Breast care screening for underserved African American women: Community-based participatory approach

Perceptions of abused Chinese women on community-based participatory approach programme in addressing their needs

BACKGROUND

The community-based participatory approach (CBPA) has gained increasing recognition worldwide for enhancing the effectiveness of intervention. It is relatively new in Chinese societies and participants' perceptions are underexplored. This study aims to explore abused Chinese women's perceptions on the CBPA programme in addressing their needs.

METHODS

A total of 11 abused Chinese women were recruited for a focus group and individual interviews. A semi-structured interview guide was used. All interviews were audio-recorded and data were transcribed verbatim. Conventional content analysis was used for analysis.

RESULTS

Four themes were identified regarding the women's perceptions and experiences of the community-based participatory approach programme: (1) Women's perceived acceptability of the CBPA programme; (2) Women's perceived usefulness of the CBPA programme; (3) Women's perceived feasibility of the CBPA programme; and (4) Empowering the women through participating in CBPA.

CONCLUSIONS

Abused Chinese women had high perceived acceptance and positive experiences towards the community-based participatory approach. Women benefited from their robust participation throughout the process. The findings confirm the potential of using the community-based participatory approach in designing interventions for future programme planning and intervention to address the needs of abused Chinese women.

Designing Worthy Waiting Spaces: A Cross-Cultural Study of Waiting Room Features and Their Impact on Women's Affective States

OBJECTIVE

This study examines the impact of ambulatory waiting room characteristics on patients' emotional states and investigates whether these states are universally experienced or influenced by social and cultural factors among women aged 18-35 from the three largest demographic groups in the United States: Black, Hispanic/Latina, and White.

BACKGROUND

Patients typically spend more time waiting for routine medical appointments than receiving care, and evidence suggests that waiting can reinforces power dynamics that benefit privileged groups, leading to different experiences for minority women seeking preventative care. Still, literature addressing the impact of waiting areas is largely limited to universal measures, and little is known about how different ethnic/race groups respond to waiting spaces.

METHODS

This inquiry used a questionnaire assessing 15 waiting room characteristics and testing four variables (furniture arrangement, room-scale, color saturation, and quantity of positive distractions) in a 2 × 3 quasiexperiment using a fractional randomized block design with 24 waiting room images.

FINDINGS

Responses from 1,114 participants revealed mutual preferences for sociopetal seating, positive distractions, neutral colors, and welcoming and calming environments. Yet, Black participants indicated significantly greater importance in seeing ethnically/racially similar patients and healthcare providers and strategies that promote transparency, including image-based provider directories and views into the clinic.

CONCLUSION

By investigating the impact of the waiting room environment on patient affect and comparing perceptions across three demographic groups of women, this study offers insights into potential strategies for improving access to preventative care services by creating more welcoming ambulatory care waiting environments.

Social determinants of health and US cancer screening interventions: A systematic review

There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US-based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer-reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8-18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.

A Health Inequity: Associations Between Cigarette Smoking Status and Mammogram Screening Among Women of Color

INTRODUCTION

We evaluated differences in yearly mammogram screening by smoking status in a sample of US women. We also examined differences in mammogram screening by race/ethnicity, age, and health care coverage.

METHODS

Data were from 1884 women participants in the 2018 Health of Houston Survey study. Binary logistic regression was used to assess the association between smoking status (current/former/non-smokers) and mammograms within 12 months. Moderators included race/ethnicity (Hispanic, Black, Asian, Other, White), age, and health care coverage.

RESULTS

In comparison to women who were non-smokers, current and former smokers showed lower odds to get a yearly mammogram (OR = 0.720; 95% CI = 0.709, .730 and OR = 0.702; 95% CI = 0.693, 0.710, respectively). Current smokers who identified as Hispanic or Black women and former smokers who identified as Hispanic, Asian, and other women showed lower odds of getting a mammogram (OR = 0.635, 95% CI = 0.611, 0.659; OR = 0.951, 95% CI = 0.919, 0.985) and (OR = 0.663, 95% CI = 0.642, 0.684; OR = 0.282, 95% CI = 0.263, 0.302; OR = 0.548, 95% CI = 0.496, 0.606) compared to White women. There were significant interactions by age and health care coverage.

CONCLUSIONS

Women of color who are current and former smokers showed lower odds to engage in mammogram screening, thus increasing their risk of undiagnosed breast cancer when compared to non-smokers. Ethnically diverse women already experience increased health disparities and smoking puts them at exacerbated risk of health complications and death.

IMPLICATIONS

Our findings suggest that smoking status is a modifiable behavioral risk factor that requires further attention in the prevention of breast cancer in ethnic minority women. Health care institutions and policymakers need to increase their awareness of and outreach efforts to women of color who smoke. These outreach efforts should focus on increasing access to smoking interventions and cancer screenings.

Breast Cancer in Black Women: Racial/Ethnic Disparities Affecting Survival

Breast cancer is the most common noncutaneous malignancy affecting women in the United States, with >245,000 cases diagnosed annually. Breast cancer mortality rates have continued to trend down in the past three decades, yet racial/ethnic disparities persist, with the worst mortality rates seen in Black women. Of note, when compared by race, this downward trend is also trailing in Black women. Survival after breast cancer is mainly driven by factors related to early detection and effective therapy. These factors can be grouped into "biological" such as age, genetic mutations, tumor characteristics; and "social" such as education, income, access to care. There have been studies attributing racial disparities solely to biological factors, and there are those attributing the disparities to social factors alone. Although the exact mechanism is unclear, a relationship between both factors as relates to racial disparities in breast cancer outcomes has been demonstrated. In this report, we review factors contributing to the increased morbidity and mortality for breast cancer in Black women and explore sociological relationships. Facing the worst poverty rates compared with other races, Black women are inevitably more likely to be uninsured, have limited access to quality education, and have fewer financial resources. The goal of this review was to elucidate the complex interplay between biological and social factors contributing to racial disparities in breast cancer outcomes. We conclude by emphasizing the need for interventions made at both local and national levels.

Health promotion interventions for African Americans delivered in U.S. barbershops and hair salons- a systematic review

BACKGROUND

African American adults suffer disproportionately from obesity-related chronic diseases, particularly at younger ages. In order to close the gap in these health disparities, efforts to develop and test culturally appropriate interventions are critical.

METHODS

A PRISMA-guided systematic review was conducted to identify and critically evaluate health promotion interventions for African Americans delivered in barbershops and hair salons. Subject headings and keywords used to search for synonyms of 'barbershops,' 'hair salons,' and 'African Americans' identified all relevant articles (from inception onwards) from six databases: Academic Search Ultimate, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, PubMed, Web of Science (Science Citation Index and Social Sciences Citation Index). Experimental and quasi-experimental studies for adult (> 18 years) African Americans delivered in barbershops and hair salons that evaluated interventions focused on risk reduction/management of obesity-related chronic disease: cardiovascular disease, cancer, and type 2 diabetes were included. Analyses were conducted in 2020.

RESULTS

Fourteen studies met criteria for inclusion. Ten studies hosted interventions in a barbershop setting while four took place in hair salons. There was substantial variability among interventions and outcomes with cancer the most commonly studied disease state (n = 7; 50%), followed by hypertension (n = 5; 35.7%). Most reported outcomes were focused on behavior change (n = 10) with only four studies reporting clinical outcomes.

CONCLUSIONS

Health promotion interventions delivered in barbershops/hair salons show promise for meeting cancer screening recommendations and managing hypertension in African Americans. More studies are needed that focus on diabetes and obesity and utilize the hair salon as a site for intervention delivery.

TRIAL REGISTRATION

PROSPERO CRD42020159050 .

Health Communication and the Arts in the United States: A Scoping Review

OBJECTIVES

Guided by the hypothesis that the arts can play a role in changing attitudes, beliefs, and health behaviors, the objectives of the study were to (1) overview artistic practices, interventions, and research being conducted at the intersection of the arts and health communication and (2) identify desired and observed outcomes and variables measured in these studies.

DATA SOURCE

The search strategy was developed iteratively with 2 health science librarians and conducted using 8 databases (Applied Social Sciences Index and Abstracts, Art and Architecture Source, CINAHL, Communication and Mass Media Complete, ERIC, PsycINFO, PubMed, and Web of Science) and hand searching. Articles included were published between 2014 and 2018.

STUDY INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria include US nonclinical setting and use of the arts (broadly defined) to change health knowledge, beliefs, behaviors, or awareness. Any articles not meeting inclusion criteria were excluded.

DATA EXTRACTION

Covidence's data extraction tool exported to MS Excel.

DATA SYNTHESIS

This final set of results was analyzed and synthesized by research design, population, sample size, health issue, purpose, variables measured, and findings.

RESULTS

In all, 78 articles met inclusion criteria. Number of participants ranged from 4 to 2140 (mean = 179); 61 (78.2%) outcome studies, including 8 experimental studies; 17 (21.79%) formative research or reports. Many different health topics were addressed and different art forms used.

CONCLUSION

The arts can help build knowledge and awareness of health issues. The authors highlight the need to build an evidence base for arts and public health.

Protocol for a systematic review of health promotion interventions for African Americans delivered in US barbershops and hair salons

INTRODUCTION

African American adults are disproportionately burdened by chronic diseases, particularly at younger ages. Developing culturally appropriate interventions is paramount to closing the gap in these health inequities. The purpose of this systematic review is to critically evaluate health promotion interventions for African Americans delivered in two environments that are frequented by this population: barbershops and hair salons. Characteristics of effective interventions will be identified and evidence for the effectiveness of these interventions will be provided. Results of this review will inform future health promotion efforts for African Americans particularly focused on the leading health inequities in obesity-related chronic diseases: cardiovascular disease, cancer and type 2 diabetes.

METHODS AND ANALYSIS

Subject headings and keywords will be used to search for synonyms of 'barbershops,' 'hair salons' and 'African Americans' to identify all relevant articles (from inception onwards) in the following databases: Academic Search Ultimate, Cumulative Index of Nursing and Allied Health Literature, Embase, PsycINFO, PubMed, Web of Science (Science Citation Index and Social Sciences Citation Index) and ProQuest Dissertations. Experimental and quasi-experimental studies for adult (>18 years) African Americans delivered in barbershops and hair salons will be included. Eligible interventions will include risk reduction/management of obesity-related chronic disease: cardiovascular disease, cancer and type 2 diabetes. Two reviewers will independently screen, select and extract data and a third will mediate disagreements. The methodological quality (or risk of bias) of individual studies will be appraised using the Effective Public Health Practice Project Quality Assessment Tool. Quality and content of the evidence will be narratively synthesised.

ETHICS AND DISSEMINATION

Since this is a protocol for a systematic review, ethical approval is not required. Findings from the review will be widely disseminated through conference presentations, peer-reviewed publications and traditional and social media outlets.

Sistas Taking a Stand for Breast Cancer Research (STAR) Study: A Community-Based Participatory Genetic Research Study to Enhance Participation and Breast Cancer Equity among African American Women in Memphis, TN

African American women are substantially underrepresented in breast cancer genetic research studies and clinical trials, yet they are more likely to die from breast cancer. Lack of trust in the medical community is a major barrier preventing the successful recruitment of African Americans into research studies. When considering the city of Memphis, TN, where the percentage of African Americans is significantly higher than the national average and it has a high rate of breast cancer mortality inequities among African American women, we evaluated the feasibility of utilizing a community-based participatory (CBPR) approach for recruiting African American women into a breast cancer genetic study, called the Sistas Taking A Stand for Breast Cancer Research (STAR) study. From June 2016 and December 2017, African American women age 18 and above were recruited to provide a 2 mL saliva specimen and complete a health questionnaire. A total of 364 African American women provided a saliva sample and completed the health questionnaire. Greater than 85% agreed to be contacted for future studies. Educational workshops on the importance of participating in cancer genetic research studies, followed by question and answer sessions, were most successful in recruitment. Overall, the participants expressed a strong interest and a willingness to participate in the STAR study. Our findings highlight the importance of implementing a CBPR approach that provides an educational component detailing the importance of participating in cancer genetic research studies and that includes prominent community advocates to build trust within the community.

"For lack of knowledge, our people will perish": Using focus group methodology to explore African-American communities' perceptions of breast cancer and the environment

Among women living in the United States, breast cancer is the second leading cause of cancer death. Disproportionate racial disparities in breast cancer exist, with African American (AA) women consistently having the highest rates of breast cancer related mortality despite lower incidence. This study attends to the Institute of Medicine's (IOM) call to action recommending the identification of effective strategies for communicating accurate and reliable breast cancer risk information to diverse audiences. Using focus group methodology, this study explores how AAs perceive and decipher information related to breast cancer and its relationship to their environment. Six focus groups were conducted. The sample (n = 50) was African American, 98% female, with an average age of 50.1 years. The focus group protocol consisted of open-ended questions designed to elicit information about participants' perceptions of their environment and its link to breast cancer. Focus groups were audio recorded and professionally transcribed. Analysis of the focus group transcripts revealed themes pertaining to these categories: (1) general knowledge and beliefs about breast cancer, (2) perceived environmental risks factors for breast cancer, (3) importance of seeking knowledge about breast cancer and the environment, and (4) recommended communication strategies. The emergent themes reflect the knowledge participants possessed about breast cancer and environmental risk factors, in addition to concerns about the importance of possessing accurate information, and how culturally appropriate health communication strategies can be used to disseminate breast cancer knowledge in the community. Findings from this study can be used for culturally appropriate communication about breast cancer and the environment with AA communities.

Reducing Disparities in Cancer Screening and Prevention through Community-Based Participatory Research Partnerships with Local Libraries: A Comprehensive Dynamic Trial

Reduction of cancer-related disparities requires strategies that link medically underserved communities to preventive care. In this community-based participatory research project, a public library system brought together stakeholders to plan and undertake programs to address cancer screening and risk behavior. This study was implemented over 48 months in 20 large urban neighborhoods, selected to reach diverse communities disconnected from care. In each neighborhood, Cancer Action Councils were organized to conduct a comprehensive dynamic trial, an iterative process of program planning, implementation and evaluation. This process was phased into neighborhoods in random, stepped-wedge sequence. Population-level outcomes included self-reported screening adherence and smoking cessation, based on street intercept interviews. Event-history regressions (n = 9374) demonstrated that adherence outcomes were associated with program implementation, as were mediators such as awareness of screening programs and cancer information seeking. Findings varied by ethnicity, and were strongest among respondents born outside the U.S. or least engaged in care. This intervention impacted health behavior in diverse, underserved and vulnerable neighborhoods. It has been sustained as a routine library system program for several years after conclusion of grant support. In sum, participatory research with the public library system offers a flexible, scalable approach to reduce cancer health disparities.