We propose to conduct a group randomized controlled trial to implement and evaluate the effect of an innovative evidence-based breast health education intervention program compared to a control group (delayed intervention) to promote breast health screening among first generation Afghan immigrant women. Sensitivity to cultural, religious, and linguistic factors is a key component of the proposed intervention. With funding from California's Breast Cancer Research Program, we have conducted the pilot work (see preliminary results) and findings from the pilot work to guide the content of the intervention. Consistent with the tenets of community based participatory research, the pilot project was administratively designed to ensure that the community was an equal partner with the academic research partners in terms of power and influence - they received their own budget and are the owners of the data that was collected (these two issues have a history of being problematic in community based participatory research). Our research will test the hypothesis that women randomly assigned to a tailored breast health education program will show increased breast cancer knowledge and awareness and increased rates of having early detection (CBE and mammography). The details of this linguistically, religious and culturally tailored (targeted - there is contention in the field as to whether this is target or tailored, the latter being more specific) program designed for low literacy and taught by lay health advisors (LHAs) with follow-up counseling and facilitation by community navigators and the support of their male relatives. The cultural/ religious/educational adaptations make our intervention specific to the needs of Muslim women and provide a unique program that distinguishes the Afghan Women's Health Project from other breast health promotion projects. Participants will be randomly assigned into the intervention or control (delayed intervention) group. The control group will receive the educational program after the post-intervention survey. Pre-and post-intervention surveys will be used to measure changes in knowledge of prevention and in early detection behaviors. As part of the post-intervention survey, women will report whether they had (or have an appointment to have) a CBE and/or a mammogram and we will inquire about the facilitators and barriers for getting a breast health screening examinations.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center--Cooperative Agreements (U54)
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Special Emphasis Panel (ZCA1)
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University of California Berkeley
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Shirazi, Mehra; Shirazi, Aida; Bloom, Joan (2015) Developing a culturally competent faith-based framework to promote breast cancer screening among Afghan immigrant women. J Relig Health 54:153-9
Hébert, James R; Satariano, William A; Friedman, Daniela B et al. (2015) Fulfilling Ethical Responsibility: Moving Beyond the Minimal Standards of Protecting Human Subjects from Research Harm. Prog Community Health Partnersh 9 Suppl:41-50
Shirazi, Mehra; Bloom, Joan; Shirazi, Aida et al. (2013) Afghan immigrant women's knowledge and behaviors around breast cancer screening. Psychooncology 22:1705-17