Samoans and Breast Cancer: Evaluating a Theory-Based Program
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: We address the Breast Cancer Research Program’s priority area of public education and early detection through the use of new methods of dissemination of information about breast cancer to Samoan women, the indigenous people of the U.S. Territory of American Samoa. Despite the high site-specific incidence of breast cancer and low levels of both awareness and utilization of screening and early detection examinations, no educational programs have been tested in this population. We will implement and evaluate an innovative, theory-based, culturally sensitive and linguistically appropriate breast cancer control educational program ("intervention") specially developed for Samoan women. The specific aims are, first, to implement and evaluate (using behavior change theory) the intervention’s effectiveness in enhancing knowledge, modifying attitudes, and most importantly, effecting positive behavior change. Second, to identify individual and structural factors that facilitate or impede behavior change. We build on an ongoing National Cancer Institute (NCI) sponsored cancer control research study among Samoans conducted collaboratively by the University of California, Irvine (UC Irvine) and the National Office of Samoan Affairs (NOSA), a community-based Samoan service organization situated in Carson, California.
 
 
 
 The intervention consists of three components: specially developed English- and Samoan-language educational materials; skills building exercises; and, interactive group discussions. The intervention, designed in four modules, address different aspects of breast cancer (i.e., risk, severity, susceptibility, screening and early detection exams). The materials and the skills building exercises necessary to model and role play new behaviors will supplement group discussions. The outcome of primary interest is the receipt of a mammogram between the pretest and posttest survey. Outcomes of secondary interest are the appropriate conduct of breast self-exams, receipt of clinical breast exams, and positive changes in knowledge and attitudes.
 
 
 
 We will conduct the study in two contiguous Southern California counties, Los Angeles and Orange. Samoan-speaking churches located in these two counties will form the study sites. We will randomly assign matched and paired study sites to the two study groups, Experimental and Control. Initially, we will select 600 Samoan women from the study sites. At the study’s end, we expect the final sample size to include approximately 480 women (240 women per study group). We will conduct a pretest and posttest survey. Between the pretest and posttest surveys, we will administer the intervention to the Experimental group. We will administer the posttest survey eight months after the pretest survey. Analysis of the survey data will provide a quantitative evaluation of the program’s effectiveness. After the posttest survey, we will conduct focus groups with women who changed their behaviors and those who did not. The focus group data will provide more in-depth explanations about factors important for behavior change.
 
 
 
 This collaborative research project has several benefits. It addresses a crucial community identified cancer control need of Samoan women. The project enhances NOSA’s research capacity providing it with additional skills and experience to develop procedures and infrastructure needed for in-house monitoring of prevention efforts. Due to the unique study design, Samoan women have an opportunity to make an impact on various aspects of the study as program developers, implementers and evaluators. Furthermore, the research project will provide crucial insights into the applicability and appropriateness of the behavior change theory and research methods for this community. Lastly, the behavior change theory, educational program, evaluation protocol and associated methods will be presented in a didactic monograph designed to be used as a guidebook for other cancer control programs through relevant community-based organizations that work with minority, hard-to-reach populations.