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Distance Education to Engage Alaskan Community Health Aides in Cancer Control

Friday, May 17, 2019   (0 Comments)
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Melany Cueva, Laura Revels, Michelle Hensel, Katie Cueva, Mark Dignan



“I think this is a great step in the right direction for educating ourselves about cancer, how to cure it; how to manage it/live with it every day.  Quyannakpuk for making these first steps!”

-Alaska Community Health Aide/Practitioner



In response to Alaska’s Community Health Aides and Community Health Practitioners (CHA/Ps) desire to learn more about cancer by engaging in online learning, funding was sought and received from NCI to ANTHC.  Our project team consists of the caring expertise of diverse people passionate about making a difference in the story of cancer with and for Alaska Native people. Dr. Melany Cueva, the Principal Investigator, is a nurse and adult educator with over 20 years of experience working with the Community Health Aide Program (CHAP) at the Alaska Native Tribal Health Consortium (ANTHC). Joining her are Dr. Michelle Hensel, the ANTHC-CHAP Medical Director, Laura Revels, who shares her technology and storytelling expertise, and the evaluation expertise of Dr. Katie Cueva, assistant professor of public policy and health at the Institute of Social and Economic Research at the University of Alaska Anchorage, and Dr. Mark Dignan, Director of the Prevention Research Center at the University of Kentucky.


Funding: This work is part of “Distance Education to Engage Alaskan Community Health Aides in Cancer Control,” supported by the National Cancer Institute of the National Institutes of Health (NIH), award R25CA186882 to the Alaska Native Tribal Health Consortium. The content of this article is solely the responsibility of the authors and does not necessarily represent the views of the NIH. 

Acknowledgements: We are grateful for Alaska’s Community Health Aides and Community Health Practitioners, content experts, and interested people who have generously shared their ideas with us as part of this learning journey. 

Alaska’s community-based primary care providers, Community Health Aides and Community Health Practitioners (CHA/Ps), requested information about cancer for themselves and their communities that would overcome geographic and economic barriers by being accessible via the Internet.  Culturally-relevant health promotion strategies are an opportunity to reach out and reduce health inequities in diseases with modifiable risk factors, including cancer. Alaska Native people bear a disproportionate cancer burden. 

To inform the development of culturally respectful distance learning, the project team conducted the following activities: 1) a focus group with 10 Alaska Native education experts; 2) a key stakeholder survey of 62 Alaska Native tribal health workers and their instructors/supervisors; 3) key informant interviews with 12 culturally diverse individuals; and 4) a literature review of distance-delivered education with Alaska Native or American Indian people.   Data from these activities were analyzed to provide a foundation for the development of 12 interactive online cancer education modules.  Key results include four principles: collaborative development, interactive content delivery, contextualizing learning, and creating connection. As an Alaskan tribal health worker shared “we’re all in this together. All about conversations, relationships. Always learn from you/with you, together what we know and understand from the center of our experience, our ways of knowing, being, caring.”

The 12 online cancer education modules are provided through the Community Health Aide Program (CHAP) Distance Learning Network (DLN).  Each asynchronous cancer education module is housed in Moodle and includes the online module content, a continuing education quiz to assess and reinforce learning, an end-of-module evaluation, as well as additional resources and community activities. Each two-hour learning experience was designed to support CHA/Ps in their capacity as healthcare providers and community members and was approved by the CHAP certification board for 2 hours of CHAP continuing education. To support learning, module content includes visuals, storytelling, interactivity, cultural teachings, and respect for diverse Alaska Native learners’ cultures. 


As of January 2019, over 1,700 online evaluation surveys had been completed for the modules. The number of evaluation surveys completed per month has generally increased over time, with an average of about 7 unique learners completing one survey each month. Almost all learners reported that the modules were respectful of their culture (97%) and they learned what they hoped to learn (99.8%).  

Learners new to online education continue to be engaged in the modules: on the first evaluation survey each learner completed, 21% had never taken an online learning course before, 33% had taken 1-4 courses before, and 46% had taken 5 or more online courses before. Of the 198 unique individuals who’ve completed evaluation surveys on the ANTHC Distance Learning Network, 13% completed just one cancer education end-of-module survey, 20% completed two or three, 49% completed 4-9 surveys, and 32% completed 10 or more. 

In response to ‘Some things I liked about the online modules…’ learners have written over 1,500 comments so far.

Learner responses included:
Informative: “Before this course I didn't know anything at all about cancer, now I feel confident I can talk with a cancer patient about it and know what to say or know my resources at least.” “Very very informative for me - I learned so much especially about terms I thought I knew.”

Format: “Mixture of learning methods.” “Nice layout and flow.”

Stories: “It was very interesting and helpful to hear about cancer treatments from real people who were in different situations of cancer treatment. Hearing the personal experiences of people who had cancer themselves and also people who had dealt with cancer as a bystander or loved one, how people deal with this terrible news and struggle, tips on how to cope and deal and just knowing that it's okay to not know what to do.  Listening to these personal stories makes it more real and gives you a better idea understanding of what we are learning.” 

Videos, visuals: “I really enjoyed all of the charts and graphs of everything.”

Interactive: “listening to the interactive parts helped me understand the module” I enjoyed the interactive parts. It made the learning more fun….keeps the information fresh in my mind.”

Relevant: “I enjoyed the realistic videos of patients who went to the hospital, it shows us that it's not that frightening. And the lady and her husband in the Chemotherapy video are people from my town. :-)”

Culturally appropriate: “Alaska Natives sharing their health experiences and also their fears, not wanting to get a check-up, etc.” “It makes you appreciate who you are and be proud of your culture.”

As a result of the modules, 97% of unique learners reported they intended to change behaviors to reduce their own cancer risk, 98% planned to share cancer information with their friends, families, or communities, and 87% intended to talk with their patients more often about cancer. 

The collaboratively developed, culturally-relevant, online learning modules are a well-received strategy to provide rural Alaska’s primary care providers with timely, medically-accurate, cancer education that has the potential to shift cancer risk reduction behavior and knowledge within the networks of CHA/P learners. The module evaluation results indicate that CHA/P learners have appreciated the content, format, and feel of the cancer education modules, and have been empowered to change both their own behavior, and engage with their patients, families, friends, and communities to share cancer information.


To learn more:
Cueva, K., Cueva, M., Revels, L., Lanier, A., Dignan, M., Viswanath, K., Fung, T., & Geller A., (2018) A Framework for Culturally Relevant Online Learning: Lessons from Alaska’s Tribal Health Workers. Journal of Cancer Education.

Cueva, K., Cueva, M., Revels, L., & Dignan, M. (2018) Culturally-Relevant Online Education Improves Health Workers’ Capacity and Intent to Address cancer. Journal of Community Health. 

Cueva, K., Revels, L., Cueva, M., Lanier, A., Dignan, M., Viswanath, K., Fung, T., & Geller A., (2017) 
Culturally-Relevant Online Cancer Education Modules Empower Alaska's Community Health 
Aides/Practitioners to Disseminate Cancer Information and Reduce Cancer Risk. Journal of Cancer Education.

Cueva, K., Revels, L., Kuhnley, R., Cueva, M., Lanier, A., & Dignan, M. (2015) Co-Creating a Culturally Responsive Distance Education Cancer Course with, and for, Alaska’s Community Health Workers: Motivations from a Survey of Key Stakeholders. Journal of Cancer Education.







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