Empowering Latinas to Obtain Breast Cancer Screenings
Condition: Breastcancer; Breast Diseases
MeSH terms: Breast Neoplasms; Breast Diseases
Study type: Interventional

Summary: 
      The participatory-based project will quantify the 'added benefit' of an empowerment
      intervention relative to an education intervention for 150 Latinas on the following outcomes:
      women's adherence to breast cancer screening guidelines; women's psychosocial facilitators
      (self-efficacy, norms, support, and knowledge); and women's dissemination of breast health
      messages throughout their social network. The empowerment intervention will train Latinas in
      how to discuss breast health with their family and friends and volunteer in local breast
      health promotion programs. Academic, clinician, and community partners will work together
      throughout intervention development and evaluation.
    

Detailed description: 
      Latinas suffer disproportionately from breast cancer relative to non-Latina Whites (NLWs),
      including late stage detection. While there have been controversies in breast cancer
      screening, non-adherence to guideline-concordant screening continues to be a major modifiable
      determinant of breast cancer outcome disparities. Thus, increasing participation in breast
      cancer screening among Latinas, especially care that corresponds with clinical and academic
      guidelines, is a public health priority. Participatory approaches are popular methods to
      improve screening within this group and have included approaches that 1) deliver education to
      non-adherent Latinas and 2) train community health advocates (community health workers,
      breast cancer survivors) to engage in breast health promotion. The second approach
      (empowerment interventions) concerns training participants to engage in social outreach
      (e.g., having conversations with family and friends about breast health) and volunteering
      (e.g., helping in health fairs, engaging in civic campaigns about breast cancer programs).
      Patient activation and volunteerism literature suggest that empowerment interventions may
      have 'added value' for participants themselves over delivering education in terms of
      preventive health psychosocial factors and practices. Relative to education interventions,
      empowerment interventions may also affect women's networks, as they may be more likely to
      disseminate evidence-based breast health promotion among their family and friends. To date,
      little research has compared interventions' effects on individual-level outcomes or used
      formal social network analysis to examine network effects. The proposed work adds to the
      literature through empirically comparing two approaches (education versus empowerment) on
      three sets of outcomes: 1) women's own screening, 2) women's own self-efficacy, norms,
      support, knowledge; and 3) women's networks (measured by egocentric analysis). I will lead
      this work and will benefit from the collective expertise and resources of my mentors (Drs.
      Ferrans, Mermelstein, Geller) and collaborators (Dr. Schneider, The Resurrection Project,
      Metropolitan Chicago Breast Cancer Task Force, Sinai Urban Health Institute, University of
      Illinois Cancer Center). Aim 1 intervention development will be accomplished through
      continuous stakeholder engagement and specifically through meetings and focus groups with a
      bilingual, bicultural community advisory engagement board (CEAB), UICC radiologists and
      target participants (non-adherent Latinas). We have already begun this process and are
      obtaining formative data. After we develop intervention materials, a pilot trial will be
      conducted with an area-level treatment control group design in Chicago. Participants will be
      150 Latinas with no history of health volunteerism, residence in one of two targeted areas,
      and non-adherence to US Preventive Services Task Force screening guidelines. Aim 1
      intervention evaluation will involve an analysis to compare differences in receipt of a
      medical record-confirmed screening within six months of participating in the study. Aim 2
      will be an analysis to compare interventions' effects on self-efficacy, norms, support,
      knowledge across three time points - pre-intervention, immediately post-intervention, and six
      months post-intervention. Aim 3 will be a social network analysis, specifically egocentric,
      to compare interventions' effects on breast health, network size, and network density as well
      as will number of peers referred to the study.
    

Intervention name(s): Empowerment; Education
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Three group sessions (breast cancer education; communication; volunteerism) 1.5 hours 3 times across 3 weeks; Three group sessions (breast cancer education; diet; physical activity) 1.5 hours 3 times across 3 weeks
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Screening
Keywords: Mammography Screening; Latinas; Breast cancer disparities