1. Cooperative Agreement Number U58/CCU323067-04 5U58DP3223067 Spirit Health Education (S.H.E.) Circle Early Detection or Survivorship of Cancer in Underserved Populations D. Magrini, Project Director Judith Bradford, Evaluator

2. Background  African American women have higher rates of certain illnesses than their Caucasian counterparts.  Compared to women in the general population, sexual minority (lesbian and bisexual) women (SMW) have reported more barriers to healthcare access and higher rates of specific health risks.  In 2001 the Mautner Project received funding from the Susan G. Komen Breast Cancer Foundation to conduct the national Women 2 Women Spirit Health Study.  We used the IOM access model as a conceptual framework to explore these concerns.  We have used Spirit Health Study results, along with best practices and our prior experience in provider education, to develop S.H.E. Circle.

3. STRUCTURAL Availability How organized Transportation FINANCIAL Insurance coverage Reimbursement levels Public support PERSONAL Acceptability Cultural Language Attitudes Education Income Visits Procedures Appropriateness Efficacy of treatment Quality of Providers Patient Adherence HEALTH STATUS Mortality Morbidity Well-being Functioning EQUITY OF SERVICES BARRIERS USE OF SERVICES MEDIATORSOUTCOMES A Model for Monitoring Access Millman M, Ed. Access to Health Care in America. Committee on Monitoring Access to Personal Health Care Services. Institute of Medicine. 19933 2

4. Research Question and Methods Are African American sexual minority women at increased health risks based on their dual minority status? Questions were focused on cancer screening behavior, behavioral risk factors, and barriers to accessing health care services. Information was distributed through list servs, community organizations, peer networks. Multiple methods were used for data collection (web-based and mail-back). Responses were anonymous, N=660+, 18 and older. Time period: August 2002 – August 2003 * Behavioral Risk Factor System, Commonwealth Fund Survey

5. SPEAK OUT! Black Women 2 Women Spirit Health Study - Results  93% had at least one established risk factor for breast cancer: such as family history, smoking, obesity, history of HPV, early menarche, history of benign breast disease, heavy alcohol use.  Only 29% were adherent to all four of the cancer screening methodologies, i.e., mammography (age 40+), breast self- examination (BSE), clinical breast exam (CBE) and Pap Test.  68% of those 40+ did not have an annual mammogram, and 69% did not perform monthly BSE.  40% did not receive yearly CBEs, and 37% did not receive a yearly Pap test.  71% were overweight (BMI above 25) or morbidly obese (BMI above 30), far exceeding national statistics for AA women(38%) and white women (24%).  26% were current smokers compared to 22% of AA women in the general population.  Study results indicated that increased education and support to access cancer screening were needed by this population.

6. As the first national health education program focused on African American women who partner with women, S.H.E. Circles provide a safe space where African American lesbian and bisexual women can learn about health issues, ask questions, share information, connect with resources, and provide support to each other toward positive change in health behaviors.

7. Goals of S.H.E Circle To actively encourage healthy living strategies among same gender loving African American women through:  Cancer Screening (Breast, Cervical, Colorectal)  Healthy Nutrition and Exercise  Smoking Cessation  Stress Management Program Goals

8. S.H.E Meetings Affirmation/Opening Ritual Education Discussion –Screening –Self-Care/Prevention (Cooking, Exercise, etc.) –Role Plays - Exercise –Games Sharing Personal Stories – Support Parting/Closing Ritual Homework

9. Major Accomplishments Spirit Health Education (S.H.E. Circle) Health Brochures Completed Curriculum in Final Draft Three Pilot Groups Completed One Training of Facilitators in South Florida Three Replication Sites Scheduled for Training Chicago Philadelphia Pittsburgh

10. Evaluation Methods, Preliminary Findings Methods Pre- and immediate-post surveys (will add remote post- in next phase of project) Focus groups after last session Findings from formative evaluation Quality and relevance of training mode and contents received consistently excellent ratings. Participants acknowledged increased stress due to sexual minority status. A majority thought that coming out to their providers would positively impact their health. Identification of personally and culturally acceptable approaches to reduce barriers are essential to improve healthcare access and use. Behavior change resulted from S.H.E. Circle participation, with implications for improved health outcomes at individual and community levels. At the end of the program, virtually all participants knew how to create a healing environment in their lives.

12. For more information on S.H.E. Circle: dmagrini@mautnerproject.org http://www.shecircle.org/index.php