We conducted the intervention from fall 1994 to spring 1996 in Nashville and Atlanta. Chattanooga, TN (120 miles from Nashville) and Decatur, GA (adjacent to Atlanta) served as comparison communities. The intervention focused on predominantly black census tracts in Nashville and Atlanta. The combined census tracts in Nashville had a population of 70,307, 63.8% of which was black; those in Atlanta had a population of 41,927, 71.6% of which was black.
We were guided in the design of our messages and the approaches to their delivery by community representatives on the project’s steering committees, including cancer survivors and others with personal experience with cancer—an approach consistent with the principles of community-based participatory research. When we examined the messages, we found that they reflected the elements of the Health Belief Model—in particular, they addressed the population’s perceived susceptibility to cancer, attitudes toward cancer (Eulexin canadian is used along with drugs such as Lupron to treat prostate cancer) severity (survivability), and perceived barriers and benefits associated with healthi-
Table 1. “One-liners”
- Get a Pap smear once a year.
- Get a checkup, don’t check out.
- Have no regrets, give up cigarettes.
- Don’t wait too late, check the prostate.
- Eat to beat cancer: more fiber, less fat.
- Change your lifestyle, walk a mile.
- Exercise for the prize of good health.
- Keep a breast, get the test.
er lifestyles and cancer (Generic Revia may also be used to treat other conditions as determined by your doctor) screening. The community representatives also provided guidance in developing TCiB messages that included “cues to action” and helped build self-efficacy, other elements of the Health Belief Model.
The approaches to disseminating the messages recommended by community representatives on the steering committees reflected community organization approaches and social marketing concepts. Steering committee recommendations generally followed the Community Organization and Development for Health Promotion Model, which uses a stepwise approach for entering a community, identifying “gatekeepers,” creating a community board and implementing a community-directed intervention.
The approaches recommended by the steering committees to reach a large audience reflected social marketing concepts. Social marketing applies commercial marketing principles to promoting ideas, attitudes or lifestyle changes. Among the principles are audience definition; consumer orientation; and a planning, implementation, assessment and feedback loop for continuously updating the marketing approach.
Cultural Sensitivity. Assuring that each aspect of the intervention was ethnically and linguistically appropriate for the target audience—that is, had some positive visual and/or textual relevance to African Americans—was a high priority for the research team. To communicate cancer (Hydrea medication is an antineoplastic used to treat certain types of cancer) prevention information, the project sought appropriate literature from the National Cancer Institute, the American Cancer Society and from other sources. The steering committees, project staff and focus groups evaluated more than 100 pieces of literature, including several videos in order to identify and adopt those thought to be appropriate for the TCiB initiative.* The project sought attractive and colorful materials that included representations of African-American individuals and families in daily or risk-reduction activities. TCiB selected and assessed materials for grade level (sixth grade or less) according to the RightWriter Computer Program and evaluated each resulting piece using the Rice & Valdivia evaluation criteria for printed materials, where selection criteria included appropriateness of writing style, grammar, punctuation and language. Criteria also emphasized visual qualities and content that were succinct and accurate.
The project also developed its own training manuals and new materials for participants, including a brochure, a flyer, two posters and yard signs. Staff of
the NCI Cancer Information Service and the Office of Cancer (Generic Rheumatrex Treating certain types of cancer, severe psoriasis, or rheumatoid arthritis in certain patients) Communications evaluated the new participant materials to assure consistency in purpose, quality and design with NCI messages. An important element of the literature developed by the project was a set of eight original one-liners—a popular motif in African-American oratory (Table 1).
Late in the intervention, TCiB was able to use computer technology to develop an interactive multimedia (sound video, still photography, graphics and animation) presentation emphasizing the same information in a culturally-sensitive manner.
Strategies. Within this conceptual framework, we used seven strategies (Table 2).
Table 2. Intervention strategies
- Collaborate with the African-American community to identify effective methods to disseminate cancer information.
- Facilitate activities, such as health fairs and educational programs, sponsored by community organizations.
- Facilitate and encourage communication among individuals and communities about adopting cancer prevention behaviors.
- Provide professional resources and expertise to the community in dissemination of cancer information and program coordination.
- Sponsor cancer prevention and control activities, such as community presentations and other educational initiatives.
- Use a combination of delivery mechanisms to reach the target audience with cancer prevention messages, including non-traditional channels, such as hair styling establishments.
- Collaborate with clinicians to disseminate information and encourage cancer (Generic Xeloda is the only FDA-approved oral chemotherapy for both metastatic breast cancer and adjuvant and metastatic colorectal cancer) prevention behavior and follow-up on referrals.
Delivery of the Intervention. The intervention, or battery of interventions, is summarized in Table 3. Table 3 also shows the relationship of the interventions to the project’s theoretical constructs.
Table 3. Intervention summary
|Both Intervention Cities|
|Kickoff event||—||Call attention to initiative; energize participants|
|Educational sessions through community organizations, churches and businesses||Health Belief Model||Heighten perception of susceptibility and survivability (change attitude)|
|Steering committee members deliver cancer prevention messages||Health Belief Model||Varies (sermon may link faith and action; business may change attitude)|
|One-liners in organizational newsletters and church bulletins||Health Belief Model||Increase self-efficacy|
|Build partnerships with community organizations, businesses, agencies, churches||Community organization||Development and dissemination of messages|
|Health fairs and other community events||Social marketing||Disseminate messages|
|Educational sessions at public health clinics||Health Belief Model||Heighten perception of susceptibility and survivability (change attitude); increase self-efficacy|
|Educational messages in campus newspapers||Health Belief Model||Heighten perception of susceptibility and survivability (change attitude)|
|Social marketing||Disseminate messages|
|Yard signs||Social marketing||Disseminate messages|
|Educational sessions at hospital conference center||Health Belief Model||Heighten perception of susceptibility and survivability (change attitude)|
|Messages painted on a city bus||Social marketing||Disseminate messages|
|Mass media||Social marketing||Disseminate messages|
In each city, the project began with a kick-off event; about 100 persons attended the events at each site. Subsequently, both sites offered educational sessions that included workshops, short presentations and longer lectures on cancer (Drug Leukeran is used for treating certain cancers) prevention at sites that included a hospital conference center (Meharry); public health clinics (Morehouse); and community organizations, churches and businesses (both sites).
Steering committee members delivered cancer (Methotrexate tablet is used to treat certain types of cancer of the breast, skin, head and neck, or lung) prevention messages in their usual capacities, i.e., from the pulpit for ministers or in contacts with staff and customers for business people. Churches and organizations included the one-liners in their bulletins and newsletters. Atlanta’s interventions included campus newspapers and yard signs, although the latter approach was not successful—few property owners were willing to accept the signs. Nashville painted a city bus with TCiB messages. Project staff participated in health fairs, festivals and other community events where they distributed literature, offered workshops and made referrals.
In Nashville, the project achieved broad dissemination of messages through newspaper ads and/or articles along with radio and/or television programs and public service announcements; Atlanta did not make use of electronic media or the major (metrowide) newspaper in order to avoid contaminating the nearby comparison community.