Translating a stress management intervention for rural Latina breast cancer survivors: The Nuevo Amanecer-II

Abstract

ObjectivesAdapt a cognitive-behavioral stress management program (Nuevo Amanecer or NA) to be generalizable to rural, low literacy Spanish-speaking Latinas with breast cancer survivors at all phases of survivorship.MethodsApply the Transcreation Framework, a community-engaged translational model, to develop the adapted program (Nuevo Amanecer or NA-II), design a randomized controlled trial for community settings, identify recruiters and interventionists, and recruit participants into the trial.ResultsAdaptations included expanding the program from eight to ten weeks, simplifying materials, and increasing skills practice. We added stress management videos, healthy lifestyles information, and survivorship information. Interventionists were trained Latina breast cancer survivors. All core components of NA were retained in NA-II including managing the impact of cancer, information on breast cancer and its treatment, finding cancer information, getting support, managing thoughts, stress management techniques, and setting goals. Participants receive a program manual. Each session includes a review of that week’s content using the manual, practicing a stress-management skill, setting a specific goal, and reviewing videos. Spanish-speaking Latinas with non-metastatic breast cancer were recruited by community recruiters. Of 231 women approached, 24% refused, 10% were ineligible, and 153 (66%) were randomized to the intervention or a wait-list control group. The sample was vulnerable: 69% had < high school education, more than half had only Medicaid or no insurance, 91% was foreign born, and 48% reported financial hardship in the past year.ConclusionsApplying the Transcreation Framework to engage stakeholders in designing community-based RCTs enhanced congruence with community contexts and recruitment of this vulnerable population.

Nuevo Amanecer‐II: Results of a randomized controlled trial of a community‐based participatory, peer‐delivered stress management intervention for rural Latina breast cancer survivors

“…This was a 6-month RCT to assess the effectiveness of NA-II in improving breast cancer-specific quality of life (primary outcomes) at 3 and 6 months. 19 Secondary outcomes included four general distress symptoms, and attainment of four stress-management skills. We compared the 10-week NA-II intervention group to a wait-list control group.…”

“…The NA‐II program was adapted from NA to expand its generalizability for rural, low literacy Spanish‐speaking Latina breast cancer survivors throughout survivorship. Adaptation processes for this trial are described in detail elsewhere 19,20 . Social cognitive theory was the conceptual framework used for NA and NA‐II 21 .…”

“…Adaptation processes for this trial are described in detail elsewhere. 19,20 Social cognitive theory was the conceptual framework used for NA and NA-II. 21 Adaptations for NA-II were based on new formative research with survivors, advocates, patient navigators, medical social workers, and iterative consultations with community representatives from the three rural areas.…”

The Importance of Patient Engagement to Quality of Breast Cancer Care and Health-Related Quality of Life: A Cross-Sectional Study among Rural and Urban Latina Breast Cancer Survivors

“…The first RCT was conducted in five urban counties in Northern California: Alameda, Contra Costa, San Francisco, San Mateo, and Santa Clara [24,25]. The second RCT was conducted in three rural counties in California: Imperial, Tulare, and Santa Cruz/Monterey (Salinas and Watsonville areas of these counties) [26]. The self-reported survey measures used to assess English fluency, patient engagement, quality of breast cancer care and information, and physical and emotional well-being were identical across studies.…”

“…The self-reported survey measures used to assess English fluency, patient engagement, quality of breast cancer care and information, and physical and emotional well-being were identical across studies. Detailed methods for both studies are available elsewhere [24][25][26]. The current analyses used aggregated baseline data from both studies.…”