Tepeyac
The Tepeyac Project: A Community-based Approach to Reducing Disparities in Breast Cancer Screening Among Latinas

Funded by: Centers for Medicare and Medicaid Services
Project Period: 8/99 - 7/05

Abstract

Objective: To evaluate the effect of a community-based intervention delivered through the church with and without peer-counselors (Promotoras) in reducing the gap in breast cancer screening (BCS) between Latinas and non-Latinas (NL) in Colorado.

Methods: In Phase I (1999-2001), there were three study groups: 1) Printed Intervention: 150 churches displayed educational materials, and/or published church bulletin messages or provided pulpit announcements; 2) Promotora Intervention: four Latino Denver parishes received, in addition, monthly visits from Promotoras and educational talks; and 3) Control States: three states where no similar intervention was occurring. The qualitative evaluation consisted of eight focus groups. In the quantitative analysis, mammogram rates observed in the intervention areas and in the control states before (1997-1998) and during/after the intervention (April 1999/March 2001) were compared. A generalized estimating equations (GEE) analysis was used to account for differences in baselines and for the fact that many subjects appeared in both baseline and follow-up samples. Phase II (2002-2005) had an additional study group where six communities across Colorado were trained by project staff to initiate health promotion in their parishes

Results: Qualitative results suggested that the church is an effective vehicle for health education, particu¬larly with an added personal component. Quantitative results for Phase I in the Medicare fee-for-service were:

All crude differences were significant with p<0.003, except between Latinas and NL in Promotora Intervention (43% vs. 46%, p=0.30). The GEE analysis revealed that the Promotora intervention was the only intervention associated with a significant disparity reduction (p=0.01) after adjustment for confounders. Phase II results are pending.

Discussion: The results suggest that a personal component is crucial in increasing BCS among Latinas. However, there were large differences in baseline rates that limited the evaluation of our interventions. This is a natural and inevitable consequence of the community-participatory approach that does not allow for randomization of the communities that are ready for more intense interventions. Once communities are engaged, randomizing them to less intense or control interventions presents insurmountable ethic and political barriers.

Additional detail about the project can be found at: http://www.cfmc.org/professionals/pro_tepeyac.htm
Key Staff: Sauaia, Kramer, Min, Colorado Foundation for Medical Care staff

Journal Articles:

Sauaia A; Dauchot CP, Borrayo E; Min S, Leyba J, Gallo SM, Kramer AM. The Tepeyac Project: A Church-Based Approach To Increase Breast Cancer Screening Among Latinas In Colorado. Journal of General Internal Medicine (submitted 2003).

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