DESCRIPTION (provided by applicant): This project addresses the important problem of disparities in cancer screening experienced by rural women with physical disabilities. Adults with disabilities receive fewer indicated cancer screening services and are more likely to have adverse cancer-related outcomes compared to their counterparts without disabilities.7-22 Disparities in cancer screening are even more pronounced among people with disabilities living in rural areas.23, 24 With the prevalence of disabilities in the United States now estimated to be 12.5 - 20.1%,1-6 this is an important population that is both underserved and understudied. Although a variety of potential and actual barriers to care for people with disabilities have been identified, few studies have examined the effectiveness of interventions designed to improve cancer screening for people with physical disabilities. The study will pilot test an innovative practical approach for overcoming barriers to screening for breast, cervical, and colorectal cancer among rural women with physical disabilities. It uses a 2 x 2 factorial design to explore the individual and combined effects of a clinic-based and a patient-based intervention. The project brings together 4 innovative elements that are complementary and synergistic. It uses a definition of disability that is conceptually rooted in the International Classification of Functioning; and the 2 x 2 design of a clinic- based and a patient-based intervention is founded on the Chronic Care Model, in which productive interactions between prepared care teams and activated patients produce the best outcomes. Each of these two complementary models emphasizes the central role of interaction between clinical care environment and patient. The study will be based in a rural practice-based research network (PBRN) and local community Centers for Independent Living (CILs). By using existing primary care clinics and actively involving community resources for adults with disabilities, the project brings together the most relevant stakeholders, grounds the study in real-world practice settings, and improves the likelihood that this approach will prove to be sustainable and applicable to rural settings across the country. Our specific aims are: Aim 1: Use a 2 X 2 factorial study design to explore the potential individual and combined effects of a clinic-based intervention and a patient intervention
on improving breast, cervical, and colorectal cancer screening among rural women with physical disabilities. Aim 2: Explore the extent to which clinic process factors (e.g., awareness of challenges faced by women with physical disabilities in receiving cancer screening; intent to improve cancer screening) and patient process factors (e.g., knowledge of cancer risk and screening recommendations; self-efficacy for being screened) are associated with cancer screening outcomes. Aim 3: Determine the feasibility and acceptability of the interventions among clinicians, clinic staff, and patients. In addition to knowledge about potential effectiveness and feasibility, this pilot intervention study will provide required sample sizes fora larger study of a refined intervention to be conducted in multiple PBRNs across the United States.
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