CARE: Collecting and Assessing Cancer Family History to Identify at Risk Individuals Educational Intervention for Community Health Workers

Background: Collection of family health history (FHH) can identify individuals at increased risk and guide disease-specific recommendations for management, early detection, and prevention. Yet, collection of FHH is often low or infrequent despite national initiatives. In the Hispanic/Latino population, community outreach and education professionals (CORE-Ps) have effectively increased cancer prevention and control behaviors; but, limited research has been conducted to assess genetic and family health history knowledge among CORE-Ps. We sought to evaluate an educational program designed to improve cancer FHH and cancer genetics knowledge, self-efficacy and attitudes. Methods: The ARBOLES Program educates bilingual (Spanish-English) CORE-P to increase knowledge about the role of genetics in cancer. We conducted a 2-hour educational session about FHH as part of the ARBOLES program. We recruited 62 bilingual CORE-Ps. Session activities included building pedigrees, identifying red flags in a patient case scenario and a brief presentation of a patient case. Results: Majority of participants were college graduates (88.9%) and identified as patient navigators (39.3%). Mean age = 39 years (SD= 12.7). Although 96.8% had heard about FHH before, 50.8 % never collected FHH as part of their job, and only 24.6% reported ever referring a community member to a genetics specialist. Self-efficacy increased significantly (t=-10.2, p= 0.032) with large effect size (Cohen’s d= 1.61). Wilcoxon signed rank test revealed statistically significant increase in cancer genetics knowledge, z= -4.01, p\u3c0.001, with a large effect size (r= 0.52), and attitudes toward collection of FHH being useful as part of their jobs z= -3.48, p\u3c0.001, with medium effect size (r=0.45). Conclusion: The educational intervention increased CORE-P’s confidence about properly collecting FHH, assessing risk based on FHH, and referring community members to genetics specialists. Furthermore, participants reported they felt comfortable integrating the information they learned in their daily jobs and referring high risk individuals for cancer to genetics specialists. The current FHH session may be one approach to help address health disparities through appropriate risk assessment and referrals to genetic services within the Hispanic/Latino population. Future research can evaluate the longer-term behavioral impacts of the intervention on FHH data collection and referrals to genetic counseling