Prioritizing rural populations in state comprehensive cancer control plans: a qualitative assessment

Rachel Hirschey^#¹, Catherine Rohweder^#², Whitney E Zahnd³, Jan M Eberth⁴, Prajakta Adsul⁵, Yue Guan⁶, Katherine A Yeager⁷, Heidi Haines⁸, Paige E Farris⁹, Jennifer W Bea¹⁰, Andrea Dwyer¹¹, Purnima Madhivanan¹², Radhika Ranganathan¹³, Aaron T Seaman¹⁴, Thuy Vu¹⁵, Karen Wickersham¹⁶, Maihan Vu¹⁷, Randall Teal¹⁷, Kara Giannone¹⁷, Alison Hilton¹⁷, Allison Cole¹⁸, Jessica Y Islam¹⁹, Natoshia Askelson²⁰

Affiliations

¹ School of Nursing, UNC Chapel Hill, and Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA. rachel@hirschey.org.
² Center for Health Promotion & Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA.
³ Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA.
⁴ Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
⁵ Department of Internal Medicine, University of New Mexico & University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
⁶ Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁷ Nell Hodgson School of Nursing, Emory University, Atlanta, GA, USA.
⁸ Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, IA, USA.
⁹ Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
¹⁰ Department of Health Promotion Sciences, Mel & Enid Zuckerman, College of Public Health, University of Arizona, Tucson, AZ, USA.
¹¹ Community and Behavioral Health, The Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
¹² University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA.
¹³ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
¹⁴ Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
¹⁵ MPH Health Promotion Research Center, University of Washington, Seattle, WA, USA.
¹⁶ College of Nursing, University of South Carolina, Columbia, SC, USA.
¹⁷ UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
¹⁸ University of Washington, Seattle, WA, USA.
¹⁹ Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
²⁰ Department of Community & Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA.

^# Contributed equally.

PMID: 36840904
PMCID: PMC9959942
DOI: 10.1007/s10552-023-01673-3

Prioritizing rural populations in state comprehensive cancer control plans: a qualitative assessment

Rachel Hirschey et al. Cancer Causes Control. 2023 Dec.

. 2023 Dec;34(Suppl 1):159-169.

doi: 10.1007/s10552-023-01673-3. Epub 2023 Feb 25.

Authors

Affiliations

¹ School of Nursing, UNC Chapel Hill, and Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA. rachel@hirschey.org.
² Center for Health Promotion & Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA.
³ Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA.
⁴ Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
⁵ Department of Internal Medicine, University of New Mexico & University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
⁶ Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁷ Nell Hodgson School of Nursing, Emory University, Atlanta, GA, USA.
⁸ Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, IA, USA.
⁹ Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
¹⁰ Department of Health Promotion Sciences, Mel & Enid Zuckerman, College of Public Health, University of Arizona, Tucson, AZ, USA.
¹¹ Community and Behavioral Health, The Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
¹² University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA.
¹³ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
¹⁴ Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
¹⁵ MPH Health Promotion Research Center, University of Washington, Seattle, WA, USA.
¹⁶ College of Nursing, University of South Carolina, Columbia, SC, USA.
¹⁷ UNC CHAI Core, Connected Health Applications & Interventions (CHAI) Core, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
¹⁸ University of Washington, Seattle, WA, USA.
¹⁹ Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
²⁰ Department of Community & Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA.

^# Contributed equally.

PMID: 36840904
PMCID: PMC9959942
DOI: 10.1007/s10552-023-01673-3

Abstract

Purpose: The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP) requires that states develop comprehensive cancer control (CCC) plans and recommends that disparities related to rural residence are addressed in these plans. The objective of this study was to explore rural partner engagement and describe effective strategies for incorporating a rural focus in CCC plans.

Methods: States were selected for inclusion using stratified sampling based on state rurality and region. State cancer control leaders were interviewed about facilitators and barriers to engaging rural partners and strategies for prioritizing rural populations. Content analysis was conducted to identify themes across states.

Results: Interviews (n = 30) revealed themes in three domains related to rural inclusion in CCC plans. The first domain (barriers) included (1) designing CCC plans to be broad, (2) defining "rural populations," and (3) geographic distance. The second domain (successful strategies) included (1) collaborating with rural healthcare systems, (2) recruiting rural constituents, (3) leveraging rural community-academic partnerships, and (4) working jointly with Native nations. The third domain (strategies for future plan development) included (1) building relationships with rural communities, (2) engaging rural constituents in planning, (3) developing a better understanding of rural needs, and (4) considering resources for addressing rural disparities.

Conclusion: Significant relationship building with rural communities, resource provision, and successful strategies used by others may improve inclusion of rural needs in state comprehensive cancer control plans and ultimately help plan developers directly address rural cancer health disparities.

Keywords: Cancer; Comprehensive cancer control; Health disparities; Rural health.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

References

1. Centers for Disease Control and Prevention (n.d.) Comprehensive cancer control plans. National Comprehensive Cancer Control Program https://www.cdc.gov/cancer/ncccp/ccc_plans.htm. Accessed 12 Aug 2022
1. Centers for Disease Control and Prevention (2012) Cancer plan self-assessment tool. National Center for Chronic Disease Prevention and Health Promotion. https://www.cdc.gov/cancer/ncccp/pdf/CancerSelfAssessTool.pdf. Accessed 12 Aug 2022
1. (2021) Quickstats: age-adjusted death rates for cancer, by urban-rural status† and sex - national vital statistics system, United States, 1999–2019. MMWR Morb Mortal Wkly Rep 70(37):1312 - PMC - PubMed
1. Hirko KA, Xu H, Rogers LQ, Martin MY, Roy S, Kelly KM, et al. Cancer disparities in the context of rurality: risk factors and screening across various US rural classification codes. Cancer Causes Control. 2022;33(8):1095–105. doi: 10.1007/s10552-022-01599-2. - DOI - PMC - PubMed
1. Bhatia S, Landier W, Paskett ED, Peters KB, Merrill JK, Phillips J, et al. Rural-urban disparities in cancer outcomes: opportunities for future research. J Natl Cancer Inst. 2022;114(7):940–952. doi: 10.1093/jnci/djac030. - DOI - PMC - PubMed

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Prioritizing rural populations in state comprehensive cancer control plans: a qualitative assessment

Affiliations

Prioritizing rural populations in state comprehensive cancer control plans: a qualitative assessment

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical