Rationale for the Comadre a Comadre Program

Special populations is a broad and diverse term that includes persons who are medically underserved, the dying patient, ethnic and racial minorities, the poor, those who are uninsured or underinsured, the unemployed, persons with low literacy, and persons in rural as well as urban areas. The cancer incidence, mortality, and survival rates for many of the leading cancers are disproportionately higher for certain special population groups. The American Cancer Society has identified challenge goals targeting the disparities in cancer care for special populations. These are: 1) To eliminate the disparities in cancer burdens among population groups by reducing age-adjusted cancer incidence and mortality rates, 2) To improve the quality of life in the poor and underserved persons to the population average, 3) To decrease breast cancer morbidity, 4)To develop a culturally and linguistically competent community navigation model for ethnic/minority women undergoing evaluation for breast cancer care.

In addition, the Comadre a Comadre program is aligned with the New Mexico Cancer Plan goals 3, 4, and 5 (increase access to care, address issues and improve coordination and collaboration-,New Mexico Cancer Plan 2007-2011 pg. 25). It also draws inspiration from Redes En Accion, the NCI national agenda for Hispanic/Latino cancer care (2007). In addition, it is also aligned with the Office of Cancer Survivorship (OCS), which supports examining the physiological, psychosocial, and economic sequeala of cancer and its treatment, and interventions that may ameliorate or prevent them. The majority of traditional research examining ethnic or minority differences in cancer survivorship outcomes has been limited largely to analyses of differences in cancer risk and survival (as opposed to survivorship), and efforts to extend these findings to address their impact on individuals living with this disease have begun only recently.

Latino/Hispanic Culture

Although Hispanic/Latinos are a diverse population, researchers agree 11 that there are common cultural characteristics that need to be considered when developing health interventions within this population. Mainstream American culture focuses on the individual. Medical care also tends to focus primarily on the individual and the individual’s disease. Hispanics value family over the individual. Familismo (familism) has been proposed as one of the most culture-specific values of Hispanics, and involves individuals’ strong identification with and attachment to their nuclear and extended families11, emphasizing interdependence over independence, affiliation over confrontation, and cooperation over competition.7 Familism includes three types of value orientation: 1) perceived obligation to provide material and emotional support to members of the family; 2) reliance on help and support from family members; and 3) the perception of relatives as behavioral and attitudinal referents.11 Familism appears to help protect individuals against physical and emotional stress by providing natural support systems.11

New Mexico Hispanic/Latina Women

New Mexico Hispanic women are met with additional barriers to care which are unique to this population: 1) Language— lack of informational/educational materials available in Spanish, resulting in increased difficulty navigating the health care system. Women are often unaware of services available to them (e.g., interpreter services); 2) Financial– many of these women may not have health insurance or may be underinsured. This population of women is frequently low-income and needs assistance in paying for health care services; 3) Distrust and Cultural Beliefs– there is distrust of the health care system, fear related to cultural beliefs about cancer such as fatalism and contagiousness and fear of the results. There is lack of understanding of the perception of how a diagnosis of breast cancer is contextualized within the cultural and familial backdrop by these women. For these reasons, Hispanic/Latina women often do not seek support or resources, and have difficulty navigating diagnostic procedures at clinic facilities. Hispanic/Latina women referred for abnormal finding for breast cancer often face unique socio-cultural and language barriers that require follow-up, and resources to facilitate.  This might be too labor intensive for clinic staff that are already overworked and understaffed. Culturally held views and lack of knowledge about breast cancer might require a more personable and emotionally supportive patient and provider interaction than is possible due to clinic constraints 12. 13.