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Examining Trust and Cancer Literacy on Breast Cancer Screening
Breast Cancer Disparities
Background: More than 90% of African American (94.8%), Latina (96.6%) and Arab American (96%) women age >40 have ever had a mammogram. While these numbers are encouraging, there is a serious gap in percentages of women who have had appropriately timed mammograms and clinical breast examinations: African American (51.8%), Latina (46.3%) and Arab American (43.2%). Conceptual barriers such as medical mistrust and low health literacy are impediments for getting appropriately timed breast screenings. Although these are distinct groups of women, culturally they have a common bond: extended family is an important component in making health care decisions. Using a female family-focused home-based intervention and instruments and materials that have been translated into Spanish and Arabic will enable the researchers to more accurately measure medical mistrust and functional cancer literacy within and among these diverse groups of women. Objective/Hypothesis: H1: The community health worker's trust relationship with the kin keeper in the family-focused intervention decreases the medical mistrust level and increases breast cancer screening behavior among family members of African American, Latina and Arab American women. H2: The community health worker's trust relationship with the kin keeper in the family-focused intervention increases the functional cancer literacy score and increases breast cancer screening behavior among family members of African American, Latina and Arab American women. H3: There will be no differences across the racial/ethnic groups in trust levels. H4: There will be no differences across the racial/ethnic groups in functional breast cancer literacy scores. Specific Aims: 1. Analyze the level of trust in relation to breast cancer screening behavior among African American, Latina and Arab American women. 2. Analyze the cancer literacy scores in relation to breast cancer screening behavior among African American, Latina and Arab American women. Study Design In this observational cohort we propose to evaluate the research from four data collection sources: 1) pre-breast cancer literacy assessment, 2) post-breast cancer literacy assessment 3) medical mistrust index and 4) action plan. Participants will be observed at baseline and follow-up using repeated design measures and computing measures of association between time-point responses such as pairwise odds ratios. Potential Outcomes/Benefits of Research: Participants will better understand the benefits and risks of breast cancer prevention and early detection. Findings will provide in-depth empirical knowledge regarding the conceptual barriers of medical mistrust and cancer literacy scores in relation to breast cancer screening behavior among these groups. Findings will also provide baseline measures to assist refining breast cancer education and interventions for these three distinct groups of women.
Researchers acknowledge that conceptual barriers impeding a woman?s breast cancer screening behaviors, such as mistrust of the health care system and a lack of understanding of the value of regular breast screenings, are difficult to overcome. One reason is that, until recently, there were few instruments that were culturally and linguistically translated into Spanish and Arabic that measured medical mistrust and functional cancer literacy. Our research team has designed and translated, both culturally and linguistically, the Medical Mistrust Index and the Breast Cancer Literacy Assessment into Spanish and Arabic. Another challenge to addressing conceptual barriers is to create a culturally appropriate environment that fosters both trust and cancer literacy, so that both can be measured accurately. The innovative Kin KeeperSM Cancer Prevention Intervention provides an ideal environment in which to carry out this study. The program uses a female family model in which a female family member (called the kin keeper) works with a trusted person, such as a bilingual community health worker of the same ethnicity, to present education in breast cancer prevention and early detection in a private, comfortable, safe setting, such as the home. We are proposing to: 1) analyze the level of trust in relation to breast cancer screening among African American, Latina and Arab American women and 2) analyze their cancer literacy scores in relation to their breast cancer screening behavior. Since all of our instruments and education material have been written at a 5th grade level in English, Spanish and Arabic, making it possible for women in our study to select the language they are most comfortable with, we anticipate that we will be able to make exciting comparisons within and across each of these ethnic groups. This will enable other health educators and researchers to further refine their culturally appropriate interventions and materials. Moreover, we anticipate that all the women in this study will be more empowered in understanding the necessity of appropriate regularly scheduled clinical breast examinations and mammograms.