Nontraditional Approaches to Nontraditional Approaches to Community Health: A Soul Community Health: A Soul

Sense of BeautySense of Beauty

Marilyn White, MD

Associate Director, Research & TrainingArthur Ashe Institute for Urban Health

The Arthur Ashe Institute for Urban Health

Founded in 1992 by Arthur Ashe to address social and cultural issues that affect health and wellness

Develops model urban health services in Brooklyn and other parts of New York that can be replicated in other urban communities nationally

The Institute Believes Strong Health Education and Services

Must: Address the whole

individual Be easily

accessible in trusted venues

Empower individuals and communities to advocate for their own health concerns

Increase urban youth pursuing health care careers

Target diseases that affect disadvantaged populations

Provide programs that address ethnic, racial, and gender disparities in health

AAIUH’s Approach: Leveraging Community Assets

All communities have assets that can be engaged on behalf of the communities health

Assets include businesses, churches, local health and social service agencies, personal care establishments, libraries, schools, etc.

Proprietors, personal care givers, stylists, barbers, ministers/faith leaders, nurses and other health care practitioners who live in communities can be engaged in community health empowerment (CHE)

Community Health Empowerment:

Lay Health Advocates Provide Informal counseling and social support Culturally competent and linguistically appropriate health

education Connections to referral and follow-up services Communication tailored for stages of change

Advocate• Individual and community health actions

Ensure• Access to needed health services & providers

Build•Individual and community capacity

AAIUH Core Programs Health Science

Academy Black Pearls and

Different “Fades” of Health

Nuestra Belleza Agape: Health

Education and Outreach Program for African-American and Caribbean Congregations

First Impressions A Clean Bill of Health A Soul Sense of

Beauty Prostate Cancer

Control Brooklyn Information

Health Access Coalition

Brooklyn Health Disparities Center

Community Health Empowerment: A

Soul Sense of Beauty

Innovative breast cancer awareness program National Cancer Institute funded training

program for hairstylists to teach them how to talk to their own customers about breast health

Three messages: practice BSE, get annual CBE, mammography

A Soul Sense of Beauty

Objectives

To select and train community-based professional stylists in specific knowledge, attitudes, and practices of delivering breast cancer control messages to their customers

To examine, via a randomized controlled trial, the impact of stylist-delivered breast cancer control messages on the breast health behaviors of beauty salon customers

Objectives(continued)

To develop a portable stylist training and communications package for ongoing training

To conduct an outcome evaluation of breast health behaviors of salon customers comparing method of stylist training (video versus live-training)

To organize a community-based Health and Beauty Council to continue the stylist training program in support of the intervention

A Soul Sense of Beauty Activities

Customers were pretested at each salon

Breast health information, including videos and shower cards on breast self-exams and pamphlets on breast health were available at each salon

Church volunteers - trained to assist in demonstrating breast self-exams during the Health and Beauty Days

Breast Cancer Survivor – played vital role in recruitment, promotion of breast healthy behaviors

A Soul Sense of BeautyEvaluation

Intervention salons compared to control salons to determine if trained stylists can affect the breast health behaviors of their clients

Stylists trained via videotape were compared to stylists trained live to assess the breast health behaviors of their clients

A Soul Sense of Beauty Cultural

Targeting Focus groups were conducted with African

American and Afro-Caribbean stylists to Inform the cultural content of the Inform the cultural content of the

training prior to its development training prior to its development Determine the cultural acceptance Determine the cultural acceptance

of the training curriculum and of the training curriculum and breast health messages breast health messages

Cultural Targeting

Denial of diagnosis Presentation language and images Personal connection to the message Race and gender issues Fears with the word cancer

Common barriers

A fear of not knowing how the customers will respond

A lack of knowledge of the issues

Difficulty talking to customers

Cultural Targeting - Denial

Focus groups revealed that denial is a common experience encountered with women in the community who are diagnosed with breast cancer.

One stylist shared knowing a woman who would not tell her family of her ongoing cancer treatment because she didn’t want them to worry about it

Cultural Targeting - More Images and Simpler Language

African American stylists indicated that more visual images and simpler language are needed to help address late detection of breast cancer

More visual aids were needed to solidify the stylists’ understanding of the more difficult concepts (i.e., tumor, toxic waste, chemically altered foods)

In response, a number of images were added to elaborate on the concepts

The addition of images resulted in more accuracy of stylists’ responses to survey questions in subsequent pilot tests

Cultural Targeting – Presentation Language

Both African American and Afro-Caribbean stylists felt that the language suggested for use in their communications with customers was acceptable

African American stylists indicated the least comfort with the following terms: late detection, benign vs. cancerous tumors, warning signs of breast cancer, lifestyle changes, and hormone therapy

Training curriculum was modified to incorporate simpler language and to reinforce these ideas through visual presentation and repetition

Cultural Targeting - Personal

Connection to the Message

Afro-Caribbean stylists’ verbal comments on the training presentation indicated that personal connection to the message and project was crucial to stylists’ commitment to participating in the project

A breast cancer survivor was invited to share her story as a segment of the training

Cultural Targeting - Race and Gender

Issues

Focus groups which evaluated video version of the training indicated that stylists felt both race and gender were important in the selection of providers who provided messages on the tape

Stylists indicated that they wanted to see providers who “look like us”

Age was another important factor for some stylists as one provider on the video looked “too young”

Other stylists felt a sense of pride to see a young Black woman doctor

Cultural Targeting - Fears with the Word “Cancer”

Qualitative data from field experiences demonstrated that some women in the community have fears associated with the word “cancer” and it inhibits their participation in the project

Some salon customers declined participating in customer surveys because they have been affected by cancer and did not want to be associated with anything that had the word “cancer” in it

“Breast Health” was promoted with less emphasis placed on the term “breast cancer”

Cultural Targeting - Common Barriers

When asked about common barriers in discussing health issues with their customers, African American stylists mentioned the following issues: fear of not knowing how the fear of not knowing how the

customers will respondcustomers will respond lack of knowledgelack of knowledge of the issues of the issues difficulty talkingdifficulty talking to customers to customers

personally affected by health issuespersonally affected by health issues

Results & Highlights

2,284 pre intervention surveys were collected from salon customers

Stylists from 50 salons in Brooklyn completed the program

Self-reported exposure to stylist-delivered messages was associated with improved breast self-examination rates and with greater intentions to have a clinical breast examination

Results & Highlights

(continued) 8 church facilitators trained Media coverage: New York Times, BET, NY

1, ABC local TV and German TV Mammography provided by ACS and

American Italian Cancer Foundation Stylists were recognized by the Brooklyn

Borough President at a special ceremony Lasting relationships

Next Steps

Seek funding for future interventions Extend reach by translating materials

into other languages (Spanish & Creole) Program Replication

Conclusion

Arthur Ashe once said: 

To achieve greatnessStart where you are

Use what you haveUse what you haveDo what you canDo what you can