Kin KeeperSM Research Articles

The ties that bind: Cancer history, communication, and screening intention associations among diverse families.

Breast and cervical cancers are screen-detectable; yet, challenges exist with ensuring uptake of mammography and Pap smear. Family, a central factor in developing knowledge to carry out health promotion behaviors, may be an asset to improving intention to screen among non-adherent women from underrepresented minority groups. We explored familial cancer; communication; and breast and cervical screening intention among non-adherent Black, Latina, and Arab women in the United States who participated in a randomized controlled trial of the Kin KeeperSM Cancer Prevention Intervention study. The intervention was a culturally-targeted breast and cervical cancer literacy tool for Black, Latina, and Arab women, consisting of two family-focused education sessions on the cancers, their screening guidelines, and risk-reducing health-related behaviors. For this secondary analysis, we assessed family cancer history, family communication, and screening intention for breast and cervical cancer in age-eligible, non-adherent participants. Descriptive statistics examined sample characteristics of the intervention and control groups. Odds ratios were estimated from logistic regression modeling to assess the intervention and sample characteristic effects on screening intention. Of the 516 participants, 123 and 98 were non-adherent to breast and cervical cancer screening, respectively. The intervention (OR = 1.95 for mammography; OR = 1.62 for Pap smear) and highly communicative (OR = 2.57 for mammography; OR = 3.68 for Pap smear) families reported greater screening intention. Family history of cancer only increased screening intention for mammography (OR = 2.25). Family-focused approaches supporting communication may increase breast and cervical cancer screening intention among non-adherent, underrepresented minority groups.

Abstract B38: The ties that bind: Associations of communication, cancer history, and screening intention among diverse Kin KeeperSM families

Abstract Background: Breast cancer incidence rates are increasing among women of color as compared to non-Latina white women as mortality rates are decreasing at slower rates. Latina women have the highest incidence of cervical cancer, followed by African American (AA) women. AA, Latina, and Arab women are more frequently diagnosed with advanced stage cancers than non-Latina Whites, which increases the risk of cancer-related death. Though breast and cervical cancer are screen detectable, most Americans are unaware of mammography and/or Pap smear screening guidelines. Understanding health disparity and deficient health literacy among women of color, the Kin KeeperSM Cancer Prevention Intervention was developed and culturally targeted to improve breast and cervical cancer literacy as well as increase health-related behaviors among AA, Latina, and Arab women living in Michigan. The purpose of this abstract is to describe a secondary analysis of associations between family communication, family cancer history, and screening intention among the nonadherent study participants (those who had never been screened or who were nonadherent to published guidelines as of 2010). Methods: Delivered by community health workers, the Kin KeeperSM intervention educated female family members in at-home group settings. Data collected were sociodemographics, family communication (Family Adaptability and Cohesion Scale IV), family history of any cancer, and mammography or Pap smear screening intention within 12 months (Kin KeeperSM Personal Action Plan). We conducted descriptive statistics, chi-square, and multiple logistic regression analyses. Results: Of the 516 Kin KeeperSM participants, 123 (AA-39.0%; Latina-15.4%; Arab-45.5%) and 98 (AA- 26.5%; Latina- 16.3%; Arab- 57.1%) women reported that they were not adhering to the published guideline for mammography (yearly after age 40) or Pap smear (every three years) exams, respectively. After adjusting for women's sociodemographics (age, ethnicity, marital status, education, employment, and insurance), receiving the Kin KeeperSM intervention (OR = 1.95 for mammography; OR = 1.62 for Pap smear) and higher family communication (OR = 2.57 for mammography; OR = 3.68 for Pap smear) increased the likelihood of having intent to screen within 12 months. Family history of cancer increased the likelihood of planning for mammography (OR = 2.25); however, family history did not affect Pap smear screening intention (OR = 0.92). Discussion/Conclusion: Kin KeeperSM with its family-centered approach improved mammography and Pap smear screening intention among a group of nonadherent, diverse women. Given that planning for a Pap smear exam was not likely to be affected by family history of cancer or ever having screening, women may not associate the Pap smear exam with cancer screening. Further study is warranted to identify factors associated with improving Pap smear adherence. Citation Format: Timiya S. Nolan, Alai Tan, Karen Patricia Williams. The ties that bind: Associations of communication, cancer history, and screening intention among diverse Kin KeeperSM families [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B38.

Casting a Wider Net: Engaging Community Health Worker Clients and Their Families in Cancer Prevention.

Engaging family members in an intervention to prevent breast and cervical cancer can be a way to reach underserved women; however, little is known about whether family member recruitment reaches at-risk women. This study reports the kin relationship and risk characteristics of family members who chose to participate in the Kin KeeperSM cancer prevention intervention, delivered by community health workers (CHWs) via existing community programs. African American, Latina, and Arab family members reported risk factors for inadequate screening, including comorbid health conditions and inadequate breast or cervical cancer literacy. CHW programs can be leveraged to reach underserved families with cancer preventive interventions.

Breast Cancer Screening Paved with Good Intentions: Application of the Information-Motivation-Behavioral Skills Model to Racial/Ethnic Minority Women.

Racial/ethnic minority women experience disparities in breast cancer. Studies suggest that this may be partly related to later stage of diagnosis. Adherence to breast cancer screening guidelines is frequently lower in racial/ethnic minority populations, which may contribute to this disparity. The purpose of this study was to examine the predictors of intentions to obtain breast cancer screening based on established guidelines using the information-motivation-behavioral skills model. Data for this study were obtained from the community-based Kin KeeperSM Cancer Prevention Intervention study and included 278 racial/ethnic minority women (Black=138; Latina=68; Arab=80). Data were collected between 2009 and 2010 and analyzed in 2013. Structural equation models were tested to examining the effects of functional breast cancer literacy, motivation, and breast cancer screening behavior. Motivation was significantly associated with breast cancer screening. Breast cancer literacy (information) is positively associated with breast cancer screening. The findings indicate that the higher the level of breast cancer literacy and the more motivated patients are, the more likely they are to be screened. In addition, there was a significant association between the covariate race and other model constructs. Functional breast cancer literacy and motivation interventions are important factors to consider when designing breast cancer screening interventions in racial/ethnic minority women. These interventions should consider cultural and contextual factors that are associated with screening behavior.

Cultural Connections: the Key to Retention of Black, Latina, and Arab Women in the Kin Keeper(SM) Cancer Prevention Intervention Studies.

Diverse racial and ethnic populations must be included in research studies in order to address health disparities. Retaining hard-to-reach populations including poor, underserved, and racial/ethnic groups in longitudinal studies can be quite difficult. Using innovative retention strategies that address culture and community are imperative. The objective of this report is to identify and describe strategies for successful retention rates among a unique group of hard-to-reach racial/ethnic participants. We analyzed the follow-up rates in two different cohorts using the Kin Keeper(SM) study design. The aim of Study A was to examine the capability of the Kin Keeper(SM) education to increase health literacy in breast and cervical cancer. The primary aim of Study B was to measure changes in breast and cervical cancer screening after receiving the Kin Keeper(SM) education. Retention rates were analyzed and compared over 12months for both cohorts. We found good retention rates for both cohorts with each having a unique set of differences. The overall follow-up rate was 82% for Study A and 88% for Study B with demographic differences between the studies reported herein. Despite changing cultural, community, and geopolitical factors, we were able to maintain consistent participation for each study. We attribute high retention rates to trusted cultural connections and the flexibility to adjust retention strategies.

Assessing the fidelity of the Kin KeeperSM prevention intervention in African American, Latina and Arab women.

We evaluated a randomized controlled treatment, utilizing Community Health Workers (CHW) to deliver breast and cervical cancer education intervention to African American, Latina, and Arab women in Detroit and Dearborn, Michigan. The main objectives of the study are to: (1) examine fidelity and consistency of treatment delivery and (2) assess qualitative elements of the intervention. We surveyed 305 women who received the intervention and 16 CHWs Survey included questions regarding the treatment integrity, treatment received, and training provided. Surveys included both quantitative and questions. The intervention group (n = 305) was made up of 48% Black, 11% Latina, and 41% Arab women. Almost all (≥ 90%) women agreed that they received the treatment in the way that it was intended. Sixteen CHWs responded affirmatively as well. Both participants and CHWs indicated that the program was mutually rewarding, indicating that there was "cross fertilization and cross benefit" of working with each other. These benefits served to endorse and confirm that CHWs are a very important mechanism in increasing health literacy in the community and referring underserved individuals to health providers. Second, with strong treatment fidelity the Kin Keeper(SM) program and has the potential to be replicated for a number of diseases in a variety of venues especially for those facing health disparities.

Abstract 1361: Treatment fidelity evaluation of the cancer prevention intervention in African American, Latina, and Arab women.

Abstract Background: Cancer education is important, especially for those facing health disparities. CHWs are increasingly utilized to educate and monitor cancer screening and surveillance for underserved populations. Here, we evaluate a randomized controlled treatment, utilizing Community Health Workers (CHW) to deliver breast and cervical cancer education intervention to African American (herein called Black), Latina, and Arab women in Detroit and Dearborn, Michigan. The main objectives of the study are to: 1) examine fidelity and consistency of treatment delivery and 2) assess qualitative elements of the intervention. Methods: CHWs and their clients recruited additional family members into the intervention. After randomization at total of 514 women were included in the study (305 intervention, 209 control). We surveyed only the intervention group because they received a behavioral intervention whereby the control group was given only reading materials. Family clusters received two home visits. The first session related to breast cancer education and the second session to cervical cancer. After each session, all women completed an evaluation of the fidelity and integrity of the education using the NIH Treatment Fidelity Workgroup Tool (Borelli, 2005). The CHW Survey included questions regarding their training, fidelity in treatment delivery and qualitative items. Results: The intervention group (n = 305) was made up of 48% Black, 11% Latina, and 41% Arab women. Almost all (> 90%) women agreed that they received the treatment in the way that it was intended. All 16 CHWs responded affirmatively as well. The greater majority (>90%), felt that they delivered the treatment the way it was intended and delivered it in the same way other Kin KeeperSM CHWs did. Qualitatively, 91% of CHWs felt they made an impact on participants’ cancer literacy and were satisfied with the project. In addition, CHWs indicated that “serving and educating their community” was personally important. Conclusions: First, both participants and CHWs indicated that the program was mutually rewarding, indicating that there was “cross fertilization and cross benefit” of working with each other. These benefits served to endorse and confirm that CHWs are a very important mechanism in increasing health literacy in the community and referring underserved individuals to health providers. Second, with strong treatment fidelity, these findings further validate the Kin KeeperSM program and its instruments (Williams, et al., 2011) and thus has the potential to be replicated for of number of diseases and in a variety of venues especially for those facing health disparities. Citation Format: Sabrina Ford, Cristian Meghea, Tamika Estes, Hiam Hamade, Mulisa Lockett, Karen Patricia Williams. Treatment fidelity evaluation of the cancer prevention intervention in African American, Latina, and Arab women. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1361. doi:10.1158/1538-7445.AM2013-1361

Kin KeeperSM: Design and baseline characteristics of a community-based randomized controlled trial promoting cancer screening in Black, Latina, and Arab women

BackgroundAlthough breast and cervical cancer deaths have declined due to early screening, detection, and more effective treatment, racial and ethnic disparities persist. This paper describes the study design and baseline characteristics of a randomized controlled trial (RCT) evaluating the effectiveness of the Kin KeeperSM Cancer Prevention Intervention, a family-focused educational intervention for underserved women applied in a community-based setting to promote health literacy and screening adherence to address cancer disparities. MethodsFemale public health community health workers (CHWs) were trained to administer the intervention. They recruited female clients from their public health program caseload and asked each to assemble two to four adult female family members for the breast and cervical cancer home-based education sessions the CHWs would deliver in English, Spanish or Arabic. We randomized the clients into the kin keeper group (treatment) or the participant client group (control). ResultsComplete data were obtained on 514 Black, Latina, and Arab women. Close to half were unemployed and had yearly family income below $20,000. Thirty-four percent had no medical insurance, and 21% had diabetes. Almost 40% had no mammography in the last year. Treatment and control groups were similar on most sociodemographics but showed differences in breast and cervical screening history. ConclusionsThis innovative study demonstrates the implementation of an RCT using community-based participatory research, while delivering cancer prevention education across woman's life span with women not connected to the health care system.

Abstract A15: The role of family communication in cancer screening practices.

Abstract Black and Latina women experience the highest disparities in incidence and mortality of cervical cancer and breast cancer mortality in spite of lower incidence than non-Hispanic white women. Among diverse and low literacy populations, family centered networks represent an important mechanism for communication about health concerns, including preventive screening practices. The purpose of the study is to examine the associations between family communication, demographic factors, and breast and cervical cancer health literacy. Black (n=216), Latina (n=65), and Arab (n=233) women enrolled in a randomized trial of Kin KeeperSM, a cancer prevention intervention delivered by community health workers. Self-reported family communication scores (FACES) were cross-tabulated with age, education, literacy scores and presence of grandmother. Analyses were replicated by race and ethnicity. Black and Arab women are the most likely to have a college degree or more and also the most likely to rate their health as excellent compared to Latina respondents. Blacks had the lowest family communication scores while Arabs had the highest family communication scores. Among Blacks, lower FACES score associated with lower cervical cancer literacy and with presence of a grandmother. FACES scores were higher among those who had lower educational attainment(less than a high school degree) and lower among all race/ethnic groups who rated their health status as poor. The unique contribution of this study is the inclusion of Arab women and its focus on family communication scores. The implications of these data are that for low-income diverse groups there are disparities in family communication, and that family network is an important and viable resource for the transmission of health cancer literacy information. Note: This abstract was withdrawn after the Program and Proceedings were printed and was not presented at the conference. Citation Format: Adnan Hammad, Karen Patricia Williams, Ruth E. Zambrana, Cristian Meghea. The role of family communication in cancer screening practices. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A15.

Abstract A22: The Kin KeeperSM Intervention: Women move beyond psychological barriers to Pap screening

Abstract Cancer health disparities are underlined by structural and conceptual barriers, such as: Adequate cancer awareness and education, functional cancer literacy, appropriate and timely access to cancer screening and follow-up care, and psychological aspects of the decision to undergo cancer screening. Cervical cancer health disparities can be impacted by early detection and screening with the Papanicolaou (Pap) test. The Kin KeeperSM Cancer Prevention Intervention is a culturally and linguistically tailored breast and cervical cancer educational intervention designed to improve functional cancer literacy. The Health Belief Model (HBM) was used as a framework to explore potential associations between responses to a cervical Cancer Literacy Assessment Tool (C-CLAT) item assessing a psychological barrier to Pap screening and a woman's screening accomplishments. Methods: The Kin KeeperSM model has three levels of participants: community health worker (CHW), CHW's female clients (“kin keepers”), and female family members of female clients. Trained CHWs recruited 543 Black, Latina, and Arab women from Detroit and Dearborn, MI to participate in the two-year study. Analysis included only women with two years of data, thus the final number of participants was 446 (117 Black, 157 Latina, 172 Arab). Kin keepers recruited female family members in year one and delivered the cervical cancer educational intervention in year two. After recruitment, CHWs from three local agencies administered the C-CLAT to all participants in English, Spanish, or Arabic before administering an educational intervention (pre-C-CLAT) and after the educational intervention (post-C-CLAT 1); and provided women with Personal Action Plans (PAPs) to identify screening goals based on three statements: Find a health care provider to do first-ever Pap; schedule first-ever Pap; and continue getting yearly Pap. The outcome of interest was indication of these goals as accomplishments in year two. After kin keepers delivered the educational intervention in year two, CHWs administered a post-C-CLAT 2 and an accomplishment-oriented PAP to all participants. Using multivariable logistic regression, we observed the potential effect of responses to a C-CLAT item and sociodemographic covariates on PAP accomplishments. The C-CLAT item “Getting a Pap test is very painful,” suggests a psychological barrier to screening, thus it is relevant to a classic HBM construct, perceived barriers. Post-C-CLAT 1 responses to this item were scored with an answer key and SPSS (PASW Statistics 18) was used for statistical analyses. Results: In year one, the most significant covariates affecting the goals women selected were race, relationship to the kin keeper, and health insurance status. Response to the C-CLAT item “Getting a Pap test is very painful” was not significant to the goal to continue annual Pap tests, yet race and possibly relationship to the kin keeper were significant (with an alpha of .105, p-values were .038 and .104, respectively). Analysis of women's PAP accomplishments 12 months later indicates the majority of women found a health care provider for a first-ever Pap test, scheduled a Pap in the past 12 months, and had a Pap in the past 12 months. Relationship to the kin keeper was the only statistically significant covariate (p = .035) in analysis of having had a Pap test in the last 12 months. Conclusions: Future interventions designed to impact cervical cancer health disparities should support women's intentions to pursue screening despite potential psychological barriers. Such studies should explore dynamics between female family members and how these relationships might modify screening decisions and accomplishments. This research was funded by National Institutes of Health (NIH), National Institute for Nursing Research (NINR), 1R01NR011323. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A22.

Abstract A21: The Kin KeeperSM Intervention: Multiple interventions may be necessary to generate permanent increases in cancer literacy

Abstract A number of studies have shown that greater cancer knowledge is correlated with increased rates of screenings and regular check-ups for the general population, which in turn is correlated with increased rates of early cancer detection and thus higher rates of cancer survival. However, a number of other studies suggest that a disproportionate burden of cancer morbidities and mortalities are borne by minority populations in the United States, and in order to address this, the Kin KeeperSM Cancer Prevention Intervention, a culturally and linguistically tailored breast and cervical cancer education intervention, was developed to address this burden at its source, cancer knowledge through literacy. The main objective of this study was to investigate the effect of the Kin KeeperSM program on breast and cervical cancer knowledge retention (i.e. literacy levels over time) among African American, Arab American, and Hispanic American women in the Detroit metropolitan area. The program involves three levels of participants: the community health worker (CHW) responsible for recruiting clients to participate as Kin Keepers; the Kin Keepers, who are responsible for recruiting female family members to participate; and the female family members. In all, trained CHWs recruited 543 participants of Black/African American, Hispanic, and Arab descent at the start of the study, to include Kin Keepers and recruited family members; the number of respondents participating in the study at follow-up (CHWs were only responsible for recruitment and did not otherwise participate in the study) dropped to 446 (117 African American, 157 Latina, 172 Arab) in the second year. Participant responses for cancer literacy assessment tests (CLATs) for both breast cancer and cervical cancer were collected three times: a pre-test, a first-year post-test, and a second-year post-test. Between the pretest and the first-year post-test the Kin KeeperSM intervention in the form of cancer education was administered to participants. No other education was administered after the first-year post-test. After one year, the second-year post-test was given to participants and their responses collected. Once all participant responses for all tests were collected, they were scored and literacy between the three tests for each eligible participant was analyzed. Overall, the cancer literacy trend for all participants increased dramatically between the pre-test and the first-year post-test, then returned to pre-test literacy levels for the second-year post-test. For instance, for the breast cancer CLAT (BCLAT), a number of individuals from all ethnic groups (n = 52 over all groups) scored 100% on the first-year posttest, but none scored 100% on the second-year post-test. When looking at scores above 75%, the number of individuals scoring at or above this level increases (n = 339 over all groups), but there are still no individuals scoring at or above 75% on the second-year post-test. This trend appears to be consistent across all ethnic groups sampled in the study. The most consistently significant (p ≤ 0.05) covariates correlated with literacy were ZIP code (i.e. location), age, level of education, and insurance status. It is likely that a lack of education intervention in the months between the first-year post-test and the second-year post-test are responsible for the return of literacy to pre-test levels. It is also possible that, because all questions on all tests were given equal value, literacy may have appeared to return to pre-test levels but in fact masks increased functional literacy related to certain sets of questions that should be given more weight than others. In order to realize permanently-increased cancer literacy in women of these ethnic groups, recommendations include more than a single application of Kin KeeperSM intervention education and the introduction of a weighting system for CLAT questions. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A21.

Abstract A5: Psychometric evaluation of cervical cancer literacy assessments with Black, Latina, and Arab women

Abstract Background: This research examined the psychometric properties of the newly revised Cervical Cancer Literacy Assessment Tool (C-CLAT) in a diverse sample (N = 543) of Black, Latina and Arab women in the United States. This study was in response to the Institute of Medicine's report Health Literacy A Prescription to End Confusion (2004) that indicated a gap in health literacy measurements. Methods: Data to validate the C-CLAT were collected in the context of a community based research intervention, Kin KeeperSM Cancer Prevention Intervention. Twentyone community health workers (CHWs) who reflected the ethnicity of the research participants, recruited women from their respective public health programs. The CHWs administered the C-CLAT in the homes of their clients. The C-CLAT is a multidimensional scale consisting or 21 items in three health literacy domains, Awareness, Knowledge & Screening, Prevention & Control. Modern psychometric methods were used including multigroup confirmatory factor analysis and analysis of differential item function. Practical aspects include interpretation of scores from a criterion-referenced framework. Results: The overall scale difficulty was .33 or 67.24% (SD = 18.78) correct. This score represents the percent of cervical cancer literacy knowledge attained at the time of testing. This score was sufficiently low so that knowledge improvements can be monitored without ceiling effects. Individual scales, were similar in difficulty level, with 63.12%, 62.15%, and 65.23% correct, for Awareness, Knowledge & Screening, Prevention & Control, respectively. The overall scale reliability was .65 in the total sample and .68, .67, and .55 for Black/African American, Latina/Hispanic, and Arab American, respectively. The subscales were moderately correlated (r's =, .26, .38, .49), each contributed significantly to the overall functional literacy score, and factor to scale relations did not differ across ethnic groups. In addition, the rank order correlations of item difficulties across ethnic groups were high (r's = .97, .98, .98). One subscale, Awareness, appeared to be easier for Hispanics. The C-CLAT total score did not differ by age, education, income, self-rated health, or insurance coverage. Divorced or separated women had higher scores (p < .05), and unemployed or self employed women had the lowest scores (p < .05). Two trends in the data were only marginally significant. There was a tendency for women with a history of cervical cancer in their family (n = 27) to have lower C-CLAT scores (p = .098) and for women with any cancer history in their family (n = 210) to have higher C-CLAT scores (p = .073). Conclusions: The psychometrics analysis supports the use of the revised C-CLAT for use in Black/African American, Latina/Hispanic, and Arab American populations. Additionally this study demonstrated that psychometric evaluation can be conducted within the context of community based methods. This study was supported by the NIH/NINR 1R21NR010366. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A5.

Abstract A22: New instrument to measure functional breast cancer literacy

Abstract A critical undertaking in designing research interventions that study effective ways to reduce health disparities among racial/ethnic and underserved women is to have instruments that are linguistically and culturally appropriate. Traditionally, when instruments are developed, even those that are used in health disparities, they have been normed using Caucasians and then used with other populations. We were funded by the National Institutes of Health, National Institute of Nursing Research to use traditional rigors of psychometric methods in the context of a community-based participatory research intervention to validate cancer literacy assessment tools (CLAT) that measure a woman's functional understanding of breast and cervical cancer in English, Spanish, and Arabic. With a sample size of 543 women, the reliability, factor structure, validity of the Breast Cancer Literacy Assessment Tool (BCLAT) was determined by exploratory and confirmatory factor analysis. We examined differential item functioning (DIF) with nonparametric IRT Multiple regression was used to identify variables predictive of performance on the BCLAT. Results: A confirmatory factor analysis (CFA), using a 2-parameter IRT model, had a good fit (CFI = .81, RMSEA = .05) to the proposed three factor structure. Maximum likelihood exploratory factor analysis of tetrachoric correlations and examination of scree plots also indicated a 3-factor solution. No items were eliminated as a result of the DIF analysis. The three scales, Awareness, Screening, and Prevention/Control, were moderately difficult with 63%, 62%, and 68% correct, respectively, with internal consistency reliability of .53, .62, and .63, respectively. The scales were only weakly inter-correlated (r's < .40). The total scale reliability was .70. Income, education and self-rated health were positively associated with Awareness but not related to Screening or Prevention/Control. Age was positively associated with Prevention/Control. Seventy seven participants were in a family with a history of breast cancer. This was associated with higher scores on Screening and Prevention/Control. Having friends with a history of breast cancer was unrelated to any of the BCLAT scales. The BCLAT scales have demonstrated internal consistency reliability and validity in this multiethnic community based sample. Even when implementing the Kin KeeperSM Cancer Prevention Intervention to deliver cancer education to Black, Latina and Arab women as the context in which we validated our cancer literacy assessment tools, we were still able to adhere to the rigorous of psychometric testing. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A22.

Community Health Workers Speak Out About the Kin KeeperSM Model

Community health workers (CHWs) informed students and researcher alike on the Kin Keeper(SM) Cancer Prevention Intervention. Students interested in medicine, guided by faculty, conducted a focus group session with 13 CHWs to find out if the intervention was effective for delivering breast and cervical cancer education. Strengths reported were (1) cultural appropriateness, (2) home visits, (3) CHW resource kits, and (4) increased awareness. The barriers were privacy perceptions and scheduling home visits. Overall, the CHWs indicated that the intervention was effective and flexible enough to accommodate the African American, Latina, and Arab groups of women.

Moving from theory to practice: implementing the Kin KeeperSM Cancer Prevention Model

This paper presents the rationale and findings of a feasibility and process study of the Kin Keeper(SM) Cancer Prevention Intervention. An observational cohort study design was implemented with African-American women in synergistic female family relationships. Community health workers (CHWs) from two Michigan public health programs recruited women to serve as 'kin keepers' who in turn recruited their female family members. In total, 161 kin keepers and female family members were sampled. Trained CHWs led kin keepers and family members in learning about breast cancer. Data methods included baseline and post-training administration of a breast cancer literacy assessment, post-training focus groups and review of personal action plans. To validate the feasibility of the process, a linear mixed-effects regression with 97% power was identified and differences in pre-post scores were detected at 5% significance level. Adjusting for family random effects, breast cancer literacy scores increased for all participants recruited (P-value = 0.0004) suggesting that the process was feasible. Analysis of focus groups and action plans indicated that participants valued the instruction and planned to act upon it. This experience with kin keepers and their families offers encouragement that the theoretical model and its community-based delivery can continue to enhance scholarship dedicated to ameliorating health care disparities.