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Yang CH, Lee J, Wilcox S, Rudisill AC, Friedman DB, Hakun JG, Neils-Strunjas J, Wei J, Miller MC, Byers MD. Implementation and evaluation of a community-based mindful walking randomized controlled trial to sustain cognitive health in older African Americans at risk for dementia. BMC Geriatr 2024; 24:579. [PMID: 38965464 PMCID: PMC11225163 DOI: 10.1186/s12877-024-05090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/17/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND With an increasing proportion of older adults and the associated risk of Alzheimer's Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs. METHODS This paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives. DISCUSSION This study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk. TRIAL REGISTRATION ClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).
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Affiliation(s)
- Chih-Hsiang Yang
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Jongwon Lee
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - A Caroline Rudisill
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jonathan G Hakun
- Department of Neurology, The Pennsylvania State University, College of Medicine, Hershey, PA, 17033, USA
- Department of Psychology, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, 17033, USA
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Margaret C Miller
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Megan D Byers
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Satagopan JM, Dharamdasani T, Mathur S, Kohler RE, Bandera EV, Kinney AY. Experiences and lessons learned from community-engaged recruitment for the South Asian breast cancer study in New Jersey during the COVID-19 pandemic. PLoS One 2023; 18:e0294170. [PMID: 37956167 PMCID: PMC10642833 DOI: 10.1371/journal.pone.0294170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND South Asians are a rapidly growing population in the United States. Breast cancer is a major concern among South Asian American women, who are an understudied population. We established the South Asian Breast Cancer (SABCa) study in New Jersey during early 2020 to gain insights into their breast cancer-related health attitudes. Shortly after we started planning for the study, the COVID-19 disease spread throughout the world. In this paper, we describe our experiences and lessons learned from recruiting study participants by partnering with New Jersey's community organizations during the COVID-19 pandemic. METHODS We used a cross-sectional design. We contacted 12 community organizations and 7 (58%) disseminated our study information. However, these organizations became considerably busy with pandemic-related needs. Therefore, we had to pivot to alternative recruitment strategies through community radio, Rutgers Cancer Institute of New Jersey's Community Outreach and Engagement Program, and Rutgers Cooperative Extension's community health programs. We recruited participants through these alternative strategies, obtained written informed consent, and collected demographic information using a structured survey. RESULTS Twenty five women expressed interest in the study, of which 22 (88%) participated. Nine (41%) participants learned about the study through the radio, 5 (23%) through these participants, 1 (4.5%) through a non-radio community organization, and 7 (32%) through community health programs. Two (9%) participants heard about the study from their spouse. All participants were born outside the US, their average age was 52.4 years (range: 39-72 years), and they have lived in the US for an average of 26 years (range: 5-51 years). CONCLUSION Pivoting to alternative strategies were crucial for successful recruitment. Findings suggest the significant potential of broadcast media for community-based recruitment. Family dynamics and the community's trust in our partners also encouraged participation. Such strategies must be considered when working with understudied populations.
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Affiliation(s)
- Jaya M. Satagopan
- Department of Biostatistics and Epidemiology, School of Public Health, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Tina Dharamdasani
- Department of Biostatistics and Epidemiology, School of Public Health, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Shailja Mathur
- Department of Family and Community Health Sciences, Cooperative Extension, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Racquel E. Kohler
- Department of Health Behavior, Society & Policy, School of Public Health, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Anita Y. Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
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Troy C, Brunson A, Goldsmith A, Noblet S, Steck SE, Hebert JR, Payne J, McCormick D, Friedman DB. Implementing Community-Based Prostate Cancer Education in Rural South Carolina: a Collaborative Approach Through a Statewide Cancer Alliance. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:163-168. [PMID: 32564252 PMCID: PMC7749809 DOI: 10.1007/s13187-020-01800-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to evaluate the impact of implementing community-based prostate health education programs in rural communities. Prostate cancer (PrCA) remains one of the most common cancers among men, and a growing body of literature demonstrates that large interracial differences in PrCA incidence and mortality rates consistently disfavor African Americans in comparison to European Americans. It also is evident, despite the overall decrease in cancer death rates in the USA in recent decades, rural areas are experiencing a reduction in death rates much more slowly. In this study, education session content focused on PrCA risk factors, symptoms, screening, healthy diet and exercise, treatment options, and provider communication strategies. Forty individuals participated and completed pre/post-education program surveys to assess changes in PrCA knowledge and cancer decision-making. Participants showed improvements in education and awareness following the session, and overall impressions of the program were consistently positive as exhibited by participants' answers on a satisfaction survey. The findings demonstrate the real need both in terms of research to understand the underlying problem and to provide practical solutions that can be implemented to reverse the current situation. The results obtained support community-based education programs as an effective means of delivering PrCA prevention, screening, and treatment information to rural communities.
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Affiliation(s)
- Catherine Troy
- College of Arts and Sciences, University of South Carolina, 1521 Greene Street, Columbia, SC, 29208, USA
- South Carolina Honors College, University of South Carolina, 1215 Blossom Street, Columbia, SC, 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Ashley Brunson
- College of Arts and Sciences, University of South Carolina, 1521 Greene Street, Columbia, SC, 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Andrew Goldsmith
- South Carolina Honors College, University of South Carolina, 1215 Blossom Street, Columbia, SC, 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Samuel Noblet
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Susan E Steck
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - James R Hebert
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Johnny Payne
- Upstate Prostate Cancer Alliance, 412 Perry Hill Road, Easley, SC, 29640, USA
| | - Doug McCormick
- AID Upstate, 811 Pendleton Street, Suite 10, Greenville, SC, 29601, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
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Owens OL, Estrada RM, Johnson K, Cogdell M, Fried DB, Gansauer L, Kim S. 'I'm not a chance taker': A mixed methods exploration of factors affecting prostate cancer treatment decision-making. ETHNICITY & HEALTH 2021; 26:1143-1162. [PMID: 30987436 PMCID: PMC7184517 DOI: 10.1080/13557858.2019.1606165] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES African American prostate cancer survivors experience post-treatment decisional regret more often than European Americans, which can lead to negative long-term effects on quality of life. A prominent driver of health-related decision-making is emotion, yet little work has examined the impact emotions may have on decisional regret. The goal of this study was to explore experiences, perceptions, and emotions of prostate cancer survivors in relation to their diagnostic and treatment decision-making processes, prostate cancer treatment, and outcomes. Additionally, we sought to identify factors that might explain differences in prostate cancer outcomes between African and European Americans. DESIGN This mixed-methods study utilized a convergent parallel design, in which quantitative and qualitative data were collected simultaneously and then integrated to more robustly explain relationships between variables. Survivors were eligible for the study if they had been previously diagnosed with localized prostate cancer and were no more than six months post-treatment. The study was guided by the Risk as Feelings Model, which predicts the relationship between emotion and cognition in high-risk decision-making. RESULTS No men experienced decisional regret following treatment, even if they experienced side effects. While all men reported being surprised about their prostate cancer diagnosis, strong negative emotions were more common among men under 65. Family support and spirituality appeared to mitigate negative emotions. Perceived authenticity of provider communication was the most influential mediator in men's decision-making and positive perceptions of their outcomes. CONCLUSIONS To mitigate the impact emotional responses have on decision-making and post-treatment regret, providers should explore alternate therapies (e.g. counseling for men diagnosed with prostate cancer at a young age) and include family members in prostate cancer treatment discussions. Most importantly, providers should be aware of the importance of quality communication on men's cognitive and emotional processes and their perceptions of treatment outcomes.
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Affiliation(s)
- Otis L Owens
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Robin M Estrada
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Kim Johnson
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Micheal Cogdell
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Daniel B Fried
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Lucy Gansauer
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Simon Kim
- Yale University Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Wieland ML, Njeru JW, Alahdab F, Doubeni CA, Sia IG. Community-Engaged Approaches for Minority Recruitment Into Clinical Research: A Scoping Review of the Literature. Mayo Clin Proc 2021; 96:733-743. [PMID: 33004216 DOI: 10.1016/j.mayocp.2020.03.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/15/2020] [Accepted: 03/31/2020] [Indexed: 01/14/2023]
Abstract
Underrepresentation of racial and ethnic minority populations in clinical research persists in the United States, highlighting the unmet ideals of generalizability and equity of research findings and products. Previous systematic reviews exploring various facets of this phenomenon concluded that community engagement with minority groups may effectively promote recruitment and retention, but the ways in which community-engaged approaches have been used for recruitment have not been examined. We performed a scoping review of the literature to identify studies of community-engaged recruitment processes. The search resulted in 2842 articles, of which 66 met inclusion criteria. These articles demonstrated a relatively large literature base of descriptive studies conveying details of community engagement approaches to enhance recruitment of minority research participants. We summarize key aspects of current practices across the spectrum of community engagement. A gap in the literature is the relative lack of the comparative studies among different engagement strategies.
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Affiliation(s)
- Mark L Wieland
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Jane W Njeru
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Fares Alahdab
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research and Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
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6
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Health behavior changes in African American family members facing lung cancer: Tensions and compromises. Eur J Oncol Nurs 2019; 38:57-64. [PMID: 30717937 DOI: 10.1016/j.ejon.2018.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Behavioral interventions targeting cancer survivors often fail to address the clustering of unhealthy behaviors among family members and friends, and the impact of close relationships on behavior change. The study's aim was to identify factors associated with receptivity and preferences for lifestyle behavior change among family members of African-American survivors of lung cancer. METHODS Principles of social cognitive theory guided the design. A descriptive, qualitative study recruited 26 African-American family members of lung cancer survivors from two teaching hospitals in the southeastern United States. A 20-item Information Form collected demographic, health status, and health behavior information. Family members participated in one of three semi-structured focus group discussions. RESULTS Four major themes emerged: family members and survivors both resisted the caregiver role; dramatic changes evoked by the diagnosis of lung cancer were facilitators and barriers to lifestyle choices; leaning on faith was the primary source of support; and these families live with a constant threat of multiple cancers. Findings emphasize the importance of meaningful conversations among health-care providers, survivors, and family members during the time of diagnosis, treatment, and recovery, so that family members are better prepared to cope with anticipated changes. CONCLUSIONS This study highlights the stressors that affect family members and sheds light on their unique needs. The stressors limit their ability to change health behaviors. Family members need basic education, skills training, and support related to the lung cancer diagnosis and other cancers. Current methods to provide these services are limited in their accessibility, availability, and effectiveness.
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7
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Allen JD, Akinyemi IC, Reich A, Fleary S, Tendulkar S, Lamour N. African American Women's Involvement in Promoting Informed Decision-Making for Prostate Cancer Screening Among Their Partners/Spouses. Am J Mens Health 2018; 12:884-893. [PMID: 29298558 PMCID: PMC6131450 DOI: 10.1177/1557988317742257] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 12/13/2022] Open
Abstract
Routine prostate cancer screening is not recommended but African American men who are at higher risk for the disease should be offered the opportunity for shared decision-making with their health-care providers. This qualitative study sought to better understand the potential role of women in educating their male spouses/partners about prostate cancer screening. Nine focus groups were conducted ( n = 52). Women were recruited from a variety of community venues. Those eligible were African American and married to or in a partnership with an African American male age ≥ 45. Women provide numerous types of support to their male partners in an effort to facilitate participation in preventive health care. While women agreed that they would like to educate their partners about prostate cancer screening, they had little information about screening guidelines or the potential harms and limitations. The current findings suggest that women are eager information-seekers and can disseminate information to men and facilitate their efforts to make more informed decisions about prostate cancer screening. Women should be included in educational interventions for to promote informed decision-making for prostate cancer screening.
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Affiliation(s)
- Jennifer D. Allen
- Department of Community Health Tufts
University, Medford, MA, USA
- Department of Community Health Tufts
University, Medford, MA, USA
| | - Ifedayo C. Akinyemi
- Department of Public Health and Community
Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Amanda Reich
- Department of Public Health and Community
Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Sasha Fleary
- Eliot-Pearson Department of Child Study and
Human Development, Tufts University, Medford, MA, USA
| | | | - Nadeerah Lamour
- Department of Community Health Tufts
University, Medford, MA, USA
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Alick CL, Samuel‐Hodge C, Ward D, Ammerman A, Rini C, Tate DF. Together Eating & Activity Matters (TEAM): results of a pilot randomized-clinical trial of a spousal support weight loss intervention for Black men. Obes Sci Pract 2018; 4:62-75. [PMID: 29479466 PMCID: PMC5818757 DOI: 10.1002/osp4.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/31/2017] [Accepted: 11/18/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives The objective of this study is to evaluate the feasibility, participation, preliminary efficacy and retention in a couples-based weight loss intervention among Black men. Design setting participants Two-arm pilot randomized clinical trial in an academic clinical setting. Forty self-identified Black men and their female cohabitating partners (n = 80) aged 18 to 65 years with body mass index from 25 to 45 kg/m2 were randomized using computer generated tables to allocate treatments. Intervention Participants were randomized to a standard behavioural weight loss (Standard) programme or the Standard programme plus partner involvement (Enhanced). Both interventions focused on calorie reduction, physical activity and self-monitoring to facilitate weight loss. Enhanced included couples skills training and couple's communication components. Main outcome and measures Changes in weight from baseline to 3 months among men. Partner weight loss (secondary). Results Forty Black couples (men mean [SD] age, 47.4[11] years; body mass index, 35.0[6.1]), were recruited. Retention was 100% of the men and 98% of female partners. Attendance at group sessions was 63-73%. Between groups, mean (SD) weight changes among men were -3.4[.04] and -4.7[5.9] kg (p = 0.57) and among women -0.23[4.46] and -2.47[3.62] kg (p = 0.09), in the standard and enhanced groups. Conclusions Weight losses from an intervention enhanced by partner involvement and an intervention with no partner involvement were not different. Treatment choice can be based on preference rather than outcome as both treatments are effective in producing clinically significant percent weight loss.Trial registration Clinical Trials NCT02458053.
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Affiliation(s)
- C. L. Alick
- Department of NutritionUNC Chapel HillChapel HillNCUSA
| | | | - D. Ward
- Department of NutritionUNC Chapel HillChapel HillNCUSA
| | - A. Ammerman
- Department of NutritionUNC Chapel HillChapel HillNCUSA
| | - C. Rini
- Hackensack University Medical CenterHackensackNJUSA
| | - D. F. Tate
- Department of NutritionUNC Chapel HillChapel HillNCUSA
- Department of Health BehaviorUNC Chapel HillChapel HillNCUSA
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King-Okoye M, Arber A, Faithfull S. Routes to diagnosis for men with prostate cancer: men's cultural beliefs about how changes to their bodies and symptoms influence help-seeking actions. A narrative review of the literature. Eur J Oncol Nurs 2017; 30:48-58. [PMID: 29031313 DOI: 10.1016/j.ejon.2017.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/16/2017] [Accepted: 06/21/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine the findings of existing studies in relation to men's cultural beliefs about changes to their bodies relevant to prostate cancer and how these affect interpretation of bodily changes and help-seeking actions. METHOD We undertook a narrative review of studies conducted from 2004 to 2017 in 6 databases that highlighted men's beliefs and help-seeking actions for bodily changes suggestive of prostate cancer. RESULTS Eighteen (18) studies reflecting men from various ethnicities and nationalities were included. The belief that blood and painful urination were warning signs to seek medical help delayed help-seeking among men compared to men that did not experience these symptoms. The belief that urinary symptoms such as dribbling, cystitis and urinary hesitancy were transient and related to ageing, normality and infection significantly delayed symptom appraisal and help-seeking. Men also held the belief that sexual changes, such as impotence and ejaculation dysfunction were private, embarrassing and a taboo. These beliefs impeded timely help-seeking. Cultural beliefs, spirituality and the role of wives/partners were significant for men to help appraise symptoms as requiring medical attention thus sanctioning the need for help-seeking. CONCLUSIONS This review underscores a critical need for further empirical research into men's beliefs about bodily changes relevant to prostate health and how these beliefs affect their interpretation of symptoms and subsequent help-seeking actions.
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Affiliation(s)
- Michelle King-Okoye
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
| | - Anne Arber
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sara Faithfull
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Bowie JV, Bell CN, Ewing A, Kinlock B, Ezema A, Thorpe RJ, LaVeist TA. Religious Coping and Types and Sources of Information Used in Making Prostate Cancer Treatment Decisions. Am J Mens Health 2017; 11:1237-1246. [PMID: 28193130 PMCID: PMC5675355 DOI: 10.1177/1557988317690977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/26/2016] [Accepted: 12/19/2016] [Indexed: 11/17/2022] Open
Abstract
Treatment experiences for prostate cancer survivors can be challenging and dependent on many clinical and psychosocial factors. One area that is less understood is the information needs and sources men utilize. Among these is the influence of religion as a valid typology and the value it may have on treatment decisions. The objective of this study was to assess the relationship between race, religion, and cancer treatment decisions in African American men compared with White men. Data were from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 877 African American and White men. The main dependent variables sought respondents' use of resources or advisors when making treatment decisions. Questions also assessed men perceptions of prostate cancer from the perspective of religious coping. After adjusting for age, marital status, education, and insurance status, race differences in the number of sources utilized were partially mediated by cancer was a punishment from God (β = -0.46, SE = 0.012, p < .001), cancer was a test of faith (β = -0.49, SE = 0.013, p < .001), and cancer can be cured with enough prayer (β = -0.47, SE = 0.013, p < .001). Similarly, race differences in the number of advisors utilized in making the treatment decision were partially mediated by cancer was a punishment from God (β = -0.39, SE = 0.014, p = .006), and cancer was a test of faith (β = -0.39, SE = 0.014, p = .006). Religious views on prostate cancer may play an important role in explaining race differences in information used and the number of advisors utilized for treatment decision making for prostate cancer.
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Affiliation(s)
| | | | | | | | | | | | - Thomas A. LaVeist
- Johns Hopkins University, Baltimore, MD, USA
- George Washington University, Washington, DC, USA
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11
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Skolarus TA, Ragnoni JA, Garlinghouse C, Schafenacker A, Webster D, Hager P, Wittmann D, Northouse L. Multilingual Self-Management Resources for Prostate Cancer Survivors and Their Partners: Results of a Long-Term Academic-State Health Department Partnership to Promote Survivorship Care. Urology 2017; 110:92-97. [PMID: 28652166 DOI: 10.1016/j.urology.2017.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 04/10/2017] [Accepted: 06/12/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide innovative, evidence-based self management information and supportive care for prostate cancer survivors and their partners. We describe how an academic-public partnership facilitated the broad dissemination of evidence-based, multilingual survivorship educational materials via a state-managed prostate cancer website. METHODS We outline the steps of an academic-public partnership leading to dissemination of online, survivorship materials as a resource for prostate cancer survivors and their partners. We examined the 5-year utilization of the materials from January 2011 to December 2015 according to 14 content areas (e.g., urinary, bowel, and sexual problems, fatigue, communication, cancer stress) and across 3 languages (English, Spanish, Arabic). RESULTS The total number of prostate cancer survivorship materials downloaded from January 2011 to December 2015 was 89,348. The number of downloaded materials increased over time from 6,421 in 2011 to 17,496 in 2015. The most commonly downloaded content area was urine problems (27.5%), followed by bowel problems (23.4%) and sexual side effects (16.2%). The majority of downloaded materials was in English (86.3%), followed by Spanish (9.8%) and Arabic (3.9%). CONCLUSION The academic-public partnership facilitated broad dissemination of evidence-based informational materials for prostate cancer survivors and their partners through a state-managed website from 2011 to 2015. Given the increasing role of academic-public partnerships in funding and development of robust, sustainable prostate cancer survivorship resources, this work serves as an introduction to these evidence-based materials and highlights a successful model of engagement between practitioners, research scientists, and public health administration.
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Affiliation(s)
- Ted A Skolarus
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | | | | | | | - Debbie Webster
- Cancer Prevention and Control, Michigan Department of Health and Human Services (formerly Michigan Department of Community Health), Lansing, MI
| | - Polly Hager
- Cancer Prevention and Control, Michigan Department of Health and Human Services (formerly Michigan Department of Community Health), Lansing, MI
| | - Daniela Wittmann
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
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12
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Owens OL, Friedman DB, Hébert J. Commentary: Building an Evidence Base for Promoting Informed Prostate Cancer Screening Decisions: An Overview of a Cancer Prevention and Control Program. Ethn Dis 2017; 27:55-62. [PMID: 28115822 DOI: 10.18865/ed.27.1.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
African American (AA) men have significantly higher mortality rates from prostate cancer (PrCA) than other racial groups. Therefore, there is a critical need to identify strategies for promoting informed PrCA screening decisions among this population. This article details the community-driven, social and behavioral research being implemented by a Statewide Cancer Prevention and Control Program (CPCP) to support the development of person-to-person and technological interventions to improve the dissemination of PrCA information to AA men and their families. This article concludes with four recommendations to advance future research and practice related to the use of interventions for promoting informed PrCA decision-making among AAs. These recommendations include: 1) informing men about controversial screening recommendations; 2) including families in educational interventions about PrCA; 3) using technology as a modality for disseminating PrCA information when appropriate; and 4) aiming to create interventions that can be translated into community and clinical settings.
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Affiliation(s)
- Otis L Owens
- College of Social Work, University of South Carolina; Statewide Cancer Prevention and Control Program, University of South Carolina
| | - Daniela B Friedman
- Statewide Cancer Prevention and Control Program, University of South Carolina; Department of Health Promotion, Education, and Behavior, University of South Carolina
| | - James Hébert
- Statewide Cancer Prevention and Control Program, University of South Carolina; Department of Epidemiology and Biostatistics, University of South Carolina
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13
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Ross L, Johnson J, Smallwood SW, Luque JS, Tedders SH, Airhihenbuwa CO, Alford T, Underwood W. Using CBPR to Extend Prostate Cancer Education, Counseling, and Screening Opportunities to Urban-Dwelling African-Americans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:702-708. [PMID: 25948412 PMCID: PMC5393453 DOI: 10.1007/s13187-015-0849-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Community-based participatory research (CBPR) is becoming one of the dominant approaches for bringing evidence- and consensus-based cancer prevention and control practices to medically underserved communities. There are many examples of how CBPR has been useful for generating culturally specific solutions for different health issues that affect African-Americans. However, few examples exist in the literature on how the CBPR approach can be applied to address prostate cancer. This paper describes a collaborative process for linking inner-city, African-American men to free prostate cancer education, physician counseling, and screening opportunities (prostate-specific antigen (PSA) testing and digital rectal examination (DRE)). The site of this community-based participatory project was the city of Buffalo, located in Erie County, New York. The collaborative, community-academic process that is described includes the following: (1) planning and conducting a community needs assessment to contextualize local prostate cancer issues, (2) organizing town and gown event planning, and (3) manipulating aspects of the built environment to build an infrastructure within the community to address disparities in screening opportunities. This paper concludes with a description of lessons learned that can help others develop and implement similar activities in other communities.
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Affiliation(s)
- Levi Ross
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA, 30460-8015, USA.
| | - Jarrett Johnson
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA, 30460-8015, USA
| | - Stacy W Smallwood
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA, 30460-8015, USA
| | - John S Luque
- Medical University of South Carolina, Department of Public Health Sciences, Hollings Cancer Center, Charleston, SC, 29445, USA
| | - Stuart H Tedders
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA, 30460-8015, USA
| | - Collins O Airhihenbuwa
- College of Health and Human Development, Pennsylvania State University, 219D Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Terry Alford
- Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Willie Underwood
- Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
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14
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Walker DM, McAlearney AS, Sova LN, Lin JJ, Abramson S, Bickell NA. Comparing Prostate Cancer Treatment Decision Making in a Resource-rich and a Resource-poor Environment: A Tale of two Hospitals. J Natl Med Assoc 2016; 108:211-219. [PMID: 27979006 DOI: 10.1016/j.jnma.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Black men with prostate cancer are diagnosed later, have poorer treatment outcomes, and higher mortality from the disease than all other racial groups. While existing literature has explored differences in the treatment decision making process between black and white men with localized prostate cancer, little is known about how environmental factors may affect the treatment decision process for men with clinically significant disease for whom treatment improves survival. The aim of this study was to compare and contrast the treatment decision process, from both patients' and treating physicians' perspectives, in a resource-rich and a resource-poor hospital. METHODS Qualitative interviews and focus groups were conducted with patients and their treating physicians from two urban hospitals. Patients were identified through retrospective review of pathology and tumor registries; their charts abstracted to ascertain treatments. Treating physicians were identified and contacted to discuss the treatment decision process. Physicians were also asked to discuss patients who did not receive definitive treatment. Transcripts were analyzed deductively using themes from the Health Belief Model, and inductively to explore emergent themes. RESULTS Overall, patients and physicians discussed similar factors that influenced the decision making process at both hospitals. However, a few important differences were found: providers at the resource-poor hospital discussed cost as a barrier, highlighted having limited treatment options for their patients, and noted issues with follow-up as external factors affecting treatment decisions. Patients at the resource-poor hospital expressed greater fear and anxiety, and less self-efficacy and motivation in comparison to patients treated at the hospital with greater resources. Importantly, patients at both hospitals described significant trust in their physician, yet only at the resource-poor hospital did patients suggest that they lacked knowledge regarding treatment side-effects, despite physicians at both hospitals describing their attempt to disclose all side-effects. CONCLUSION These findings identify both medical-system factors, and practice-level factors that can help guide the development of interventions to reduce prostate cancer treatment disparities.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA.
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA; Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH, USA
| | - Lindsey N Sova
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Health Equity & Community Engaged Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place; Box 1077, New York, NY 10029, USA
| | - Sarah Abramson
- Center for Health Equity & Community Engaged Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place; Box 1077, New York, NY 10029, USA
| | - Nina A Bickell
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Health Equity & Community Engaged Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place; Box 1077, New York, NY 10029, USA
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15
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Owens OL, Friedman DB, Brandt HM, Bernhardt JM, Hébert JR. Digital Solutions for Informed Decision Making: An Academic-Community Partnership for the Development of a Prostate Cancer Decision Aid for African American Men. Am J Mens Health 2016; 10:207-19. [PMID: 25563381 PMCID: PMC4492917 DOI: 10.1177/1557988314564178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
African American (AA) men are significantly more likely to die of prostate cancer (PrCA) than other racial groups, and there is a critical need to identify strategies for providing information about PrCA screening and the importance of informed decision making (IDM). To assess whether a computer-based IDM intervention for PrCA screening would be appropriate for AA men, this formative evaluation study examined their (1) PrCA risk and screening knowledge; (2) decision-making processes for PrCA screening; (3) usage of, attitudes toward, and access to interactive communication technologies (ICTs); and (4) perceptions regarding a future, novel, computer-based PrCA education intervention. A purposive convenience sample of 39 AA men aged 37 to 66 years in the Southeastern United States was recruited through faith-based organizations to participate in one of six 90-minute focus groups and complete a 45-item descriptive survey. Participants were generally knowledgeable about PrCA. However, few engaged in IDM with their doctor and few were informed about the associated risks and uncertainties of PrCA screening. Most participants used ICTs on a daily basis for various purposes including health information seeking. Most participants were open to a novel, computer-based intervention if the system was easy to use and its animated avatars were culturally appropriate. Because study participants had low exposure to IDM for PrCA, but frequently used ICTs, IDM interventions using ICTs (e.g., computers) hold promise for AA men and should be explored for feasibility and effectiveness. These interventions should aim to increase PrCA screening knowledge and stress the importance of participating in IDM with doctors.
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16
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Jackson DD, Owens OL, Friedman DB, Dubose-Morris R. Innovative and Community-Guided Evaluation and Dissemination of a Prostate Cancer Education Program for African-American Men and Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:779-85. [PMID: 25510370 PMCID: PMC4469634 DOI: 10.1007/s13187-014-0774-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
African Americans (AA) are more likely to develop and die from cancer than any other racial or ethnic group. The aims of this research were to (1) evaluate current education materials being implemented in a community-based prostate cancer education program for AA communities, (2) refine materials based on findings from aim 1, (3) share updated materials with participants from aim 1 for additional improvements, and (4) disseminate and evaluate the improved education program through a statewide videoconference with AA men and women. AA individuals evaluated the current education program through a mail survey (n=32) and community forum (n=38). Participants reported that the existing prostate cancer education program content could be understood by lay persons, but recommendations for improvement were identified. They included the following: defining unknown and/or scientific terminology, increasing readability by increasing font size and enlarging images, and including more recent and relevant statistics. Following refinement of the education materials based on survey and forum feedback, a statewide videoconference was implemented. Following the videoconference, participants (25 men; 3 women) reported that they would encourage others to learn more about prostate cancer, talk to their doctor about whether or not to get screened for prostate cancer, and recommend the conference to others. There is great potential for using this type of iterative approach to education program development with community and clinical partners for others conducting similar work.
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Affiliation(s)
- Dawnyea D Jackson
- United States Army Public Health Command, Army Institute of Public Health, Aberdeen Proving Ground, MD, 21010, USA
| | - Otis L Owens
- College of Social Work, University of South Carolina, Columbia, SC, 29208, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior and the Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208, USA.
- Arnold School of Public Health, Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 235, Columbia, SC, USA.
| | - Ragan Dubose-Morris
- South Carolina Area Health Education Consortium and Department of Library Science and Informatics, Medical University of South Carolina, Charleston, SC, 29425, USA
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17
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King KM, Morris D, Jones L, Lucas-Wright A, Jones F, del Pino HE, Porter C, Vargas R, Kahn K, Brown AF, Norris KC. The Los Angeles Healthy Community Neighborhood Initiative: A Ten Year Experience in Building and Sustaining a Successful Community-Academic Partnership. HSOA JOURNAL OF COMMUNITY MEDICINE & PUBLIC HEALTH CARE 2015; 2:007. [PMID: 27747314 PMCID: PMC5061128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Developing effective Community-Academic Partnerships (CAPs) is challenging, and the steps to build and sustain them have not been well documented. This paper describes efforts to form and sustain the Healthy Community Neighborhood Initiative (HCNI), a CAP to improve health in a low-income community in South Los Angeles. METHODS Moderated, semi-structured discussions with HCNI community and academic partners were used to develop a framework for CAP formation. RESULTS We identified two key features, shared values and respect, as critical to the decision to form the HCNI. Five elements were identified as necessary for building and sustaining the HCNI: trust, transparency, equity and fairness, adequate resources and developing protocols to provide structure. We also identified several challenges and barriers and the strategies used in the HCNI to mitigate these challenges. CONCLUSION We developed a framework to incorporate and reinforce the key elements identified as crucial in building and sustaining a CAP in a low-income community.
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Affiliation(s)
- Keyonna M King
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
| | - D’Ann Morris
- Division of General Internal Medicine and Health Services Research, Los Angeles Urban League, University of California, Los Angeles, California, USA
| | - Loretta Jones
- Healthy African American Families, University of California, Los Angeles, California, USA
| | - Aziza Lucas-Wright
- Healthy African American Families, University of California, Los Angeles, California, USA
| | - Felica Jones
- Healthy African American Families, University of California, Los Angeles, California, USA
| | - Homero E del Pino
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
- Department of Aging, Charles R Drew University, Los Angeles, California, USA
| | - Courtney Porter
- Division of General Internal Medicine and Health Services Research, Los Angeles Urban League, University of California, Los Angeles, California, USA
- Department of Aging, Charles R Drew University, Los Angeles, California, USA
| | - Roberto Vargas
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
- Department of Aging, Charles R Drew University, Los Angeles, California, USA
| | - Katherine Kahn
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
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Kimmel AL, Wang J, Scott RK, Briggs L, Lyon ME. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers. Contemp Clin Trials 2015; 43:172-8. [PMID: 26044463 DOI: 10.1016/j.cct.2015.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 01/14/2023]
Abstract
Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.
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Affiliation(s)
- Allison L Kimmel
- Center for Translational Science, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, USA.
| | - Jichuan Wang
- Center for Translational Science, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, USA; The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC, USA.
| | - Rachel K Scott
- MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, USA.
| | - Linda Briggs
- Gunderson Lutheran Medical Foundation, Inc., 1900 South Avenue, La Crosse, WI, USA.
| | - Maureen E Lyon
- Center for Translational Science, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, USA; The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC, USA.
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Schoenfeld ER, Francis LE. Word on the Street: Engaging Local Leaders in a Dialogue About Prostate Cancer Among African Americans. Am J Mens Health 2015; 10:377-88. [PMID: 25595017 DOI: 10.1177/1557988314566503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
African American men face the highest rates of prostate cancer, yet with no consensus for screening and treatment, making informed health care decisions is difficult. This study aimed to identify approaches to empowering African American men as proactive participants in prostate cancer decision making using an established community-campus partnership employing elements of community-based participatory research methods. Community stakeholders with an interest in, and knowledge about, health care in two local African American communities were recruited and completed key informant interviews (N = 39). Grounded theory coding identified common themes related to prostate cancer knowledge, beliefs, attitudes, and responses to them. Common barriers such as gender roles, fear, and fatalism were identified as barriers to work-up and treatment, and both communities' inadequate and inaccurate prostate cancer information described as the key problem. To build on community strengths, participants said the change must come from inside these communities, not be imposed from the outside. To accomplish this, they suggested reaching men through women, connecting men to doctors they can trust, making men's cancer education part of broader health education initiatives designed as fun and inexpensive family entertainment events, and having churches bring community members in to speak on their experiences with cancer. This study demonstrated the success of community engagement to identify not only barriers but also local strengths and facilitators to prostate cancer care in two suburban/rural African American communities. Building collaboratively on community strengths may improve prostate cancer care specifically and health care in general.
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20
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Greiner KA, Friedman DB, Adams SA, Gwede CK, Cupertino P, Engelman KK, Meade CD, Hébert JR. Effective recruitment strategies and community-based participatory research: community networks program centers' recruitment in cancer prevention studies. Cancer Epidemiol Biomarkers Prev 2015; 23:416-23. [PMID: 24609851 DOI: 10.1158/1055-9965.epi-13-0760] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Community-based participatory research (CBPR) approaches that involve community and academic partners in activities ranging from protocol design through dissemination of study findings can increase recruitment of medically underserved and underrepresented racial/ethnic minority populations into biomedical research. METHODS Five cancer screening and prevention trials in three National Cancer Institute (Bethesda, MD)-funded Community Networks Program Centers (CNPC), in Florida, Kansas, and South Carolina, were conducted across diverse populations. Data were collected on total time period of recruitment, ratios of participants enrolled over potential participants approached, selected CBPR strategies, capacity-building development, and systematic procedures for community stakeholder involvement. RESULTS Community-engaged approaches used included establishing colearning opportunities, participatory procedures for community-academic involvement, and community and clinical capacity building. A relatively large proportion of individuals identified for recruitment was actually approached (between 50% and 100%). The proportion of subjects who were eligible among all those approached ranged from 25% to more than 70% (in the community setting). Recruitment rates were very high (78%-100% of eligible individuals approached) and the proportion who refused or who were not interested among those approached was very low (5%-11%). CONCLUSIONS Recruitment strategies used by the CNPCs were associated with low refusal and high enrollment ratios of potential subjects. Adherence to CBPR principles in the spectrum of research activities, from strategic planning to project implementation, has significant potential to increase involvement in biomedical research and improve our ability to make appropriate recommendations for cancer prevention and control programming in underrepresented diverse populations. IMPACT CBPR strategies should be more widely implemented to enhance study recruitment.
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Affiliation(s)
- K Allen Greiner
- Authors' Affiliations: Departments of Family Medicine and Preventive Medicine, University of Kansas Medical Center; University of Kansas Cancer Center, Kansas City, Kansas; South Carolina Statewide Cancer Prevention and Control Program; Arnold School of Public Health; College of Nursing, University of South Carolina, Columbia, South Carolina; and Moffitt Cancer Center and the University of South Florida, Tampa, Florida
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21
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Thompson B, Hébert JR. Involving disparate populations in clinical trials and biobanking protocols: experiences from the community network program centers. Cancer Epidemiol Biomarkers Prev 2015; 23:370-3. [PMID: 24609845 DOI: 10.1158/1055-9965.epi-14-0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Beti Thompson
- Authors' Affiliations: Fred Hutchinson Cancer Research Center, Seattle, Washington and University of South Carolina, Columbia, South Carolina
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Friedman DB, Toumey C, Porter DE, Hong J, Scott GI, Lead JR. Communicating with the public about environmental health risks: a community-engaged approach to dialogue about metal speciation and toxicity. ENVIRONMENT INTERNATIONAL 2015; 74:9-12. [PMID: 25305416 DOI: 10.1016/j.envint.2014.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/18/2014] [Accepted: 09/26/2014] [Indexed: 05/09/2023]
Affiliation(s)
- Daniela B Friedman
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Christopher Toumey
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Dwayne E Porter
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Jie Hong
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Geoffrey I Scott
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Jamie R Lead
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
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Owens OL, Jackson DD, Thomas TL, Friedman DB, Hébert JR. Prostate Cancer Knowledge and Decision Making Among African-American Men and Women in the Southeastern United States. INTERNATIONAL JOURNAL OF MEN'S HEALTH 2015. [PMID: 26190946 DOI: 10.3149/jmh.1401.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study used multiple methods for assessing African-American (AA) men's and their female relatives, friends, and significant others' knowledge and cancer-related decision-making practices within the context of a prostate cancer (PrCA) education program. Data were collected from 81 participants using qualitative focus groups and 49 participants also completed quantitative pre/post surveys. Findings showed that men often relied on their female "significant other" and doctors for guidance on cancer-related decisions. Women described their role in assisting with their male partners' cancer decisions. AA men's and women's knowledge scores increased between pre- and post-tests which can indicate a greater likelihood of future participation in informed cancer-related decision making. Also, using multiple methods in formative research can provide relevant information for developing effective cancer-related interventions.
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Affiliation(s)
- Otis L Owens
- College of Social Work, University of South Carolina, Columbia SC, 29208 ; Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia SC, 29208
| | - Dawnyéa D Jackson
- Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia SC, 29208 ; Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia SC, 29208
| | - Tracey L Thomas
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia SC, 29208
| | - Daniela B Friedman
- Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia SC, 29208 ; Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia SC, 29208
| | - James R Hébert
- Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia SC, 29208 ; Department of Epidemiology & Biostatistics, University of South Carolina, Columbia SC, 29208
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Hébert JR, Satariano WA, Friedman DB, Armstead CA, Greiner A, Felder TM, Coggins TA, Tanjasiri S, Braun KL. Fulfilling Ethical Responsibility: Moving Beyond the Minimal Standards of Protecting Human Subjects from Research Harm. Prog Community Health Partnersh 2015; 9 Suppl:41-50. [PMID: 26213403 PMCID: PMC4659710 DOI: 10.1353/cpr.2015.0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PROBLEM Rules for protecting human subjects, in place federally since 1974, have focused primarily on guarding against placing research subjects at social, physical, or psychological risk or violating their privacy and confidentiality. Nevertheless, high-risk communities are routinely subjected to "sins of omission," which limit access to potentially significant research opportunities and result in the absence of studies that could confer high degree of community beneficence. PURPOSE OF ARTICLE To describe "sins of omission" and provide examples from the Community Networks Program Centers (CNPC) to illustrate how community-based participatory research (CBPR) can prevent them. KEY POINTS CBPR is an effective antidote to sins of omission. Activities undertaken by the CNPCs illustrate how adherence to CBPR principles can improve research access and outcomes. CONCLUSIONS By working with community members as partners, we expand the concept of beneficence to include "community beneficence," thus reducing the probability of "sins of omission."
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Owens OL, Jackson DD, Thomas TL, Friedman DB, Hébert JR. Prostate Cancer Knowledge and Decision Making Among African-American Men and Women in the Southeastern United States. INTERNATIONAL JOURNAL OF MEN'S HEALTH 2015; 14:55-70. [PMID: 26190946 PMCID: PMC4505933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
This study used multiple methods for assessing African-American (AA) men's and their female relatives, friends, and significant others' knowledge and cancer-related decision-making practices within the context of a prostate cancer (PrCA) education program. Data were collected from 81 participants using qualitative focus groups and 49 participants also completed quantitative pre/post surveys. Findings showed that men often relied on their female "significant other" and doctors for guidance on cancer-related decisions. Women described their role in assisting with their male partners' cancer decisions. AA men's and women's knowledge scores increased between pre- and post-tests which can indicate a greater likelihood of future participation in informed cancer-related decision making. Also, using multiple methods in formative research can provide relevant information for developing effective cancer-related interventions.
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Affiliation(s)
- Otis L. Owens
- College of Social Work, University of South Carolina, Columbia SC, 29208
- Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia SC, 29208
| | - Dawnyéa D. Jackson
- Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia SC, 29208
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia SC, 29208
| | - Tracey L. Thomas
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia SC, 29208
| | - Daniela B. Friedman
- Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia SC, 29208
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia SC, 29208
| | - James R. Hébert
- Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia SC, 29208
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia SC, 29208
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Sarra LD, Ghezzi V, Eastland TY, Antonini F, Scialò G, Zega M, Alvaro R. Applying the Theory of Planned Behavior to Explain Women’s Role in Prostate Cancer Screening. Res Theory Nurs Pract 2015; 29:200-13. [DOI: 10.1891/1541-6577.29.3.200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective:To test the suitability of the theory of planned behavior (TPB) for explaining Italian women’s role in prostatic cancer screening promotion.Design/Methods:A descriptive, cross-sectional, online self-report survey was conducted with a convenience sample of 235 Italian women. Variables included attitudes women’s role, perceived behavioral control, subjective norm, behavioral intention, and prostate cancer screening promotion behavior. A survey composed of the Eastland Prostate Cancer Survey subscales that were consistent with the TPB was distributed via e-mail to potential participants. The survey was live for 12 weeks (March 2013 to May 2013). Responses were collated with eSurv.org. Data were analyzed using latent path analysis and structural equation modeling.Results:Behavioral intentions in promoting prostate cancer screening significantly predicted the likelihood of the Italian women to adopt self-reported prostate cancer screening promotion behaviors. In addition, the exclusive direct impact of the intentions explained 39% of the variance in self-reported behaviors.Conclusions:The TPB could represent a good framework to explain the role of Italian women in prevention behaviors related to the prostatic screening domain. Consistent with literature findings in social and nursing sciences, the intention to promote prostate cancer screening was a powerful “predictor” of the behavior itself.
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Jackson DD, Owens OL, Friedman DB, Hebert JR. An intergenerational approach to prostate cancer education: findings from a pilot project in the southeastern USA. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:649-56. [PMID: 24557505 PMCID: PMC4141905 DOI: 10.1007/s13187-014-0618-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
African Americans (AA) are more likely to develop and die from cancer than any other racial or ethnic group. This study assessed older and younger/middle-aged African-American (AA) men's (1) knowledge and attitudes about prostate cancer (PrCA) and PrCA screening, (2) participation in clinical research, and (3) health and cancer-related decision making. Twenty-eight AA men (14 older, mean age 59.8; 14 younger/middle age, mean age 30.4) received a PrCA education program and completed pre/post-education program surveys, as well as qualitative post-education interviews. Younger/middle-aged men were more knowledgeable about PrCA and PrCA screening than older men. Older men reported being invited to participate in a clinical trial more often than younger men but were more likely to report that participation in clinical trials was risky and they did not plan to participate in medical research in the future. Younger/middle-aged men were more willing to participate in a clinical trial in the future and reported fewer barriers to participation in clinical research. There is potential for using intergenerational communication strategies with older/younger AA male dyads in PrCA interventions.
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Affiliation(s)
- Dawnyea D Jackson
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, USA
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Friedman DB, Foster C, Bergeron CD, Tanner A, Kim SH. A qualitative study of recruitment barriers, motivators, and community-based strategies for increasing clinical trials participation among rural and urban populations. Am J Health Promot 2014; 29:332-8. [PMID: 24670073 DOI: 10.4278/ajhp.130514-qual-247] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Participation in clinical trials (CTs) is low among rural communities. Investigators report difficulty recruiting rural individuals for CTs. The study purpose was to identify recruitment barriers, motivators, and strategies to help increase access to and participation in CTs in rural and urban communities. APPROACH Qualitative focus groups/interviews. SETTING Rural and urban counties in one southeastern state. PARTICIPANTS Two hundred twelve African-American and white men and women ages 21+. METHOD Nineteen focus groups and nine interviews were conducted. Audio files were transcribed and organized into NVivo10. Recurring themes were examined by geographic location. RESULTS Although similar barriers, motivators, and strategies were reported by urban and rural groups, perceptions regarding their importance varied. Recruitment barriers mentioned in both rural and urban groups included fear, side effects, limited understanding, limited time, and mistrust. Rural groups were more mindful of time commitment involved. Both rural and urban participants reported financial incentives as the top motivator to CT participation, followed by personal illness (urban groups) and benefits to family (rural groups). Recruitment strategies suggested by rural participants involved working with schools/churches and using word of mouth, whereas partnering with schools, word of mouth, and media were recommended most by urban groups. CONCLUSION Perceived recruitment barriers, motivators, and strategies did not differ considerably between rural and urban groups. Major barriers identified by participants should be addressed in future CT recruitment and education efforts. Findings can inform recruitment and communication strategies for reaching both urban and rural communities.
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Key Words
- Clinical Trials
- Focus Groups
- Health focus: prevention, treatment, participation in clinical trials
- Interviews
- Manuscript format: research
- Motivators
- Outcome measure: perceptions, knowledge
- Prevention Research
- Qualitative
- Recruitment Barriers
- Research Participation
- Research purpose: descriptive
- Setting: statewide, community
- Strategy: education, recruitment
- Study design: qualitative
- Target population age: adults, seniors
- Target population circumstances: all education levels, all income levels, South Carolinians, rural and urban, African-American and white
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Friedman DB, Owens OL, Jackson DD, Johnson KM, Gansauer L, Dickey J, Miller R, Payne J, Bearden JD, Hebert JR. An evaluation of a community-academic-clinical partnership to reduce prostate cancer disparities in the South. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:80-5. [PMID: 24078315 PMCID: PMC3968180 DOI: 10.1007/s13187-013-0550-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Engaging partners in the planning, implementation, and evaluation of cancer education programs is critical for improving the health of our communities. A 2-year pilot education intervention on prostate cancer decision making and participation in medical research was funded by the National Cancer Institute. The partnership involving community members and clinical staff at a cancer center was used to develop recruitment strategies and plan for the implementation of the intervention with African-American middle-age and older men and female family members. We assessed partners' perceptions of this community-academic-clinical research collaboration. In year 2, eight project advisory council members were selected among existing partners and year 1 participants to serve as a formal committee. Council members were required to participate in telephone and in person meetings and actively support recruitment/implementation efforts. At the conclusion of the project, 20 individuals (all clinical and community partners, including the eight advisory council members) were invited to complete a survey to assess their perceived impact of the collaboration on the community and provide suggestions for future collaborations. Most partners agreed that their organization benefitted from the collaboration and that various aspects of the advisory council process (e.g., both formal and informal communication) worked well. The most noted accomplishment of the partnership related to leveraging the collaboration to make men more knowledgeable about prostate cancer decision making. Suggested improvements for future collaborations included distributing more frequent updates regarding project successes. Evaluating partners' perceptions of this collaboration provided important recommendations for future planning, implementation, and evaluation of community-based cancer education programs.
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Owens OL, Jackson DD, Thomas TL, Friedman DB, Hébert JR. African American men's and women's perceptions of clinical trials research: focusing on prostate cancer among a high-risk population in the South. J Health Care Poor Underserved 2013; 24:1784-800. [PMID: 24185170 PMCID: PMC3818250 DOI: 10.1353/hpu.2013.0187] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
While African Americans are at a significantly higher risk for developing certain cancers, they also have low rates of participation in cancer research, particularly clinical trials. This study assessed both African American men's and African American women's (1) knowledge of and participation in cancer-related clinical research and (2) barriers to and motivations for participating in clinical research. Data were collected from a total of 81 participants. Phase I of this research consisted of qualitative focus groups (all 81 participants). Phase II included quantitative pre/post survey data from an education program (56 participants). Findings from the study revealed that African American men and women had poor knowledge about clinical trials and the informed consent process, limited experience in participating in clinical trials, and they feared and mistrusted cancer research. Participants identified incentives, assurance of safety, knowledge and awareness, and benefiting others as motivators to participate in clinical trials research.
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Thomas TL, Owens OL, Friedman DB, Torres ME, Hébert JR. Written and spoken narratives about health and cancer decision making: a novel application of photovoice. Health Promot Pract 2012; 14:833-40. [PMID: 23171652 DOI: 10.1177/1524839912465749] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Photovoice is a community-based participatory research method that researchers have used to identify and address individual and community health needs. We developed an abbreviated photovoice project to serve as a supplement to a National Cancer Institute-funded pilot study focusing on prostate cancer (PrCA) that was set in a faith-based African American community in South Carolina. We used photovoice for three reasons: (a) to enhance communication between study participants and researchers, (b) to empower African American men and women to examine their health decisions through photographs, and (c) to better understand how participants from this community make health-related decisions. The 15 individuals participating in the photovoice project were asked to photograph aspects of their community that informed their health-related decisions. Participants provided written and oral narratives to describe the images in a small sample of photographs. Four primary themes emerged in participants' photographs and narratives: (a) food choices, (b) physical activity practices, (c) community environment and access to care, and (d) influences of spirituality and nature on health. Although written and audio-recorded narratives were similar in content, the audio-recorded responses were more descriptive and emotional. Results suggest that incorporating audio-recorded narratives in community photovoice presentations may have a greater impact than written narratives on health promotion, decision making, and policy makers because of an increased level of detail and personalization. In conclusion, photovoice strengthened the parent study and empowered participants by making them more aware of factors influencing their health decisions.
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Friedman DB, Thomas TL, Owens OL, Hébert JR. It takes two to talk about prostate cancer: a qualitative assessment of African American men's and women's cancer communication practices and recommendations. Am J Mens Health 2012; 6:472-84. [PMID: 22806569 PMCID: PMC3463645 DOI: 10.1177/1557988312453478] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Prostate cancer (PrCA) is the most commonly diagnosed nonskin cancer among men. African American (AA) men in South Carolina have a PrCA death rate 150% higher than that of European American (EA) men. This in-depth qualitative research explored AA men's and women's current practices, barriers, and recommended strategies for PrCA communication. A purposive sample of 43 AA men and 38 AA spouses/female relatives participated in focus groups (11 male groups; 11 female groups). A 19-item discussion guide was developed. Coding and analyses were driven by the data; recurrent themes within and across groups were examined. Findings revealed AA men and women agreed on key barriers to discussing PrCA; however, they had differing perspectives on which of these were most important. Findings indicate that including AA women in PrCA research and education is needed to address barriers preventing AA men from effectively communicating about PrCA risk and screening with family and health care providers.
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