Empowering Promotores de Salud as Partners in Cancer Education and Research in Rural Southwest Kansas

Less than 10% of all adult patients with cancer participate in cancer clinical trials (Baquet, Ellison, & Mishra, 2009; Comis, Miller, Aldige, Krebs, & Stoval, 2003; Sateren et al., 2002). Participation in clinical cancer research studies is even lower for patients from vulnerable minority populations (Murthy, Krumholz, & Gross, 2004), and little is known about the participation rates of rural Latinos. Multi-level barriers hinder participation in clinical research among minority patients (Anwuri et al., 2013; Hubbard, Kidd, Donaghy, McDonald, & Kearney, 2007; Schmotzer, 2012). Among Latinos and other immigrant groups, limited English proficiency serves as a barrier to participation in clinical research, with about half of U.S. Latino families reporting Spanish as their primary language (Schnoll et al., 2005). Temporary pending migrant or undocumented status further impedes access to clinical research and services among immigrant Latinos in the United States (Loue, Faust, & Bunce, 2000). Fortunately, evidence suggests that when they are provided with opportunities to participate, minority patients participate in clinical research studies, including those focused on cancer, at the same rate as non-Latino Caucasians (Wendler et al., 2005). Building community infrastructure to enhance participation in cancer research is critical, particularly in vulnerable ethnic minority and rural communities that typically face the additional burden of geographic isolation (Chiu, Mitchell, & Fitch, 2013; Schensul & Trickett, 2009). Interventions that use multi-level networking and capacity-building strategies have effectively engaged Latino communities in cancer research. Including multi-ethnic populations in all stages of the cancer research continuum is more likely to generate research programs that are more responsive to the groups largely affected by cancer disparities (Baquet, Commiskey, Daniel Mullins, & Mishra, 2006). In fact, a systematic review of community-based participatory approaches to conducting randomized clinical trials found that most of these were effective in recruiting and retaining minority populations and resulted in significant health improvement (De las Nueces, Hacker, DiGirolamo, & Hicks, 2012). A community-participatory model that has been employed effectively in minority communities and fits well within the Latino cultural context is the use of promotores de salud, or community lay health workers. Promotores programs have used social networks to successfully disseminate information on prevention (e.g., immunizations, physical activity) (Ayala, Vaz, Earp, Elder, & Cherrington, 2010), early detection (e.g., cancer screening) (Larkey et al., 2012; Wells et al., 2011), and self-management of chronic illnesses (e.g., diabetes self-care) (McCloskey, 2009). Recently, promotores have been used to increase participation in cancer research studies (Elliott, Belinson, Ottolenghi, Smyth, & Belinson, 2013; Guadagnolo et al., 2009; Livaudais et al., 2010), but the feasibility of extending these models to rural Latino communities requires further evaluation. The aims of this study were to describe community-based participatory processes used to develop a promotore leadership and cancer research education training curriculum for use among rural, Spanish-speaking Latinos, and to assess the feasibility of training a core of rural, Spanish-speaking promotores to disseminate information on cancer and cancer research among rural Latinos. The intent was to build community capacity to test in a future study the effects of the promotore-delivered intervention on attitudes and willingness to participate in cancer research among rural Latino communities in Kansas.