In 1995–1996, Linda Burhansstipanov, MSPH, DrPH at AMC Cancer Research Center in Denver, Colo., implemented and evaluated the effectiveness of Native American Women's Wellness through Awareness (NAWWA).
NAWWA is a culturally competent recruitment model aimed at increasing the number of underserved urban American Indian women participating in an early detection breast cancer screening program. The target population, Native American women 40 years of age and older, lived in the Denver metropolitan area or in the greater Los Angeles/Orange County area.
"High"-level recruitment strategies involving steps and elements specific to Native Americans were much more effective than the typical "culturally sensitive" strategies used by most government programs.
Among the high-level strategies tested, the Native Sisters Program, a "navigator program," was the most effective. Unlike other programs that provide a health care "navigator" only once breast cancer is discovered, this project used the Native Sisters throughout the recruitment and screening process.