48x96 poster template

1
Development of a Spiritually-based Educational
Program to Promote Colorectal Cancer Screening
through African American Churches Cheryl Holt,
PhD1, Isabel Scarinci, PhD2, Martha Crowther,
PhD3, John Bolland, PhD3, Mark Litaker, PhD4,
Mohamad Eloubeidi, MD5, Steve Coughlin, PhD,
MPH6, Leonardo Stroud, MD, MPH7, Joanice
Thompson, BSM1, Chastity Roberts, BS, MPH, CHES1,
and Penny Southward, BS1. (1) Division of
Preventive Medicine, Univ. of Alabama,
Birmingham, 1717 11th Ave. South, Medical Towers,
Suite 641, Birmingham, AL 35205, 205-934-2816,
cholt_at_uab.edu, (2) Preventive Medicine,
University of Alabama at Birmingham, 1717 11th
Avenue South, Room 609, Birmingham, AL 35205, (3)
School of Public Health/Department of Health
Behavior, Univ. of Alabama, Birmingham, 1530 3rd
Avenue South, RPHB 227H, Birmingham, AL
35294-0022, (4) Diagnostic Sciences, Univ. of
Alabama, Birmingham, 1530 3rd Avenue South, LHRB
134, Birmingham, AL 35294-0007, (5)
Medicine/Gastroenterology, Univ. of Alabama,
Birmingham, 1530 3rd Avenue South, ZRB 408,
Birmingham, AL 35294-0007, (6) Division of Cancer
Prevention and Control, CDC, Atlanta, GA,
[phone], (7) Division of Cancer Prevention
and Control, Centers for Disease Control and
Prevention, 4770 Buford HWY NE, Atlanta, GA 30341

Introduction
Results
Discussion
African Americans have higher colorectal cancer
incidence and mortality than do all other
racial/ethnic groups1. Underutilization of
screening by African Americans has been
identified as a probable cause of the significant
racial disparity. Screening rates differ
among African Americans and Caucasians (41 AA v.
47 CA for blood stool test 47 AA v. 50 CA for
sigmoidoscopy or colonoscopy)2. A number of
interventions have been proposed to address the
underutilization of screening.  One approach is
to work through churches using a
spiritually-based approach. This is done by
including relevant spiritual themes to frame the
cancer educational message thereby putting health
in a spiritual context.
Table 1 Participant Demographics (n66)

• Formatting/Graphics/Design
• Most respondents preferred booklet A because of
  the Christian symbols on the cover, pictures on
  the cover, and larger text font.
• Booklet B was considered by most respondents to
  be a medical brochure, one you would expect to
  see in a more clinical setting.
• Suggestions for improvement included adding more
  culturally relevant pictures (Afrocentric vs.
  Eurocentric) and making the colors of the cover
  of Booklet A bolder to reflect the Take Charge
  of Your Health theme.
• Educational Content
• Although some of the colorectal cancer content in
  the booklets was technical, it could be
  understood within context.
• Scriptures and spiritual-based content provoked
  reflection of personal experiences in which
  reliance upon faith helped to overcome barriers
  to participation in other screenings.

Advisory Panel (n10) Focus Groups 1 2 (n20) Focus Groups 3 4 (n16) Cognitive Response Interviews (n20)
African American 80 100 100 100
Female 60 60 69 85
Age (range) 39-71 50-82 50-80 51-82
Educational level (avg.) Bachelors Degree Some College High School Graduate/GED Some College
Married/ Live w/ Partner 75 55 44 50
Denominations Represented Baptist, Non-denominational, Lutheran Baptist, Missionary Baptist Pentecostal, African Methodist Episcopal Baptist, Pentecostal, Methodist, Lutheran

• Table 2 Advisory Panel Recommendations
• Emphasize stewardship of the body
• Incorporate scriptures that will help people to
  overcome fear
• Incorporate scriptures that will empower people
  to make a change
• Share anecdotal stores, personalize
• Dont be too preachy
• Make sure scriptures and core content are
  related, smooth linkages
• Add pictures to illustrate concepts that may be
  difficult to understand
• (dietary portions and colonoscopy procedures).

• Table 3 Focus Group 12 Recommendations
• Define colorectal cancer
• Identify early warning signs and symptoms
• Identify who is at risk
• Identify methods of prevention
• Provide information about the screening tests
• Provide information about insurance coverage
• Provide questions for the patients to ask their
  doctors
• Supply information about alternative treatments
  (i.e.
• herbs, vitamins etc.)

Purpose

• With the assistance of community members
• Develop and pilot test spiritually-based
  educational print materials through focus groups
  and cognitive response testing.

Method

• The intervention consists of providing
  training to Community Health Advisors from each
  church, who deliver two educational group
  sessions on colorectal cancer and early detection
  to their fellow church members.  
• The intervention is supplemented by
  spiritually-based print materials developed and
  pilot tested in this project.  
• Phase 1 Intervention Development
• The expertise of an Advisory Panel (n10) and two
  focus groups (n20) consisting of individuals
  from the priority population was utilized to
  assist in the development of the
  spiritually-based messages and the colorectal
  cancer content to be used in the intervention.
• Phase 2 Pilot Testing the Intervention Materials
  (Print)
• Two additional focus groups (n16) were
  conducted to pilot test the graphics and layout
  of the intervention print materials.  
• Twenty Cognitive Response Interviews were
  conducted to assess the acceptability and
  appropriateness of the content of these print
  materials.
• Following a qualitative review of the focus
  group results and the Cognitive Response
  Interviews, the print materials will be revised
  as recommended by the priority population, and
  the intervention implemented and evaluated.

Conclusions
Prototype
Development ?
Booklet A
Booklet B ?
Using a community-based approach to formative
research in the development of an intervention
ensures that the program is culturally
appropriate, personally relevant, and will be
more likely to stimulate cognitive elaboration,
leading to attitudinal and behavior change.

• Table 4 Focus Group 34 Recommendations
• Find booklet A more attractive than B
• Booklet A is more religious-looking, pleasant,
  and
• hopeful (i.e. images of Christ, bright
  colors)
• Booklet B is bold, medical-looking, solemn
• Like questions to ask MD found in both books
• Booklet A needs more Afro-centric pictures
• Booklet B needs pictures on the cover to increase
  attractiveness

Acknowledgments
This project is supported by Health Promotion and
Disease Prevention Research Centers Special
Interest Project Competitive Supplements, SIP
5-2005, RFA DP-04-003A.

• Table 5 Cognitive Response Interview Findings
• Scriptural passages were understood by the
  majority of respondents
• Colorectal cancer-specific content was
  understood by the majority of respondents
• Non-scriptural, but thematic religious concepts
  were a little difficult for some respondents to
  explain However,
• those respondents did indicate that they
  understood the point.
• Some of the technical terminology as it relates
  to vitamins, minerals, procedures were difficult
  to pronounce and
• translate into useful information.

References
1. American Cancer Society. Cancer facts and
figures 2004. Atlanta, Georgia American Cancer
Society, Inc. 2004 2. Centers for Disease
Control and Prevention. BRFSS online information.
U.S. Department of Health and Human Services.
Available at http//cdc.gov/brfss/. Accessed
January 23, 2003.