Dr. Rachel Shelton, assistant professor of sociomedical sciences at the Mailman School of Public Health, has received a four-year Research Scholar Grant from The American Cancer Society to conduct one of the first studies on sustaining and adapting a nationally disseminated program for addressing cancer disparities in community settings. Dr. Shelton, a social and behavioral researcher with expertise in cancer prevention, health disparities, and implementation science, will lead research on the factors that predict the sustainability of evidence-based interventions in medically underserved community settings.
[Photo: Dr. Rachel Shelton]
To build off her prior work, Dr. Shelton is collaborating with The National Witness Project, one of the most robust Lay Health Advisor programs with whom she has had an eight-year partnership. The National Witness Project has been recognized by the National Cancer Institute as one of the ‘Research Tested Intervention Programs’. Until now, little was understood about how to maintain the impact of the Lay Health Advisor programs — evidence-based peer-led interventions that are effective in promoting health and reducing disparities for many chronic diseases, including cancer. The programs use group education, navigation, and cancer survivor narratives to increase participation in regular breast and cervical cancer screening and follow-up among underserved African American women. In addition, Dr. Shelton will study the critical issue of how programs adapt to changing scientific evidence that suggest the need for stopping or changing cancer screening practices.
For the past 25 years, the National Witness Project has been implemented in over 40 sites across 22 states, with over 400 volunteers, reaching over 15,000 women annually. “The National Witness Project is one of the few lay health advisor programs with longevity and evidence on its outcomes and provides an excellent platform for studying these critical questions,” said Dr. Shelton. “The proposed study provides a critical opportunity to advance research on the sustainability and adaptation of evidence-based cancer disparities programs. While focused on lay health advisory programs for breast and cervical cancer screening, findings are relevant in advancing research and practice on the sustainability of cancer prevention and control programs more broadly.”
To gain an in-depth understanding and test factors that predict sustainability among a national sample of National Witness Project sites, Dr. Shelton and colleagues will conduct a longitudinal mixed-methods study. Using qualitative interviews, she will compare case studies among sites and conduct annual surveys with 200 Lay Health Advisor staff, leadership and participants across three years, focusing on 20 National Witness Project sites. This includes investigating how well the sites have adapted to meet new cancer screening guidelines as well as identifying barriers and what might facilitate adapting the program to reflect new screening guidelines.