New York City (NYC) is home to a large and diverse immigrant population. Many of these groups face significant barriers to preventive health care, including lack of insurance, poor health care access and language difficulties. Most African immigrant women are likely to live below the poverty line and have low health literacy, are less likely to have health insurance and visit a doctor, particularly for primary/preventive care. Without access to primary care, many preventive services, such as breast cancer screenings go unattended. The barriers and facilitators to breast cancer screening for other minority groups from underserved populations, such as African Americans and Latina women have been studied. Less is known about these for African immigrant women and how to most effectively engage their participation in regular screening. Our data of over 2,000 African-born immigrants living in NYC show that 77% report not having health insurance; 75% do not have a primary care physician; and 57% have less than a high school education. As for cancer screening, when corrected for age, 44% have never had a mammogram. Through our unique collaboration with the African Services Committee and the African Advisory Council of the Bronx, two non- governmental community-based service organizations, we are poised to have a significant impact on these immigrant women, who have emigrated from more than 20 countries in Africa. This is a population with great need for increased breast cancer knowledge, access to breast cancer screening, and basic medical care. The Health Belief Model (HBM) provides a framework for addressing cultural health barriers by positing that making a decision to engage in a health behavior is determined by weighing perceived threats versus benefits. Health education programs developed using HBM constructs are effective tools towards reducing barriers that lead to health disparities in cancer. Further, the presentation of health information via narrative communication (i.e., storytelling; personal testimonials) is an effective method of educating participants about cancer prevention and screening. Our work in minority and immigrant communities has shown that combining narrative communication and navigation assistance can increase participation in breast cancer screening. However, the efficacy of these interventions has not been empirically tested among African-born immigrants. The long term goal of the proposed project is to conduct a randomized clinical trial that tests the adapted intervention to increase breast cancer screening rates for African-born immigrants. In the short term, we plan to pursue the following specific aims: (1) Identify barriers and facilitators to breast cancer screening among African-born immigrants and (2) Culturally adapt and pilot test the Witness Project breast cancer education program for African-born women. Thus, we will culturally adapt an effective, innovative intervention to address this significant health disparity in African-born immigrant communities. Once we have pilot tested the feasibility and acceptability of the intervention, we will apply for R01 funding.
African immigrant women are at significant risk for not participating in preventive screening, such as for breast cancer. Thus, this project will culturally adapt an existing evidenced-based, the Witness Project, by identifying potential barriers and guided by the Health Belief Model incorporate those findings into a group- based narrative education program. We will then evaluate feasibility and acceptability by piloting the program, to prepare for a larger, future study to increase breast cancer screening rates in this underserved population.
