An Innovative Community-Based Intervention for African American Women with Breast Cancer: The Witness Project(R)

Abstract

Overall, the incidence rates of breast among women have continually increased since 1980 (American Cancer Society [ACS], 2005). Despite advances made in the prevention, diagnosis, and treatment of breast over the past several decades, there continues be a major disparity in breast morbidity and mortality between African American and white women. ACS estimated that 211,240 U.S. women would be diagnosed with breast in 2005 and 40,410 would die from the disease. African American women have a lower incidence of breast than white American women (119.9 per 100,000 compared with 141.7 per 100,000), but a higher mortality rate (35.4 per 100,000 compared with 26.4 per 100,000) (ACS). There are a variety of reasons postulated explain the lower incidence yet higher mortality rate of breast in African American women, including less access health care, lack of health insurance, lower socioeconomic status, communication barriers, and perceptions among this population that is fatal (Paskett et al., 2004; Schwartz, Crossley-May, Vigneau, Brown, & Banerjee, 2003; Smedley, Stith, & Nelson, 2003). BREAST CANCER OUTREACH TO THE AFRICAN AMERICAN COMMUNITY: THE WITNESS PROJECT[R] The focus of outreach combat mortality from breast in African American women has been develop culturally relevant and spiritually based programs aimed at dispelling many of the barriers screening, diagnosis, and treatment held by African American women regarding (Altpeter, Earp, Bishop, & Eng, 1999). Breast is not a subject openly discussed among many in the African American community (Personal communication from K. Cuthbert, African American breast survivor, U.S. Army, October 5, 2003) and many believe that treatment is not effective in saving lives (Phillips, 1999). Many African Americans view breast as inevitably fatal and believe that there is little value in detecting the disease early. Long (1993) identified interventions noted to be effective in empowering poor and African-American women combat the fear and fatalism associated with a diagnosis of breast cancer (p. 10) including community organization and coalition, health education and community outreach programs, client education motivate desired behavior by framing the message in terms of gains or losses, among others. African American women use a combination of informal and formal supports cope with their breast (Henderson & Fogel, 2003). The Witness Project[R] (WP) was started in 1991 at the University of Arkansas Medical Science Center as a response the high mortality rate of African American women with breast living in Arkansas. This innovative project was designed reach out low-income and rural African American women in a way that was culturally relevant increase awareness and participation in breast screening (Erwin, Spatz, Stotts, Hollenberg, & Deloney, 1996). A community-based screening program of proven effectiveness, the WP is grounded in the deep spiritual roots of African American women and uses affirmation increase women's belief in their ability seek action save their lives. Breast survivors, referred as Witness Role Models, tell their breast story--from detection through treatment--using the spiritual method of witnessing, in which a person shares a personal religious experience with the congregation and testifies by explaining how this experience changed her life (Erwin, Spatz, & Turturro, 1992). Survivors are paired with a Lay Health Advisor who teaches breast self-exams (BSE) and talks about mammography and the role it plays in early detection. Erwin, Spatz, and colleagues (1996) suggested that the behavior of WP participants changes because the messages are crafted meet the women's ... [by] the witness role models present[ing] their stories within a framework that honors culture and local health beliefs (p. …