A new, practical program, entitled Getting Ahead in a Just-Gettin'-By World, provides a novel approach to addressing this previously intractable problem. During the progression through the Getting Ahead program, individuals develop an understanding of the hidden rules of economic class and have an opportunity to craft a hopeful future story based on the practical concepts investigated in the modules. Getting Ahead has shown great success in various organizations and communities in multiple sectors, including healthcare, but has not been studied in the context of advancing cancer prevention and control.

The study team hypothesizes that the Getting Ahead program, applied in safety net practices with primary care patients living in poverty, will improve cancer prevention and early detection activities, mediated by a shift in future orientation gained through the program.

This pilot study aims to adapt, apply, and evaluate the established Getting Ahead program in a health care setting and assess its effect on cancer prevention and early detection activities for vulnerable populations. By generating process and outcome data on a novel intervention to help people advance out of poverty, this research will set the stage for larger intervention studies, and also will advance understanding of the mechanisms by which growing a future orientation can improve cancer preventive service delivery among vulnerable populations.

Specifically, this study aims to:

1. Implement Getting Ahead among cohorts of patients at a network of safety net practices.
2. Assess the paradigm shift in developing a future orientation associated with participation in the Getting Ahead program.
3. Evaluate the effect of the Getting Ahead program and its associated paradigm shift on graduates' cancer prevention and early detection activities.

Inclusion Criteria:

• Interest and willingness to commit to the 8 week Getting Ahead training program that will occur over 16 sessions occurring twice a week
• Willingness to commit to follow-up with his/her primary care provider after completion of the Getting Ahead training program
• Willingness to be randomized to an immediate or delayed (by 8 weeks) start date
• Ability to speak English

Exclusion Criteria:

• There are no exclusion criteria