosis and treatment. The proposed multidisciplinary project (nursing, public health, and statistics) employs a community-based participatory approach using mixed methods to examine use of Native navigators as an intervention in the Comanche Nation. Goal setting based on principles of Goal Attainment Scaling (GAS) will be implemented one-on-one with each Native Navigator in order to facilitate training. It will also be used with NA participants in community cancer education workshops as a means of assisting NAs to make progress towards achieving cancer-related behavior change. The goal of this project is to test GAS to assist the Comanche Nation in refining, expanding and adapting various navigator models currently used in other NA communities to address the community's and patients'needs across the continuum of cancer care. The expected outcome is the development of a site-specific (tailored), Native Navigator cancer education program that addresses the full continuum of cancer care in the Comanche Nation that facilitates cancer-related behavioral change in participants. Specific aims are: 1. To determine to what extent Native Navigator-initiated Native American community education workshops will improve knowledge regarding cancer prevention, screening, and treatment among Native American participants. 2. To determine whether demographic variables of age, education, and annual family income in NA participants attending Native Navigator-initiated community education workshops are associated with pre- and post-test scores on cancer-related knowledge items developed for NAs. 3. To determine if goal setting based on GAS will facilitate training of Native Navigators. 4. To determine if goal setting based on GAS will be an effective method for participants in community cancer education to make progress in cancer-related behavioral change.

PUBLIC HEALTH RELEVANCE: The relevance of the proposed study is twofold: 1) Findings of testing the use of Native Navigators to provide community cancer education in Comanche Nation may result in knowledge that can be applied to resolving cancer health disparities, not only in Comanche Nation, but in possibly in other tribal communities with similar characteristics;and 2) Findings of application of Goal Attainment Setting to training of Native Navigators, as well as progress towards cancer-related behavioral change in Native American participants attending community education workshops, may lead to decreased cancer health disparities among Native Americans.

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