Development of a Spiritually-based Prostate Cancer Informed Decision Making Educational Program for African American Men: A Feasibility Study Cheryl L. Holt, PhD; Theresa A. Wynn, PhD; Penny Southward, MPPM ; Emily Schulz, PhD, OTR/L, CFLE; Sanford Jeames, MA; Mark Litaker, PhD University of Alabama at Birmingham – School of Medicine – Division of Preventive Medicine This research examined the development and pilot testing of a spiritually- based educational program designed to promote informed decision making (IDM) for prostate cancer among church-attending African American men age 45 and older using community based participatory research principles. Phase 1: Advisory Panel Role in Intervention Development Advisory Panel members recruited from a local church 9 African American men Provided input into all aspects of the intervention Received $100 for participation Phase 2: Pilot testing the Intervention for Acceptability (Focus Groups A & B: Print-based Materials) Two groups of 8 African American men Recruited from local churches to participate in a focus group Eligibility criteria: African American male, age 45 or older, no history of prostate cancer Provided feedback on the appropriateness of graphic design and content Received $25 for participation Phase 3: Cognitive Response Interviews 10 African American men who met the above eligibility criteria were recruited from local churches Participated in 1-hour interview to read passages and answer open-ended questions about what they read Received $25 for participation It is thought that one way of making church-based cancer communication interventions more culturally appropriate is to integrate spiritually-based content. Using the newly developed spiritually-based educational booklet, the feasibility of a spiritually-based prostate cancer screening IDM intervention will be established, and preliminary data for efficacy will be provided. The intention of the spiritually-based intervention is to work within churches and use the existing spiritual aspects of the culture to support and convey the health message. The intention is not to increase religiosity or spirituality. The aim is to make a cancer communication intervention more culturally appropriate and personally relevant for this population by working within important cultural belief systems. Introduction Purpose MethodResults Literature Review Table 2: Focus Group Demographics Total N = 16 African American men Age Range: years Mean: 55 (SD = 6.1) Marital Status Married: n = 14 (88%) Separated/Divorced: n = 1 (6%) Single: n = 1 (6%) Employment Employed: n = 14 (88%) Unemployed: n = 1 (6%) Retired: n = 1 (6%) Education Average Education: years (SD = 1.87) Household Income Range: $20,000 - >$60,000 Median: >$60,000 Family History of Cancer Yes: n = 8 (50%) No: n = 7 (44%) Not Sure: n = 1 (6%) Table 4: Focus Group Results Table 5: Cognitive Response Results -Make the font larger; add more color contrast -Use bullets to summarize statements -Make the booklet slender in shape -Add more religious symbols -The men understood and found acceptable most of the content -Emphasize particular words through use of bold or underlined font -Liked the phrase “Brother to Brother Guide” -Link phrase to a spiritual theme -Keep the older gentleman’s face on the cover -Break up long sentences into shorter sentences for easier reading and comprehension -Include testimonials from real men -Booklet needs to be more direct and forceful -Colors are appropriate; not too Afro-centric -Keep the word cancer in the title to reinforce the seriousness of the booklet -The controversy about prostate cancer screening is still confusing to men and needs to be explained carefully -Difficulty in pronouncing words such as “devastated” -Liked the use of Bible verses to support prostate health messages -Title for booklet was selected from a brief list of finalists With the assistance of community members: Develop and pilot test spiritually-based educational print materials through focus groups and cognitive response testing. Background African American men are 60% more likely to get prostate cancer and twice as likely to die from it as compared to European-American men. 1 The benefits of screening and treatment remain unclear for many men. 2 Informed decision making (IDM) is the focus of educational interventions, in which men make the best choice based on their risk assessment, values, and preferences. 3 Importance of Religion and Church in African American Community African Americans tend to be more religiously involved than other groups in the U.S. 4,5 The church has historically served as a cornerstone of the African American community. 6 Spiritually-based cancer communication interventions can be developed by partnering with churches and using relevant spiritual themes to frame the cancer educational message, thereby putting health in a spiritual context. Community Based Participatory Research This approach involves significant participation of the priority population in all stages of the intervention development. Table 1: Advisory Panel Demographics Total N = 9 African American men Marital Status Married: n = 8 (89%) Single: n = 1 (11%) Age Range: years Mean: 49 (SD = 13.14) Education Bachelor’s: n = 4 (44%) Post-graduate: n = 5 (56%) Denomination Baptist: n = 9 (100%) Employment Employed: n = 7 (78%) Retired: n = 2 (22%) Table 3: Cognitive Response Demographics Total N = 10 African American Men Marital Status Married: n = 8 (80%) Single: n = 1 (10%) Widowed: n = 1 (10%) Age Range: years Mean: 55 (SD = 8.5) Education ≤ Bachelor’s: n = 6 (60%) Post-graduate: n = 4 (40%) Employment Employed: n = 8 (80%) Retired: n = 1 (10%) Disabled: n = 1 (10%) Conclusions Literature cited 1. Stanford JL, Stephenson RA, Coyle LM, et al. Prostate cancer trends , SEER Program. Bethesda, MD: National Cancer Institute; Harris TM, Parrott R, Dorgan KA. Talking about human genetics within religious frameworks. Health Commun. 2004;16(1): Taylor RJ, Chatters LM, Jayakody R, Levin JS. Black and white differences in religious participation: A multisample comparison. Journal for the Scientific Study of Religion. 1996;35(4): Levin JS, Taylor RJ, Chatters LM. Race and gender differences in religiosity among older adults: Findings from four national surveys. Journal of Gerontology. 1994;49(3):S137-S Lincoln, C. E., & Mamiya, L. H. The Black church in the African American experience Durham, NC: Duke University Press. Prototype and Logo Development