Our target area includes 105 rural, frontier and US-Mexico border counties in West Texas located in Public Health Regions (PHR) 9 & 10 (36 counties), PHR 1 (41 counties) PHR 7 (3 counties) and PHR 2 and 3 (25 counties). This area has a population of about 2.8 million, covers more than 131,000 miles and is larger than 46 States of the US. This population has high rates of poverty, low educational attainment, low rates of health care coverage and comprises a significant proportion of Hispanics (ranging from 31%-82.8% in different areas).

Hispanic women have a higher cervical cancer incidence, are diagnosed at later stages, and suffer disproportionate cervical cancer mortality compared to...

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Need: Our target area includes 105 rural, frontier and US-Mexico border counties in West Texas located in Public Health Regions (PHR) 9 & 10 (36 counties), PHR 1 (41 counties) PHR 7 (3 counties) and PHR 2 and 3 (25 counties). This area has a population of about 2.8 million, covers more than 131,000 miles and is larger than 46 States of the US. This population has high rates of poverty, low educational attainment, low rates of health care coverage and comprises a significant proportion of Hispanics (ranging from 31%-82.8% in different areas).

Hispanic women have a higher cervical cancer incidence, are diagnosed at later stages, and suffer disproportionate cervical cancer mortality compared to non-Hispanic white women. Yet cervical cancer screening rates in this region (63.3%-71.2%) are significantly lower than state (77.7%) and national rates (82.3%). These areas are also medically underserved with low physician to population ratios and have major gaps across the whole spectrum of cervical cancer prevention, detection and treatment.

We have designed a program that addresses the needs of our community, addresses gaps in services and creates a coordinated program of outreach, education, clinical services, navigation, capacity building and sustainability. De Casa 2 is a multicomponent evidence-based program designed to reduce cervical cancer burden among uninsured women in 105 West Texas Counties. It improves upon the previous program and expands it to a large area of West Texas.

We plan a stepwise approach to intervention delivery with the whole area being targeted immediately for capacity building activities and community education. Screening services will initially be provided to 19 counties that contain half of the population of the area: 10 within the Big Bend Country region (population of 923,729) and 9 counties in the Panhandle plains region (population 407,387).

De Casa 2 will continue as a community wide partnership led by Texas Tech University Health Sciences Center- El Paso, in collaboration with over 150 organizations including key new partners (West Texas AHEC, Family and Community Health Services program Texas DSHS Region 9/10, Cactus Health Services, and Combest Community clinic) as well as continuing collaborations with the El Paso County Public Hospital system, federally qualified health center systems, free clinics, TTUHSC Family and Community Medicine Center, local faith-based organizations, El Paso Public Housing Authority, food banks, the American Cancer Society, Rio Grande Cancer Foundation, the BCCS program, the Public Health Department and the State 2-1-1 among others.

De Casa 2 program components are: 1) An enhanced program for women in El Paso and Hudspeth counties that incorporates new outreach strategies, a new education delivery method, motivational interviewing techniques and a new in-reach component to increase repeat screening rates; 2) Decentralized cervical cancer screening and diagnostic services for eligible women in new rural, frontier, and border West Texas counties; 3) Development and dissemination of a bilingual, culturally competent and literacy level appropriate video education program to rural and frontier areas of West Texas; 4) Capacity building for cervical cancer early detection in West Texas by developing, implementing, and institutionalizing an interdisciplinary cervical cancer screening training curriculum for nursing students and community health workers; and 5) Sustainability through institutionalization of new clinical processes, the formation of a cohort of well-informed women, through incorporation of program elements into curricula and through the creation of enduring partnerships.

The long term goal is to reduce the burden of cervical cancer in West Texas. Specific goals are: 1) Deliver enhanced cervical cancer screening services to women in El Paso and Hudspeth counties; 2) Enhance access to comprehensive cervical cancer screening services for West Texas women; 3) Disseminate culturally tailored cervical cancer prevention education to women of West Texas; and 4) Increase capacity for cervical cancer prevention in West Texas. Achievable targets, based on our previous experiences, are to directly serve 12,424 individuals and have 3,036 screening and diagnostic tests completed.

 

This project is innovative, as it will: 1) incorporate new strategies to enhance ongoing program services; 2)Use a decentralized model to expand program services to distant West Texas counties; 3)Employ a diverse set of disseminate strategies; and 4)Incorporate capacity building and sustainability directly into program services. This program will meet the goals of the Texas Cancer Plan which are to reduce the impact of cancer in Texas through the implementation of sustainable and effective programs that target the underserved and reduce disparities in cancer throughout the State.

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