title: Randomized controlled trial of Nuevo Amanecer: a peer-delivered stress management intervention for Spanish-speaking Latinas with breast cancer.
abstract: BACKGROUND
  Latinas with breast cancer suffer symptom and psychosocial health disparities. Effective interventions have not been developed for or tested in this population.
  
  
  OBJECTIVE
  We describe community-based participatory research methods used to develop and implement the Nuevo Amanecer program, a culturally tailored, peer-delivered cognitive-behavioral stress management intervention for low-income Spanish-speaking Latinas with breast cancer, and unique considerations in implementing a randomized controlled trial to test the program in community settings.
  
  
  METHODS
  We applied an implementation science framework to delineate the methodological phases used to develop and implement the Nuevo Amanecer program and trial, emphasizing community engagement processes.
  
  
  RESULTS
  In phase 1, we established project infrastructure: academic and community co-principal investigators, community partners, community advisory board, steering committee, and funding. In phase 2, we identified three program inputs: formative research, a community best-practices model, and an evidence-based intervention tested in non-Latinas. In phase 3, we created the new program by integrating and adapting intervention components from the three sources, making adaptations to accommodate low literacy, Spanish language, cultural factors, community context, and population needs. In phase 4, we built community capacity for the program and trial by training field staff (recruiters and interventionists embedded in community sites), compensating field staff, and creating a system for identifying potential participants. In phase 5, we implemented and monitored the program and trial. Engaging community partners in all phases has resulted in a new, culturally tailored program that is suitable for newly diagnosed Latinas with breast cancer and a trial that is acceptable and supported by community and clinical partners. Lessons learned Engagement of community-based organizations and cancer survivors as research partners and hiring recruiters and interventionists from the community were critical to successful implementation in community settings. Having culturally and linguistically competent research staff with excellent interpersonal skills facilitated implementation. Facilitating and maintaining excellent communication among community partners was imperative to troubleshoot implementation issues. Randomization was challenging due to community concerns about assigning women to a control group. Patient privacy regulations and the need for extensive outreach to establish relationships between community partners and clinical sites hampered initial recruitment.
  
  
  CONCLUSIONS
  These were resource-intensive processes to develop and implement the program that need to be compared to less-intensive alternatives.
  
  
  CONCLUSIONS
  Engaging community members in design and implementation of community-based programs and trials enhances cultural appropriateness and congruence with the community context. If the randomized trial demonstrates that the intervention is effective, it will fill a gap in evidence-based programs to address ethnic disparities in quality of life among Spanish-speaking Latinas with breast cancer.
authors.affiliation: aCenter for Aging in Diverse Communities, University of California, San Francisco (UCSF), San Francisco, CA, USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Nápoles
authors.forename: Jasmine
authors.initials: J
authors.lastname: Santoyo-Olsson
authors.forename: Carmen
authors.initials: C
authors.lastname: Ortiz
authors.forename: Steven
authors.initials: S
authors.lastname: Gregorich
authors.forename: Howard E
authors.initials: HE
authors.lastname: Lee
authors.forename: Ysabel
authors.initials: Y
authors.lastname: Duron
authors.forename: Kristi
authors.initials: K
authors.lastname: Graves
authors.forename: Judith A
authors.initials: JA
authors.lastname: Luce
authors.forename: Peggy
authors.initials: P
authors.lastname: McGuire
authors.forename: Marynieves
authors.initials: M
authors.lastname: Díaz-Méndez
authors.forename: Anita L
authors.initials: AL
authors.lastname: Stewart
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D055812:Community-Based Participatory Research / Q000379:methods*; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D018579:Patient Selection; D010379:Peer Group; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D013315:Stress, Psychological / Q000628:therapy*