Use of chemoprevention, such as tamoxifen, among high-risk African American women could significantly reduce mortality among this group. However, cultural barriers may exist to African-American women adopting chemoprevention. An African American health maintenance model, characterized by the concept of the body as a fragile homeostatic system that is easily disrupted by impure elements such as unnecessary medications, negative thinking and stress, may impact chemoprevention uptake and use. In order to understand the dimensions of this model and its potential impact on chemoprevention among African American women, we intend to: 1) Verify the elements of the above model, identify any other contributing elements prior research did not uncover, and clarify dynamic relationships among the elements to define a culturally specific model of health maintenance and disease prevention among African American women; 2) Discover whether this model may affect preventive medical decision making about tamoxifen use among African American women who are at high risk of breast cancer; and 3) Lay the groundwork for future research examining how this model functions relative to other models known to be important to medical decision making. These goals will be best achieved through a two-step qualitative study, to reduce complexity and allow emerging insights to guide inquiry throughout the research process. Study 1 will guide the accurate representation of the above model and inform development of the data manual to be used in Study 2. Data from existing literature, focus groups and in-depth interviews will inform this step. Study 2 will explore what role the model defined in Study 1 plays in decision making about chemoprevention use among women at risk for breast cancer. A purposive sample of 120 African American women with a first-degree relative diagnosed with breast cancer will be sufficient to conduct analyses. Semi-structured interviews will elicit how this model might play a role in decision making about tamoxifen and consensus analysis will estimate how strongly the overall group knows about and believes in the model. Analysis will provide preliminary information regarding points of convergence and divergence between the biomedical and African American models of health maintenance. This understanding may lay the groundwork for improved understanding and trust between biomedical practitioners and African American patients. ? ?
