Community and faith-based education programs have long been proven successful in reaching black communities. As an African American woman and advanced practice nurse, I have participated in many projects and studies to identify effective approaches to increase awareness, prevention, and treatment of health issues that impact my racial/ethnic group. After serving as a nurse expert for several successful community faith-based programs focused on various health issues, I worked with a local organization, in which I am a member, to address prostate cancer awareness and screening among black men in two counties in Virginia.
Prostate cancer is the second most common cancer in men, and, despite being treatable when detected early, is one of the leading causes of cancer death among men of all races, according to the Centers for Disease Control and Prevention. Prostate cancer rates among black men are significantly higher than any other race, with more than 150 new diagnoses annually per 100,000 men in the United States. Clinical progression of prostate cancer is known to be more aggressive in black men as compared to white men. However, black men are less likely than their white counterparts to engage in shared decision making (SDM) with their health care provider about the benefits and risks of the gold-standard prostate specific antigen (PSA) test. Due to the increased risk for prostate cancer among black men, screening is recommended at earlier ages than the general population.
The Education Program
Over a one-year period, I was a nurse researcher for a prostate health education program that examined whether participants had an increased awareness about key issues of prostate cancer, following a culturally targeted education program, and whether participants were more likely to engage in SDM with their health care provider about prostate cancer screening. Their knowledge was assessed through pre- and post-test surveys that addressed three topics:
- Increase in knowledge about prostate cancer screening
- Increase in intentions to have an SDM conversation with a physician about prostate cancer screening within 12 months
- Participation in an SDM conversation with a physician about prostate cancer screening within three months after the educational program
The program worked with 438 black men over the age of 40 who were recruited primarily through churches, as well as social media and community, civic, and social activities. Participants needed to be able to speak and understand English and reside in either Prince William or Stafford County in Virginia. Religious beliefs serve as a fear reducer and motivator for increased prostate cancer screening behaviors among black men, demonstrating the importance of faith and spirituality in the black community. Programs were implemented at 12 black churches, and prayer and scripture were included before and after each program session.
It’s important to ensure that programs are meeting the needs of the community. As a result, a community advisory board was developed for this program, which included key stakeholders such as nurses, physicians, ministers, local hospital representatives, prostate cancer survivors. and community advocates for black men’s health issues.
After the pretest to assess black men’s existing knowledge about prostate cancer, an educational session began with a five to 10-minute personal testimony by a black prostate cancer survivor, followed by an engaging question-and-answer session. The men then watched a short National Cancer Institute video clip, “Prostate Cancer Survivor: An African-American Man’s Perspective.” Next, two physicians who specialize in urology taught a two-hour information session that focused on prostate cancer statistics, prevention, screening, early detection, and quality of life. Last, there was another question-and-answer session, which was followed by the post-test. Contrary to previous community and faith-based programs, this one included a second post-assessment three months after the initial program to evaluate whether patients had an SDM conversation with their physician about prostate cancer screening.
The Program Results
The results showed that educating black men about prostate cancer through a community and faith-based program increased their general knowledge of prostate cancer and its treatment by 40.2%, improved their intention to have an SDM conversation with their health care provider by 17.8%, and impacted whether an SDM conversation took place within three months of the program by more than 80%. Although the results are encouraging, it’s important to note that the black men in this program were predominantly middle class and the majority were employed full-time and possessed private health insurance. Additional programs of this nature should be conducted with those without health insurance and with lower levels of household income.
The Importance of Research
Nurses can play a vital role in helping community and faith-based organizations develop and execute programs to address health disparities. The program I was a part of is an example of how community partnerships can implement a successful health education program. Doctoral programs, like Walden University’s PhD in Nursing, train nurses to become effective researchers and scholars to tackle complex health care questions and issues. It’s critically important for research to be conducted, especially in developing culturally appropriate models for diverse communities, so more contributions toward reducing health disparities can be made available to effect positive social change.
For more information about this prostate community and faith-based program, please view the summer 2018 issue of the Association of Black Nursing Faculty (ABNF) Journal.