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Testing A family Breat Cancer Prevention Intervention: Kin Keeper
Background: It is estimated that over 215,000 U.S. women will be diagnosed with breast cancer in 2004, and over 40,000 women will succumb to the disease. The age-adjusted rate of breast cancer mortality is 30% higher for African American women compared to White women (35.9 deaths compared to 27.2 deaths per 100,000), despite a lower incidence of the disease. Innovative, culturally appropriate interventions are needed to educate African American women about breast cancer prevention and screening. A family systems approach to treating illness assumes that an individual’s illness impacts other members within that family and in turn the family’s reaction affects the ill family member. There is a paucity of data on the efficacy of family-focused breast cancer interventions for African American women and how the family s ocial support moderates the effects of health literacy. Testing integrative approaches that use the best practices from other disciplines are vital if the breast cancer mortality burden among African Americans is to be lifted. This feasibility study is a multigenerational life span breast cancer prevention and screening intervention called Kin Keeper that incorporates health literacy. Objectives/Hypothesis: We hypothesize that the family-focused intervention, Kin Keeper, will increase the breast cancer literacy of multigenerational female family members (grandmother, mother, daughter, sister, aunt). Objectives are: 1) to validate a Breast Cancer Literacy assessment tool with low income African American Women and 2) to conduct an observational cohort study using a female-family educational intervention. Study Design: This feasibility cohort study will utilize both formative and summative approaches to evaluate the implementation of the intergenerational female family home-based breast cancer education intervention that includes the cancer literacy assessment and is administered by community health workers. Potential Outcomes and Benefits of the Research: We see four potential benefits of the research: 1) This model promotes breast cancer prevention and screening practices across the life span. 2) This adaptable model builds on the existing resources of prenatal programs by expanding service delivery and resources. 3) This research will contribute to the theories linking community, provider and family to behavioral outcomes in low-income African American women. 4) We will expand the limited number of health literacy assessment tools.
Thus far breast cancer prevention and early screening projects have neglected the rich relationships that African American women enjoy with their female family members. These relationships are diverse; they include mothers, grandmothers, aunts and sisters of varying incomes and educational backgrounds. Understanding how the familial structure can be used to empower all the female family to incorporate and practice breast cancer prevention and early dedication is the focus of this research project. In this project we will be working with community health workers who have had successful outcomes in delivering home-based prenatal services to high-risk low-income African American women to implement the project. We hypothesize that the family-focused intervention called Kin Keeper will increase the breast cancer literacy of multigenerational female family members (grandmother, mother, daughter, sister, aunt). We know African American women are eager to learn about their individual and family breast cancer risks and how they can minimize their risks. Because of cultural preferences, they want to learn in an intimate setting where they are free to ask questions without fear of embarrassment and among trusted people. The study’s design, called an observational cohort, allows us to follow the same families throughout the two years of this project. Using a novel approach that addresses the aforementioned concerns we are proposing to: 1) test an assessment tool that measures a women’s functioning understanding of breast cancer and 2) use that tool to conduct a feasibility study of a female family-centered home-based breast cancer intervention delivered by community health workers. We anticipate that this project will accomplish two things. It will expand breast cancer prevention and screening education in order to reach younger women in their childbearing years. It will also empower family members to encourage each other to participate in appropriate early detection screening by exposing everyone to knowledge of their individual and family breast cancer risks.