Changing Cultural Beliefs Contributing to Breast Cancer Deaths

Purpose: Chicago has one of the largest disparities in breast cancer mortality in the nation, with African American death rates twice that of Caucasians at its peak.  Previous work of our team showed that the cultural beliefs we identified were associated with (1) longer delays after finding a suspicious breast symptom, (2) later stage of breast cancer at diagnosis, and (3) longer delays between diagnosis and the start of treatment for African American women.  The purpose of this study was to determine whether cultural beliefs about breast cancer could be changed by viewing a short film on DVD followed by at question and answer session, which would provide a simple, cost-effective technique that could be widely disseminated. 

Methods: A 14-minute film on DVD was produced, in which five African American cancer survivors address the cultural beliefs identified in our earlier work, speaking compellingly in their own words. A pretest-posttest design was used to evaluate the DVD, with 260 African American women participating in community settings. Cultural beliefs were evaluated by questionnaire before and after watching the DVD, and again after a question and answer period led by an African American nurse, all in one continuous session lasting 90 minutes. 

Results: Changes in beliefs were found for the entire intervention (DVD plus Q&A), with the largest change occurring after watching the DVD, as shown by logistic regression (p <.0001). Significant changes were found for total cultural belief scores, as well as specific beliefs. One of the most important beliefs that increased was endorsement of idea that breast cancer can be cured if treated correctly, even for poor women. There was a decrease in the belief that breast cancer would grow faster if it were cut open in surgery. Examples of faith-based beliefs that changed were faith in God can protect you from breast cancer and prayer can make breast lumps disappear. Ninety-nine percent considered the DVD to be worth watching, and 79% stated that it helped them decide to get screened for breast cancer (other women reported that they were already participating in screening).

Conclusion: This is the first study we are aware of that demonstrated that cultural beliefs about breast cancer can be changed by viewing a short film on DVD. This DVD provides a simple, cost-effective technique that can be easily used for wide dissemination, with the goal of reducing disparities in breast cancer mortality. Our team is currently conducting a dissemination project focused on the south side of Chicago with the DVD. To date more than 8,500 women have participated in the project. The film has been endorsed by the American Cancer Society and was selected for a national Telly Award.

This work was funded by the U.S. National Institutes of Health: National Cancer Institute, National Institute on Aging, and National Institute on Minority Health and Health Disparities.