Development of a Church-Based Cancer Education Curriculum Using CBPR

Introduction

Cancer is the second leading cause of death (following heart disease) in the United States. An estimated 1.4 million cases of invasive cancer were diagnosed in the U.S. in 2005.¹ Racial and ethnic minorities constitute a disproportionate number of these cases. African Americans have both higher cancer incidence and higher rates of cancer mortality than Whites. For instance, African American men are 20% more likely than White males to be diagnosed with cancer and are 40% more likely to die, considering all cancers combined. The five year survival rate for African American women diagnosed with breast cancer is 75%, compared with 89% for White females. Differences in survival rates are due to various factors, including poverty, disparities in treatment, reduced access to medical care, and diagnosis at a later stage.² In general, African Americans have a decreased likelihood of surviving five years after diagnosis for all cancer types in comparison with Whites.

Wisconsin cancer incidence and mortality rates mirror national patterns. From 1996 through 2000, Wisconsin's average cancer mortality rate was 195.7 per 100,000 for the whole population and 271.6 per 100,000 for African Americans. The state average for cancer incidence was 454.3 per 100,000 compared with 523.5 per 100,000 for African Americans. Milwaukee County, located in southeastern Wisconsin, has the highest concentration of African Americans in the state (24.6%) and, not surprisingly, significantly higher cancer mortality and incidence rates than the state as a whole (488.7 per 100,000 compared with 218.9 per 100,000, respectively).³

In April 2002 the Center for Healthy Communities (CHC) in the Department of Family and Community Medicine at the Medical College of Wisconsin (MCW) began to address these cancer disparities by forming a partnership with the MCW Cancer Center, a local hospital, and an African American church. The goal of this partnership is to change inaccurate myths, perceptions, knowledge, and negative attitudes and behaviors concerning cancer. This report will describe the partnership and the collaborative process used to develop, implement, and evaluate a culturally appropriate, literacy-accessible church-based cancer prevention curriculum for underserved African American communities.

Partnership Background

The CHC was developed in 1997 to form community-academic partnerships to improve health. The Center operates with a philosophy of working with communities instead of doing things to or for them.^4,5 In early 2002, the Center joined with the MCW Cancer Center, a local hospital, and a well-respected African American church to provide culturally appropriate cancer education and prevention information, understandable even for those with limited literacy, to the church's faith community.

Traditionally, churches have been deeply rooted in African American communities and represent a trusted social institution second in importance only to the family.⁶ Churches have a strong tradition of caring for people in need and providing fellowship, support, and education. In many low-income neighborhoods, churches provide short-term emergency assistance to individuals and families in the form of food, clothing, and shelter.⁷ The faith community, particularly the African American church, has been a partner and/or site for the delivery of health education messages for at least the past two decades.⁸ Programs that encourage healthy eating, early and routine mammograms, and prostate screening have all been successfully implemented at African American churches throughout the country. ^{9,10,11,12,13}

A community-based participatory research (CBPR) approach was used to develop and implement a series of activities within the church to increase cancer awareness and knowledge, and to motivate participants to seek recommended screening and early detection. Community-based participatory research is a collaborative partnership approach to research that equitably involves in all aspects of the research process those who are affected by the issue being studied—community members, organizational representatives, and academic researchers.¹⁴ The process assists with a) development of trust and mutual acceptance between researcher and community, b) verification of...