Increasing African Immigrant Women's Participation in Breast Cancer Screening

New York City (NYC) is home to a large and diverse immigrant population. Many of these groups face significant barriers to preventive health care, including lack of insurance, poor health care access and language difficulties. Most African immigrant women are likely to live below the poverty line and have low health literacy, are less likely to have health insurance and visit a doctor, particularly for primary/preventive care. Without access to primary care, many preventive services, such as breast cancer screenings go unattended. The barriers and facilitators to breast cancer screening for other minority groups from underserved populations, such as African Americans and Latina women have been studied. Less is known about these for African immigrant women and how to most effectively engage their participation in regular screening. Data of over 2,000 African-born immigrants living in NYC show that 77% report not having health insurance; 75% do not have a primary care physician; and 57% have less than a high school education. As for cancer screening, when corrected for age, 44% have never had a mammogram. Through the study team's unique collaboration with the African Services Committee and the African Advisory Council of the Bronx, two non-governmental community-based service organizations, the study team is poised to have a significant impact on these immigrant women, who have emigrated from more than 20 countries in Africa. This is a population with great need for increased breast cancer knowledge, access to breast cancer screening, and basic medical care. The Health Belief Model (HBM) provides a framework for addressing cultural health barriers by positing that making a decision to engage in a health behavior is determined by weighing perceived threats versus benefits. The long term goal of the proposed project is to conduct a randomized clinical trial that tests the adapted intervention to increase breast cancer screening rates for African-born immigrants. In the short term, the study team plans to pursue the following specific aims: (1) Identify barriers and facilitators to breast cancer screening among African-born immigrants and (2) Culturally adapt and pilot test the Witness Project breast cancer education program for African-born women. Thus, the study team will culturally adapt an effective, innovative intervention to address this significant health disparity in African-born immigrant communities.

Sex

All

Minimum age

18 Years

Maximum age

74 Years

AIM 1:

Inclusion criteria in-depth interviews with leaders:

* ≥ 18 years of age
* Stakeholder/gatekeeper in the African immigrant community, and read and speak English or French.

Inclusion criteria for In-depth Interviews and Quantitative Surveys:

* Women 40 years of age or older;
* Born in Africa;
* Speak English or French.

Exclusion Criteria

* \<18 years of age
* Cannot read and speak English or French

AIM 2:

Inclusion Criteria

* ≥ 38 years of age
* Women born in Africa, and read and speak English or French.

Exclusion Criteria

* \<38 years of age
* Cannot read and speak English or French

• BACKGROUNDErwin DO, Johnson VA, Trevino M, Duke K, Feliciano L, Jandorf L. A comparison of African American and Latina social networks as indicators for culturally tailoring a breast and cervical cancer education intervention. Cancer. 2007 Jan 15;109(2 Suppl):368-77. doi: 10.1002/cncr.22356. PMID 17173279
• BACKGROUNDSaad-Harfouche FG, Jandorf L, Gage E, Thelemaque LD, Colon J, Castillo AG, Trevino M, Erwin DO. Esperanza y Vida: training lay health advisors and cancer survivors to promote breast and cervical cancer screening in Latinas. J Community Health. 2011 Apr;36(2):219-27. doi: 10.1007/s10900-010-9300-3. PMID 20711645
• BACKGROUNDHurtado-de-Mendoza A, Song M, Kigen O, Jennings Y, Nwabukwu I, Sheppard VB. Addressing cancer control needs of African-born immigrants in the US: a systematic literature review. Prev Med. 2014 Oct;67:89-99. doi: 10.1016/j.ypmed.2014.07.006. Epub 2014 Jul 14. PMID 25034729
• BACKGROUNDWafula EG, Snipes SA. Barriers to health care access faced by black immigrants in the US: theoretical considerations and recommendations. J Immigr Minor Health. 2014 Aug;16(4):689-98. doi: 10.1007/s10903-013-9898-1. PMID 24006174
• BACKGROUNDJanz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984 Spring;11(1):1-47. doi: 10.1177/109019818401100101. PMID 6392204
• BACKGROUNDKreuter MW, Green MC, Cappella JN, Slater MD, Wise ME, Storey D, Clark EM, O'Keefe DJ, Erwin DO, Holmes K, Hinyard LJ, Houston T, Woolley S. Narrative communication in cancer prevention and control: a framework to guide research and application. Ann Behav Med. 2007 Jun;33(3):221-35. doi: 10.1007/BF02879904. PMID 17600449
• BACKGROUNDKreuter MW, Holmes K, Alcaraz K, Kalesan B, Rath S, Richert M, McQueen A, Caito N, Robinson L, Clark EM. Comparing narrative and informational videos to increase mammography in low-income African American women. Patient Educ Couns. 2010 Dec;81 Suppl(Suppl):S6-14. doi: 10.1016/j.pec.2010.09.008. Epub 2010 Nov 10.