Innovative and Community-Guided Evaluation and Dissemination of a Prostate Cancer Education Program for African-American Men and Women

Prostate Cancer Foundation Screening Guidelines for Black Men in the United States

BACKGROUND

In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States.

METHODS

A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis.

CONCLUSIONS

These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).

Knowledge, Attitudes, and Behaviors of Imams on Prostate Cancer in Kahramanmaras, Turkey

Imams are Muslim religious leaders in Turkey, who have a significant influence on society's healthcare attitudes and behavior, and all of them are male. In this study, it is aimed to investigate the knowledge and attitudes of Imams toward prostate cancer (PCa) in order to evaluate their contribution to the fight against PCa in one part of Turkey. This study was carried out on 287 Imams serving in Kahramanmaraş Province in Turkey. A questionnaire investigating the sociodemographic characteristics of the participants and their knowledge, attitudes, and behaviors on PCa was conducted. The mean age of Imams was 40.46 ± 8.93 (min = 22, max = 60). Of the participants, 266 (92.7%) said they had heard of PCa, and 16 (5.6%) had heard of the prostate-specific antigen (PSA) test. The majority of Imam's had poor knowledge regarding PCa. The knowledge score of Imams did not change according to marital status (p = 0.304) or education level (p = 0.16), but the knowledge score significantly increased with age groups (as age increased) (p = 0.010). Results of the present study revealed that Imams lack significant knowledge on PCa. Training on PCa should be organized for Imams, and the issuance of fatwa for PCa should be encouraged. The coordinated work of media, medical personnel, religious officials, and religious schools on PCa will be an important factor in the fight against PCa.

Elements for successful implementation of a clinic-based health literacy intervention

Improving health literacy is a national public health priority. Given the context of the COVID-19 pandemic, it is even more critical for health and medical information to be clear and understandable for patients and their families. Clinic-based programs to improve health literacy need to be pragmatic, feasible, and helpful for the implementing clinic and patients. This paper describes the development, implementation, and evaluation of a pragmatic, clinic-based health literacy intervention in a safety-net clinic that serves uninsured and indigent patients. Study methods are guided by a previous pilot study and components recommended for pragmatic interventions. An electronic readiness assessment was distributed to out-patient clinics affiliated with a statewide hospital association. The AskMe3 tool was used for the intervention as it is evidence informed and relatively easy to implement. Implementation included ongoing dialogue between the clinic and the academic research team. Within the implementing clinic, data collected from patients via verbally administered questionnaires was analyzed using descriptive statistics and chi-squares. Interview data collected from the clinic director was analyzed qualitatively for themes. The implementing clinic had some of the lowest average scores of the 34 clinics who participated in the initial readiness assessment. Despite this, they were able to successfully implement the health literacy intervention during a global pandemic. Eighty-eight participants completed patient questionnaires at this clinic. Most patients (96%) agreed the AskMe3 questions helped them talk with the doctor or nurse at their current appointment. Most (99%) also perceived the AskMe3 tool to be very helpful when used in a clinical setting. The clinic director offered that the staff initially thought the intervention would be difficult to implement. However, implementation by clinic volunteers with encouragement and prioritization of health literacy by the clinic director contributed to success. When considering interventions for clinical settings, a pragmatic approach can help with selection and implementation of a program that fits with the realities on the ground. Further, frequent technical assistance can help resolve implementation barriers. Interventions utilizing tools such as AskMe3, because of their simplicity, allow creative solutions to capacity issues for clinics who see a need for health literacy improvements.

Development of a Minority Prostate Cancer Research Digest: Communication Strategy Statement for Black Men

Since prostate cancer incidence, prevalence and mortality are still highest among Black men in the United States, it is important to effectively address the factors that contribute to prostate cancer disparities in this at-risk population as well as their low participation in biomedical research/clinical trials. An effective communication strategy that can be used to disseminate information with high public health impact to Black men is one way to combat prostate cancer disparities. The objective of this study was to develop a Minority Prostate Cancer (MiCaP) research communication strategy using focus group methodology and expert in-depth interviews. The communication strategy statement developed in this study provides a guide for message concepts and materials for Black men, including communication content, source, channel, and location. Specifically, it provides recommendations on how to deliver information, how to choose the language and relevant images, how to gain attention, who is preferred to deliver messages, and other ways to engage Black men in health communication strategies. The communication strategy statement was used to develop the MiCaP Research Digest, a research communication program that is currently being tested in Orange County, Duval County, Leon County, Gadsden County, and the Tampa Bay area of Florida.

A Prostate Cancer Prevention Education Program to Increase Knowledge and Self-Efficacy Among African American Men

The purpose of this study was to determine whether a nurse practitioner-guided prostate cancer education program was beneficial in decreasing gaps in knowledge and self-efficacy among African American men in a small, rural community in the middle of the state of Georgia.

Implementing Community-Based Prostate Cancer Education in Rural South Carolina: a Collaborative Approach Through a Statewide Cancer Alliance

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.

Development of a Clinical-Academic-Community Collaboration to Improve Health Literacy

Limited health literacy is associated with poor patient health outcomes and increased hospitalization rates. Patient-provider communication plays an important role in patient health literacy and the understanding of medical terminology. This study demonstrates how a collaboration between clinical, academic, and community partners was instrumental in the design and implementation of a clinic readiness assessment and a clinic-based pilot intervention to encourage patient-provider communication and improve patient health literacy. A state hospital association, academic research team, and community adult literacy center director collaborated to develop a 60-item clinic readiness assessment and an evidence-informed pilot intervention. The clinic readiness assessment captured clinics’ motivation and capacity for pilot implementation and providers’ current communication strategies. The intervention centered around AskMe3™ educational materials and involved 2 patient visits (initial and follow-up visits). Data collection instruments for the intervention were administered verbally and included questions about patient demographics and communication needs, and a single-item health literacy measure. Descriptive statistics (frequencies/percentages) were used to analyze results from the clinic readiness assessment and pilot intervention. Establishment of the partnership, and collaborative, iterative development of the clinic readiness assessment and pilot intervention are described. This pilot project resulted in important lessons learned which led to critical modifications that will inform future expansion of the intervention. Collaboration between healthcare leaders, researchers, and community partners is recommended for developing clinic-based health literacy initiatives.

"Talk About Cancer and Build Healthy Communities": How Visuals Are Starting the Conversation About Breast Cancer Within African-American Communities

African-American (AA) women are at higher risk of breast cancer mortality than women of other races. Factors influencing breast cancer risk, including exogenous environmental exposures, and debate around timing of exposure and dose-response relationship, can cause misunderstanding. Collaboration with priority populations encourages culturally relevant health messaging that imparts source reliability, influences message adoption, and improves understanding. Through six focus groups with AA individuals in rural and urban counties in the southeastern United States, this study used a community-engaged participatory approach to design an innovative visual tool for disseminating breast cancer information. Results demonstrated that participants were generally aware of environmental breast cancer risks and were willing to share new knowledge with families and community members. Recommended communication channels included pastors, healthcare providers, social media, and the Internet. Participants agreed that a collaboratively designed visual tool serves as a tangible, focused "conversation starter" to promote community prevention and education efforts.

Health disparities and equity in the era of COVID-19

Over the last year, COVID-19 has emerged as a highly transmissible and lethal infection. As we address this global pandemic, its disproportionate impact on Black, Indigenous, and Latinx communities has served to further magnify the health inequities in access and treatment that persist in our communities. These sobering realities should serve as the impetus for reexamination of the root causes of inequities in our health system. An increased commitment to strategic partnerships between academic and nonacademic health systems, industry, local communities, and policy-makers may serve as the foundation. Here, we examine the impact of the recent COVID-19 pandemic on health care inequities and propose a strategic roadmap for integration of clinical and translational research into our understanding of health inequities.

Adaptation and Initial Psychometric Evaluation of an Informed Prostate Cancer Screening Decision Self-Efficacy Scale for African-American Men

OBJECTIVE

To evaluate whether computer-based prostate cancer screening decision aids enhance decision self-efficacy for African-American men, culturally relevant and reliable measures are needed. However, limited psychometric evidence exists on the health-related decision self-efficacy of African-American men. This study describes the development and psychometric evaluation of the 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale among 354 African-American men.

METHODS

Exploratory factor analysis was conducted with maximum-likelihood estimation and polychoric correlations followed by Promax and Varimax rotations.

RESULTS

Exploratory factor analysis yielded a one-factor, 11-item model of the modified scale with excellent internal consistency reliability at 0.95 and factor loadings ranging from 0.70 to 0.90. Both parallel analysis and a scree plot confirmed the retention of one factor, and the standardized root mean square residual (0.06) indicated that the factor structure explained most of the correlations.

CONCLUSIONS

Findings suggest the one-factor, 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale has excellent psychometric properties and utility in reliably measuring health-related decision self-efficacy in African-American men. Future research is needed to confirm this factor structure among socio-demographically diverse African Americans.

Evaluation of a Computer-Based Decision Aid for Promoting Informed Prostate Cancer Screening Decisions Among African American Men: iDecide

PURPOSE

To evaluate the effects of iDecide on prostate cancer knowledge, informed decision-making self-efficacy, technology use self-efficacy, and intention to engage in informed decision-making among African American men.

DESIGN

One-group, pretest/posttest.

SETTING

Community settings in South Carolina.

PARTICIPANTS

African American men, ages 40 years +, without a prior prostate cancer diagnosis (n = 354).

INTERVENTION

iDecide, an embodied conversational agent-led, computer-based prostate cancer screening decision aid.

MEASURES

Prostate cancer knowledge, informed decision-making self-efficacy, technology use self-efficacy, and intention to engage in informed decision-making.

ANALYSIS

Descriptive statistics, paired t tests, general linear modeling, Spearman correlations.

RESULTS

On average, participants experienced significant improvements in their prostate cancer knowledge ( P ≤ .001), informed decision-making self-efficacy ( P ≤ .001), and technology use self-efficacy ( P ≤ .001), postintervention. Additionally, 67% of participants reported an intention to engage in informed decision-making.

CONCLUSION

Given the significant improvements across all measures, this research demonstrates that embodied conversational agent-led decision aids can be used to enhance the capacity for making informed prostate cancer screening decisions among African American men and increase their technology use self-efficacy. One critical limitation of this study is that most men had received prostate cancer screening prior to engaging in our intervention, so the implications of this intervention may be different for men who do not have a history of screening. Additionally, actual engagement in informed decision-making postintervention was not assessed.

Talking About Your Prostate: Perspectives from Providers and Community Members

Prostate cancer (PrCA) screening is controversial, especially for African-American (AA) men who have higher PrCA incidence and mortality than other racial/ethnic groups. Patient-provider communication is important for the PrCA screening decision process. The study purpose was to better understand the current dialogue between primary care providers (PCPs-physicians and nurse practitioners) and AA men about PrCA prevention and screening. An online survey with 46 PCPs, education sessions (including pre/post surveys) with 56 AA men, and a forum with 5 panelists and 38 AA men for open dialogue were held to examine both provider and community perspectives on PrCA communication needs and practices. PCPs' perceptions of PrCA screening were varied and they used different PrCA screening guidelines in their practices. PCPs and AA men had different experiences with PrCA communication. PCPs reported that they have discussions about PrCA screening and prostate health with AA patients; few AA men reported these same experiences. About 38.0% of PCPs reported that they remain neutral about PSA testing during discussions; however, only 10.7% of AA men reported that their doctor remained neutral. Prostate health knowledge among AA men increased significantly following participation in the education sessions (p < 0.001). AA community members reported high satisfaction regarding the education session and forum. Different recommendations from PCPs may hinder AA men's decisions about PrCA screening. The forum used in this study could be a model for others to help improve patient-provider communication and increase engagement in dialogue about this common cancer.

Improving Cancer Literacy for the Deaf Using Deaf-Tailored Educational Interventions: a Review of the Literature

To date, there have been many strategies, including educational interventions, for cancer prevention and control, but most of them are not deaf-tailored ones. This narrative review aimed to examine cancer educational programs to improve the deaf individuals' knowledge and attitude toward cancer. The design of this study is a narrative review. We searched ISI Web of Science, Scopus, Science Direct, and MEDLINE/PubMed using the following search strategy: ("cancer education" AND "deaf") OR ("cancer" AND "deaf" AND literacy). Publication years ranged from 1983 to 2016 for studies on cancer educational interventions for the deaf. Included studies were analyzed regarding research methodologies, types of intervention, and major findings. In total, 12 included studies were classified into three research methodologies. Although short-term and long-term knowledge improvement has been reported, since there is limited evidence on the types of cancer-related educational interventions and there are insufficient studies, longterm effectiveness of educations in improving cancer knowledge of the deaf has to be reported cautiously. Current deaf-tailored education interventions are limited, but included functional features which facilitate communicating cancer health information to the deaf community. In fact, cancer literacy might improve considering deaf community preferences such as using a short open caption, sign language, and plain language in educational interventions, but further research is recommended.

Choosing Channels, Sources, and Content for Communicating Prostate Cancer Information to Black Men: A Systematic Review of the Literature

The purpose of this study was to identify effective channels, sources, and content approaches for communicating prostate cancer prevention information to Black men. The Web of Science, PubMed and GoogleScholar databases, as well as reviews of reference lists for selected publications, were searched to select articles relevant to cancer communication channels, sources or content for Black men, focused on male-prevalent cancers and published in English. Articles were excluded if they examined only patient–provider communication, dealt exclusively with prostate cancer patients or did not separate findings by race. The selection procedures identified 41 relevant articles, which were systematically and independently reviewed by two team members to extract data on preferred channels, sources, and content for prostate cancer information. This review revealed that Black men prefer interpersonal communication for prostate cancer information; however, video can be effective. Trusted sources included personal physicians, clergy, and other community leaders, family (especially spouses) and prostate cancer survivors. Men want comprehensive information about screening, symptoms, treatment, and outcomes. Messages should be culturally tailored, encouraging empowerment and “ownership” of disease. Black men are open to prostate cancer prevention information through mediated channels when contextualized within spiritual/cultural beliefs and delivered by trusted sources.

African American Women's Involvement in Promoting Informed Decision-Making for Prostate Cancer Screening Among Their Partners/Spouses

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.

Increasing Routine Cancer Screening Among Underserved Populations Through Effective Communication Strategies: Application of a Health Literacy Framework

Cancer prevention and control efforts serve as national priorities, as cancer is the second leading cause of death in the USA. In addition, cancer disparities exist, with racial/ethnic minority, low-income, and uninsured populations suffering the greatest burden. The goal of this paper is to describe the role that effective health communication can play in increasing routine cancer screening among medically underserved populations, thus decreasing persistent health disparities. For this paper, we applied Sorenson's integrated model of health literacy as a framework for identifying communication gaps and opportunities that can help improve cancer screening specifically at federally qualified health centers (FQHCs). This integrated model consists of four interrelated dimensions: access, understand, appraise, and apply. Employing communication strategies across this health literacy framework has the potential to facilitate improved decision making and cancer screening outcomes among the most underserved populations.

Commentary: Building an Evidence Base for Promoting Informed Prostate Cancer Screening Decisions: An Overview of a Cancer Prevention and Control Program

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.