A number of studies have shown that greater cancer knowledge is correlated with increased rates of screenings and regular check-ups for the general population, which in turn is correlated with increased rates of early cancer detection and thus higher rates of cancer survival. However, a number of other studies suggest that a disproportionate burden of cancer morbidities and mortalities are borne by minority populations in the United States, and in order to address this, the Kin KeeperSM Cancer Prevention Intervention, a culturally and linguistically tailored breast and cervical cancer education intervention, was developed to address this burden at its source, cancer knowledge through literacy. The main objective of this study was to investigate the effect of the Kin KeeperSM program on breast and cervical cancer knowledge retention (i.e. literacy levels over time) among African American, Arab American, and Hispanic American women in the Detroit metropolitan area.
The program involves three levels of participants: the community health worker (CHW) responsible for recruiting clients to participate as Kin Keepers; the Kin Keepers, who are responsible for recruiting female family members to participate; and the female family members. In all, trained CHWs recruited 543 participants of Black/African American, Hispanic, and Arab descent at the start of the study, to include Kin Keepers and recruited family members; the number of respondents participating in the study at follow-up (CHWs were only responsible for recruitment and did not otherwise participate in the study) dropped to 446 (117 African American, 157 Latina, 172 Arab) in the second year. Participant responses for cancer literacy assessment tests (CLATs) for both breast cancer and cervical cancer were collected three times: a pre-test, a first-year post-test, and a second-year post-test. Between the pretest and the first-year post-test the Kin KeeperSM intervention in the form of cancer education was administered to participants. No other education was administered after the first-year post-test. After one year, the second-year post-test was given to participants and their responses collected. Once all participant responses for all tests were collected, they were scored and literacy between the three tests for each eligible participant was analyzed.
Overall, the cancer literacy trend for all participants increased dramatically between the pre-test and the first-year post-test, then returned to pre-test literacy levels for the second-year post-test. For instance, for the breast cancer CLAT (BCLAT), a number of individuals from all ethnic groups (n = 52 over all groups) scored 100% on the first-year posttest, but none scored 100% on the second-year post-test. When looking at scores above 75%, the number of individuals scoring at or above this level increases (n = 339 over all groups), but there are still no individuals scoring at or above 75% on the second-year post-test. This trend appears to be consistent across all ethnic groups sampled in the study. The most consistently significant (p ≤ 0.05) covariates correlated with literacy were ZIP code (i.e. location), age, level of education, and insurance status.
It is likely that a lack of education intervention in the months between the first-year post-test and the second-year post-test are responsible for the return of literacy to pre-test levels. It is also possible that, because all questions on all tests were given equal value, literacy may have appeared to return to pre-test levels but in fact masks increased functional literacy related to certain sets of questions that should be given more weight than others. In order to realize permanently-increased cancer literacy in women of these ethnic groups, recommendations include more than a single application of Kin KeeperSM intervention education and the introduction of a weighting system for CLAT questions.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A21.