Skip to main content

Advertisement

SpringerLink
Log in

Community Empowerment Partners (CEPs): A Breast Health Education Program for African-American Women

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

Peer educators have been shown to provide effective interventions in breast cancer screening. Few studies have compared the effects of peer education on breast cancer knowledge among peer educators and the community members who are subsequently reached through the peer education. Further, little is known as to whether those who received the education then go on to educate others in the community. The purpose of this study is to address those gaps. Using a pre- and post-test study design, we trained peer educators, provided the educators with resources to train community members, and assessed changes in knowledge. We sought to train ten educators and recommended each train ten community members in breast cancer knowledge and screening strategies. A total of 14 peer educators were trained, who subsequently trained a total of 121 community members, of whom 94 were African American women. Peer educators and community members, showed comparable increases in knowledge. Community members who were educated also increased intention to discuss breast cancer and breast cancer screening with their family, friends, and acquaintances. Our study suggests that it is feasible to train peer educators to increase knowledge among community members to the same level that they themselves experience when trained. Further, community members are interested in sharing information learned related to how much they learn from peer educators.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Cancer Society (2016). Cancer Facts & Figures 2016. Atlanta, GA: American Cancer Society.

    Google Scholar 

  2. U.S. Preventive Services Task Force (2016). Final Recommendation Statement: Breast Cancer: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening1.

  3. DeSantis, C. E., Fedewa, S. A., Goding Sauer, A., Kramer, J. L., Smith, R. A., & Jemal, A. (2016). Breast cancer statistics, 2015: Convergence of incidence rates between black and white women. CA: A Cancer Journal for Clinicians, 66(1), 31–42. https://doi.org/10.3322/caac.21320.

    Article  Google Scholar 

  4. Bigby, J., & Holmes, M. D. (2005). Disparities across the breast cancer continuum. Cancer Causes & Control, 16(1), 35–44. https://doi.org/10.1007/s10552-004-1263-1.

    Article  Google Scholar 

  5. Howlader, N., Noone, A. M., Krapcho, M., et al. (2014). SEER Cancer Statistics Review, 1975–2011. Bethesda, MD: National Cancer Institute.

    Google Scholar 

  6. Gerend, M. A., & Pai, M. (2008). Social determinants of Black-White disparities in breast cancer mortality: A review. Cancer Epidemiology Biomarkers & Prevention, 17(11), 2913–2923. https://doi.org/10.1158/1055-9965.epi-07-0633.

    Article  Google Scholar 

  7. Amend, K., Hicks, D., & Ambrosone, C. B. (2006). Breast cancer in African-American women: differences in tumor biology from European-American women. Cancer Research, 66(17), 8327–8330. https://doi.org/10.1158/0008-5472.can-06-1927.

    Article  PubMed  CAS  Google Scholar 

  8. DeSantis, C., Ma, J., Bryan, L., & Jemal, A. (2014). Breast cancer statistics, 2013. CA: A Cancer. Journal for Clinicians, 64(1), 52–62. https://doi.org/10.3322/caac.21203.

    Article  Google Scholar 

  9. Harper, S., Lynch, J., Meersman, S. C., Breen, N., Davis, W. W., & Reichman, M. C. (2009). Trends in area-socioeconomic and race-ethnic disparities in breast cancer incidence, stage at diagnosis, screening, mortality, and survival among women ages 50 years and over (1987–2005). Cancer Epidemiology Biomarkers & Prevention, 18(1), 121–131. https://doi.org/10.1158/1055-9965.epi-08-0679.

    Article  Google Scholar 

  10. Mishra, S. I., DeForge, B., Barnet, B., Ntiri, S., & Grant, L. (2012) Social determinants of breast cancer screening in urban primary care practices: A community-engaged formative study. Women’s Health Issues, 22(5):e429–e438. https://doi.org/10.1016/j.whi.2012.06.004.

    Article  PubMed  Google Scholar 

  11. Wolff, M., Bates, T., Beck, B., Young, S., Ahmed, S. M., & Maurana, C. (2003). Cancer prevention in underserved African American communities: Barriers and effective strategies–A review of the literature. WMJ: Official Publication of The State Medical Society of Wisconsin, 102(5), 36–40.

    Google Scholar 

  12. Alexandraki, I., & Mooradian, A. D. (2010). Barriers related to mammography use for breast cancer screening among minority women. Journal of the National Medical Association, 102(3), 206–218. https://doi.org/10.1016/S0027-9684(15)30527-7.

    Article  PubMed  Google Scholar 

  13. Freeman, H. P. (2005). Determinants of cancer disparities: Barriers to cancer screening, diagnosis, and treatment. Surgical Oncology Clinics of North America, 14(4), 655–669. https://doi.org/10.1016/j.soc.2005.06.002.

    Article  PubMed  Google Scholar 

  14. Healthy People 2020. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Available from https://www.healthypeople.gov/2020/topics-objectives/topic/cancer/objectives.

  15. Merkin, S. S., Stevenson, L., & Powe, N. (2002). Geographic socioeconomic status, race, and advanced-stage breast cancer in New York City. American Journal of Public Health, 92(1), 64–70.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Brownstein, J. N., Cheal, N., Ackermann, S. P., Bassford, T. L., & Campos-Outcalt, D. (1992). Breast and cervical cancer screening in minority populations: A model for using lay health educators. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 7(4), 321–326. https://doi.org/10.1080/08858199209528189.

    Article  CAS  Google Scholar 

  17. Earp, J. A., Viadro, C. I., Vincus, A. A., et al. (1997). Lay health advisors: A strategy for getting the word out about breast cancer. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 24(4), 432–451. https://doi.org/10.1177/109019819702400404.

    Article  CAS  Google Scholar 

  18. Jackson, E. J., & Parks, C. P. (1997). Recruitment and training issues from selected lay health advisor programs among African Americans: A 20-year perspective. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 24(4), 418–431.

    Article  CAS  Google Scholar 

  19. Shelton, R. C., Dunston, S. K., Leoce, N., Jandorf, L., Thompson, H. S., & Erwin, D. O. (2017). Advancing understanding of the characteristics and capacity of African American Women who serve as lay health advisors in community-based settings. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 44(1), 153–164. https://doi.org/10.1177/1090198116646365.

    Article  Google Scholar 

  20. Rosenthal, E. L., Brownstein, J. N., Rush, C. H., et al. (2010). Community health workers: Part of the solution. Health Affairs (Project Hope), 29(7), 1338–1342. https://doi.org/10.1377/hlthaff.2010.0081.

    Article  Google Scholar 

  21. Kim, K., Choi, J. S., Choi, E., et al. (2016). Effects of community-based health worker interventions to improve chronic disease management and care among vulnerable populations: A systematic review. American Journal of Public Health, 106(4), e3–e28. https://doi.org/10.2105/ajph.2015.302987.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Giese-Davis, J., Bliss-Isberg, C., Carson, K., et al. (2006). The effect of peer counseling on quality of life following diagnosis of breast cancer: An observational study. Psycho-oncology, 15(11), 1014–1022. https://doi.org/10.1002/pon.1037.

    Article  PubMed  Google Scholar 

  23. Maxwell, A. E., Jo, A. M., Crespi, C. M., Sudan, M., & Bastani, R. (2010). Peer navigation improves diagnostic follow-up after breast cancer screening among Korean American women: Results of a randomized trial. Cancer Causes & Control: CCC, 21(11), 1931–1940. https://doi.org/10.1007/s10552-010-9621-7.

    Article  PubMed  Google Scholar 

  24. Meneses, K. D., & Yarbro, C. H. (2008). An evaluation of the Train the Trainer International Breast Health and Breast Cancer Education: Lessons learned. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 23(4), 267–271. https://doi.org/10.1080/08858190802188883.

    Article  Google Scholar 

  25. Robertson, E. M., Franklin, A. W., Flores, A., Wherry, S., & Buford, J. (2006). African American community breast health education: A pilot project. The ABNF Journal: Official Journal of the Association of Black Nursing Faculty in Higher Education, Inc, 17(1), 48–51.

    Google Scholar 

  26. Shelton, R. C., Dunston, S. K., Leoce, N., Jandorf, L., Thompson, H. S., & Erwin, D. O. (2016). Advancing understanding of the characteristics and capacity of African American women who serve as lay health advisors in community-based settings. Health Education & Behavior: The Official Publication of the Society for Public Health Education. https://doi.org/10.1177/1090198116646365.

    Article  Google Scholar 

  27. Wells KJ, Luque JS, Miladinovic B, et al. (2011) Do Community health worker interventions improve rates of screening mammography in the United States? A systematic review. Cancer Epidemiology Biomarkers & Prevention, 20(8), 1580-1598. https://doi.org/10.1158/1055-9965.epi-11-0276.

    Article  Google Scholar 

  28. Plescia, M., Groblewski, M., & Chavis, L. (2008). A lay health advisor program to promote community capacity and change among change agents. Health Promotion Practice, 9(4), 434–439. https://doi.org/10.1177/1524839906289670.

    Article  PubMed  Google Scholar 

  29. Shelton, R. C., Dunston, S. K., Leoce, N., et al. (2016). Predictors of activity level and retention among African American lay health advisors (LHAs) from The National Witness Project: Implications for the implementation and sustainability of community-based LHA programs from a longitudinal study. Implementation Science: IS, 11, 41. https://doi.org/10.1186/s13012-016-0403-9.

    Article  PubMed  Google Scholar 

  30. Molina, Y., Kim, S., Berrios, N., & Calhoun, E. A. (2015). Medical mistrust and patient satisfaction with mammography: The mediating effects of perceived self-efficacy among navigated African American women. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 18(6), 2941–2950. https://doi.org/10.1111/hex.12278.

    Article  Google Scholar 

  31. Viswanathan, M., Kraschnewski, J. L., Nishikawa, B., et al. (2010). Outcomes and Costs of Community Health Worker Interventions: A Systematic Review. Medical Care, 48(9), 792–808. https://doi.org/10.1097/MLR.0b013e3181e35b51.

    Article  PubMed  Google Scholar 

  32. Molina, Y., McKell, M. S., Mendoza, N., et al. (2016). Health Volunteerism and Improved Cancer Health for Latina and African American Women and Their Social Networks: Potential Mechanisms. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education. https://doi.org/10.1007/s13187-016-1061-y.

    Article  Google Scholar 

  33. Smith, M. A., Conway-Phillips, R., & Francois-Blue, T. (2016). Sisters saving lives: Instituting a protocol to address breast cancer disparities. Clinical Journal of Oncology Nursing, 20(4), 427–432. https://doi.org/10.1188/16.cjon.427-432.

    Article  PubMed  Google Scholar 

  34. Santos, S. L. Z., Tagai, E. K., Wang, M. Q., Scheirer, M. A., Slade, J. L., & Holt, C. L. (2014). Feasibility of a web-based training system for peer community health advisors in cancer early detection among African Americans. American Journal of Public Health, 104(12), 2282–2289. https://doi.org/10.2105/ajph.2014.302237.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Shelton, R. C., Charles, T. A., Dunston, S. K., Jandorf, L., & Erwin, D. O. (2017). Advancing understanding of the sustainability of lay health advisor (LHA) programs for African-American women in community settings. Translational Behavioral Medicine. https://doi.org/10.1007/s13142-017-0491-3.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Suarez, L., Nichols, D. C., & Brady, C. A. (1993). Use of peer role models to increase Pap smear and mammogram screening in Mexican-American and black women. American Journal of Preventive Medicine, 9(5), 290–296.

    Article  PubMed  CAS  Google Scholar 

  37. Landry, R., Amara, N., Pablos-Mendes, A., Shademani, R., & Gold, I. (2006). The knowledge-value chain: A conceptual framework for knowledge translation in health. Bulletin of the World Health Organization, 84, 597–602.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Valente, T. W., & Pitts, S. R. (2017). An appraisal of social network theory and analysis as applied to public health: Challenges and opportunities. Annual Review of Public Health, 38, 103–118. https://doi.org/10.1146/annurev-publhealth-031816-044528.

    Article  PubMed  Google Scholar 

  39. Valente, T. W. (2012). Network interventions. Science, 337(6090), 49–53. https://doi.org/10.1126/science.1217330.

    Article  PubMed  CAS  Google Scholar 

  40. American FactFinder: 2011–2015 American Community Survey 5-Year Estimates [database on the Internet] 2011–2015 Retrieved December 11, 2016, from http://factfinder.census.gov.

  41. Washington State Department of Health (2015) cancer by race and ethnicity by site (2011–2013). Olympia, WA: Washington State Department of Health.

    Google Scholar 

  42. Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010.

    Article  PubMed  Google Scholar 

  43. Scheel, J. R., Molina, Y., Briant, K. J., Ibarra, G., Lehman, C. D., & Thompson, B. (2015). Latinas’ mammography intention following a home-based promotores-led intervention. Journal of Community Health, 40(6), 1185–1192. https://doi.org/10.1007/s10900-015-0046-9.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Pan, W. (2001). Akaike’s information criterion in generalized estimating equations. Biometrics, 57(1), 120–125.

    Article  PubMed  CAS  Google Scholar 

  45. Giarratano, G., Bustamante-Forest, R., & Carter, C. (2005) A multicultural and multilingual outreach program for cervical and breast cancer screening. Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN, 34(3):395–402. https://doi.org/10.1177/0884217505276059.

    Article  PubMed  Google Scholar 

  46. Freire, P. (1970). Pedagogy of the oppressed. New York: Herder and Herder.

    Google Scholar 

Download references

Acknowledgements

We would like to thank all the Cierra Empowerment Partners and all the members of the community who were involved in this project. We also thank Dr. Kerryn Reding and Ashley Scherman from the University of Washington for their technical assistance. This project was supported by Grant No. P30CA015704 from the National Cancer Institute (NCI) and the Institute of Translational Health Science Grant (UL1 RR025014) from the National Center for Research Resources (NCRR) at the National Institutes of Health (NIH). YM’s effort on this project was also supported by the University of Illinois Cancer Center and Center for Research on Women and Gender as well as Grant Nos. K01CA193918, U54CA202995, U54CA202997, and U54CA203000 from NCI. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCI, NCRR, or the National Institutes of Health.

Author information

Authors and Affiliations

  1. Cierra Sisters, Inc., P.O. Box 1634, Renton, WA, 98057, USA

    Bridgette Hempstead & Cynthia Green

  2. Health Disparities Research Program, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, USA

    Katherine J. Briant & Beti Thompson

  3. University of Illinois at Chicago, 1603 West Taylor Street, MC923, Chicago, IL, 60622, USA

    Yamile Molina

Authors
  1. Bridgette Hempstead
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia Green
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katherine J. Briant
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beti Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yamile Molina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine J. Briant.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hempstead, B., Green, C., Briant, K.J. et al. Community Empowerment Partners (CEPs): A Breast Health Education Program for African-American Women. J Community Health 43, 833–841 (2018). https://doi.org/10.1007/s10900-018-0490-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-018-0490-4

Keywords

Search

Navigation