Family Cancer Literacy to Promote Mammography Screening Among Navajo Women

This proposal describes a community-based participatory research study to develop and pilot
test a new behavioral intervention to promote mammography screening among Navajo women. From
a public health perspective, the intervention has the potential to reach many Navajo women,
as 80% of women scheduled for mammography appointments do not follow through. These women
(over 1,500 each year) are referred to the Nation Breast and Cervical Cancer Prevention
Program (NNBCCPP). A key barrier toward implementing cancer prevention and control efforts in
the Navajo community is a lack of cancer literacy or cultural and conceptual knowledge
regarding cancer. Other barriers to screening are fear of cancer, stigma of cancer (even
talking about cancer) often experienced by the patient, family and community, and lack of
knowledge about the etiology of cancer and importance of early detection. Therefore,
communication about cancer is impeded within Navajo families and the community.

This proposal builds on our successful partnership and collaboration with Diné College (the
Navajo tribal college). The proposed study is designed to assess the feasibility and
potential efficacy of a cancer-literacy focused, family-based intervention on completion of
mammography screening for Navajo women. The intervention will include culturally and
linguistically appropriate educational materials about cancer (e.g., the Navajo Cancer
Glossary). The project will be implemented in two phases. During Phase 1, the investigators
will develop the family cancer literacy intervention with feedback from our community
advisory committee. In addition, the Cancer Literacy Measure will be adapted for Navajo women
through focus groups and individual interviews. Phase 2 will consist of a formative
evaluation of the intervention. The NNBCCPP patient and a female family member will be
randomly assigned in pairs to the control condition (existing NNBCCPP health education
services, N=40 pairs) or to receive these health education services plus the family cancer
literacy intervention (N=40 pairs). The investigators will assess the intervention's
feasibility and acceptability as indicated by the recruitment and retention rates and
qualitative ratings of treatment acceptability. In addition, the investigators will examine
the effect of the intervention compared with the control group on the proportion of women who
complete mammography screening at 3-month follow-up documented by NNBCCPP records. The
investigators will also examine changes in Cancer Literacy Measure scores from baseline to
3-month follow-up among both patients and family members. The investigators expect that as a
result of this project, the investigators will have developed a replicable, feasible, and
acceptable intervention, the efficacy of which can be tested in future large-scale randomized
clinical trials. In addition, the adapted Cancer Literacy Measure could be used in future
cancer prevention and control projects within the Navajo Nation. The overall objective is to
reduce breast cancer morbidity and mortality among Navajo women.

Inclusion Criteria:

In Phase 1, we will recruit 17 Navajo women for individual interviews (n=5) and focus
groups (n=12) to adapt our measures. Eligibility criteria are:

1. aged 40 years or older and

2. provides written informed consent. We chose to develop our measures based on feedback
from the general community of women who are screening eligible instead of matching the
inclusion/exclusion criteria to that used in the formative evaluation of the
intervention (Phase 2). This will enhance our ability to use the Cancer Literacy
Measure and other assessments in subsequent breast cancer prevention and control
studies.

In Phase 2, we will recruit a total of 40 patient-family member pairs. To be eligible for
the study, the NNBCCPP patient must:

1. be aged 40 years or older,

2. provide written informed consent,

3. be referred to the NNBCCPP as a "no-show" for mammography screening after three
scheduling attempts,

4. have no prior history of mammography screening,

5. have no prior history of breast cancer, and

6. can identify a female family member or other individual who resides in or near the
home who could participate in the project.

In addition, the family member must:

1. be female,

2. aged 18 years or older,

3. be fluent and literate in Navajo,

4. be interested and able to participate, and

5. provide written informed consent.

Exclusion Criteria:

Phase 2: History of breast cancer or mammography screening