Community Engagement, Culturally Tailored Care as a Gateway to Advancing Health Equity

As the Associations of Cancer Care Centers (ACCC) 41st National Oncology Conference came to a close, multiple sessions centered around methods and initiatives for the advancement of health equity. Branching off of this theme of this year’s meeting, “Realizing Innovation,” presenters spoke to the Renacer and Learn2Derm programs to emphasize the value of community engagement and culturally relevant health education.

Of primary importance throughout these presentations were strategies to engage more effectively with surrounding communities, the power of community partnerships and tailored patient education, and the need for culturally effective care to create more equitable health systems.

Renacer: Culturally Tailored Care and Services Builds Trust

Magbis Nunez Love, MHR, Atrium Health Levine Cancer/Wake Forest Baptist Comprehensive Cancer Center plays an integral part in the Renacer program, which offers community-based and culturally tailored support to cancer survivors in the Latino community in North Carolina. Renacer, which essentially translates to “rebirth,” was created to achieve a singular goal: to eliminate barriers to care for Latino cancer survivors.

Nunez Love emphasizes the importance of care that considers a patient’s cultural context—especially for this patient population. “For me, it’s very important to build a good relationship with the Latino patient. If you build a good relationship, you will know their needs. They will be more honest with you,” Nunez Love stated. Establishing this trust helps clinicians to better address their needs, she added, which are often overlooked to assumptions that Latino patients can be “low maintenance” or “frequent flyers.”

Furthermore, Nunez Love commented on how Latino cancer survivors often avoid participating in wellness activities due to cultural unfamiliarity, language barriers, and fear. These hesitancies highlight the need for clinics and care centers to build trust and provide more culturally tailored and accessible services.

The Renacer provides culturally relevant services to Latino cancer survivors and more | image credit: Djavan Rodriguez - stock.adobe.com

To tackle low participation numbers, Renacer partners with community organizations that already serve the Latino population, such as the Latin American Coalition who do great work to help immigrants or newcomers with cancer get connected with primary care. Financial counselors and others are also brought in to help patients navigate the health care system—financially and otherwise. Additionally, the Mecklenburg County Health Department provides lots of support and meals to ensure people have food throughout the week, as many Latino patients can endure financial hardships if their condition prevents them from working.

Thus far, their efforts have led to the distribution of 480 meals throughout 52 food pantries; they have helped facilitate 120 referrals to primary care and 180 referrals for cancer screening; 220 cancer survivors have received education for the management of hospital bills.

Mental health services include mindfulness, art therapy, and music healing. Feedback from 98 surveys indicates that participates have benefited greatly from these wellness activities, experiencing reduced tension, pain, and stress, and were happier as a result. Other activities such as Zumba, yoga, nutrition services, and bibliotherapy are also offered—sometimes virtually. All programs are held in accessible community areas—such as churches, community centers, etc—and take place at convenient times to avoid conflicting with individuals’ working schedules and increase attendance. However, Nunez Love mentioned, a lack of bilingual mental health providers is a challenge in this area. Therefore, they plan to form a Latino mental health network to improve these services and better connect patients with bilingual professionals.

In the last year, attendance has increased from 42 participants to 60. During this time, offered wellness activities increased from 3 to 5, and referrals to community resources grew from 12 to 25, demonstrating the program’s growing impact and the need for community support for Latino cancer survivors.

“Culturally sensitive wellness education for Latino cancer survivors should include material in Spanish, involve family in health care decision, and respect traditional practices and dietary preferences,” Nunez Love concluded, adding, “Tailoring information to address specific health concerns and socioeconomic barriers while leveraging community support can significantly enhance the effectiveness and acceptance of the education provided.

Learn2Derm: Engaging the Community to Promote Health Literacy

Sarah Millan, MD, dermatology PGY-3, Georgetown University and MedStar Washington Hospital Center, picked up right where Nunez Love left off, following her discussion with a presentation on the Learn2Derm program. Learn2Derm is a community-based educational initiative that seeks to tackle gaps in dermatology care and awareness, particularly in underserved communities of color.

Darker skin tones require sun protection and benefit from skin cancer screenings | image credit: Gorodenkoff - stock.adobe.com

Learn2Derm primarily focuses on Ward 7 and 8 in Washington, DC, which Millan mentioned has limited access to dermatology care and houses a large Black population with lower household income. Through offerings of youth curriculum and an annual skin health fair, Learn2Derm works to address health disparities and boost patients’ awareness of what early disease presentation looks like, as well as resources for detection and treatment.

“Physician-community engagement can build trust through transparent communication, while dispelling myths and encouraging early detection of skin cancer in underserved communities,” Millan stated, echoing Nunez Love’s sentiments. Not only can these efforts establishing stronger, more trusting bonds between physicians and surrounding patient populations, but Millan added how these events can enhance health literacy, empower patients to recognize the signs of abnormal changes to their skin. “There’s a common misconception that people with darker skin are not at risk for skin cancer, which contributes to lower rates of skin checks and sunscreen use in these populations,” Millan explained.

They also consistently collaborate with organizations that are already well-known in the community, such as local medical schools who offer skin cancer screenings, to establish more trusting relationships. “Partnerships are truly the backbone of these events. By collaborating with local organizations and trusted community leaders, we can engage underserved populations more effectively, build trust, and promote skin health in a way that resonates with their needs,” Millan said.

Learn2Derm recognizes that, due to misconceptions about skin cancer and darker skin tones, the offering of a free screening may not attract patients of color as effectively; therefore, they pair skin cancer screening alongside topics that garner greater interest such as hyperpigmentation, acne, eczema, and more as gateways to talking about skin cancer.

It tailors educational offerings are interactive, evidence-based, delivered by trained medical students, cover a diverse range of skin tones, and are kept simple and relatable to help patient’s retain information regardless of their background or health knowledge.

Survey data from Learn2Derm's events revealed that a primary barrier for sunscreen use is costs; however, Millan took this opportunity to recognize the value of in-kind donations they receive to help patients overcome obstacles here.

More data found that the program's educational efforts had a significant effect on participants. After attending, 50% of respondents reported trusting dermatologists more, with comprehensible language and cultural relatability driving this trust. Furthermore, nearly 100% of respondents walked away with better knowledge about how sunscreen can prevent skin cancer, how darker skin tones still require sunscreen and protection, and how to recognize early presentations of skin cancer.