Nontraditional Approaches to Community Health

Nontraditional Approaches to Community Health: A Soul Sense of Beauty Marilyn White, MD Associate Director, Research & Training Arthur Ashe Institute for Urban Health The Arthur Ashe Institute for Urban Health   Founded in 1992 by Arthur Ashe to address social and cultural issues that affect health and wellness Develops model urban health services in Brooklyn and other parts of New York that can be replicated in other urban communities nationally The Institute Believes Strong Health Education and Services Must:    Address the whole individual Be easily accessible in trusted venues Empower individuals and communities to advocate for their own health concerns    Increase urban youth pursuing health care careers Target diseases that affect disadvantaged populations Provide programs that address ethnic, racial, and gender disparities in health AAIUH’s Approach: Leveraging Community Assets    All communities have assets that can be engaged on behalf of the communities health Assets include businesses, churches, local health and social service agencies, personal care establishments, libraries, schools, etc. Proprietors, personal care givers, stylists, barbers, ministers/faith leaders, nurses and other health care practitioners who live in communities can be engaged in community health empowerment (CHE) Community Health Empowerment: Lay Health Advocates Provide     Informal counseling and social support Culturally competent and linguistically appropriate health education Connections to referral and follow-up services Communication tailored for stages of change • Individual and community health actions Advocate Ensure • Access to needed health services & providers Build •Individual and community capacity AAIUH Core Programs     Health Science Academy Black Pearls and Different “Fades” of Health Nuestra Belleza Agape: Health Education and Outreach Program for African-American and Caribbean Congregations       First Impressions A Clean Bill of Health A Soul Sense of Beauty Prostate Cancer Control Brooklyn Information Health Access Coalition Brooklyn Health Disparities Center Community Health Empowerment: A Soul Sense of Beauty    Innovative breast cancer awareness program National Cancer Institute funded training program for hairstylists to teach them how to talk to their own customers about breast health Three messages: practice BSE, get annual CBE, mammography A Soul Sense of Beauty Objectives   To select and train community-based professional stylists in specific knowledge, attitudes, and practices of delivering breast cancer control messages to their customers To examine, via a randomized controlled trial, the impact of stylist-delivered breast cancer control messages on the breast health behaviors of beauty salon customers Objectives (continued)    To develop a portable stylist training and communications package for ongoing training To conduct an outcome evaluation of breast health behaviors of salon customers comparing method of stylist training (video versus live-training) To organize a community-based Health and Beauty Council to continue the stylist training program in support of the intervention A Soul Sense of Beauty Activities  Customers were pretested at each salon Breast health information, including videos and shower cards on breast self-exams and pamphlets on breast health were available at each salon Church volunteers - trained to assist in demonstrating breast self-exams during the Health and Beauty Days Breast Cancer Survivor – played vital role in recruitment, promotion of breast healthy behaviors    A Soul Sense of Beauty Evaluation Intervention salons compared to control salons to determine if trained stylists can affect the breast health behaviors of their clients Stylists trained via videotape were compared to stylists trained live to assess the breast health behaviors of their clients   A Soul Sense of Beauty Cultural Targeting  Focus groups were conducted with African American and Afro-Caribbean stylists to Inform the cultural content of the training prior to its development  Determine the cultural acceptance of the training curriculum and breast health messages  Cultural Targeting Common barriers  A fear of not knowing how the customers will respond  A lack of knowledge of the issues  Difficulty talking to customers Denial of diagnosis  Presentation language and images  Personal connection to the message  Race and gender issues  Fears with the word cancer   Cultural Targeting - Denial   Focus groups revealed that denial is a common experience encountered with women in the community who are diagnosed with breast cancer. One stylist shared knowing a woman who would not tell her family of her ongoing cancer treatment because she didn’t want them to worry about it Cultural Targeting More Images and Simpler Language     African American stylists indicated that more visual images and simpler language are needed to help address late detection of breast cancer More visual aids were needed to solidify the stylists’ understanding of the more difficult concepts (i.e., tumor, toxic waste, chemically altered foods) In response, a number of images were added to elaborate on the concepts The addition of images resulted in more accuracy of stylists’ responses to survey questions in subsequent pilot tests Cultural Targeting – Presentation Language    Both African American and Afro-Caribbean stylists felt that the language suggested for use in their communications with customers was acceptable African American stylists indicated the least comfort with the following terms: late detection, benign vs. cancerous tumors, warning signs of breast cancer, lifestyle changes, and hormone therapy Training curriculum was modified to incorporate simpler language and to reinforce these ideas through visual presentation and repetition Cultural Targeting Personal Connection to the Message   Afro-Caribbean stylists’ verbal comments on the training presentation indicated that personal connection to the message and project was crucial to stylists’ commitment to participating in the project A breast cancer survivor was invited to share her story as a segment of the training Cultural Targeting Race and Gender Issues     Focus groups which evaluated video version of the training indicated that stylists felt both race and gender were important in the selection of providers who provided messages on the tape Stylists indicated that they wanted to see providers who “look like us” Age was another important factor for some stylists as one provider on the video looked “too young” Other stylists felt a sense of pride to see a young Black woman doctor Cultural Targeting Fears with the Word “Cancer”  Qualitative data from field experiences demonstrated that some women in the community have fears associated with the word “cancer” and it inhibits their participation in the project  Some salon customers declined participating in customer surveys because they have been affected by cancer and did not want to be associated with anything that had the word “cancer” in it “Breast Health” was promoted with less emphasis placed on the term “breast cancer”  Cultural Targeting Common Barriers  When asked about common barriers in discussing health issues with their customers, African American stylists mentioned the following issues: fear of not knowing how the customers will respond  lack of knowledge of the issues  difficulty talking to customers personally affected by health issues  Results & Highlights    2,284 pre intervention surveys were collected from salon customers Stylists from 50 salons in Brooklyn completed the program Self-reported exposure to stylist-delivered messages was associated with improved breast self-examination rates and with greater intentions to have a clinical breast examination Results & Highlights (continued)      8 church facilitators trained Media coverage: New York Times, BET, NY 1, ABC local TV and German TV Mammography provided by ACS and American Italian Cancer Foundation Stylists were recognized by the Brooklyn Borough President at a special ceremony Lasting relationships Next Steps    Seek funding for future interventions Extend reach by translating materials into other languages (Spanish & Creole) Program Replication Conclusion Arthur Ashe once said: To achieve greatness Start where you are Use what you have Do what you can