Dr. Isabel C. Scarinci is Professor of Medicine, Associate Director for Globalization and Cancer at the O’Neal Comprehensive Cancer Center, and Associate Director for Faculty Development at the Division of Preventive Medicine, University of Alabama at Birmingham. As a behavioral scientist, the focus of her work is on the application of behavioral science to public health by promoting behavior change at the population level. She has expertise and experience in the development, implementation, and evaluation of cancer prevention and control programs in low-resource settings. She also leads a number of capacity building programs in health disparities targeting undergraduate and graduate students, post-doctoral fellows, and junior faculty in collaboration with other universities in the U.S. and abroad.
Questions & Answers
The program was developed, implemented, and evaluated in a participatory manner for rural African American women. That is, very careful consideration was given the needs/wants of this population as well as their political and social context. Efficacy was examined as one program, and, therefore, it is difficult to speculate what components could be adapted without testing it in the real world.
Most of the facilitators center around our detailed training manuals, and step-by-step guide that can used in training Peer Health Educators, and that it can be implemented in low-resource settings. The challenges are around promoting and sustaining behavior change because healthy eating and engagement in physical activity are complex behaviors with multiple sub-behaviors that involves an array of cognitive-behavioral skills. Training lay individuals to deliver the intervention and promote these complex behavior changes is a major challenge and it takes time and very close supervision to assure acquisition of knowledge and skills and adherence to protocol over time.
Although this was a pragmatic group randomized trial, it was conducted under the lens of rigorousness of an efficacy trial. At times, when disseminating an evidence-based intervention across different settings, it is critical to consider the political, social, and organizational context. I think that as practitioners plan to implement the program, I recommend two theoretical approaches that may be useful when assessing the appropriateness of the intervention in different settings: (1) The AIDED Model which provides a framework for scaling up evidence-based interventions (dissemination); and (2) the Diffusion of Innovations Theory which provides information on how, and why the intervention is being adopted at the organization level by the partners and at the individual level by the individuals in the targeted counties (behavior change).
1. Bradley EH, Curry LA, Taylor LA, Pallas SW, Talbert-Slagle K, Yuan C, Fox A, Minhas D, Ciccone DK, Berg D, Pérez-Escamilla R. (2012). A model for scale up of family health innovations in low-income and middle-income settings: a mixed methods study. BMJ Open Access, 2, 1-12.
2. Rogers EM (1983). Diffusion of innovations (3rd edition). New York, The Free Press
My research continues to focus on the development, implementation and evaluation of theory-based, culturally relevant interventions in cancer prevention and control among rural populations, racial/ethnic minorities in the U.S. (primarily Latinos and African Americans), and other underserved populations in low-resource setting across the globe. Within this context I strive to further understand some of the underlying mechanisms for behavior change in these populations as well as advance the Community Health Worker model as promising strategy in low-resource settings.