ABSTRACT
Background: Breast cancer is the most common cancer in women in the U.S. and the leading cause of cancer related death among U.S. Latinas. Despite having lower breast cancer incidence, U.S. Latinas are more likely to be diagnosed with advanced stage disease compared to non-Hispanic White (NHW) women. This can be attributed to lower rates of screening and longer time to follow up after an abnormal mammogram in the former group. We developed a comprehensive promotores-led education and risk stratification program for Spanish-speaking Latinas to increase mammography screening, genetic testing, and the understanding of the impact of family history on cancer risk. Due to COVID-19 we adapted the program to a virtual platform. This study aimed to record and share the experience from the promotores' perspective as they educated the Latino(x) community through virtual sessions. Methods: We used a stakeholder continuous engagement approach and the construct of relational culture to build the program materials. The promotores were part of two organizations in California: Vision y Compromiso (Sacramento region, and San Francisco) and Promoters for Better Health (Los Angeles). Their experience was captured using semi-structured interviews guided by a set of questions and a request for additional thoughts. Demographic information was captured using a questionnaire. The promotores' voices were incorporated into this program through multiple interactions including the revision of the interviews. Results: All promotores (N=14) in the program were fluent in Spanish and self-identified as Hispanics/Latinos(x). Ages ranged between 34 and 62, most being first generation immigrants. Educational achievement varied from high school to college degree. Through the interviews and informal interaction, promotores shared that virtual platforms helped alleviate numerous obstacles for attendance like transportation, scheduling conflicts, and childcare costs. However, the online approach removed the personal connection that promotores usually have with participants. The most important challenge described was the lack of privacy and a safe space for participants to share, since many took the class in the middle of their homes near family members. The promotores agreed delivering the program gave them a greater sense of self-worth and confidence. They never thought that they could learn, and teach, community members about genetics and cancer risk. Conclusions: Despite the challenges brought about by COVID-19, the experience of transforming the 'tu historia cuenta' program to a virtual platform provided unique opportunities for bi-directional collaboration between the academic and community partners and with the participants. Overall, we learned that the virtual program had both positive and negative aspects regarding community engagement. It also consistently empowered promotores as well as allowed them to continue their paid work during lock-down, which was equally appreciated during challenging economic times.