Growing Healthier Communities Through Prevention

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Women's and Men's Health Program's (WMHP) aims to increase enrollment in breast, cervical and cardiovascular screening programs, with a strong focus on engagement with strategic partners. While this particular project has an emphasis on breast and cervical cancer screening specifically, the comprehensive data listed below was utilized and reviewed as a foundation overall as the project got underway.

Breast and Cervical Disease Burden Health Equity Scores by Jurisdiction

Methodology for Simplistic Disease Burden and Health Equity Scoring 10-17-23
    Breast Cancer Disease Burden Map   ||   Breast Cancer Health Equity Map
    Cervical Cancer Disease Burden Map  ||   Cervical Cancer Health Equity Map
    Colon Cancer Disease Burden Map    ||   Colon Cancer Health Equity Map
    Cardiovascular Disease Burden Map   ||   Cardiovascular Health Equity Map  

The program identified a significant drop in screening rates – from over 14,000 women screened annually to a 30% reduction – and seeks to reverse this trend through a strategic, partner-driven process.  (See Enrollment Trends Data)

Challenge: There is a need to understand regional variations in screening rates, access to services, and barriers to enrollment.  This work must rebuild trust in communities experiencing medical mistrust and historical inequities in care.

Opportunity: WMHP will pilot regional partner meetings across Nebraska during May-December 2025.  The meetings will engage key partners (local health departments, medical providers, and community-based organizations), review screening data and identify service gaps, brainstorm actionable strategies tailored to local populations and prioritize next steps and commitments for implementation.

Grant Objectives and Goals:  Use data to assess burden, examine differences in screening rates, and cancer morbidity and mortality rates across the state, and inform efforts.

Description: Use state and local level health, disease burden, and demographic data, including Nebraska Cancer Registry data, as well as Geographic Information System (GIS) mapping, Small Area Health Insurance Estimates (SAHIE) data, and/or data from other sources to identify and describe the program-eligible populations. Prioritize screening and diagnostic services for populations that are disproportionately burdened by breast or cervical cancer, especially those who experience higher mortality and late-stage disease.

Deliverables Proposed for Fiscal Year 4: 

• Start Date: June 30, 2025
  End Date: August 31, 2025
  Develop a statewide “resource infographic" showing relationship between disease burden, eligible population to be served and resources supported by the program to provide access to screening and diagnostic services. 
• Start Date: June 30, 2025
  End Date: December 31, 2025
  Use the statewide “resource infographic" to identify gaps in resource allotment or access to care barriers.  Through collaborative partnership, a statewide engagement plan will be developed to mitigate structural and access barriers to increase breast and cervical cancer screening in underserved communities.
• Start Date: June 30, 2025
  End Date: December 31, 2025
  Print final Statewide Engagement Plan – Increasing Screening in Underserved Communities.
• Start Date: June 30, 2025
  End Date: January 31, 2026
  Timeline for implementation of Statewide Engagement Plan to Increase Screening in Underserved Communities distributed to partners, including actionable workplan and hold collaborative meetings with free clinics working within neighborhoods serving populations that are in high disease burden areas.  The goal being to screen up to 400 women specifically in high disease burden areas through community engagement activities.

Grant Activities:

• Utilize previous Disease Burden mapping to develop a statewide “resource infographic" identifying high disease and need areas with available resources.  Resource maps will also show existing projects in relationships to areas identified as high disease burden areas.

• Engage clinical providers and health systems to participate in community engagement to increase screening rates and decrease mortality rates and late-stage disease either in the planning processes or implementation phase.
  

• Hold weekly planning sessions with program staff, internal partners and community partners, in high disease burden areas with noted gaps in care.  Partners include individuals participating in cancer plan screening and early detection work group. Collaborative group will identify and discuss recommendations and develop comprehensive plans to address barriers; Statewide Engagement Plan - Increasing Screening in Underserved Communities.

• Development of timeline for implementation of recommendations from the Statewide Engagement Plan to Increase Screening in Underserved Communities. 
  

As a part of the internal synthesis process during the engagement meetings, each meeting gathered partner-generated input, county-level data insights and recommendations from the sessions.  WMHP identified priority focus areas which include:

1. Elevating positive outcomes through trusted community storytelling
2. Reducing structural barriers to care delivery
3. Reengage providers and assess opportunities for local screening
4. Increasing awareness of personal risk and best options for screening
5. Empowering communities to make informed health choices
6. Family-focused, community-based events; other non-traditional partnerships
7. Improve workplace culture to promote wellness
   

These priority areas were selected based on their alignment with DHHS's organizational role, capacity and established and emerging relationships with community-based partners.  They also represent strategic opportunities to advance equitable access to breast and cervical cancer screening across Nebraska.  While each county has specific strategies that may be unique to their county or region, WMHP gathered the promising strategies that were most common amongst all 21 counties and included them below:

Trusted Community Storytelling

• Diverse stories about positive outcomes
• Positive messaging/experiences
• Trusted voices/messengers – clients and doctors
• Awareness Campaigns
• Share real patient stories
  

Reducing Structural Barriers:

• Extended clinic hours/imaging hours
• Offer mobile clinics
• Transportation Assistance
• Clear messaging about screening recommendations
  

Reengage Providers:

• Provider Training (onsite)
  
• Provider Site Visits; training; drop off materials
  
• Education on Screening Guidelines
• Assist with development of client reminders/recall
• Provider engagement surveys
• Materials for staff meetings
  

Increasing Awareness of Personal Risk:

• Education on high risk and what that means
• Educate on importance of regular screening and where to access screening services
  
• Address screening misconceptions and identify barriers
  
• Education on EWM guidelines, coverage, services offered
• Social media, television ads, billboards
• Dispel myths that cause barriers to screening
• Campaign on importance of physical activity (PA) and relationship between PA, obesity and increased risks for breast and cervical cancer
  

Empowering Communities to Make Informed Health Choices:

• Awareness around understanding insurance benefits and coverages
• Education on hereditary risks
• Education on self-exams
• Awareness information about EWM screening and other resources available
  

Community Based Events; Non-Traditional Partnerships:

• Flyers/handouts at local pharmacies/grocery stores
• Faith based community centers/ministerial alliance
• Collaborate with cultural centers – offer training, classes and education
• Information at food and clothing distribution center sites
• Partner with Indian Health Services
  

Workplace Culture:

• Engage employer messaging in workplaces (preventive screening)
  
• Education for employers/employees on screening and coverage benefits
• Paid time off to get screening – ability to use sick ti​me for screening
  
• Job incentives for getting screened
• Educational messaging through employers and worksites
• Worksite wellness communications and strategies to promote screening and access
• Educational messaging at large employers and diverse worksites
• Work with employers to provide time off for screening/on-site screening through mobile unit
  

Local Health Departments within the 21 counties submitted plans that fell in line with evidence-informed insights.  Utilizing the one-pagers that were created for each of the counties, local health departments developed workplans that addressed key issues and utilized ideas that were brought forth from the engagement meetings.  

Once plans are received, they are reviewed to see how plans and strategies align appropriately.

​PROVIDER ENGAGEMENT:

In all counties where there is not a local health department with a strategic workplan the program will be providing provider engagement implementation projects. WMHP will be working with specific FQHCs on their own branding of campaign materials for the campaigns below as well.  Provider engagement implementation projects include:

• Insurance Campaign - which will take place January 2026-May 2026 and will have the sole purpose of educating Nebraskans about knowing that WMHP/EWM is here for well-woman visits if they are losing or changing their health insurance due to Medicaid cuts, etc. Ads will be placed in Nebraska statewide newspapers for 8 weeks and digitally in Lincoln and Omaha papers. A QR code is available for someone to quickly go to the EWM/NCP Healthy Lifestyle Questionnaire to enroll for services.  Ad copy was placed in the Client and Provider newsletters. (Examples of the Insurance Campaign ad copy is featured below) 
  
  
   

   

   

   
  
  
• Colorectal Cancer Awareness Campaign – this campaign will take place for 8 weeks over the course of February through April.  Ads will be placed in Nebraska statewide newspapers and digitally in Lincoln newspapers.  A QR code is available for someone to quickly go to the online FIT Kit Request Form to request a FIT Kit be sent directly to their home. Ad copy was placed in the Client and Provider newsletters. (campaign materials can be seen on the Colon Cancer Awareness & Prevention website​)
• Cervical Cancer Awareness Campaign – ad copies were created and put on DHHS social media to help raise awareness about Cervical Cancer Awareness Month.  Ad copy was placed in the Client and Provider newsletters. 
  
• WMHP Provider Newsletter – a newsletter that is sent out quarterly with newsworthy information about program happenings, updates about trainings, webinars and such. (link to newsletters is featured in the Women's & Men's Health Rebuilding & Rebranding tab above)

When looking to place advertisements or create marketing materials we are looking back at the engagement meeting notes for insights for guidance on decisions with marketing and placement.  In the upcoming year, WMHP will continue to work with providers on the following engagement pieces:

• Provider Site Visits (offer training, drop off materials, etc.)
  
• Screening Guideline Education
• Client Reminders/Recall Development
• Provider Engagement Surveys​
  

Region 1: Northeast 
Northeast Region Quick Facts Snapshot
Colfax County || Dakota County || Dodge County || Madison County || Platte County
Saunders County || Washington County

Region 2: Lancaster
Lancaster Region Quick Facts Snapshot
Lancaster County

Region 3: Eastern 
Eastern Region Quick Facts Snapshot
Cass County || Douglas County || Sarpy County

Region 4: Western 
Western Region Quick Facts Snapshot
Box Butte County || Scotts Bluff County 

Region 5: Central 
Central Region Quick Facts Snapshot
Adams County || Buffalo County || Dawson County || Hall County || Lincoln County

Region 6: Southeast 
Southeast Region Quick Facts Snapshot 
Gage County || Otoe County || Saline County