Improving Female Preventive Health Care Delivery
Improving Female Preventive Health Care Delivery
Screening programs for women aim to prevent disease such as cervical and breast cancer. However, such programs are only effective in bringing down the incidence of disease when utilized by the majority of women, most especially those from vulnerable subgroups. Program implementation must therefore consider effective strategies to promote utilization. The purpose of this paper is to analyze the factors that led to the failure of the Every Woman Matters program and compare with the factors that made two other prevention programs for women successful.
The Every Woman Matters (EWM) program is a state-run but federally funded cervical and breast cancer prevention program. The objective of the program is to eliminate the known barriers to women’s utilization of screening for these two types of cancers by enhancing women’s awareness and offering screenings at low or no cost (Backer et al., 2005). Screening includes mammography, clinical examination of the breast, and the Papanicolaou smear. The overall program goal is to decrease the rate of breast and cervical cancers at the level of the state and nationwide.
The program was implemented by partnering with primary care clinics. Physicians and clinic staff are responsible for planning and implementing processes of identifying patients eligible for screening, educating patients about breast and cervical cancer, increasing awareness of the purpose of screening, and providing related health literature. Processes also include notifying patients and clinic staff of when each screening is due, documenting screenings, and retrieving the findings of previous screenings conducted in other clinics or settings to ensure complete patient records.
Factors Contributing to Program Failure
Backer et al. (2005) conducted a program evaluation study of 7 clinics. The findings showed that poor leadership was a key factor that led to failure in some clinics, manifested by low utilization by eligible women or lack of improvements in baseline utilization rates. In some clinics, the top-down approach was used which generated strong resistance among clinic staff to the change in practice (Backer et al., 2005). Evidence of resistance included reluctance, lack of enthusiasm, and low compliance to the tasks and responsibilities that would have ensured the attainment of program goals and objectives. In some clinics, screening and cancer prevention were not even prioritized but rather regarded as merely an auxiliary service (Backer et al., 2005).
In a top-down approach, change is implemented in an autocratic manner by the leader using his or her authority alone. For instance, leaders in some clinics decided on the changes and expected their staff to implement it (Backer et al., 2005). The drawback of this approach is that it is difficult to force the staff to enact new behaviors without engagement. With engagement that is a feature of the participatory approach, the leader works with the staff to build awareness on why female cancer prevention is a priority, program goals and objectives, and how a high screening utilization determines success. By getting the staff onboard, they become co-owners of the program and are more likely to be committed to its implementation (Bernardres et al., 2015).
The evaluation also highlighted poor planning as a factor to the non-attainment of program goals. While resistance is to be expected with every change initiative, no strategies were employed to increase buy-in and reduce resistance. For instance, there were no program champions or staff members who were most supportive of the program and tasked to convince less supportive staff members about the advantages or benefits of participating in the program (Backer et al., 2005). Another advantage of having program champions would have been their ability to generate enthusiasm for the change among the staff.
Furthermore, planning also did not consider how to promote collaboration among the staff as one finding was the absence of cohesion and difficulties in achieving teamwork (Backer et al., 2005). Resources, both material and human, were also insufficient to enable successful implementation. Finally, the program lacked mechanisms of accountability is lacking as staff found satisfaction in their clinic’s cancer screening utilization rate at baseline (Backer et al., 2005). There was no impetus to set new goals to achieve higher and higher rates of utilization.
Other Prevention Programs Advocating for Early Screening
Nuno et al. (2010) implemented a group-based education program called Entre Amigas (Between Friends) to improve cervical and breast cancer screening among Hispanic women in a rural community in Arizona. The choice of program target population was the disparity between Hispanic women and White non-Hispanic women in the incidence and death rates related to cervical and breast cancer (Nuno et al., 2015). Two-hour group education was delivered by lay community health workers (CHWs) or navigators called promotoras who underwent standardized training (Nuno et al., 2015).
The program provided information on cervical and breast cancer, related screening, healthy nutrition, self-esteem, and community health and cancer screening resources (Nuno et al., 2015). These topics addressed the barriers to screening identified in the target population. The study showed that women in the education group were twice as likely to state having obtained a mammogram within the past 12 months compared to the usual group (Nuno et al., 2015). The likelihood to state having obtained a Papanicolaou smear was also 1.5 times more in the education group within the same period (Nuno et al., 2015).
The Hopi Women’s Health Program (HWHP) is another program that aims to improve cervical and breast cancer screening in American Indian women, a subpopulation also experiencing disparity in relation to these two cancers (Brown et al., 2011). The HWHP is community-based and operated by the Hopi tribal council but funded by the CDC. The program similarly provides education on cancer and cancer screening also by trained CHWs. However, the program also provides community-based mammography, breast examination, and Papanicolaou smear services through the local health center (Brown et al., 2011). Moreover, CHWs provide counseling and emotional support to women found to have positive screening results. Compared to baseline, there was significant increase in knowledge of screening and screening utilization rates among Hopi women (Brown et al., 2011).
Strategies to a More Effective EWM Program
Women can benefit from improvements in the EWM program. The Entre Amigas and HWHP programs highlight the importance of engaging stakeholders. First, training on change leadership and management will be provided to clinic nurses to enable them to employ the participatory approach to change. The training will also enhance their knowledge and skills in engaging the staff, fostering team-work, and motivating others to contribute to the change. Engagement can be achieved through team-based goal-setting, modification of clinic processes, and implementation of change (Bernardres et al., 2015). In this manner, clinic staff members become active participants ensuring that changes are necessary, acceptable, and appropriate to the context of the organization (Bernardres et al., 2015). As such, there is a greater assurance of buy-in with a staff engagement.
Second, the Entre Amigas and HWHP programs also underscore the engagement of the target population especially the members of vulnerable subgroups of women. As such, an innovative engagement strategy is to partner with community organizations such as faith-based or ethnic minority groups and governmental, academic, or private organizations advocating for women’s health (Ponic, Reid & Frisby, 2010). Through joint efforts, there is a likelihood of building awareness in a wider population of women and encouraging the utilization of the clinic’s screening services. For this reason, the capacity of nurses to establish community partnerships will be enhanced as well.
References
Backer, E.L., Geske, J.A., McIlvain, H.E., Dodendorf, D.M., & Minier, W.C. (2005). Improving female preventive health care delivery through practice change: An Every Woman Matters study. Journal of the American Board of Family Practitioners, 18(5), 401-408. Retrieved from http://www.jabfm.org/content/18/5/401.long
Bernardres, A., Cummings, G., Gabriel, C.S., Martinez Evora, Y.D., Gomes Maziero, V., & Coleman-Miller, G. (2015). Implementation of a participatory management model: Analysis from a political perspective. Journal of Nursing Management, 23(7), 888- 897. doi: 10.1111/jonm.12232.
Brown, S.R., Nuno, T., Joshweseoma, L., Begay, R.C., Goodluck, C., & Harris, R.B. (2011). Impact of a community-based breast cancer screening program on Hopi women. Preventive Medicine, 52(5), 390-393. doi: 10.1016/j.ypmed.2011.02.012.
Nuno, T., Martinez, M.E., Harris, R., & Garcia, F. (2010). A promotora-administered group education intervention to promote breast and cervical cancer screening in a rural community along the U.S.-Mexico border: A randomized controlled trial. Cancer Causes Control, 22, 367-374. doi: 10 .1 0 07/1s0 552-100 -9705
Ponic, P., Reid, C., & Frisby, W. (2010). Cultivating the power of partnerships in feminist participatory action research in women’s health. Nursing Inquiry, 17(4), 324-335. doi: 10.1111/j.1440-1800.2010.00506.x
