Nontraditional Approaches to Community Health: A Soul Sense of Beauty

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Nontraditional Approaches to Community Health
A Soul Sense of Beauty

• Marilyn White, MD
• Associate Director, Research Training
• Arthur Ashe Institute for Urban Health

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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

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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

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AAIUHs 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)

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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
• Advocate
• Individual and community health actions
• Ensure
• Access to needed health services providers
• Build
• Individual and community capacity

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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

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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

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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

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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

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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

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A Soul Sense of BeautyEvaluation

• 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

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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

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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

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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 didnt want them to worry about it

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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

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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

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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

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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

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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

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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

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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

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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

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Next Steps

• Seek funding for future interventions
• Extend reach by translating materials into other
  languages (Spanish Creole)
• Program Replication

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Conclusion

• Arthur Ashe once said
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• To achieve greatness
• Start where you are
• Use what you have
• Do what you can
•