"Learn, Share, and Live," a St. Louis community-based intervention targeted at low-income, urban, African-American women, trains lay women to encourage their peers to get mammograms, says Celette Sugg Skinner, PhD, assistant professor at the Washington University School of Medicine's Mallinckrodt Institute of Radiology in St. Louis. The program uses an existing peer-based network that provides community support through a social services agency. Women are trained to teach basic information about breast cancer screening and to encourage screening among their peers through group programs and individual counseling.
Specific methods used include:
· The dandelion metaphor.
Peer educators tell patients with the "why go looking for trouble?" attitude to think of what happens to dandelions if they are allowed to spread their seeds. "If you mow down a dandelion in your yard, it's gone," Skinner says. "But if you let it go and the seeds go everywhere, then all of a sudden you've got a yard full of dandelions. It's the same with breast cancer."
· Wooden bead necklaces.
Women are given free necklaces constructed with colorful beads in graduated sizes from 6mm to 28mm that show the difference between lumps that could be felt in a self-exam and those only detectable by mammogram.
"Many were amazed to learn that they would probably only be able to feel the largest or second largest size in their own breasts and probably only a very skilled and careful health care provider could feel the next size or two," Skinner says.
"These are low-tech but creative and memorable education tools," she says. "Many of these women don't consider cancer a polite topic, so we gave them some tools to give them openings to conversations and to impart information in a memorable way."
A similar program called "Save Our Sisters" helps low-income African-American women in rural North Carolina, says Eugenia Eng, PhD, associate professor in the School of Public Health at the University of North Carolina at Chapel Hill. "The social norm is that you don't talk about cancer, and if you do talk about it, it's not to your doctor or your pastor," Eng says. "We train women in the community who have a reputation for being trusted to sit at the kitchen table and go to the churches and club meetings and talk to their peers about breast cancer."
It's critical to use lay health advisors instead of health care professionals, Eng says, because of the fear and intimidation older women feel. Many of them remember a segregated health care system, and they don't trust white doctors and nurses. Besides influencing women to have mammograms, Eng's program also provides follow-up support for those whose tests show evidence of cancer.
[For more information on breast cancer education, contact Celette Sugg Skinner, PhD, assistant professor, Mallinckrodt Institute of Radiology, Box 8131, 510 S. Kingshighway Blvd., St. Louis, MO 63110. Telephone: (314) 362-2995). Eugenia Eng, PhD, associate professor, School of Public Health, UNC-Chapel Hill, CB 7400, Chapel Hill, NC 27599. Telephone: (919) 966-3909.]