PRP190: Using the fRAP methodology to identify multi-level policy levers to improve cervical cancer disparities in US Hispanic women
Autumn Kieber-Emmons, MD, MPH; Benjamin Crabtree, PhD; William Miller, MD, MA
Context: Cervical cancer is preventable and curable, yet Hispanic populations in certain areas of the country have higher mortality rates from invasive cervical cancer than non-Hispanic white women. Objective: Our study aims to identify contextual and environmental features at the county level that act as possible policy change targets that could impact cervical cancer disparities in US Hispanic women. Study Design: This is a mixed methods exploratory study utilizing fRAP (focused Rapid Assessment Process) methodology to uncover modifiable differences in cervical cancer survivorship contributing to mortality differences. We investigate multi-level community, medical and policy contextual elements within a county through both quantitative GIS mapping of ZCTA level data linked to qualitative fieldwork and key informant interviews. This poster highlights the final Phase III of the fRAP methods - the synthesis of the qualitative and quantitative phases of the study to identify possible policy change targets for subsequent intervention. Setting: This American Cancer Society (ACS) funded pilot study was undertaken in three Texas counties, Bexar, Dallas and Tarrant. Population studied: This study included ZCTA level mapping of data obtained from the Texas Cancer Registry, for cervical cancer cases in the three counties from 1995-2015, alongside qualitative methods with participant observation fieldwork and 39 key informant interviews across levels. Outcome Measures: Quantitative ZCTA level mapping results allows for illumination and identification of areas of interest in each county for qualitative inquiry. Qualitative investigation then proceeds with iterative cycles of community involvement and mapping until saturation of themes is determined. Results: Research to date has uncovered modifiable environmental and contextual differences within each of the three counties contributing to how Hispanic cervical cancer survivors experience care. This work to date has shown that regions with higher levels of community engagement for survivorship care, alongside more supportive medical and payer environments for undocumented immigrants may be contributing to lower cervical cancer disparities. Outcomes to be Reported: The results from our current Phase III will be the identification of policy change targets in each of three counties. As a study funded by the ACS, Phase III also will include dissemination of possible policy options back to the local ACS branch offices.