Table 5 Program adoption and appropriateness from perspectives of CBO administrators, recruiters, and compañeras

Implementation Outcome: Adoption

Aligns with CBO’s priority population

“We are a very poor community, 85% of the people we’re serving are Latinos. It’s a very disadvantaged community: we’re medically underserved, we’re rural, and so their needs are very complex.”–CBO administrator

Aligns with CBO’s mission and/or service model

“Well, it made it attractive because it’s the type of work that we’re already doing. We provide a lot of health education to the community at no cost to them, working with promotoras and we are doing that work in English and Spanish. I knew there was the need in our area.“–CBO administrator

“We are a community-based organization that focuses in approaching the patient, which makes us a very unique and strong model. We have strong social capital in our community. So, when we have the opportunity to work with our patients, work with the medical system, locally and out of county, and work with the community at large, I think we just have a very good reputation for being supportive and able to help in whatever capacity we’re functioning.”–CBO administrator

CBO’s existing resources

• CBO’s internal resources

“We are a hospital and have a data analyst that would send me the list of women with certain indicators to make sure that they could participate in the program.”–CBO administrator

“We’re very good at integrating activities and commitments ourselves; the team is very versatile and adaptable. So, if someone is unable to be available, the other staff easily steps in and provides support as they can. They are social workers, they’re all CITI-trained, they have a very high set of expertise that I trust very well.”–CBO administrator

• CBO’s existing relationships with external organizations

“One of my coworkers, who was also one of the recruiters, has established incredible connections in the community with medical teams and she took advantage of it in trying to recruit people. We have good connections with nurse navigators and social workers, and they were helpful in referring women to us. I think those connections and our history of being involved in the community were certainly a benefit.“–CBO administrator

“We have memorandums of understanding with two oncology clinics and a radiation clinic. Since we’re not clinic-based or hospital-based those clinics are key, which gave us the opportunity to immerse ourselves in the clinic.”–CBO administrator

Funding agency’s priorities

“We’re familiar with the funder, and the research that’s produced, the translational research that they offer is very good. So, we wanted to be a part of it.”–CBO administrator

“I always have a hard time when a project only serves one particular cancer. We have women that have other cancers. It’s just that narrow focus is hard. And I know that’s often where the funding is, but nevertheless, I think it’s a disservice to so many women in rural areas.“–CBO administrator

Implementation Outcome: Appropriateness

Program model and research process

• Program fit

“This program fit in really well because a lot of our population are used to working with community health workers and we had done some home visits in the past. And also, because we’re rural it’s kind of hard to get the women together to do a group. So, I think doing the one-on-one and being able to do the program in all the different areas that we serve.“–CBO administrator

“I’m speaking about the curriculum. It was a great resource for women who are breast cancer survivors and the fact that it’s in Spanish and it’s delivered by a compañera, somebody who has gone through that problem themselves.”–CBO administrator

“At the beginning when we talked about this program, it seemed interesting to me because it was going to be in the Spanish language and for the first time it was going to focus on Latina women.”–Compañera

• Input on program

“Before we even started, we were given the opportunity to give feedback on the program. I think it was even expanded based on some feedback. It got tailored…we anticipated what those needs were going to be.”–CBO administrator

“There has never been a program that was supportive to our women with breast cancer. We’ve never had this type of support, peer support, in Spanish before, utilizing the tools that they did, that they used with the patients in their home, it was most appropriate.“–CBO administrator

• Input on research methods

“[The academic team] took our input about the survey. They made it shorter. And they changed some of the hard words on the consent form.”–Community recruiter

• Flexibility with locale

“If we had space available, they could use it for the [enrollment] interview or compañeras could meet with participants. In some instances, the participants were more comfortable coming to our office because it’s private and they’re able to focus without any distractions at home, no phone or family.”–CBO administrator

“Normally I would see women in their home because they did not have transportation.”–Community recruiter

Staffing

• Hire community members

“You know, the fact that we would be able to provide some type of part-time employment to a few community members. We were able to hire three per diem staff through this grant, anytime we can do that, that’s amazing.”–CBO administrator

• Overseeing staff

“I had not previously known either [compañera], and one of them was wonderful, and the other one was not very prompt or very good at communicating. I think she let [the academic partner] know that she went out of town, but she didn’t let me know, and I would be calling her, and then I would find out that she was out of town.”–CBO administrator

“I personally do a good job with my volunteers here in the agency, but somehow I had a blind spot, and I didn’t translate that to how valuable it would have been to check-in with program staff. The program allowed my employer to add a few hours a month to my schedule. But sometimes I felt like I wasn’t able to give as much time as I ideally would have liked to.“–CBO administrator

• Staff turnover

“We had to pause our recruitment because we lost a compañera. We found a new one, but we had a hard time assigning women to her because she was only available in the late afternoon, so we had to let her go. The last [compañera] worked out.”–CBO administrator

Implementation Outcome: Sustainability

Need for new funding sources

“Funding, that’s always the question when we think about sustaining the program in the future. Actually, last week, I had a conversation with our foundation director, and she asked about any projects that we wanted to do and needed funding for. So, I mentioned Nuevo Amanecer and I think we found a source that we’re gonna apply to. I’m gonna ask [the academic partner] to provide me with some preliminary data that I can use on the application.”–CBO administrator

“We are a Medicare provider, and we are preparing to become a Medicaid provider. We can bill for psychotherapeutic support. That’s within our capacity and within our designation. So, this skillset from Nuevo Amanecer is billable through us. We want to expand this skillset, doesn’t matter the type of cancer, that is where the strength for perpetuating sustainability is for us. It would be through our capacity to bill Medicare, Medicaid, and private insurance.”–CBO administrator

“At this point we don’t have funding to pay compañeras to do the one-on-one ten-week program. We might be able to do it in a group setting. We’re hoping to continue to take advantage of and utilize the program because it’s extremely valuable, but at this point we don’t have any funding ideas.”–CBO administrator

Incorporate aspects of program into current CBO services

“We’ve talked about perhaps one of the compañeras delivering some levels of the program to our support groups, you know, our Latina support groups or something like that.”–CBO administrator

“Our intention is to continue this very good, structured model, but we’ll integrate it within our own capacity. Maybe not in its purest form and we are limited in home visits. However, we are able to integrate the majority of the coping skills and the program within our agency in either individual or group form.”–CBO administrator