2/2 Partnership for Native American Cancer Prevention

The Navajo Nation is reporting the highest per-capita coronavirus infection rate in the United States (US) with 3.6% infected and a 4.7% case fatality rate, despite quickly responding to the first cases with prevention messaging and community lock-down measures. Chronic conditions like diabetes and obesity, prevalent on the Navajo Nation, have been associated with severe COVID-19 illness. Although several factors have contributed to the high incidence of infection in this population, cultural and economic factors are playing a major role. These conditions complicate maintaining medical care while engaging with the recommendations to reduce COVID-19 transmission. The impact of COVID-19 for the Navajo Nation can become broader than the immediate morbidity and mortality; cancer prevention and early detection screenings may have been postponed, cancer treatments may have been stopped or delayed. It is unknown how SARS-CoV-2 infection and the measures to prevent infection will impact health care delivery, including cancer screening, detection, and care. To address these disparities and to better respond to the impact of the pandemic within one of the most impoverished regions of the US, we propose to use a multimethod approach to determine the impact of the COVID-19 pandemic from the perspectives both the health care providers and facilities and from the individual patients' perspective on health related care delivery, including cancer prevention, early detection, screening, diagnosis, and treatment planning, and the interaction of chronic diseases with SARS-CoV-2 infection. Specifically, we will 1) investigate provider/health care worker perceptions about COVID-19 impacts using online surveys and semi-structured interviews and 2) investigate changes in patients' and communities' care seeking capacity, using online and telephone surveys and Zoom-based focus groups with members of the community and with cancer patients. Our research team from two universities and Navajo community members is uniquely suited to respond because of our current partnerships with the Navajo Nation and medical facilities. Beyond understanding what factors are contributing to the high transmission on the Navajo Nation, the data collected for this project may allow for future assessment of the impact of delay in cancer treatment or detection for patients. Through surveys, semi-structured interviews, and focus groups, we will provide a broad assessment of the experiences of Navajo households and Navajo cancer patients throughout the pandemic and how this widespread community transmission and infection has influenced access, utilization, and quality of health care.