Historical discrimination against communities of color in the health care industry
has resulted in broad distrust of health care interventions. When it comes to
developing a cancer screening program, organizations must over come this
deep-seated barrier of community mistrust to bring patients in the door.
Increasing community presence can bridge this mistrust. To start, consider
partnering with other entities.
Grow preexisting partnerships
Even after you’ve identified which communities require additional screening
support, you’ll need additional information to know how to best reach and
interact with those communities. This can be a challenge if your organization’s
facilities are not located within or close to the community.
UVA Health, a health system in Charlottesville, Virginia, redesigned their mobile
mammography program in 2015 to boost regional breast cancer screening rates.
While data analysis identified the southwest region of Virginia as needing
additional services, the breast cancer program had no ties to this rural area. The
program director leveraged a preexisting relationship between UVA’s lung cancer
program and the Virginia Department of Health (VDH) to seek assistance. The
VDH identified clinic sites in the region where screening rates were particularly
low and facilitated initial communication between UVA and the clinics. Because
the VDH had established community relationships, UVA could quickly earn trust.
As a result of this partnership, UVA Health’s van is able to see between 10 and
30 patients a day who would otherwise have had to travel 2 to 3 hours for
In addition to looking at existing programs to help gain trust, screening programs
should also consider their existing workforce.
Support workers such as community health workers (CHWs), care navigators, or
patient advocates can help build networks for trust building. CHWs aren’t
typically utilized by screening programs, yet research shows they can effectively
reach out to underserved patients and communities. While no two programs are
alike, CHWs are usually deployed to address the social determinants of health,
drive chronic disease self-management, or a mixture of the two.
If your organization already works with CHWs, there may be an opportunity to
expand their scope of responsibilities. Start by connecting with a population
health or care transformation leader to understand how CHWs interact with the
community and how cancer screening can be incorporated into current
Build new community partnerships
If your organization doesn’t already have community partnerships, create new
ones to facilitate both short- and long-term trust with your community.
Ascension Medical Group Saint Thomas, located in Nashville, Tennessee, has a
mobile mammography program to meet the need for low- or no-cost screening
for a large rural and uninsured population. Given that these patients have a low
profitability margin, it’s critical that patients show up for appointments. To attract
patients, the health system partners with trusted community organizations such
as local banks, grocery stores, and churches. These organizations market
Ascension Medical Group Saint Thomas’s mobile mammography bus by doing
things like posting signs and mentioning screening events on their Facebook
pages. The partners then host the mobile mammography van, so patients don’t
have to travel far. These community organizations agree to host the program for
multiple years, which increases patient familiarity with the screening process.
This community partnership model has helped build the medical group’s
screening program. It operates at least four days a week and is in the process of
purchasing a second bus. But leaders found that barriers to follow-up care
remained. Many patients, who live two hours or more from Ascension Medical
Group Saint Thomas’s main facility, were unlikely to travel for their follow-up
diagnostic mammogram. Cancer screening leaders realized they needed to
address this issue as well.
To make sure these patients receive follow-up care, the medical group connects
rural patients with cancer diagnostic services close to patients’ homes.
Communication lines are kept open between the local primary care physician in
case Ascension Medical Group Saint Thomas is needed for specialist care.
Considering that 53% of low-income Americans don’t trust their doctor, this
integration of different providers into a united network of care also helps mend
long-standing gaps in trust.