Community-Based Intervention to Promote Breast Cancer Screening, Awareness, Knowledge and Motivation among Homeless Women

Purpose:

A national efforts is underway to detect breast cancer in its early stages which is very necessary to reduce breast cancer-associated mortality (National Cancer Institute, 2014) Despite many initiatives to increase breast cancer screening in the United States, minority homeless women continue to have alarmingly lowered rates of breast cancer screening, therefore increasing their risk for delay diagnosis and decreased survival after diagnosis (Bhargava & Du 2009; DeSantis, Siegel, Bandi & Jemal, 2011; Miller, King, Joseph & Richardson, 2012; Ooi, Martinez, & Li, 2011). A doctoral prepared nursing faculty member and RN-BSN Students facilitated a community-based Intervention to promote breast cancer screening, awareness, knowledge and motivation among minority homeless women.The purpose of this educational intervention for homeless women living in transitional housing was to evaluate the effectiveness of a culturally appropriate multifaceted learning intervention on increasing awareness, knowledge and motivation for breast cancer screening and health promotion.

Methods:

A pre-and-post quasi-experimental study was conducted.  Prior to the intervention, a pretest was administered by the nurse researcher. The RN-BSN students under the supervision of the nurse researcher implemented the ten-session two hour-weekly multifaceted educational intervention. In the intervention a convenient sample of 24 women completed the educational intervention based on Green & Kreuter  (2005)) Health Belief Model  Awareness and knowledge of breast cancer were measured by a pre- and post-education demographic breast cancer risk factor 36 questions and a self-administered 16 multiple-choice questions breast cancer knowledge test. The posttest was administered by the nurse researcher. Content validity for both instruments was obtained with a panel of 5 experts.  The participants’ motivation for breast cancer screening was evaluated by a two week follow up telephone interview by the researcher.

Results:

Demographics: of the 24 participants, 95% of the sample was ethnic minorities (48% Hispanic, 44% African American, 4% Caucasian and 4% identified themselves as other). Of the women, 75% reported little or no worried about breast cancer while 68% reported their health as poor.  Furthermore,  48% of the women reported never having had a mammography and 30% of the participants were identified as in need of mammography as recommended by the U.S. Preventive Services Task Force (USPSTF). Effectiveness of the educational intervention was estimated through a paired t test. The mean percentage of correct answers increased from 64% at baseline to 84% post-education (P < 0.0001). After the telephone interview 75 % of the women requested help with obtaining a clinical breast examination or a free mammography.

Conclusion:

Findings in this sample suggest an apathetic view of breast cancer risk factors by these women despite reports of poor health by this sample. This community-based education intervention was effective in increasing breast cancer awareness knowledge among homeless women .The invention also made these fragile women more likely to undergo clinical breast examination and mammography in future and recommend it to their relatives and friends. This community based educational study effectively facilitated health-promotion education and awareness among homeless women. Findings from this study may be used to decrease breast cancer screening gaps and to promote programs that are population specific as recommended by the overall objectives of Healthy People 2020. Findings also may be used to inform public policy about the health disparities experienced by these vulnerable populations.