Community Cancer Screening:Reducing Health Disparities among Native Americans in Rural, Tribal Communities

Abstract

Native Americans have higher cancer morbidity and mortality rates than non-Native Americans and cancer screening rates are lower. This qualitative case study used community-based participatory research principles to identify individual, family, community, and environmental factors that positively influenced screening rates in a rural, Native American community. Over a two-year period, 90 people participated in 11 focus groups to inform the evaluation of the Standing Rock Reservation Men’s and Women’s Health Days Program.

Focus group interviews were digitally recorded, transcribed, and saved into NVivo for analysis. Categories and themes were developed using a modified grounded theory approach, leading to a comprehensive model that allowed coding of all comments.

The evaluation confirmed that many components of the screening were valuable, such as the advantages of holistic, culturally appropriate approaches within a social setting. Individual experience with cancer and other chronic diseases, family experience with cancer and family support, and friends and exposure to toxins in the community influenced participation in cancer screening. Collaboration between organizations, intensive outreach and recruitment, multiple services provided in one location, consistency of staff, incentives, and the opportunity to socialize and share a meal increased participation. Barriers to screening, such as transportation, changing funding and criteria for screenings, reductions in other services, and unpleasant screening procedures, have required ongoing patience and problem solving on the part of the community team to ensure that high rate of screenings continue. These findings led to recommendations for program development in the target community and other similar communities nationally.