Theresa A. Wynn

African American community health advisors trained as research partners: recruitment and training.

The African American community has played an influential role in generating change. Grass-roots organizations and concerned individuals can be included in programs designed to increase cancer awareness and cancer early detection practices to ultimately eliminate cancer disparities. The utilization of a formalized Community Health Advisors program can be an infrastructure by which effective cancer prevention and control programs can be conducted in underserved African American communities. The purpose of this article is to outline the steps necessary to develop an infrastructure for recruitment and training of grass-root African Americans to serve as Community Health Advisors trained as Research Partners.

Development of a Spiritually Based Educational Intervention to Increase Informed Decision Making for Prostate Cancer Screening Among Church-Attending African American Men

One way of developing culturally relevant health communication in the African American church setting is to develop spiritually based interventions, in which the health message is framed by relevant spiritual themes and scripture. In this article we describe the development of a community health advisor(CHA)-led intervention aimed at increasing informed decision making (IDM) for prostate cancer screening among church-attending African American men. Full-color print educational booklets were developed and pilot tested with extensive community participation of church-attending African American men age-eligible for screening. The intervention development phase consisted of ideas solicited from an advisory panel of African American men (N = 10), who identified core content and developed the spiritual themes. In the intervention pilot testing phase, prototypes of the intervention materials were pilot tested for graphic appeal in two focus groups (N = 16), and content was tested for acceptability and comprehension using individual cognitive response interviews (N = 10). Recommendations were made for project branding and logo and for use of graphics of real people in the educational materials. Significant feedback was obtained from the focus groups, on the graphics, colors, fonts, continuity, titles, and booklet size/shape. The importance of working closely with the community when developing interventions is discussed, as well as the importance of pilot testing of educational materials.

Community health advisors as research partners: an evaluation of the training and activities.

The feasibility of training large numbers of community health advisors as research partners (CHARPs) was evaluated using talking circles data and cancer activity questionnaires and logs. The talking circles data indicated that the CHARPs (n = 108) valued their training and believed they learned necessary research partner skills. A review of contacts (n = 7,956) provided evidence that CHARPs (n = 883) could work as a team to deliver a variety of services over time to the community. The findings suggested that implementing a large scale intervention with CHARPs has the potential to increase the dissemination of cancer information and to reduce cancer disparities.

Statewide Tuskegee Alliance for clinical trials

Cancer mortality rates for all sites are nearly 2.5 times greater for African‐Americans compared with whites. In addition, there are data implying that cancer treatment outcomes for minorities are unfavorable compared with whites. Whether this is due to poor access to health care or a biologic property of malignancies occurring in specific populations remains to be determined. Because of these unknown factors, targeting minorities for clinical trials may contribute toward the reduction of the overall morbidity and mortality associated with specific cancers.

Perceptions of the Religion—Health Connection Among African Americans in the Southeastern United States: Sex, Age, and Urban/Rural Differences

Extensive literature reviews suggest that religiousness is positively associated with health. Much less understood is the particular nature of the religion—health connection. Religion and the church play a central role in the lives of many African Americans. This study used a mixed-methods approach to examine perceptions of the religion—health connection among African Americans in urban and rural areas. Four hundred participants were randomly selected and interviewed by telephone, answering open-ended questions about their perceptions of the role of religiousness in their health. Data were analyzed using an open-coding technique. Codes were arranged into families involving the role of a higher power, health behavior, physical factors, social support, mental health, and contextual factors in determining physical health, as well as the potential negative role of religiousness. Quantitative analysis revealed the stronger presence of themes among women, older participants, and those in rural counties. Applications for theory and health promotion are discussed.

Targeted Intervention Strategies to Increase and Maintain Mammography Utilization Among African American Women

OBJECTIVES We assessed the impact of a theory-based, culturally relevant intervention designed to increase mammography screening among African American women in 8 underserved counties in Alabama. METHODS Using principles derived from the Stages of Change, Community Health Advisor, and Community Empowerment models, we developed strategies to increase mammography screening. Trained volunteers (N = 143) provided tailored messages to encourage adoption and maintenance of mammography screening. We collected baseline and follow-up data on 1513 women in the communities targeted for the intervention. Our goal was to decrease the number of women in stage 1 (never screened) while increasing the number of women in stage 2 (infrequently screened) and stage 3 (regularly screened). RESULTS At baseline, 14% (n = 211) of the women were in stage 1, 16% (n = 247) were in stage 2, and 70% (n = 1055) were in stage 3. After the 2-year intervention, 4% (n = 61) of the women remained in stage 1, 20% (n = 306) were in stage 2, and 76% (n = 1146) were in stage 3. CONCLUSIONS Tailored motivational messages and peer support can increase mammography screening rates for African American women.

Religious involvement and prostate cancer screening behaviors among Southeastern African American men.

This study examined the relationship between religious involvement and prostate cancer screening behavior among a probability sample of 199 African American men. Religious involvement was assessed by telephone via a multidimensional instrument. Engaging in religious behaviors was predictive of reporting a digital rectal examination (DRE) within the past year. Religious beliefs and behaviors were predictive of behavioral intention for DRE in the next 6 months. Religious behaviors were predictive of reporting an appointment for a DRE in the next 6 months. All analyses were controlled for age, education, and marital status. None of the predictions were significant for prostate-specific antigen testing. Understanding the role of religious involvement in cancer beliefs and screening is important. Such knowledge can inform educational interventions for this group, which is disproportionately affected by prostate cancer.

Cancer Health Disparities: What We Have Done

It is well established that disparities in health care exist and that they exist for many disease processes.1 Disparities in cancer outcomes are a significant contributor to this problem.1–5 Disparities in cancer outcomes and treatment have been documented in ethnic minorities and the poor; in addition, inhabitants of rural areas experience healthcare disparities due to compromised access.5,6 This paper will focus on practical solutions to the problem of cancer health disparities among ethnic minorities in both rural and urban areas, developed through 3 programs of the University of Alabama at Birmingham: the Deep South Network for Cancer Control (DSN), the Racial and Ethnic Approaches to Community Health 2010 (REACH 2010), and the Community Health Advisors in Action Program (CHAAP). DSN was established to improve the awareness regarding cancer risks and preventive strategies, enhance the participation of African Americans and other special populations in clinical trials, and develop novel, community-based strategies to reduce cancer disparities.7–9 REACH 2010 was developed to build coalitions and mobilize resources within the community to address breast and cervical cancer issues. CHAAP was developed to help patients navigate the health-care system and receive appropriate high-quality care. While REACH 2010 and CHAAP were implemented only in Alabama, DSN was implemented both in Alabama and Mississippi. The overarching goal of all 3 programs was to reduce cancer health disparities by increasing cancer awareness and improving the access to state-of-the-art cancer care for medically underserved, primarily African American, populations.

Developing a community action plan to eliminate cancer disparities: lessons learned.

Background: African Americans bear an unequal burden of breast, cervical, and colorectal cancer. The Deep South Network for Cancer Control (DSN) is a community–academic partnership operating in Alabama and Mississippi that was funded by the National Cancer Institute (NCI) to address cancer disparities using community-based participatory research approaches. Objective: In addition to reporting on the plans of this work in progress, we describe the participatory process that local residents and the DSN used to identify needs and priorities, and elaborate on lessons learned from applying a participatory approach to the development of a community action plan. Methods: We conducted 24 community discussion groups involving health care professionals, government officials, faith-based leaders, and other stakeholders to identify cancer health disparity needs, community resources/assets, and county priorities to eliminate cancer health disparities. To develop a community action plan, four working groups explored the themes that emerged from the discussion groups, taking into consideration evidence-based strategies and promising community practices. Results: The DSN formulated a community action plan focusing on (1) increasing physical activity by implementing a campaign for individual-level focused activity; (2) increasing the consumption of fruits and vegetables by implementing NCI’s Body and Soul Program in local churches; (3) increasing cancer screening by raising awareness through individual, system, and provider agents of change; and (4) training community partners to become effective advocates. Conclusions: A community–academic partnership must involve trust, respect, and an appreciation of partners’ strengths and differences. The DSN applied these guiding principles and learned pivotal lessons.

Development of a Barbershop-Based Cancer Communication Intervention.

Purpose – Prostate and colorectal cancer (CRC) rates are disproportionately high among African‐American men. The purpose of this paper is to describe the development of an intervention in which barbers were trained to educate clients about early detection for prostate and CRC.Design/methodology/approach – Working with an advisory panel of local barbers, cancer survivors and clients, educational materials are developed and pilot tested through use of focus groups and cognitive response interviews.Findings – The advisory panel, focus groups, and interviews provide key recommendations for core content, intervention structure, and evaluation strategies. The men suggest a variety of things they want to know about prostate cancer, however the perceived need for CRC information is much broader, suggesting a knowledge gap. The men prefer print materials that are brief, use graphics of real African‐American men, and provide a telephone number they can call for additional information.Research limitations/implicatio...