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Breast Cancer and African American Women

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Table of Contents
Preparing and Adapting to the Field..……………………………………………………………..5
Medical Anthropology Fieldwork Methodology...………………………………………………..6
Ethnographic Fieldwork Data Analysis …………………………………………………………..9
Reflective Comments/ Conclusion……………………………………………………….…….....9

Targeting Breast Cancer among African American Women in Nash County:
A Proposal to Identify Enabling and Reinforcing Factors of Seeking Preventative Screening Services
Ethnographic field work is an excellent strategy in understanding and describing a cultural group. Field work is also an asset in performing a needs assessment in the planning phase of developing health promotion interventions. As described by Bailey (2002), “ethnographic techniques are integral tools for galvanizing and mobilizing communities for social action relative to generating a promotion and disease prevention agenda.” (Bailey, 2002) This paper serves as a proposal to conduct a medical anthropology field work project to assess reinforcing and enabling factors that promote the use of early detection and preventative breast cancer screening services among African American women. The study design consists of a qualitative ethnographic approach utilizing observation and focus group methodology. This project consists of conducting a focus group with a group of African American women age 40-65 years of age at a Nash County church, who regularly receive early detection and preventative breast cancer screenings. Qualitative data collected will be analyzed utilizing qualitative research coding and content analysis to identify common themes. Data will allow us to identify factors that enable African American women to engage in responsible health behavior practices such as performing monthly breast self exams and receiving preventative care services such as clinical breast exams and annual mammograms. Qualitative data analysis will reveal reinforcing enabling factors that encourage women to receive described preventative care services. This data will be utilized to identify effective preventative intervention strategies to increase the number of middle aged African American women receiving regular mammograms and early detection services to decrease the number of breast cancer related deaths among this population.
In the United States, breast cancer is one of the most common cancers among women, and the most common cause of death from cancer among African American women. It is estimated that approximately 180,000 women each year develop breast cancer nation wide, and of those who develop breast cancer, approximately 40,000 die. Although African Americans rank 2nd among breast cancer rates, following white, they rank first in the number of deaths from breast cancer (CDC, 2009). According to the 2009 Nash County needs assessment, cancer was ranked as number four of the top ten health concerns for the county. Cancer is also the second leading cause of death for the county as well as the state of North Carolina; with breast cancer being one the leading causes of cancer deaths. In 2006, the breast cancer rate for Nash County was 33.7, higher than the states average of 27.9 (Nash County, 2009). Limited data and literature is provided displaying to effectiveness of utilizing a Salutogenic approach in promoting breast cancer early detection screenings among African American women. The concept of Salutogenesis discusses the origins of health. Salutogenesis focuses on factors and behaviors that enable health and promote overall wellness, rather than factors and behaviors that contribute to disease and illness. In theory this fieldwork project will allow one to identify enabling and reinforcing factors that encourage middle aged African American women to receive or perform regular breast cancer preventative screening.

Preparing and Adapting to the Field Before conducting a medical anthropology fieldwork project, one must prepare and adapt to the field. This is an important step in the ethnographic field work process to ensure the ethnographer is knowledgeable of the health issue of study and is aware of their personal inhibitions and biases. This also allows the ethnographer to prepare to immerse themselves within the community (Bailey, 2002). To prepare for this project, the ethnographer will conduct a literature review of enabling and reinforcing factors identified by researchers that influence the use of breast cancer prevention screenings among African American women. Data of the incidence, prevalence, and mortality rates of breast cancer among middle aged-African American women will also be obtained and reviewed for further understanding. Local data comparing the number of African American women who received and/or performed preventative breast cancer screenings in relation to the implementation of breast cancer education and awareness interventions within the community will also be analyzed. In preparation of engaging into this population, the ethnographer will contact local health care providers (i.e. Nash Health Care Systems, Nash County Health Department) as well as local churches to conduct observations of middle aged African American women receiving breast cancer prevention screenings. Interaction between health care providers and patients as well as patient interactions will also be observed. Local BCCCP Coordinators from the Nash County Health Department and local partners will be interviewed and observed to discuss their perceptions of factors that enable and encourage African American women in performing and receiving early detection and preventative screenings.

Medical Anthropology Fieldwork Methodology An ethnographical approach was utilized in designing this field work project to identify reinforcing and enabling factors to promote early detection and preventative screening among middle aged African American women in Nash County. According to Creswell (2007) ethnography refers to the study of an intact cultural or social group based primarily on observation and a prolonged period of time spent by a research in the field. These studies are often carried out utilizing various data collection methods including individual interviews with members of the cultural/social group studied. Utilizing an ethnographic approach allows one to describe and interpret shared and learned patterns of values, behaviors, beliefs, and language of culture-sharing groups (Creswell, 2007). Utilizing this approach allows us to identify common views, attitudes, and perceptions of factors that influence receiving preventative health care screenings by answering the following questions: 1. What factors enable African American women to receive regular preventative care services such as mammograms and clinical breast exams? 2. What factors enable African American women to perform monthly self breast exams? 3. What do African American women perceive as benefits of receiving and performing early detection/preventative care screenings? 4. What cultural competent strategies can health care providers implement to ensure African American women continue to perform and or receive breast cancer screening? A purposive convenience sample of five African American women aged 40-65 will be selected to participate in focus group. These women will be recruited from a local predominately African American church will to participate in this project. Utilizing the purposive sampling strategy will allow the selection of women to collect data to purposely provide insight of effective strategies to enable them to receive or perform regular preventative breast cancer screenings. The first and most important step of conducting an applied medical anthropology field work project is to perform observation. Observation is an effective method in gaining valuable qualitative data (Bailey, 2002). Observation will be conducted while visiting the Nash Health Care Systems Mammography Radiology Department. Several hours will be spent simply sitting the waiting area, and facilitating discussion with African American clients preparing to receive preventative care services to identify attitudes, perceptions, and believes of receiving early detection screenings. Observations of interaction between hospital staff and patients will also be recorded as well as interactions between the patients themselves. Further observation will include accompanying Nash County Health Department’s Breast and Cervical Cancer outreach coordinator while performing daily community outreach activities within local African American communities. Participant observation is important in gaining insight on perceived benefits of receiving breast cancer preventative screening services as perceived by the population of study. To achieve this, the ethnographer will receive a clinical breast self exam and mammogram provided by Nash Health Care Systems. Coordinator will also attend a community based breast cancer education and awareness program conducted by Nash County’s Breast and Cervical Cancer outreach coordinator. Women will be recruited to participate in a focus group by presenting to a group of women attending a regularly scheduled bible study class. Women will be asked to fill out an interest card and place it in the collection box providing their name, age, and contact information. Flyers will also be placed in church bulletins to recruit participants. Women participating in focus group will be offered free refreshments as well as a “Pink Ribbon” tote and a “Pink Ribbon” bible book- mark engraved with inspirational messages. Women returning interest cards will be contacted by field work project coordinators via phone to conduct a preliminarily assessment to determine if participants meet the following criteria to participate in the focus group: (1) Must be 40 to 65 years of age, must have had performed monthly breast self exams every month for the past 6 months, must have had received regular mammograms as suggest by health professional based on health background and related risks. Women meeting requirements for participation will be invited to attend a focus group session as a participant held at their church; those who do not meet requirements will have the option of being trained to assist with the facilitation of the focus groups or to serve as recorders and project assistants. A separate training session will be scheduled and conducted for these individuals. When conducting the focus group, participants will be oriented of the purpose of conducting this project: to identify “positive” factors that enable or encourage them to seek preventative breast cancer screening services. They will be informed that their participation is vital in allowing health promotion specialist to modify current Breast Cancer Prevention and Awareness Outreach Initiatives implemented to encourage women of their population to receive preventative screenings. Consent to participate in focus group will also be obtained. A series of questions will be read by the focus group facilitator to provide participants an opportunity to share reasons why they either practice or receive regular breast cancer screenings. The questions will also explore their perception and attitudes of practicing or receiving breast cancer screenings, encouraging them to discuss positive experiences as well as to identify if religious concepts also influence their decisions and behaviors. Recorded responses will be organized and compiled for data analysis.
Ethnographic Fieldwork Data Analysis As described by Creswell (2007) data analysis begins consists of preparing and organizing data for analysis and further reducing the data to identify common themes for interpretation. Coding data analysis strategies are utilized to reduce data obtained during the interviewing process to identify common themes expressed by the participants (Creswell, 2007). Coding labels will be developed using common themes expressed by participants during focus group sessions. For example, a question may ask “What do you like most about visiting your doctor when receiving your annual mammogram?”, the code “Reinforcing Factors: Favorable Patient to Health Provider interaction” may be assigned, any comments expressed by the participants describing positive experiences when visiting their health provider when receiving breast cancer screenings will be labeled under this code. A similar process will be utilized in analyzing initial observation data recorded by ethnographer. Upon completion of data analysis final results, outcomes, and knowledge learned will be presented to focus group participants, members of their church, and community partners utilized in completing this project. Suggested strategies to increase number of middle aged African American women performing/receiving regular breast cancer screenings will also be presented in addition to future actions to be taken.
Reflective Comments and Conclusion: Targeting breast cancer among African American women is important for Nash County health care providers because many women of this population fail to receive early detection services which are important in early detection and treatment of breast cancer. A number of breast cancer prevention, education, and awareness program have been developed and implemented within the community to make breast cancer screening services accessible; however usage by the African American community has been limited. Utilizing a Salutogenic approach in identifying factors that encourage African American women to continue to receive these services will allow program developers and health professionals to better tailor outreach initiatives and services to better appeal to the African American community. Offering programs and services that improve trust of health care services provided, comfort of receiving services; knowledge and understanding of services as well as attitudes and perception towards breast cancer awareness, access to services, and self efficacy to perform personal preventative screenings are important in improving the use of preventative screenings among this population and addressing this health disparity.

Bailey, E. (2002). Medical anthropology and african american health. Westport, Connecticut: Bergin & Garvey.
Centers for Disease Control. (2009). Breast cancer: fast facts. Retrieved April 23, 2009 from,
Creswell, J.W. (2007). Research design: Qualitative, quantitative, and mixed methods approaches . Thousand Oaks, CA: Sage Publications.
Nash County Government. (2009). Community needs assessment. Retrieved April 23, 2009 from,

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