1. Creating a Mobile Device-based Educational Intervention
for African American Women with Hereditary Breast Cancer Risk
DeLawnia Comer-HaGans1, Vickii Coffey1, Giesela Grumbach1, Shirley Spencer1, Carolyn Rodgers1, Ravneet Kaur3, Karen Aguirre2, Ifeanyi Beverly Chukwudozie2, Vida Henderson3, Karriem S. Watson2, Catherine Balthazar1, Angela Odoms-Young3, Robert A. Winn2, Kent F. Hoskins3 A
B A C K G R O U N D
R E S U L T S
Our prior work with CGRA in primary care clinics in AA communities on the south side of Chicago revealed that women who have a family history of breast cancer (BC) and meet criteria for genetic counseling (GC) are unlikely to attend a GC consultation even when they are referred by their primary care physician (PCP).
In foundational work we found a strong desire among both AA women and their PCPs for culturally sensitive educational material tailored to AA women at risk for hereditary BC to help them understand the purpose of genetic counseling.
We are creating a story-based educational intervention delivered on a mobile device platform that is designed to motivate AA women with familial BC risk to attend GC.
Content for the intervention is informed by constructs from the Integrative Model of Behavioral Prediction and by themes identified through qualitative research with high-risk AA women.
Kreuter’s model for culturally tailoring health interventions guided the creation of the intervention.
Findings from semi-structured interviews (N=20) were augmented with data collected
from group story circle sessions with a subgroup of women who participated in the
one-on-one interviews (N=11).
Nine thematic domains emerged from the combined data that are relevant to attendance
at a GC appointment:
health education/health literacy;
trust, relationships, and communication with providers;
Empowerment;
health beliefs;
motivation/facilitators of breast care;
family support and secrecy;
religion/spirituality;
barriers;
fear resulting from equating genetic counseling with receiving a cancer diagnosis.
The findings were used to create a story-based script. Focus groups conducted with
community stakeholders and the target audience led to revision in the overall design
and style of the intervention (e.g. increased use of live actors and decreased animation)
and additional content revisions (e.g. addressing familial secrecy and self-efficacy for women
who do not have a referral for GC from a physician). Additional findings from focus groups
will be presented and the completed educational video will be previewed.
Figure 1: Study Timeline (2015 – 2019)
Focus groups to test intervention for cultural sensitivity Final revisions to intervention based on focus group data
Pilot feasibility study in mammography center
Year 4:
9/ /2019
Focus groups to test script and artwork
Create & revise animation Film live action segments Integrate live action and animation
Year 3:
9/ /2018
Conduct Qualitative interviews & story circles Analyze data
Develop & compose script Create & revise storyboard (iterative process)
Year 2:
9/ /2017
Creation of a study team
Planning and IRB submissions
Year 1:
9/ /2016
M E T H O D O L O G Y
Sample: Twenty (20) African American women (n=2 attended a genetic counseling session, n=18 did not attend genetic counseling).
Data collection
Step 1:
Semi-structured qualitative interviews: Using an iterative process encompassing semi-structured individual interviews and subsequent with AA women referred for GC (primarily non-attenders), we identified themes that represent barriers and motivators to attending GC
Step 2:
“Story circles”: A storyographer was used to develop the storyline by engaging the participants in group story circle sessions with a subset of women who participated in Step 1. Educational content for the script were based on the analysis of the qualitative data, i.e., themes that emerged.
Step 3:
Focus groups: The script and artwork were verified using focus group feedback that included members of the target audience (AA women with a family history of BC), key community stakeholders, and PCPs providing care for AA women.
Step 4:
Creation of intervention: The intervention, which includes story-driven live-action video sequences and segments of animation to illustrate key educational content is based on the script that emerged through this iterative process.
Development and Implementation
Figure 2: Integrative Model of Behavioral Prediction (IMBP)
Beliefs about outcome of engaging in behavior
Attitudes
Skills
Normative beliefs & motivation to comply
Perceived social norms
Behavior
Intention
Efficacy beliefs
Environmental constraints
Self-efficacy
C O N C L U S I O N
A technology-enabled, culturally-sensitive scientific educational intervention that motivates AA women with increased breast cancer risk to attend a genetic counseling consultation will facilitate implementation of a population-based, precision health approach to addressing BC disparities.
Acknowledgements
This research was supported by the GUIDE Cancer Research Training Project, through funding provided by the National Cancer Institute of the National Institutes of Health (Award #: P20CA202907). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
SAWBO
Scientific Animations Without Borders