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Can a Faith-Based Participatory Intervention Study Increase Breast Health Care Participation in African American Women?: A Randomized Comparison
Background: Female breast cancer accounts for 7.7% of all cancer deaths in Maryland and is the second leading cause of cancer deaths among women in the state. During the period of 1995-1999, female breast cancer age-adjusted mortality rates were 31.2 for the state and 39.3 for Baltimore City. Maryland ranks fifth for breast cancer mortality in the US. In large part, the high rank is due to the disproportionate amount of cancer mortality occurring among low SES African Americans women residing in the City of Baltimore. The state’s mortality rates appear inconsistent with the rates of mammography screening. In 2000, 81.6% of Maryland women over age 40 reported receiving a mammogram within the previous two years; this rate is inclusive of all races of women and does not speak to a pattern of regular screening habits. The reasons for racial differences in screening are complex and require continued examination of both barriers and potential solutions that can lead to declines in premature death and disability and improve the overall quality of women’s lives. While a number of state-sponsored programs exist for women who need mammograms, little is known about screening practices performed by African American women and adequate follow-up is rarely incorporated into community-based interventions. Specific Aims: Given the state of breast cancer in Baltimore, particularly for African Americans, the proposed goal of this grant is to investigate and test the feasibility of conducting culturally relevant prevention interventions in faith-based settings. The working hypothesis is that many African American women tend to underestimate their risks for breast cancer, get screened irregularly, feel mistrustful of the medical system, have anxiety and fear about screening procedures, and often lack resources for obtaining screening. The specific aims include: 1) Utilizing a “Women’s Health Day” theme, test three levels of interventions – standard care (program that includes a focus on overall health), breast health care (program that is exclusively on breast health care), and comprehensive cancer care (a program that includes breast health care and other cancer screening practices); 2) Determining the benefits and tradeoffs of categorical versus comprehensive health care programs; and 3) Assessing the acceptability and feasibility for implementation of an ongoing, lay-led intervention in one of the three tested formats in faith-based settings. The interventions will target all women ages 20 and older with particular focus on non-users, one-time users, and intermittent users of mammography. The main outcome measure is participation in breast health care screening following the intervention. Study Design: Six churches will participate in the study with a set of three churches randomly assigned to each of the intervention formats. These are among the churches that have been partnering with the investigator on another cancer study and whose leadership has expressed an interest. An estimated total of 200 women will be assigned to each intervention group. Data collected will include demographic information, pre and post telephone and electronic surveys of breast cancer screening practices, attitudes, knowledge as well as questions regarding lifestyle behaviors. Implications: Too few studies have been conducted of culturally relevant prevention interventions in minority and/or socioeconomically disadvantaged women (NCI 2003) and most have failed to include follow-up assessments. This study is unique in that it builds on existing partnerships with churches and responds to their expressed need to develop a capacity for planning and maintaining health interventions that can be integrated into their ministry programs. The findings may also shed light on whether categorical rather than holistic health programs modify breast screening practices.
Can a Faith-Based Participatory Intervention Study Increase Breast Health Care Participation in African American Women? A Randomized Comparison
Background: Breast cancer is the second leading cause of cancer deaths in Maryland and ranks fifth in the US for deaths due to breast cancer. Part of the reason for this high rate is the amount of breast cancer deaths occurring among low-income African American women living in the city of Baltimore. Although a large number of Maryland women over age 40 report receiving mammograms, these rates are inconsistent with where the state ranks in deaths from breast cancer. Furthermore, the mammography screening rate includes all women and does not speak to a pattern of regular screening habits. The reasons for the race differences in death rates are complex and require continued examination of both barriers and solutions to reduce premature deaths and improve the quality of women’s lives. While many state-sponsored programs exist for women who need mammograms, little is known about the ongoing screening practices of African American women and many community programs do not provide adequate follow up.
Specific Aims: In light of the state of breast cancer in Maryland and Baltimore, particularly for African Americans, the goal of this grant is to determine if developing church-based programs that are designed in conjunction with its members will lead to a greater focus on health activities for congregations and neighboring communities. The specific aims include: 1) Planning a “Women’s Health Day” in one of three formats – a standard program that would include a focus on overall health; a breast health care program that would focus exclusively on breast health issues; and a comprehensive cancer program that would address all relevant cancer sites; 2) Determining if a single topic program is better than a comprehensive one; and 3) Finding out if it is feasible for faith-based settings to plan and conduct programs that can potentially be ongoing. These programs will be designed to attract women ages 20 and older with special attention paid to women not currently or irregularly practicing breast screening behaviors. The main outcome is the change in women’s screening practices following participation in the faith-based programs.
Study Design: Six African American churches in the Baltimore area have expressed interest in participating in the research project. These are churches that have been partnering with the study team on other cancer prevention research. An estimated total of 200 women from each church will participate. A set of three churches will be assigned to one of the three Women’s Health Day program formats (standard, breast health care, or comprehensive program). Survey information will be collected before and after the programs on breast cancer screening practices, attitudes, knowledge, as well as questions on lifestyle behaviors.
Implications: According to the National Cancer Institute, too few culturally relevant studies have been conducted that include minorities and the socioeconomically disadvantaged. Additionally, few studies include follow-up assessments. This study is unique in that it occurs within a cultural context, builds on existing partnerships with churches and responds to their expressed need to develop a capacity for planning and maintaining health programs that can be integrated into their ministries, and includes follow-up assessments. The findings from this research project may also shed light on whether categorical versus holistic health programs affect breast screening practices.