W-SCHOLARLY PP

Lung Cancer in the United States: A Health Promotion Proposal Part 2

Student’s name: William Carrazana

Institution: Florida National University

Course: Health Promotion & Role Development in Adv. Nursing Practice

Instructor’s name: Nora Hernandez Pupo

Date: April 14, 2025

Lung Cancer in the United States: A Health Promotion Proposal Part 2

Health Promotion Program Using Evidence-Based Intervention

The new health promotion program will implement evidence-based interventions to reduce the prevalence of lung cancer among vulnerable groups, including current and former smokers, low-income families, and rural communities. The program has three core components: quitting smoking, early detection programs, and risk factor education. The interventions will be HBM-driven by focusing on perceived susceptibility, severity, benefits, and barriers to behavior change (Alyafei & Easton-Carr, 2024).

The smoking cessation intervention will include community-based workshops facilitated by advanced practice nurses integrating pharmacotherapy and behavioral counseling. This approach is endorsed by research that, in the past few years, has shown that nurses are the key professionals involved in helping patients quit smoking as assessors, educators, and facilitators. These roles facilitate nurses to build patient trust, provide individualized counseling, and provide interventions using strategies like motivational interviewing and the 5A model (Jiang et al., 2024). Additionally, integrated care in primary settings significantly increases long-term quit rates where interventions are nurse-led and based in the community.

To make the program more accessible, especially in rural settings, the program will partner with local clinics and utilize mobile health units. Mobile clinics have proved highly effective in delivering care to vulnerable groups. For instance, during the COVID-19 crisis, mobile health clinics could reach low-access families to pediatric care and achieve high user satisfaction rates due to being flexible and culturally responsive (Leibowitz et al., 2021). The resources required for this intervention include trained facilitators, culturally responsive education materials, and low-cost nicotine replacement products. The timeline is 12 months, with bi-monthly workshops for the first half year to promote consistent attendance and quarterly workshops to keep the pace going thereafter. Follow-up surveys at 3, 6, and 12 months, as well as attendance records, will provide measurable indicators of success in quitting and retention of participants.

The early detection strategy seeks to increase access to low-dose computed tomography (LDCT) scanning in high-risk individuals. Early diagnosis is essential since patients who are diagnosed with Stage 1A lung cancer have a five-year survival rate of more than 75%, whereas it is less than 5% in Stage 4 (Lancaster et al., 2022). Evidence also shows that LDCT reduces the death rate due to lung cancer by 20–24% compared to regular X-rays or none at all. To benefit from such advantages, underserved communities should have screening centers manned by nurse navigators who can guide the participants through the process.

To enhance feasibility, LDCT screenings will be done bi-annually, supported by awareness campaigns launched a month prior to every screening period. Strategic partnerships with local radiology centers will allow the program to reimburse for screening in uninsured participants, promoting equity of access. The early detection program begins with a six-month pilot to pilot logistics and community acceptance, after which it will scale up based on available resources and demonstrated need.

The educational component of the program serves to improve public awareness of lung cancer risk through an integrative communications plan. Town hall meetings will be held in community centers, and multilingual pamphlets and online awareness campaigns will target varying literacy levels. The initiative is connected to the HBM's "cues to action" concept through the utilization of text messages and computer-automated reminders for screening or cessation clinics. Implementing culturally relevant and linguistically appropriate materials has been shown to improve participant engagement and health outcomes. This element will be implemented alongside the other interventions throughout the 12 months, with milestones for assessment at the 6th and 12th months to gauge knowledge retention and behavioral changes.

Intended Outcomes Utilizing SMART Goals

The program objectives are defined using the SMART criteria (Specific, Measurable, Achievable, Relevant, Time-bound) to ensure clarity and simplicity of monitoring. The overall objective is to achieve a 15% reduction in smoking among program participants over five years, measured through pre- and post-intervention surveys and state tobacco use databases. The rationale for this target lies in evidence regarding the effectiveness of nurse-provided behavioral and pharmacologic smoking cessation interventions (Jiang et al., 2024).

The second objective is to increase LDCT screening among rural and low-income populations by 30% over three years. This will be tracked by clinic visit records, screening completion, and follow-up visits. LDCT has already been shown to dramatically increase early-stage diagnosis and, therefore, survival rates, so this is a critical step (Lancaster et al., 2022).

The tertiary goal is to increase public awareness of lung cancer risk factors and prevention measures by 20%. This will be quantified through pre- and post-education questionnaires at workshops and online portals. These goals are aligned with national health indicators and specifically tailored to address primary focus areas for prevention, awareness, and early intervention.

Evaluation Plan

The evaluation system will include process and outcome measures for careful monitoring and data-driven adjustments. Process evaluation will track program implementation and adherence, such as workshop attendance rates, LDCT screening, and practical resource use. For inclusiveness and cultural appropriateness, community boards will check materials quarterly for clarity and appropriateness.

The outcome evaluation will assess smoking behavior and knowledge changes using pre- and post-intervention surveys. Screening data will be cross-referenced with regional cancer registries to investigate changes in detection rates and stages of diagnosis. Longitudinal follow-ups at 6- and 12-months post-intervention will track maintained behavior change, including smoking cessation over the long term and adherence to screening guidelines.

The RE-AIM framework will guide the evaluation, enabling systematic measurement of the program's Reach, Effectiveness, Adoption, Implementation, and Maintenance. For example, "reach" will be measured by the proportion of the target population reached, while "effectiveness" will examine reductions in late-stage diagnosis and improved smoking cessation (Verhey et al., 2022). Collaborations with academic institutions will be established to ensure independent and rigorous data analysis. In addition, community advisory boards will be instrumental in identifying new barriers like low digital literacy or transportation challenges and will provide recommendations on measures to adapt.

Barriers and Mitigation Strategies

The program is likely to face some significant hurdles. The most significant are inadequate health infrastructure in rural areas and economic hardship among lower-income groups. To counter these, the program will implement telehealth platforms for smoking cessation counseling and mobile health units for LDCT screenings. These delivery models have been found to show promise in extending outreach to populations otherwise excluded from preventive care services (Leibowitz et al., 2021).

Cultural stigma surrounding smoking and cancer fatalism may deter participation in cessation and screening behaviors. In counteraction, the program will develop culturally relevant messaging with the assistance of local leaders and patient advocates. Community input will ensure that campaign tone, imagery, and language are consistent with the target population, promoting help-seeking behavior.

Institutional barriers also exist. For instance, confident clinicians can de-emphasize preventive care due to competing priorities. This will be overcome by offering interdisciplinary training sessions on early intervention cost savings and clinical benefits. Nurse leaders will also campaign for policy to receive state dollars to cover screening expansion and promote stricter tobacco control policies, such as increased taxes on tobacco and restricted advertising.

Sustainability challenges will be addressed through the inclusion of program components within existing healthcare systems, such as the delivery of preventive services by federally qualified health centers. These inclusions enhance continuity and reduce operational duplication. In addition, ongoing review and stakeholder feedback will cause the program to evolve to tackle community needs effectively.

Low participant retention logistical issues and a lack of follow-up will be solved by efficient reminder systems, such as SMS reminders, calls by community health workers, and follow-up visits. Small incentives like transportation allowances or wellness kits may motivate participants to remain in the program. Ongoing feedback loops with participants will make the program adaptive and user-centered.

References

Alyafei, A., & Easton-Carr, R. (2024). The health belief model of behavior change. In  StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606120/

Jiang, Y., Zhao, Y., Tang, P., Wang, X., Guo, Y., & Tang, L. (2024). The role of nurses in patient smoking cessation interventions: a scoping review.  BMC Nursing,  23(1), 1-12. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-024-02470-2

Lancaster, H. L., Heuvelmans, M. A., & Oudkerk, M. (2022). Low‐dose computed tomography lung cancer screening: Clinical evidence and implementation research.  Journal of Internal Medicine,  292(1), 68-80. https://pmc.ncbi.nlm.nih.gov/articles/PMC9311401/

Leibowitz, A., Livaditis, L., Daftary, G., Pelton-Cairns, L., Regis, C., & Taveras, E. (2021). Using mobile clinics to deliver care to difficult-to-reach populations: a COVID-19 practice we should keep.  Preventive medicine reports,  24, 101551. https://pmc.ncbi.nlm.nih.gov/articles/PMC8428151/

Verhey, R., Chitiyo, C., Mboweni, S., Turner, J., Murombo, G., Healey, A., ... & Araya, R. (2022). Using the RE-AIM framework to evaluate the implementation of scaling-up the Friendship Bench in Zimbabwe–a quantitative observational study.  BMC health services research,  22(1), 1392. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08767-9#:~:text=Implementation%20science%20offers%20a%20robust,FB%20implementation%20sites%20%5B22%5D.