Every Woman matters (EWM) is federally funded program run at the state level, which is designed to aid women ages 40 to 74 meet their healthcare needs. It is intended to get rid of obstacles some women find when trying to obtain preventative breast and cervical cancer screening. EWM initiatives aim to increase public awareness of the types of risks women encounter in regards to their health and to make screening affordable for all women. Reduced cost and free services are provided to women for breast exams, mammography and Pap smears. Funding is given to health care provides to help them execute the program objectives (Feresu, Zhang, Puumala, Ullrich, & Anderson, 2008).
Women’s preventive healthcare was approached from a practice-based intervention model. The design involved helping practices identify obstacles to the provision of breast and cervical cancer screening, create plans to overcome these obstacles and to promote the delivery of the EWM services to low income women. The investigators hypothesized that by individualizing examinations of barriers and the creation of practice specific plans that the rate of mammograms and pap smears would increase. While the study did provide evidence for the importance of individually targeting practices for change based on their unique characteristics, with the exception of two practices, the efforts to identify and remove barriers to basic women’s healthcare was not successful. This was likely due several reasons. First, due to feeling already overburdened with normal daily functions the staff were hesitant to implement change as that would add to the sense of being overwhelmed. Second, some practices which exhibited stability were set in their ways and didn’t feel the need to change. Third, some practices were part of a lager corporation that overtly discouraged change due to concerns over increasing cost or changing a system that, in their minds, didn’t need changing (Backer, Geske, McIlvain, Dodendorf, & Minier, 2005).

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One screening prevention program that has met with success is the National Breast and Cervical Cancer Early Detection Program, (NBCCEDP), (Adams, Breen, & Joski, 2007). This program, administered by the CDC, instigated agreements with state health agencies in order to increase provision of screening, referral and follow-up services for women in underserved populations. The program includes annual breast exams, mammograms and diagnostic services for women over 40. It also includes educational efforts to increase knowledge of risk factors for the development of breast and cervical cancer and the importance of preventive screening measures. They contract with a variety of health care providers including community health care centers, private practices, radiology centers, and health departments among others. The goal of the program is to reduce breast and cervical cancer rates especially cases diagnoses at a late stage. Part-time community health workers are used to increase screening in underserved populations and to provide follow-up screenings in cases where initial screening are unclear or suggest problems as well as HPV vaccinations. Community care workers are used to target ethnic disparities. Success with the program has been demonstrated in life-years (LYs) gained; quality-adjusted life-years (QALYs) gained; and deaths averted. Those participating in the program were compared with n who received screening without the program and women who received no screening. The success with this program appears to be the result of the community outreach workers who are used to establish services in underserved communities and encourage women through education about the benefits of early detection programs. Additionally, the program’s success is due to the large network of professionals, coalitions and national organizations committed to the early detection of breast and cervical cancer. Currently state screening programs are linked to this national study.

In a related program, Lantz, Keeton, Romano, & DeGroff (2004), implemented case management services in a large public health screening program. Service components focused on a patient navigator model by providing help and guidance not only with medical issues related to screening but also general life areas for low income and underserved women. Structured counseling sessions were added along with coaching sessions around coping with difficult life issues. Outcomes of the program demonstrated positive effects showing that case management services aided women with abnormal screening results by overseeing care coordination, educating women about the necessity of follow-up screenings, transitions to treatment, enrollment in Medicaid to pay for treatment and coping with hardship in daily life. The success of this program was linked to addressing the entire needs of the patient through outreach, education, oversight of care coordination, guidance in handling everyday struggles such as banking difficulties and housing issues integrating medical care with support and counseling for non-medical issues with which the women were struggling. When there are major life issues it is difficult to add medical related issues and treatment to efforts to cope with daily life problems. Counseling, support and practical guidance promotes overall coping and adjustment for low income and other underserved populations.

To create an effective follow-up to the Every Woman Matters Program I would focus effort first on where that program failed. Specifically, before attempting to implement change in individual practices I would focus on how to relieve the sense of being overwhelmed with daily operations and create methods for coping with this in the future. Second, I would provide a strong rational for how change could benefit individual practices despite their already established stability. Third, for practices that were overseen by large corporations that discouraged change, I would first implement meetings with those in charge at the larger corporation to communicate how the overall company could benefit by recommended changes at the practice level. I would also include aspects of the studies reviewed here including case management strategies to enhance general life coping skills along with addressing medical issues for all women, not just low income populations.

In order to ensure funding and access to care in countries where screening for women’s health care concerns are limited requires advocacy at the international level. One program that has provided support for ongoing efforts to improve screening and follow-up care worldwide is the Breast Health Global Initiative (BHGI), (Anderson, Shyyan, Eniu, Smith, Yip, Bese, & Carlson, 2006). The guidelines and recommendations were published and made freely available on the Internet for worldwide access. This advocacy effort specifically addresses issues surrounding the implementation of breast cancer screening and care in countries with limited resources. The success of this advocacy initiative is based on the use of evidence-based research as a foundation and providing economically feasible and culturally relevant recommendations along with advocacy efforts.

Another advocacy effort for cancer screening is CDC’s advocacy program for colorectal cancer screening (n.d.). Since 2006, C4 has become an independently operating organization that unites individuals and groups across California in order to increase screening to prevent loss of life from colorectal cancer. One way this is done is through advocating for colorectal cancer screening programs. Components of the program included an advocacy forum intended to involve community members in lobbying for increased screening. The organization also had March designated as Colorectal Cancer Awareness Month in California. The group holds lobby days at the State Capitol which has successfully gathered support from Senate leader and other state legislators. Those attending the even work as a team to inform legislature members about colorectal cancer. State legislators are provided with maps of their districts that display the number of their constituents who have died from colon cancer, compared to the general population and how many of their constituents were diagnosed at late stages to better understand how effective screening programs have been in their districts. Screening days that connect with the uninsured are held throughout the year. Finally, they communicate with media providing messages on the importance of colorectal cancer prevention and screening.

The success of this program in increasing awareness is primarily due to the diversity of the board, which includes survivors, physicians, community advocates, members of the American Cancer Society and representatives from Kaiser Permanente, the California Department of Public Health, and the California Endowment. This wide variety of board members has translated into the ability to implement projects in numerous areas and to approach community leader and governmental officials in different bodies and organizations. This includes establishing continuing medical education (CME) for health care providers.

    References
  • Adams, E. K., Breen, N., & Joski, P. J. (2007). Impact of the National Breast and Cervical Cancer
  • Early Detection Program on mammography and Pap test utilization among white, Hispanic, and African American women: 1996–2000. Cancer, 109(S2), 348-358.
  • Anderson, B. O., Shyyan, R., Eniu, A., Smith, R. A., Yip, C. H., Bese, N. S. & Carlson, R. W. (2006).
  • Breast Cancer in Limited‐Resource Countries: An Overview of the Breast Health Global Initiative 2005 Guidelines. The breast journal, 12(s1), S3-S15.
  • Backer, E. L., Geske, J. A., McIlvain, H. E., Dodendorf, D. M., & Minier, W. C. (2005). Improving female preventive health care delivery through practice change: an Every Woman Matters study. The Journal of the American Board of Family Practice, 18(5), 401-408.