Need: De Casa En Casa 3: Cervical Cancer Screening in Undeserved Rural and Border Communities in West and South Texas was designed to systematically address critical barriers to cervical cancer screening among CPRIT priority populations of the uninsured, the underinsured, those residing in geographically isolated, rural and frontier counties and cultural and racial/ethnic minorities. This program addresses several levels of the socioecological model for health, and includes research-tested outreach, education, clinical service delivery, patient navigation, dissemination and implementation and capacity building. Our target service area comprises 58 counties located within Texas Public Health ...

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Need: De Casa En Casa 3: Cervical Cancer Screening in Undeserved Rural and Border Communities in West and South Texas was designed to systematically address critical barriers to cervical cancer screening among CPRIT priority populations of the uninsured, the underinsured, those residing in geographically isolated, rural and frontier counties and cultural and racial/ethnic minorities. This program addresses several levels of the socioecological model for health, and includes research-tested outreach, education, clinical service delivery, patient navigation, dissemination and implementation and capacity building. Our target service area comprises 58 counties located within Texas Public Health Regions (PHRs) 1, 2, 8, 9 and includes West Texas, Big Bend, South Plains, and South Texas. These counties have a combined population of 2.56 million. Our priority populations have low socioeconomic status (SES), are medically underserved, rural, geographically remote, and cultural and racial/ethnic minorities. They have high rates of poverty (70 % of target counties have a higher poverty rate than the national average), low educational attainment (only two counties exceed the national average), and high rates of being uninsured (all counties have a greater uninsured rate than the national average). Furthermore the Hispanic population is significant and exceeds state and national averages of 39.6% and 18.3% respectively. The target population has high cervical cancer incidence and mortality and low rates of cervical cancer screening and suffer health disparities. Women of low SES or residing in rural counites have higher cervical cancer incidence and mortality compared to those of higher SES or those residing in urban counties, as do Hispanic women living in border states compared to those in non-border states. Hispanic women and women in rural areas have a higher cervical cancer incidence, are diagnosed at later stages, and suffer disproportionate cervical cancer mortality compared to non-Hispanic white women or women in urban areas, respectively. Uptake of cervical cancer prevention services are also lower in this population: none of our target county screening rates exceed the state or national screening averages of 75.8% and 79.9% respectively. Overall Project Strategy: De Casa is an evidence based program incorporating outreach, education, clinical service delivery, navigation and dissemination and implementation of effective elements into care delivery in communities to create sustainable system changes. The De Casa 3 program builds upon and expands a multilevel, multicomponent evidence-based, culturally tailored, bilingual and theory based program to new areas in West and South Texas. This project will double the number of screening delivery sites from eight to a total of 16 and will almost double the target clinical service area from the current 30 counties to 58. It is led by the Texas Tech University Health Sciences Center El Paso (TTUHSC EP) and is a community wide partnership of over 200 organizations including the El Paso County Public Hospital, rural hospitals, federally qualified health center systems, free clinics, several TTUHSC EP departments, local faith-based organizations, El Paso Public Housing Authority, food banks, the American Cancer Society, Rio Grande Cancer Foundation, the BCCS program, community colleges, public health departments and the State 2-1-1 among others. Key new clinic and community partners have been added to achieve project goals. Goals 1): Expand access to an established cervical cancer screening program for individuals in new rural and medically underserved West and South Texas counties. Goal 2): Increase the number of individuals reached and screened by the program in targeted expansion counties. Goal 3): Increase cervical cancer prevention capacity in rural and medically underserved target counties. Achievable targets based on our track record and prior experiences are 3,450 pap smears, 240 colposcopy procedures and 26,244 education and navigation services. Innovative new components are: 1) Expanded network of clinical and community partners in target counties; 2) A structured implementation process to facilitate the uptake of evidence-based strategies into clinical settings; 3) Integrated new outreach strategies; 4) Creative dissemination strategies; 4) Leverage of pre-existing resources across cancer prevention programs; 5) Addressing sustainability by design; and 6) A comprehensive individual and organizational level evaluation Significance and impact: This program can have a significant impact on cervical cancer prevention as it expands an established and successful program to individuals in over 20% of all Texas counties. It can help to meet the goals of the Texas Cancer Plan to reduce the impact of cancer in Texas through the implementation of sustainable and effective programs that target the underserved and reduce cancer disparities throughout Texas.

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