About

Community, Awareness Resilience, Empowerment (CARE) Program

Project Overview 

The overall goal of the CARE Program is to circumvent barriers to mammography screening among women in the White Mountain Apache community through an innovative patient navigation model which includes culturally tailored education. The intervention (CARE + COACH) was developed using community-based participatory research process (IRB00022667) which builds on formative work done with the community to identify specific barriers to cancer screening.

What We Are Doing 

We are conducting a 1:1 randomized waitlist control trial to test the effectiveness of CARE compared to CARE + COACH for increasing mammography uptake among a sample of 300 women with a referral for screening mammography.

Women will be randomly assigned to receive one of the following:

    • CARE: Culturally tailored breast cancer prevention educational materials

    • CARE + COACH: the CARE educational materials plus access to an Apache Women’s Health Coach (patient navigator)

All participants will complete assessments at baseline, 1-, and 2- months. Women in the CARE group who have not received a mammogram at 3 months will be offered support from the Women’s Health Coach through 4 months.

We are testing the following aims: 

  • Aim 1: To assess whether CARE + COACH leads to more women scheduling and completing a mammogram within 2 months of referral (compared to CARE alone). 
  • Aim 2: To assess whether CARE + COACH improves women’s understanding and attitudes about mammogram screening and reduces barriers. 

Why Does This Matter? 

  • Addresses urgent health concerns raised by White Mountain Apache leaders about low breast cancer screening rates, particularly following the COVID-19 pandemic. 
  • Responds to real community barriers identified through previous research, including limited time during appointments to discuss screening, confusion about referrals, and lack of support and comfort in scheduling mammograms. 
  • Provides culturally tailored education developed by Apache women for Apache women. 
  • Connects women with trusted 1:1 support by offering access to a Women’s Health Coach (patient navigator) from the community. 
  • Helps the Whiteriver community by promoting earlier cancer detection, improving access to preventive care, and supporting long-term health outcomes for Apache women through community-based and culturally grounded solutions.

For more information:

  • Dr. Allison Barlow (Principal Investigator) – abarlow@jhu.edu
  • Dr. Katie Nelson (Co-Investigator) – knelso46@jhmi.edu 
  • Dr. Francene Larzelere-Sinquah (Co-Investigator) – flarzel1@jhu.edu
  • Office Phone: 928-338-5215