This three-year project is designed to address the need for expanded efforts to reduce risks from breast cancer among low-income and minority women in the Houston area as well as in selected areas of rural south and south central Texas. The four- phase project will involve training of physician assistant (PA) and certified nurse midwifery (CNM) students on breast cancer risks and risk education approaches.It will also involve training of community advocates to serve as health information extenders in taking breast cancer messages to the community. Phase I specific aims will involve (1) review of PA and CNM curricula and identification of strengths and weaknesses with regard to breast cancer; (2) modification of PA and CNM curricula to enhance the relevancy of breast cancer instruction in addressing the needs of low-income and minority women; and (3) development of materials and assessment strategies to support instructional modification. Phase II specific aims will (4) identify individuals in the community who have the commitment, interest, and familiarity with community resources to serve as health information extenders; (5) team PA and CNM students and faculty with health information extenders and prepare them to function effectively as community intervention teams; and (6) provide resources necessary to allow the teams to function at optimal effectiveness in community- based interventions. Phase III specific aims will (7) implement community educational interventions using the PA/CNM student/health information extender teams;and (8) gather data to be used in determining the effectiveness of intervention efforts in enhancing community knowledge concerning breast cancer risk and risk reduction strategies. Phase IV specific aims are designed to (9) identify those components of the program that worked most effectively based on results of extensive evaluation efforts; and (10) prepare materials that have undergone rigorous expert review and refinement for dissemination to other health professional training programs and other community intervention groups. The minimum number of persons expected to be trained in this project are 90PA students, 30 CNM students, 50 health information extenders, and 1,800 low income and minority women in the Houston area alone. Estimates of numbers of persons to be trained in rural areas are much more difficult to make, but a conservative estimate of the number of women in rural areas who will benefit from enhanced information on breast cancer risks and risk reduction strategies is 250. The project is designed to make optimal use of primary care providers--PAs and CNMs--who have a documented commitment to health promotion efforts, as well as untapped community resources in the form of the health information extenders, to address in culturally and linguistically appropriate ways, the breast cancer informational needs of currently underserved populations. It is also designed to evaluate outcomes of these efforts and to capture assessment data that can be used to create materials that foster replication of project components that have been shown to work effectively.
