Empowering Latinas to Obtain Breast Cancer Screenings

Latinas suffer disproportionately from breast cancer relative to non-Latina Whites (NLWs),
including late stage detection. While there have been controversies in breast cancer
screening, non-adherence to guideline-concordant screening continues to be a major modifiable
determinant of breast cancer outcome disparities. Thus, increasing participation in breast
cancer screening among Latinas, especially care that corresponds with clinical and academic
guidelines, is a public health priority. Participatory approaches are popular methods to
improve screening within this group and have included approaches that 1) deliver education to
non-adherent Latinas and 2) train community health advocates (community health workers,
breast cancer survivors) to engage in breast health promotion. The second approach
(empowerment interventions) concerns training participants to engage in social outreach
(e.g., having conversations with family and friends about breast health) and volunteering
(e.g., helping in health fairs, engaging in civic campaigns about breast cancer programs).
Patient activation and volunteerism literature suggest that empowerment interventions may
have 'added value' for participants themselves over delivering education in terms of
preventive health psychosocial factors and practices. Relative to education interventions,
empowerment interventions may also affect women's networks, as they may be more likely to
disseminate evidence-based breast health promotion among their family and friends. To date,
little research has compared interventions' effects on individual-level outcomes or used
formal social network analysis to examine network effects. The proposed work adds to the
literature through empirically comparing two approaches (education versus empowerment) on
three sets of outcomes: 1) women's own screening, 2) women's own self-efficacy, norms,
support, knowledge; and 3) women's networks (measured by egocentric analysis). I will lead
this work and will benefit from the collective expertise and resources of my mentors (Drs.
Ferrans, Mermelstein, Geller) and collaborators (Dr. Schneider, The Resurrection Project,
Metropolitan Chicago Breast Cancer Task Force, Sinai Urban Health Institute, University of
Illinois Cancer Center). Aim 1 intervention development will be accomplished through
continuous stakeholder engagement and specifically through meetings and focus groups with a
bilingual, bicultural community advisory engagement board (CEAB), UICC radiologists and
target participants (non-adherent Latinas). We have already begun this process and are
obtaining formative data. After we develop intervention materials, a pilot trial will be
conducted with an area-level treatment control group design in Chicago. Participants will be
150 Latinas with no history of health volunteerism, residence in one of two targeted areas,
and non-adherence to US Preventive Services Task Force screening guidelines. Aim 1
intervention evaluation will involve an analysis to compare differences in receipt of a
medical record-confirmed screening within six months of participating in the study. Aim 2
will be an analysis to compare interventions' effects on self-efficacy, norms, support,
knowledge across three time points - pre-intervention, immediately post-intervention, and six
months post-intervention. Aim 3 will be a social network analysis, specifically egocentric,
to compare interventions' effects on breast health, network size, and network density as well
as will number of peers referred to the study.

Inclusion Criteria:

- Age 52-75 years old;

- Identification as Latina/Hispanic/Chicana female;

- Residence in Pilsen, Little Village, East Side or South Chicago;

- No history of health volunteerism;

- No history of breast cancer; and

- Lack of a mammogram within the last two years

Exclusion Criteria:

- Not meeting all inclusion criteria;

- Women will be excluded if they participated in formative focus groups