We propose to develop, implement, and evaluate a breast cancer education program for Black women, 40 to 49 to address their special needs in making informed decisions about breast cancer screening. This includes mammography screening, in the face of unclear guidelines. The intervention will translate epidemiological and laboratory findings regarding breast cancer mortality and cancer virulence in younger black women, poorer understanding of personal breast cancer risk, and delayed symptom care in a culturally-relevant format.
Specific aims of the intervention are to: (1) evaluate the effectiveness of the proposed breast caner education program in promoting informed screening decisions through accurate risk appraisal, prompt symptom care, and communication with physicians: and (2) evaluate the relative effectiveness of nurses and lay health advisors as breast cancer educators in delivering the program and accomplishing its stated objectives. The education program will enable women to make informed screening decisions through: (a) accurately identifying breast cancer risk factors, including personal level of risk; (b) performing competent monthly breast self-examinations in conjunction with regular clinical breast examinations and mammograms (when relevant); (c) identifying breast cancer symptoms and the process of obtaining prompt care for them; and (d) effectively communicating with physicians and health professional about screening frequency, risk and symptom care. The """"""""Partners"""""""" breast cancer education program is based on Social Cognitive Theory and the Theory of Planned Behavior. Participants will be 448 Black women ages 40-49, identified through Black churches in Pitt County, NC. They will be randomized to one of four education conditions: (1) Nurse-delivered education; (2) Lay health advisor-delivered education; (3) combined nurse and lay health advisor- delivered education; (4) No education (control). Participants will receive three education sessions designed to accomplish program objectives through group discussion, role plays, skill training and video modeling. The video program and training manuals produced and evaluated during this project will be suitable for distribution through other Black churches and social networks. Telephone baseline interviews will be completed pre- intervention to collect data on: (1) knowledge of mammography and clinical breast examination (cbe) screening guidelines and responses to change in the guidelines. (2) knowledge of breast cancer risk factors and personal risk: (3) screening practices (cbe, mammography, and breast self-examination), (4) techniques used during breast self-examination, (5) knowledge of breast cancer symptoms and the process of obtaining prompt care for them, (6) self-efficacy and perceived control when seeking screening and care for breast symptoms from physicians, and (7) sociodemographics. Follow-up interviews will be conducted 6 months post- intervention to assess the impact of the education program. Regression models will be used to identify key components of the education participant and staff reactions to the program, and the likelihood of program continuation and dissemination through other churches and social networks after the funding period.
