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HL S- 301V - M72
HUMAN SEXUALITY
Section Instructor: Kathleen Thompson
Examining the Breast Cancer Prevention Programs Available for
Ethnic Minority Women
Submitted by: Khaled Almedej
Student Number: 800381515
Table of contents
The Critical Thinking Process………………………………………………………. Page 2
Introduction………..…………………………………………………………………. Page 3
The Breast Cancer Prevention Programs For Ethnic Minority Women ………… Page 5
The Project SAFe (Screening Adherence Follow-Up Program) ………………….. Page 5
Prevention Care Management……………………………………………………….. Page 7
Relevant Findings …………………………………………………………………….. Page 9
Design Theory-based Intervention ………………………………………………….. Page 10
Conclusion……………………………………………………………………………... Page 12
References …………………………………………………………………………….. Page 14
The Critical Thinking Process
The research activity assigned to me is what I considered as a perfect reflection of what other gender is experiencing. It is a common understanding that differences in gender often results to misunderstanding, discrimination, and conflicts. This activity however has helped me open my view on the other aspects of life, the one that I do not personally experience but is exposed to, because I live and dwell with the opposite sex. When given this task to complete, I began researching what is the common health problems experienced by women, and who are the most disadvantaged when struck by this problem. In this regard, I selected the topic, “Examining the Breast Cancer Prevention Programs Available for Ethnic Minority Women”.
Honestly, before this activity, I do not care about breast cancer and ethnic women, however, there is a curiosity in me every time I hear about how high is the prevalence of this disease among women and how it become one of the common causes of death among them. Decided on the topic, I started the research study on breast cancer as one of the dreaded women’s diseases, specifically on the ethnic minority women, and what prevention programs are there for them, through getting all relevant information and putting them in a file. The next thing I did was read and sorted critically each article and stories that I filed so that it will be easy for me to go back to them when I write the formal paper and also, it makes it easier for me to create references. I reread the documents and began my analysis and drafting of the paper. After I finished the draft, I examined it again and I checked for common errors such as spelling, grammar, punctuation, etc. to ensure that when I write the final paper, it will be perfect as expected. In writing the final paper, I also critically examine the flow of my narrative, ensuring that everything falls right into places. Once finished, I reread the paper, feeling contented that I just did an excellent research paper.
Introduction
Based on my personal research, statistics showed that breast cancer is considered as the most common gender-specific cause of death among women. Various researches have recorded a much higher prevalence of breast cancer among Caucasian women than with ethnic minority women (Kiser-Larson, 2001). The ethnic minority women who have breast cancer recorded a higher mortality rate because they tend to learn their condition at a later stage, and when no cure can be performed (Kiser-Larson, 2001). The incidence and mortality rates are the two commonly used measurements in evaluating the burden of cancer to the total population (SEER, 2000). In a survey conducted to 1500 women in 2009, it was revealed that only 36% of Asian women have an understanding of the cervical cancer risks; more than 45% of black and ethnic minority women whose age are more than 50, had never been to a breast screening appointment; 76% of the respondents have admitted that they had not received any invitation for breast screening; of the black minority women, 43% have never had self examination of their breasts fro lumps, this is quite higher because in a survey of the general population, the record was only 11 %; and lastly, 55% of the black, ethnic minority women did not even know what should be looked for when they perform breast examination. (Basu, 2010)
Cancer screening among minority women are less likely because of the various barriers such as language, lack of or low health knowledge, cultural norms, and lack of health care insurance coverage. The National Cancer Institute stated that the racial and ethnic minorities receive poor quality healthcare that white Americans not because of their ethnicity but because of their social class (NCI, 2005). The NCI believed that the socioeconomic status of the ethnic minorities play as a major factor in the differences of cancer mortality rates and incidences, risks factors involved, and the screening prevalence (NCI, 2005). The American Society of Clinical Oncology (ASCO) revealed that minority groups lack the same health care provided to white people. The ASCO shared a statistics from the 2008 Commonwealth Fund and the 2006 US Census Bureau revealing that the uninsured rate of the non-Hispanic compared to whites remained only at 11% in 2006. The rate of uninsured African Americans raised from 19% in 2005 to 21% in 2006; the rate of uninsured Asian people living in the US have also declined from 17% in 2005, to 16% in 2006; of the total American Hispanic people, the uninsured rate raised from only 32% in 2005, to 34% in 2006. What is even more alarming is the fact that the ratio of the American Indian/Alaska Native people that do not have health insurance is 1 is to 3. Lastly, 16% of the African Americans, and 13% of Hispanic American depend on the local hospitals or clinics as their source of average health care, this is also higher compared with the 8% of white Americans.
Recently, the government expanded the access to cancer care and clinical trials to minority groups, with the aim of ensuring that these groups of people are provided access to the same benefits that the white patients receive (CDC, 2005). This paper intends to provide the following
(a) review the breast cancer prevention programs for ethnic minority women;
(b) discusses various intervention programs designed to:
a. build awareness of breast cancer risks and the importance of regular screening;
b. motivate ethnic minority women to attend follow-up screenings; and
c. Modify behavior of ethnic women towards breast cancer prevention.
(c) Design theory-based interventions:
a. Discuss theory;
b. apply theoretical constructs to address behavior that is being modified; and
c. apply theoretical constructs to components of the intervention.
The Breast Cancer Prevention Programs For Ethnic Minority Women
Davies, et al., (2010) reported that there is a growing interest in the use of behavioral, cognitive and organizational theories, in the understanding of various reasons that pose as barriers to the design, and implementation of intervention programs. The new method was recorded as tremendously helpful in improving the professional conduct, and to help explore the social impacts of intervention programs. However, the problem that is still persistent until today is how to perform a systematic evaluation of the effects of the procedures used in the distribution and implementation strategies, and the interpretation of the controlled group. (Davies, et al., 2010) Various studies revealed a strong relationship between the cognitive and behavioral factors of ethnic women and the higher rate of cancer deaths. Barriers to the incidence may specifically include, lack or low health awareness, negative attitudes toward screening and follow-up, and the socioeconomic factors. In order to effect change on the cognitive, motivation, and behavior of ethnic women, various behavioral modification and cognitive programs such as the Project SAFe (Screening Adherence Follow-Up Program) and the Prevention Care Management were created by the National Cancer Institute.
The Project SAFe (Screening Adherence Follow-Up Program)
The SAFe Project is a program of the National Cancer Institute, through the Research-tested Intervention Programs (RTIPs), which is intended to diagnose breast cancer at its early stage, do follow-up monitoring, and treatment sessions that help in increasing the survival rates of breast cancer patients. The SAFe is particularly focus on ethnic-minority women because of the fact that they tend to delay or take for granted follow-up appointments, after knowing any abnormal results in their mammogram test. According to the Research-tested Intervention Programs (RTIPs), ethnic-minority women tend to take for granted their health because of various factors including lack of or low health literacy, irregular sources of medical care, psychological distress, culture, language conflicts, uncoordinated treatment services, and lack of insurance.
The Project SAFe is a behavior modification program, primarily intended to create patient navigation counseling and case management with specific focus on lowering the barriers that prevent low-income, ethnic-minority women, aged 19 years and above, to receive regular screening and abnormal mammogram follow-up treatments. (Centers for Disease Control and Prevention (CDC), 2007) The Project SAFe intervention is done by an organization using only train counselors, and after identifying a targeted patient. The procedure begins by making phone calls to identified target patients, with the help of the medical records, adhere each participant to making follow-up and subsequent diagnostic sessions with their physicians. The time needed to implement the SAFe intervention depends on the efficiency of the procedures used in identifying the targeted patient-respondents, the time required to create the emails or direct mails, and other message prompts, and the sampling size. (Centers for Disease Control and Prevention (CDC), 2007)
Samples were taken from a list of all women who had abnormal mammography conducted at any public medical center for low-income women. The participants of the survey are two hundred four randomly selected patients who have agreed to participate in the study. The samples were grouped into two: the intervention which consists of 96 women, and the usual-care control condition, through a mailed appointment-reminder postcards, which is 108 women in total. Most of the participants were born non-English speaking Latinas, and were foreign-born. (Centers for Disease Control and Prevention (CDC), 2007)
The procedure of the intervention started in the investigator explaining the purpose of the study and the design, obtaining their consents, and performing a scripted Adherence Risk Evaluation, to help confirm the potential reasons that pose as barriers to follow-up appointments. It is important that the investigator speaks Spanish and English. Afterward, the barriers are evaluated based on the respondent’s concerns which included “concerns about diagnostic procedures, lack of understanding of the nature of the follow-up test, worry about costs, transportation, perceived emotional support, and family problems or responsibilities that could interfere with adherence. Outcomes included completed follow-up appointments (i.e., adherence) and timely follow-up appointments (i.e., timeliness of adherence). Outcomes were assessed based on a periodic review of patients' medical records”. (Centers for Disease Control and Prevention (CDC), 2007)
Prevention Care Management
Prevention Care Management (PCM) is described as system that uses a centralized telephone care management to influence an increase in the cancer screening rate of women in the age of 50-69. The need to increase the rates of screening for people who are suspected to have cancer including breast, cervical, and colorectal, is directly related to lowering the cancer mortality rate. The rate of cancer screening among ethnic minorities and individuals who also belong to low socioeconomic status are low, which often results to late-stage diagnoses that results to higher rate of deaths from cancer. In this regard, an intervention program is needed to influence an increase in the cancer screening rate. (National Cancer Institute (NCI), 2006) Through the PCM, women receive calls from prevention care managers or staff, who performs the screening process, asking them the possible reasons why they delay or prevent the cancer screening procedures performed on them.
The PCM intervention program was targeted at women who are between ages 50 to 69 and to their health care providers. The respondents are taken through routine visits to participating health centers or through referrals from clinicians. The selected participants are women from low-income minority groups who were subjected to cancer screening, and have to be subjected to follow up screenings. The samples consisted of Spanish-speaking women who are 873 in total, English-speaking women, 513 in total, and 4 Haitian Creole speaking women. The participants were randomly grouped into an intervention group and a usual-care control group. The participants have received an average of four calls, from the prevention care managers, in the period covering 18 months.
A structured script was used by the prevention care manager during the phone calls, to motivate support and ensure that each of the patient’s specific reason is covered, allow writing provisions and clinician recommendations for future screenings, and to provide activation cards to patient that will improve their communication with the clinician. Scheduled appointments, providing of accurate information about the screening, reminder calls to prompt women of their appointments, sending letters, sending directions of screening facilities, and assisting women to find means of transportation to help them come to their appoints are some other ways utilized in this intervention. The time required to conduct all the activities of the intervention program depends widely on the efficiency of the targeting process, and the respondent size. The results included change in the status of screening for cancer tests, evaluated through checking the medical records on examinations when the patients have come.
Relevant Findings
This section of the paper describes the existing health prevention interventions and relating programmatic and methodological characteristics to study outcomes.
The Project SAFe (Screening Adherence Follow-Up Program)
The Project SAFe study showed that the patients under the intervention group are the more likely patients who adhere to recommendations for diagnostic follow-up appointments which is 90% compared to the usual-care patients who gathered a 66% result, or p<.001. The intervention group patients tend to follow recommendation for appointments for diagnostic follow-up on a timely manner as evidenced by the result which is 77 % compared to the usual-care group, which was recorded at 57%; thus, p= .01. In the evaluation of the SAFe services, 44 patients were selected randomly through a telephone survey, of which 80% or 35 women said the services are good to excellent, and overall. 94.3% have rated the SAFe services as mostly or very satisfying. Likewise, the 90% women rated that the study helped them realized the importance of follow-up test when abnormal mammogram was found, and getting future mammograms to ensure health. The program under a 5-point rate (1.0 being the lowest and 5.0 as the highest) received an integrity rating of 4.1 percent, intervention impact of 3.5 %, and dissemination capability of 5.0%.
Prevention Care Management
The PCM intervention program revealed that between the baseline and follow-up services, the women belonging to the intervention group have increased their knowledge and awareness of cancer screening by 5% while the usual treatment group was increased by only 1%; (p<.017). The women in the intervention group has also showed an increase of 14% when they underwent up-to-date for two cancer screenings which is higher than the usual treatment group that increased only by 1%; (p<.017). On the third cancer screening, an increase of 22% was recorded of the women under the intervention group while the usual treatment group who were up-to-date increased only by 8% (p<.017). The rate of mammography screenings also increased among the women in the intervention group who were up-to-date by 10% whereas, the usual treatment group decreased by 2%, but the decrease has no significant effect based on statistical treatment.
The intervention program under the rate of 1-5, one being the lowest, and 5 as the highest, received a 4.1 rate on research integrity; 3.0 on intervention impact; and 5.0 on dissemination capability.
Design Theory-based Intervention
Davies, et al (2010), concluded that theory-based approach provide a greater importance in understanding the barriers, and design interventions, as well as in exploring mediation methods that result to scientific improvements of the science of implementation research. Davies, et al (2010) recommended that theory-based studies should be considered when conducting a study. The rate of breast cancer mortality rate among ethnic minorities was reportedly higher because of the negative behavior of these groups toward intervention and prevention programs. In this regard, improving the knowledge of the ethnic minorities on the risks of not meeting follow-up checkups and undergoing screening will help in increasing the screening rates that will in turn lower the cases of deaths from cancer. The researchers should critically provide theory-based approach in understanding the reasons why despite the government’s campaign on breast cancer prevention, the rate of mortality is still high among ethnic minority women in the United States.
The author believes that psychosocial factor plays an important role in the prevalence. Angell, et al (2003) believed that women diagnosed with breast cancer, who live in rural areas, require continued emotional and educational support. The role of the behavior is very important in the prevention of breast cancer among ethnic minority women. Fry and Prentic-Dunn, (2005) in their study titled Effects of a psychosocial intervention on breast self-examination attitudes and behaviors, a study conducted to promote self-examination of breasts among young women, used the Protection Motivation Theory in understanding the attitudes and behaviors of women on the adaption process, and the effects of psychosocial intervention. Napoles-Springer, & Ortiz (2005) in their study of Latina breast cancer patients, believe that psychosocial support services help in improving the quality of life of women with breast cancer.
Protection Motivation Theory was referred to as the cognitive processes that happen when a person receives the health information (Fry and Prentic-Dunn, 2005). In the PMT study, it described the process by which respondents through their basic cognition of the breast self-examination responded to the requirements of the study. The PMT considered the probability of responses based on perception of the threat and the vulnerability of the threat against the likelihood of negative response. Coping appraisal plays an important role in testing this theory because coping appraisal is the ability of evaluating the level of threat in the situation (Fry and Prentic-Dunn, 2005).
Ethnic minority women tend to be more subdued to their husbands, and prioritize their family before themselves. Applying the Protection Motivation Theory, in the intervention programs to lessen the breast cancer deaths will require the use of information campaigns and awareness programs. Ethnic minority women should realize the risk involved in their decisions to attend screening schedules and follow-ups. Relating the possible impact of taking the screening schedules for granted to their family when they become sickly or die, will also be more effective. Graves, (2001) studied the impact of social cognitive variables to the coping behaviors and quality of life interventions of the breast cancer survivors.
Graves, (2000) believed that psychosocial interventions have provided helpful effects to cancer survivors, as evidenced in the various reviews conducted on the same topic. Graves (2001) concluded that intervention programs that help in improving social skills and education of the patients on the breast cancer provide better developments to cancer patients than any supportive programs or standard healthcare. Behavior modification is likewise important in building self-efficacy, outcome expectations, and self-regulations that help in removing rejections and turn them to positive intervention (Graves, 2001). Lim (2009) also revealed that there are unique ethnic and linguistic patterns which provide relevance in the behaviors towards risk and cancer screening.
Conclusion
Studying and resolving women’s health issue is very important to a society, primarily because, women performs various important roles and responsibilities in the family, which contributes largely to the kind of society there will be. The important tasks hold by women in the family and in her society, exposed her to many diseases that can destroy her health and eventually result to death. The need to examine the diseases that struck women and claim their lives is very necessary so that prevention programs can be created to halt the possible spread or increase in mortality ratings of women. As statistics revealed, breast cancer is one of the main causes of women’s death and early intervention and prevention programs are critical in halting or stopping the death rate from breast cancer. However, as important as providing intervention programs, the government should ensure that the common publics, especially the indigent people understand that there are prevention and intervention programs that can help them.
The knowledge of the people on the benefit of the intervention program is very important. Ethnic minority women have higher mortality rate because of various reasons that are mostly related to their social statuses. Using the theory of psychosocial may help in improving intervention programs. Gaining their cooperation and ensuring effective intervention approach are the results of improving the psychosocial elements in an intervention program especially to ethnic minority groups. Learning what is important to them, knowing their language, and understanding the ethic’s belief are helpful ways to effectively implement an intervention program. Lastly, the government should create policies that require every woman to have a regular breast check up, so that the issues of cancer determination delay and intervention rejection can be avoided.
References
Angell, K. L, Kreshka, M. A., McCoy, R., Donnelly, P. Turner-Cobb, J. M., Graddy, K., Kraemer, H. C., and Koopman, C. (2003). Psychosocial intervention for rural women with breast cancer. The sierra stanford partnership. Journal of General Internal Medicine. Volume 18, Number 7, 499-507, DOI: 10.1046/j.1525-1497.2003.20316.x.
Basu, S. (2010). Ethnic Minority Cancer Awareness. Desiblitzteam. Retrieved from: http://www.desiblitz.com/content/ethnic-minority-cancer-awareness
Chollette, V. Y. Croyle, R.T., Glanz, K. and Pinn, W. (2003). Cancer-Related Health Disparities in Women. February 2003, Vol 93, No. 2. American Journal of Public Health 292-298.
Davies, P. Walker, A.E., and Grimshaw, J. M. (2010). A Systematic Review Of The Use Of Theory In The Design Of Guideline Dissemination And Implementation Strategies And Interpretation Of The Results Of Rigorous Evaluations. Implementation Science 2010, 5:14.
Eliminate Disparities in Cancer Screening & Management. CDC, Office of Minority Health (OMH). 2005. Retrieved from: http://www.cdc.gov/omh/AMH/factsheets/cancer.htm
Fry, R. B. and Prentic-Dunn, S. P. (2005) Effects of a psychosocial intervention on breast self-examination attitudes and behaviors. Oxford Journals.
Graves, K.D. (2000). Social cognitive theory and cancer patients’ quality of life: Meta-analysis of psychosocial intervention components. Manuscript under revision, Virginia Polytechnic and State University.
Graves, K.D. (2001). Quality of Life Intervention For Breast Cancer Survivors: Application of Social Cognitive Theory. Virginia Polytechnic and State University.
Health Disparities and Cancer in the United States: Facts and Figures. American Society of Clinical Oncology (ASCO). Cancer.net. Last updated in August 05, 2008. Retrieved from: http://www.cancer.net/patient/All+About+Cancer/Risk+Factors+and+Prevention/Health+Disparities+and+Cancer/Overview+of+Health+Disparities+and+Cancer
Health Disparities in Cancer. Cancer Prevention and Control. Centers for Disease Control and Prevention. 2010. Retrieved from: http://www.cdc.gov/cancer/healthdisparities/#pia
Incidence and Mortality. (2000). SEER, Cancer.gov. Retrieved from: http://seer.cancer.gov/publications/ses/incidence.pdf
Kiser-Larson, N. (2001). Breast Cancer Treatment Options: Do Minority Women Have a Choice? Minority Nurse. Alloy Corporation. Retrieved from: http://www.minoritynurse.com/nurse-researchers/breast-cancer-treatment-options-do-minority-women-have-choice
Lim, J-W.. Journal of Women's Health. June 2010, 19(6): 1097-1107. doi:10.1089/jwh.2009.1614.
Napoles-Springer, A. and Ortiz, C. (2005). Psychosocial Support Services for Latinas with Breast Cancer. University of California, San Francisco. Retrieved from: http://www.cbcrp.org/research/pagegrant.asp?grant_id=4032
NCI Health Information Tip Sheet for Writers: Cancer Health Disparities. NIH, NCI, 2005. Retrieved from: http://www.cancer.gov/newscenter/tip-sheet-cancer-health-disparities
Prevention Care Management. National Institute of Health, National Cancer Institute, and USA.gov. 2005. Retrieved from: http://rtips.cancer.gov/rtips/programDetails.do?programId=295722
Project SAFe (Screening Adherence Follow-Up Program). Research-tested Intervention Programs (RTIPs). National Cancer Institute. CDC (Grant number: U57/CCU315111-01). Published in 2007, and last modified on March 24, 2010, Retrieved from: http://rtips.cancer.gov/rtips/about.do
HL S- 301V - M72
HUMAN SEXUALITY
Section Instructor: Kathleen Thompson
Examining the Breast Cancer Prevention Programs Available for
Ethnic Minority Women
Submitted by: Khaled Almedej
Student Number: 800381515
Table of contents
The Critical Thinking Process………………………………………………………. Page 2
Introduction………..…………………………………………………………………. Page 3
The Breast Cancer Prevention Programs For Ethnic Minority Women ………… Page 5
The Project SAFe (Screening Adherence Follow-Up Program) ………………….. Page 5
Prevention Care Management……………………………………………………….. Page 7
Relevant Findings …………………………………………………………………….. Page 9
Design Theory-based Intervention ………………………………………………….. Page 10
Conclusion……………………………………………………………………………... Page 12
References …………………………………………………………………………….. Page 14
The Critical Thinking Process
The research activity assigned to me is what I considered as a perfect reflection of what other gender is experiencing. It is a common understanding that differences in gender often results to misunderstanding, discrimination, and conflicts. This activity however has helped me open my view on the other aspects of life, the one that I do not personally experience but is exposed to, because I live and dwell with the opposite sex. When given this task to complete, I began researching what is the common health problems experienced by women, and who are the most disadvantaged when struck by this problem. In this regard, I selected the topic, “Examining the Breast Cancer Prevention Programs Available for Ethnic Minority Women”.
Honestly, before this activity, I do not care about breast cancer and ethnic women, however, there is a curiosity in me every time I hear about how high is the prevalence of this disease among women and how it become one of the common causes of death among them. Decided on the topic, I started the research study on breast cancer as one of the dreaded women’s diseases, specifically on the ethnic minority women, and what prevention programs are there for them, through getting all relevant information and putting them in a file. The next thing I did was read and sorted critically each article and stories that I filed so that it will be easy for me to go back to them when I write the formal paper and also, it makes it easier for me to create references. I reread the documents and began my analysis and drafting of the paper. After I finished the draft, I examined it again and I checked for common errors such as spelling, grammar, punctuation, etc. to ensure that when I write the final paper, it will be perfect as expected. In writing the final paper, I also critically examine the flow of my narrative, ensuring that everything falls right into places. Once finished, I reread the paper, feeling contented that I just did an excellent research paper.
Introduction
Based on my personal research, statistics showed that breast cancer is considered as the most common gender-specific cause of death among women. Various researches have recorded a much higher prevalence of breast cancer among Caucasian women than with ethnic minority women (Kiser-Larson, 2001). The ethnic minority women who have breast cancer recorded a higher mortality rate because they tend to learn their condition at a later stage, and when no cure can be performed (Kiser-Larson, 2001). The incidence and mortality rates are the two commonly used measurements in evaluating the burden of cancer to the total population (SEER, 2000). In a survey conducted to 1500 women in 2009, it was revealed that only 36% of Asian women have an understanding of the cervical cancer risks; more than 45% of black and ethnic minority women whose age are more than 50, had never been to a breast screening appointment; 76% of the respondents have admitted that they had not received any invitation for breast screening; of the black minority women, 43% have never had self examination of their breasts fro lumps, this is quite higher because in a survey of the general population, the record was only 11 %; and lastly, 55% of the black, ethnic minority women did not even know what should be looked for when they perform breast examination. (Basu, 2010)
Cancer screening among minority women are less likely because of the various barriers such as language, lack of or low health knowledge, cultural norms, and lack of health care insurance coverage. The National Cancer Institute stated that the racial and ethnic minorities receive poor quality healthcare that white Americans not because of their ethnicity but because of their social class (NCI, 2005). The NCI believed that the socioeconomic status of the ethnic minorities play as a major factor in the differences of cancer mortality rates and incidences, risks factors involved, and the screening prevalence (NCI, 2005). The American Society of Clinical Oncology (ASCO) revealed that minority groups lack the same health care provided to white people. The ASCO shared a statistics from the 2008 Commonwealth Fund and the 2006 US Census Bureau revealing that the uninsured rate of the non-Hispanic compared to whites remained only at 11% in 2006. The rate of uninsured African Americans raised from 19% in 2005 to 21% in 2006; the rate of uninsured Asian people living in the US have also declined from 17% in 2005, to 16% in 2006; of the total American Hispanic people, the uninsured rate raised from only 32% in 2005, to 34% in 2006. What is even more alarming is the fact that the ratio of the American Indian/Alaska Native people that do not have health insurance is 1 is to 3. Lastly, 16% of the African Americans, and 13% of Hispanic American depend on the local hospitals or clinics as their source of average health care, this is also higher compared with the 8% of white Americans.
Recently, the government expanded the access to cancer care and clinical trials to minority groups, with the aim of ensuring that these groups of people are provided access to the same benefits that the white patients receive (CDC, 2005). This paper intends to provide the following
(a) review the breast cancer prevention programs for ethnic minority women;
(b) discusses various intervention programs designed to:
a. build awareness of breast cancer risks and the importance of regular screening;
b. motivate ethnic minority women to attend follow-up screenings; and
c. Modify behavior of ethnic women towards breast cancer prevention.
(c) Design theory-based interventions:
a. Discuss theory;
b. apply theoretical constructs to address behavior that is being modified; and
c. apply theoretical constructs to components of the intervention.
The Breast Cancer Prevention Programs For Ethnic Minority Women
Davies, et al., (2010) reported that there is a growing interest in the use of behavioral, cognitive and organizational theories, in the understanding of various reasons that pose as barriers to the design, and implementation of intervention programs. The new method was recorded as tremendously helpful in improving the professional conduct, and to help explore the social impacts of intervention programs. However, the problem that is still persistent until today is how to perform a systematic evaluation of the effects of the procedures used in the distribution and implementation strategies, and the interpretation of the controlled group. (Davies, et al., 2010) Various studies revealed a strong relationship between the cognitive and behavioral factors of ethnic women and the higher rate of cancer deaths. Barriers to the incidence may specifically include, lack or low health awareness, negative attitudes toward screening and follow-up, and the socioeconomic factors. In order to effect change on the cognitive, motivation, and behavior of ethnic women, various behavioral modification and cognitive programs such as the Project SAFe (Screening Adherence Follow-Up Program) and the Prevention Care Management were created by the National Cancer Institute.
The Project SAFe (Screening Adherence Follow-Up Program)
The SAFe Project is a program of the National Cancer Institute, through the Research-tested Intervention Programs (RTIPs), which is intended to diagnose breast cancer at its early stage, do follow-up monitoring, and treatment sessions that help in increasing the survival rates of breast cancer patients. The SAFe is particularly focus on ethnic-minority women because of the fact that they tend to delay or take for granted follow-up appointments, after knowing any abnormal results in their mammogram test. According to the Research-tested Intervention Programs (RTIPs), ethnic-minority women tend to take for granted their health because of various factors including lack of or low health literacy, irregular sources of medical care, psychological distress, culture, language conflicts, uncoordinated treatment services, and lack of insurance.
The Project SAFe is a behavior modification program, primarily intended to create patient navigation counseling and case management with specific focus on lowering the barriers that prevent low-income, ethnic-minority women, aged 19 years and above, to receive regular screening and abnormal mammogram follow-up treatments. (Centers for Disease Control and Prevention (CDC), 2007) The Project SAFe intervention is done by an organization using only train counselors, and after identifying a targeted patient. The procedure begins by making phone calls to identified target patients, with the help of the medical records, adhere each participant to making follow-up and subsequent diagnostic sessions with their physicians. The time needed to implement the SAFe intervention depends on the efficiency of the procedures used in identifying the targeted patient-respondents, the time required to create the emails or direct mails, and other message prompts, and the sampling size. (Centers for Disease Control and Prevention (CDC), 2007)
Samples were taken from a list of all women who had abnormal mammography conducted at any public medical center for low-income women. The participants of the survey are two hundred four randomly selected patients who have agreed to participate in the study. The samples were grouped into two: the intervention which consists of 96 women, and the usual-care control condition, through a mailed appointment-reminder postcards, which is 108 women in total. Most of the participants were born non-English speaking Latinas, and were foreign-born. (Centers for Disease Control and Prevention (CDC), 2007)
The procedure of the intervention started in the investigator explaining the purpose of the study and the design, obtaining their consents, and performing a scripted Adherence Risk Evaluation, to help confirm the potential reasons that pose as barriers to follow-up appointments. It is important that the investigator speaks Spanish and English. Afterward, the barriers are evaluated based on the respondent’s concerns which included “concerns about diagnostic procedures, lack of understanding of the nature of the follow-up test, worry about costs, transportation, perceived emotional support, and family problems or responsibilities that could interfere with adherence. Outcomes included completed follow-up appointments (i.e., adherence) and timely follow-up appointments (i.e., timeliness of adherence). Outcomes were assessed based on a periodic review of patients' medical records”. (Centers for Disease Control and Prevention (CDC), 2007)
Prevention Care Management
Prevention Care Management (PCM) is described as system that uses a centralized telephone care management to influence an increase in the cancer screening rate of women in the age of 50-69. The need to increase the rates of screening for people who are suspected to have cancer including breast, cervical, and colorectal, is directly related to lowering the cancer mortality rate. The rate of cancer screening among ethnic minorities and individuals who also belong to low socioeconomic status are low, which often results to late-stage diagnoses that results to higher rate of deaths from cancer. In this regard, an intervention program is needed to influence an increase in the cancer screening rate. (National Cancer Institute (NCI), 2006) Through the PCM, women receive calls from prevention care managers or staff, who performs the screening process, asking them the possible reasons why they delay or prevent the cancer screening procedures performed on them.
The PCM intervention program was targeted at women who are between ages 50 to 69 and to their health care providers. The respondents are taken through routine visits to participating health centers or through referrals from clinicians. The selected participants are women from low-income minority groups who were subjected to cancer screening, and have to be subjected to follow up screenings. The samples consisted of Spanish-speaking women who are 873 in total, English-speaking women, 513 in total, and 4 Haitian Creole speaking women. The participants were randomly grouped into an intervention group and a usual-care control group. The participants have received an average of four calls, from the prevention care managers, in the period covering 18 months.
A structured script was used by the prevention care manager during the phone calls, to motivate support and ensure that each of the patient’s specific reason is covered, allow writing provisions and clinician recommendations for future screenings, and to provide activation cards to patient that will improve their communication with the clinician. Scheduled appointments, providing of accurate information about the screening, reminder calls to prompt women of their appointments, sending letters, sending directions of screening facilities, and assisting women to find means of transportation to help them come to their appoints are some other ways utilized in this intervention. The time required to conduct all the activities of the intervention program depends widely on the efficiency of the targeting process, and the respondent size. The results included change in the status of screening for cancer tests, evaluated through checking the medical records on examinations when the patients have come.
Relevant Findings
This section of the paper describes the existing health prevention interventions and relating programmatic and methodological characteristics to study outcomes.
The Project SAFe (Screening Adherence Follow-Up Program)
The Project SAFe study showed that the patients under the intervention group are the more likely patients who adhere to recommendations for diagnostic follow-up appointments which is 90% compared to the usual-care patients who gathered a 66% result, or p<.001. The intervention group patients tend to follow recommendation for appointments for diagnostic follow-up on a timely manner as evidenced by the result which is 77 % compared to the usual-care group, which was recorded at 57%; thus, p= .01. In the evaluation of the SAFe services, 44 patients were selected randomly through a telephone survey, of which 80% or 35 women said the services are good to excellent, and overall. 94.3% have rated the SAFe services as mostly or very satisfying. Likewise, the 90% women rated that the study helped them realized the importance of follow-up test when abnormal mammogram was found, and getting future mammograms to ensure health. The program under a 5-point rate (1.0 being the lowest and 5.0 as the highest) received an integrity rating of 4.1 percent, intervention impact of 3.5 %, and dissemination capability of 5.0%.
Prevention Care Management
The PCM intervention program revealed that between the baseline and follow-up services, the women belonging to the intervention group have increased their knowledge and awareness of cancer screening by 5% while the usual treatment group was increased by only 1%; (p<.017). The women in the intervention group has also showed an increase of 14% when they underwent up-to-date for two cancer screenings which is higher than the usual treatment group that increased only by 1%; (p<.017). On the third cancer screening, an increase of 22% was recorded of the women under the intervention group while the usual treatment group who were up-to-date increased only by 8% (p<.017). The rate of mammography screenings also increased among the women in the intervention group who were up-to-date by 10% whereas, the usual treatment group decreased by 2%, but the decrease has no significant effect based on statistical treatment.
The intervention program under the rate of 1-5, one being the lowest, and 5 as the highest, received a 4.1 rate on research integrity; 3.0 on intervention impact; and 5.0 on dissemination capability.
Design Theory-based Intervention
Davies, et al (2010), concluded that theory-based approach provide a greater importance in understanding the barriers, and design interventions, as well as in exploring mediation methods that result to scientific improvements of the science of implementation research. Davies, et al (2010) recommended that theory-based studies should be considered when conducting a study. The rate of breast cancer mortality rate among ethnic minorities was reportedly higher because of the negative behavior of these groups toward intervention and prevention programs. In this regard, improving the knowledge of the ethnic minorities on the risks of not meeting follow-up checkups and undergoing screening will help in increasing the screening rates that will in turn lower the cases of deaths from cancer. The researchers should critically provide theory-based approach in understanding the reasons why despite the government’s campaign on breast cancer prevention, the rate of mortality is still high among ethnic minority women in the United States.
The author believes that psychosocial factor plays an important role in the prevalence. Angell, et al (2003) believed that women diagnosed with breast cancer, who live in rural areas, require continued emotional and educational support. The role of the behavior is very important in the prevention of breast cancer among ethnic minority women. Fry and Prentic-Dunn, (2005) in their study titled Effects of a psychosocial intervention on breast self-examination attitudes and behaviors, a study conducted to promote self-examination of breasts among young women, used the Protection Motivation Theory in understanding the attitudes and behaviors of women on the adaption process, and the effects of psychosocial intervention. Napoles-Springer, & Ortiz (2005) in their study of Latina breast cancer patients, believe that psychosocial support services help in improving the quality of life of women with breast cancer.
Protection Motivation Theory was referred to as the cognitive processes that happen when a person receives the health information (Fry and Prentic-Dunn, 2005). In the PMT study, it described the process by which respondents through their basic cognition of the breast self-examination responded to the requirements of the study. The PMT considered the probability of responses based on perception of the threat and the vulnerability of the threat against the likelihood of negative response. Coping appraisal plays an important role in testing this theory because coping appraisal is the ability of evaluating the level of threat in the situation (Fry and Prentic-Dunn, 2005).
Ethnic minority women tend to be more subdued to their husbands, and prioritize their family before themselves. Applying the Protection Motivation Theory, in the intervention programs to lessen the breast cancer deaths will require the use of information campaigns and awareness programs. Ethnic minority women should realize the risk involved in their decisions to attend screening schedules and follow-ups. Relating the possible impact of taking the screening schedules for granted to their family when they become sickly or die, will also be more effective. Graves, (2001) studied the impact of social cognitive variables to the coping behaviors and quality of life interventions of the breast cancer survivors.
Graves, (2000) believed that psychosocial interventions have provided helpful effects to cancer survivors, as evidenced in the various reviews conducted on the same topic. Graves (2001) concluded that intervention programs that help in improving social skills and education of the patients on the breast cancer provide better developments to cancer patients than any supportive programs or standard healthcare. Behavior modification is likewise important in building self-efficacy, outcome expectations, and self-regulations that help in removing rejections and turn them to positive intervention (Graves, 2001). Lim (2009) also revealed that there are unique ethnic and linguistic patterns which provide relevance in the behaviors towards risk and cancer screening.
Conclusion
Studying and resolving women’s health issue is very important to a society, primarily because, women performs various important roles and responsibilities in the family, which contributes largely to the kind of society there will be. The important tasks hold by women in the family and in her society, exposed her to many diseases that can destroy her health and eventually result to death. The need to examine the diseases that struck women and claim their lives is very necessary so that prevention programs can be created to halt the possible spread or increase in mortality ratings of women. As statistics revealed, breast cancer is one of the main causes of women’s death and early intervention and prevention programs are critical in halting or stopping the death rate from breast cancer. However, as important as providing intervention programs, the government should ensure that the common publics, especially the indigent people understand that there are prevention and intervention programs that can help them.
The knowledge of the people on the benefit of the intervention program is very important. Ethnic minority women have higher mortality rate because of various reasons that are mostly related to their social statuses. Using the theory of psychosocial may help in improving intervention programs. Gaining their cooperation and ensuring effective intervention approach are the results of improving the psychosocial elements in an intervention program especially to ethnic minority groups. Learning what is important to them, knowing their language, and understanding the ethic’s belief are helpful ways to effectively implement an intervention program. Lastly, the government should create policies that require every woman to have a regular breast check up, so that the issues of cancer determination delay and intervention rejection can be avoided.
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