Breast cancer and cervical cancer control program enrollees inform the Kin Keeper^SM curriculum

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The purpose of this study is to present the methodology and process of informing a breast and cervical cancer prevention curriculum through participatory engagement of women from underserved communities. The Kin Keeper^SM Cancer Prevention Curriculum Guide and Workbook© were developed to cross train community health workers (CHWs) from public health programs other than cancer to deliver a breast and cervical cancer prevention education intervention for Black, Latina and Arab women. Data collection included a review of existing educational materials, a 10-minute telephone survey of 146 women enrolled in a county-wide Breast and Cervical Cancer Control program (BCCCP) and a pair of pre- and post-training cancer literacy assessments of 31 CHWs recruited from existing public health programs in a Midwestern state. Both quantitative and qualitative analytic tools were used to analyze the data. BCCCP enrollees sampled consisted of 51% Black women, 46% White and 3% Arab or Latina women. The mean age of the women was 51 years and most women (42%) earned annual incomes below $10,000. Thirty-one percent of the women indicated attaining a high school diploma as their highest level of education while 36% said they had some college level education. Eleven percent (16 women) reported having been or currently being treated for a cancer with the majority (15 out of 16) indicating breast or cervical cancer as the type of cancer in question.
 >Content analysis of the qualitative responses made by BCCCP enrollees was performed. When asked what they thought was important for a family-based breast and cervical cancer education program their qualitative responses were categorized into four major themes. For breast cancer education: “everyone is at risk” “empowerment education” “screening” and “life style risks”. For cervical cancer education: “screening,” “symptoms,” “Pap procedures,” and “empowerment”. With this information and the review from existing educational materials we developed the 8-module curriculum and 6-unit workbook to cross train 31 CHWs on the basics of breast and cervical cancer as well as how to implement the Kin Keeper^SM model. The CHWs consisted of 52% Black, 26% Arab and 22% Latina women with an average age of 42 years. Seventy seven percent of these women were recruited from a diabetes cardiovascular public health program while 23% were recruited from a maternal support services program.
 >To validate the finding that our methodology helped correctly informed the curriculum, paired t-tests were performed to analyze the differences between pre- and post-training mean scores attained by the CHWs using our breast and cervical cancer literacy assessments. Results show that the curriculum design was well-informed. On average, CHWs significantly increased their test scores by 7% and 14% in the breast and cervical cancer literacy, respectively (p=0.001 and p<0.001 respectively).
 >With practical input from BCCCP enrollees who mirror our targeted population, we successfully developed a curriculum and workbook to cross train CHW and expanded its utility by translating it into Spanish and Arabic, while building capacity.