Korean Outreach Workers Reducing Screening Barriers for Korean WomenMaryland Breast & Cervical Cancer ProgramCourtney Lewis MPH, CHESPublic Education Coordinator

Maryland Breast & Cervical Cancer Program (BCCP)

• National program screening for eligible, low income, un/under insured women for breast and cervical cancer

• Priority populations for screening described as women who are racial, ethnic and/or cultural minorities

• Program is operated through the 22 Local Health Departments and 2 hospitals in Maryland

Korean Population in Baltimore County and Howard County

• Baltimore and Howard Counties both have significant Korean populations

• From 1990 to 2000 Howard County’s Korean population increased from 2,369 to 6,188, or 161%

• From 1990 to 2000 Baltimore County’s Korean population increased from 4,893 to 5,249 or 7.2%

• Source: www.census.gov

Korean Language MapSource: Modern Language Association www.mla.org

Barriers to Screening for Korean Women

• Language• Lack of familiarity of with preventative health

services• Fatalistic attitude• Embarrassment and/or dislike of Pap test• Misperceptions about cancer risk• Procrastination• Fear of having cancer or other disease• Source: http://www.cdc.gov/cancer/nbccedp/publications/cc-strategies/korean.htm

Korean Outreach Workers

• Are trusted, natural helpers from within the community

• Provide emotional support, advice, and tangible aid to members in their network

• Provide language interpretation during screening appointments, case management and recall

Korean Outreach Strategies

• One-to-one recruitment• PSAs in a local Korean newspapers• Outreach to Korean grocery stores • Word of mouth within the Korean

community• Korean faith-based organizations and

community centers• Program brochures translated in Korean

Howard County Korean Outreach Program Results

• Implemented in 1998 in Howard County • 2.5 times increase in percentage of

Asian/Korean clients in the first two fiscal years following implementation

Howard County Korean Outreach Program Results

12%

31%

35%

0%5%

10%15%20%25%30%35%

FiscalYear1997

FiscalYear2001

FiscalYear2006

Percentage of Asian/Korean Clients in Howard County Breast & Cervical Cancer Program

Asian/Korean Clients

Baltimore County Korean Outreach Program Results

• Implemented in 2000 in Baltimore County

• 3.2 times increase in percentage of Asian/Korean clients in the first two fiscal years following implementation

Baltimore County Korean Outreach Program Results

4%

13%

4%

0%

5%

10%

15%

FiscalYear2000

FiscalYear2002

*FiscalYear2006

Percentage of Asian/Korean Clients in Baltimore County Breast & Cervical Cancer Program

Asian/Korean Clients

*Korean Outreach Worker took leave of absence from program for 5 months in Fiscal Year 2006, resulting in lower Asian/Korean women enrolled in program

Implications

• The use of bi-lingual Korean outreach workers has demonstrated success in decreasing access barriers and enabled many high-risk Asian/Korean women to obtain breast and cervical cancer screening that they may not have received otherwise.

Sustainability

• Continued funding and employment of culturally relevant outreach workers is needed. This concept is illustrated in the significant decrease in percentage of Asian/Korean women served during the period without a Korean Outreach Worker in Baltimore County.

• Culturally relevant outreach produces meaningful health communication and progress eliminating related disparities by bridging the health care divide.