REACH UP & OUT: Eliminating Breast and Cervical Cancer Disparities

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It has been well documented that disparities exist between African American and white women with regard to morbidity and mortality associated with breast and cervical cancer. We have established a very active coalition, conducted comprehensive needs assessments, and developed and pilot-tested a community action plan to reduce breast and cervical cancer screening disparities between white and African American women in Alabama's Black Belt. Although effective and well received by the community, this intervention did not lead to behavior change among all women within the targeted population. The overall purpose of the proposed intervention is to further reduce breast and cervical cancer disparities between white and African American women in the Black Belt of Alabama by increasing Pap smear and mammography rates. We propose to develop and implement a multi-component intervention that uses media, education, and enhanced access, incorporating sociological and cognitive behavioral approaches in the development and implementation of the messages. This intervention is an extension of our pilot work utilizing community health advisors (CHAs) (sociologic approach). Although the pilot intervention showed significant increase in breast and cervical cancer screening among African American women in the Black Belt, there is still a hard to-reach group, which, despite our efforts, has not engaged in breast and cervical cancer screening. Based on the results of follow-up interviews with this group of women and discussions with our coalition members and CHAs, we propose the development, implementation, and evaluation of an enhanced intervention, which incorporates cognitive behavioral approaches that will challenge the barriers (e.g., fear of finding out they have cancer, the belief that screening will not make any difference) and reinforce the motivators (e.g., support from other women) to engage this group in breast and cervical cancer screening. Although the Community-Based Participatory Research and the Empowerment Model will be the overall conceptual framework used in this study, the PEN-3 and the Health Belief Model will guide intervention development and implementation. The intervention counties will receive education and cognitive/behavioral skills training delivered by CHAs, while the control counties will continue to receive our current intervention that has proven to be successful. The study will be carried out in two phases. In Phase I, we will refine the enhanced intervention and assessment tools through formative assessment. In Phase II, we will randomly assign the counties to intervention/control groups, implement, and evaluate the intervention.