Dr. Keith Argenbright on Engaging Hard to Reach Populations

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By Susan Kirtz, MPH
Managing Editor, Texas Health Journal
Director of Special Projects, Center for Health Communication
The University of Texas at Austin

 
 

The Texas Health Journal first spoke with Keith Argenbright, MD, Director of the Moncrief Cancer Institute at UT Southwestern, in January about his work launching Moncrief’s Mobile Cancer Survivor Clinic, an 18-wheeler that brings specialized cancer expertise to cancer survivors in nine rural counties in north Texas.

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Dr. Argenbright, who also serves as a Professor in the Simmons Comprehensive Cancer Center and Department of Clinical Sciences where he is the Chief of Community Health Sciences at UT Southwestern Medical Center, leveraged his academic, business, and political skills to form community coalitions and alliances to provide cancer prevention and early detection clinical services and bring population science research to rural communities surrounding Fort Worth. The result is a network of breast, cervical, and colorectal cancer screening collaborators including nurse navigation to provide services to rural and medically underserved residents. Under his supervision, Moncrief also expanded genetic screening services to include remote and underserved areas, closing the critical disparity in adherence to medical management guidelines.

What are some of the challenges you have encountered in providing prevention services and health care in rural areas of Texas?

Prior to sending the mobile clinic into any of these rural counties, Moncrief Cancer Institute established relationships through face-to-face meetings with leaders in each county including judges, commissioners, and health care providers. Without exception, the immediate concern was the perception that Moncrief Cancer Institute was coming into their county as a competitor, with the intent of redirecting patients away from their local providers. Establishing that our goal was to refer patients locally for services and connect survivors with support services in the county in which they live resulted in endorsements and a warm welcome into each county.

What are some of the barriers to care that patients in rural areas face when it comes to accessing survivorship services?

Fifty-five percent of the counties in this region are either fully or partially designated as medically underserved areas. The health professional and facility shortages combined with a lack of reliable transportation, inexperience of accessing care within a complex medical network, and an overarching hesitation to seek help outside a zone of familiarity, negatively affect a cancer survivor’s ability to receive appropriate post-treatment care. Additionally, funding to deliver these services at no cost is difficult to sustain as the current Medicaid waiver program is winding down.

What are some ways you and your team work to build trust, both in a community and with individual patients?

In order to maintain strong relationships with our community partners, an Outreach Coordinator is assigned to each county. Outreach Coordinators visit their counties regularly to cultivate and sustain trust and support from health care providers, retailers and local groups like the VFW, Chamber of Commerce and Women’s Clubs. Additionally, Moncrief invites community partners and leaders from all nine counties to an annual luncheon to facilitate networking and dialogue between counties.

What are some of the most effective means of communicating about your services to communities that are spread out in rural areas of the state?

Successfully engaging the populations in these counties requires you to meet them where they are. Along with advertising in local media outlets, Moncrief Coordinators attend rodeos, flea markets, food banks, church events and school carnivals, distributing reminder cards and posters to promote Moncrief screening programs available in that county.

What are your top 5 tips for engaging hard to reach populations in prevention services and health care?

  1. Partner with health care providers to facilitate patient referrals

  2. Reduce barriers to accessing care

  3. Provide incentives for residents to participate

  4. Employ bilingual (English/Spanish) staff and disseminate bilingual program information

  5. Maintain a regular presence in each community