The presented article describes a case of a community capacity-enhancement approach being implemented in order to promote breast and cervical cancer screenings among older women of color. The case covers the reasons for choosing this specific group, the difficulties in implementation, and provides a series of guidelines for further use. This paper will outline which community was targeted, the process of implementation, contributing factors, and alternative solutions.
Target Community
The target communities for this case were African American Women, and Latina women living in African American and Latino neighborhoods of Waterbury, Connecticut, and Boston, Massachusetts. These communities were selected because of the increased dangers of breast and cervical cancer among African American women (DeSantis et al., 2016) and Latina women (Roman et al., 2014). These cities were chosen due to a high proportion of women of color living in similar demographic and socioeconomic conditions (Bullock & McGraw, 2006). These communities are often considered hard to reach which results in lower statistics of cancer screenings. Subsequently, that puts women of color at higher risk when dealing with breast and cervical cancer (Williams, Ford, & Meghea, 2015).
Assessment, Engagement, and Implementation
A thorough assessment was conducted to consider such factors as local values, history, culture, and expectations. The goal was to gain validation from the local citizens in order to successfully implement the program. To fulfill this goal, a local professional advisory group of health professionals and community agency representatives was organized. The majority of the responsibilities of the group were in providing suggestions to the research team after identifying issues that affect the heath of the community members. Subsequently, the group would propose solutions that are uniquely based on their perspectives as members of the community. Also, the group advised the research team on how to better engage the older women of color in the program. The research team used local churches to create focus groups that were educated on the merits of the health program and subsequently hired to promote it (Bullock & McGraw, 2006).
The engagement phase involved the employment of women from these cities as community outreach workers to facilitate the promotion of the health program. During this phase, two health care facilities were contacted for the purpose of collaboration on the project. Saint Mary’s Hospital in Connecticut and Dimock Community Health Center in Boston agreed to the collaboration. Their combined catchment area included more than a million people. Information about the health behavior theories, cancer facts, interviewing methods, administrative procedures for data collection quality and accuracy, as well as recruitment competencies was provided to the coworkers to help them during this phase. Six hours of training per week, over six months was provided to them to make them competent health promotion educators. Before recruitment, a preintervention process was used to test the methodology of the coworkers. The Theory of Planned Behavior was used to develop the format of the intervention, as well as the Health Belief Theory (Bullock & McGraw, 2006).
The implementation phase was based on community capacity enhancement. Women for the study were recruited for the project based on the recommendation of the coworkers. Cohesive group settings, public settings, and health care facilities were used to publicize the study. Face-to-face interactions were also utilized in homes of potential participants. Younger women were asked to nominate older women for health promotions because studies suggest that women between 30 and 45 years of age are likely to be in contact with people who can benefit from cancer screening services. Bringing people together from different age groups helped to accomplish the goals of the program (Bullock & McGraw, 2006).
Contributing Factors and Alternative Avenues
A number of factors contributed to the success of the intervention. The first is the careful assessment of the communities that the program was implemented in. The research team involved a lot of members of the community to provide accurate suggestions to the research team. Collaboration with the health care facilities in the area allowed the program to be implemented over a much wider area. The use of community facilities such as churches and beauty salons to publicize the program in a less formal manner helped to recruit more participants. Lastly, the engagement of younger women from the community brought together multiple age groups to work on the goals of the program (Bullock & McGraw, 2006).
Alternatively, the research group could implement a marketing emphasis in health education as opposed to the community capacity-enhancement approach. A study suggests four recommendations for this strategy. The first is that the research team should focus on an ecological behavior-based philosophy of health education. They should utilize opportunity marketing management in their programming. Their processes should concern both marketing and health education. Finally, their health –education needs assessments should include marketing concepts (Stellefson & Eddy, 2008). Another option would be to adapt an existing program to the communities in question. An existing program that has proven to be successful may be slightly changed while maintaining its fundamental functions to adapt to these communities (Okamoto, Kulis, Marsiglia, Holleran Steiker, & Dustman, 2013). Both tactics have shown to be successful in various communities.
Conclusion
When implementing a health program into a specific community, its cultural aspects should be considered. This case shows that by involving the members of the community, even difficult goals can be overcome. However, alternative approaches of different types can also be utilized.
References
Bullock K., & McGraw S.A. (2006). A community capacity-enhancement approach to breast and cervical cancer screening among older women of color. Health and Social Work, 31(1), 16-25.
DeSantis, C., Siegel, R., Sauer, A., Miller, K., Fedewa, S., Alcaraz, K., & Jemal, A. (2016). Cancer statistics for African Americans, 2016: Progress and opportunities in reducing racial disparities. CA: A Cancer Journal for Clinicians, 66(4), 290-308.
Okamoto, S., Kulis, S., Marsiglia, F., Holleran Steiker, L., & Dustman, P. (2013). A continuum of approaches toward developing culturally focused prevention interventions: From adaptation to grounding. The Journal of Primary Prevention, 35(2), 103-112.
Roman, L., Meghea, C., Ford, S., Penner, L., Hamade, H., Estes, T., & Williams, K. (2014). Individual, provider, and system risk factors for breast and cervical cancer screening among underserved black, Latina, and Arab women. Journal of Women’s Health, 23(1), 57-64.
Stellefson M. & Eddy M. (2008). Health education and marketing processes: 2 related methods for achieving health behavior change. American Journal of Health Behavior, 32(5), 488-96.
Williams, K., Ford, S., & Meghea, C. (2015). Cultural connections: The key to retention of black, Latina, and Arab women in the kin KeeperSM cancer prevention intervention studies. Journal of Cancer Education, 31(3), 522-528.