Carol Calderon

HSC 405

Professor Theodora Papachristou

Grant Proposal

We can fight this, Breast Cancer Program

 2

Table of Contents

Specific Aims ---------------------------------------------------------------------------------------3

Background and Significance ---------------------------------------------------------------------6

Critical Review on Similar Programs ------------------------------------------------------------ 7

Linking goals and Objectives to their Theoretical Relevance --------------------------------10

Hypotheses to be examined ----------------------------------------------------------------------- 12

Description of population and method of sample selection -----------------------------------13

Design of experimental methodology ------------------------------------------------------------14

Operationalization of Concepts -------------------------------------------------------------------16

Formative Evaluation Methods-Pilot Testing ---------------------------------------------------17

Process Evaluation --------------------------------------------------------------------------------- 19

Timeline ----------------------------------------------------------------------------------------------19

Appendix --------------------------------------------------------------------------------------------- 20
 3

Specific Aims:

Goal:

The goal of We can fight Breast Cancer program is to help increase mammogram

screening among Hispanic women ages 40-69 living in Long Beach California. The Hispanic

women will be taught about what breast cancer is and what it means to be diagnosed with breast

cancer. Women in the program will be also taught how to do self-breast exams and where to go

to obtain a mammogram screening. Lastly, the goals of the program is to teach of ways to

prevent breast cancer therefor their will be lessons about eating healthy, doing physical activity,

the importance of doctor visits and obtaining mammogram screenings. Prevention by obtaining

mammograms is the main goal.

Objectives:

The objective of this program is to be able to increase the knowledge of Hispanic women

living in Long Beach California on the importance of obtaining a mammogram screening at least

once a year. There should be changes occurring by the end 6 months. There should be change in

knowledge, attitude and behavior. Knowledge should increase by 25 % measured by a self-

reported questionnaire. Participants attitudes towards obtaining a mammogram screening should

also increase by at least 20% also measured in a self reported questionnaire Lastly, the behavior

of the participants actually going out of their way on their own to go obtain a mammogram

screening should increase as well. The behavior should increase at least 10% also by a self-

reported questionnaire Change will always be measured by doing a pre and poste test.
 4

Outcome:

At the end of the program the outcome is for the Hispanic women to change their

behavior and actually go out and sign up to do a mammogram screening. Women should also

have knowledge on what breast cancer is and why early detection is important. The participants

should also know about ways to prevent and what type of life style to follow to try to prevent

breast cancer.

Program:

The program takes place in Long Beach California and is called We can fight Breast

Cancer program. The program will be six weeks long and approximately two hours long and

one day a week. The class will be offered in both English and Spanish. Class will consist of

breast cancer awareness, healthy diets to prevent cancer and why it is important to obtain a

mammogram. Yet, The main goal of the program is to increase mammogram screening among

Hispanic women in Los Angeles County to be more specific, Long Beach. The Health Belief

Model will be followed through the whole program. Perceived Susceptibility, Perceived

Severity, Perceived Benefits and Perceived Barriers. The participants attending the program will

be taking a pre test at the beginning of the program and a posttest at the end of the program.

Activities happening in class will be group discussions; there will be a lot of engagement and

active participation. Topics about health such as healthy diets will be covered as well. Videos

about breast cancer prevention will also be covered in class. The student will be given

pamphlets and books to learn about the importance of mammogram screening as well.
 5

Population:

The population for this program is Hispanic women ages 40-69 living in Long beach

California specifically in North Long Beach. Participants can speak English or Spanish. Hispanic

women must be low-income residents. This population may also have an immigration status or

be second generation Hispanic Americans. To enter the program participants must have no prior

history of breast cancer. Must also be Women attending local free health clinics in long beach.

Sampling:

Representative sample for the program were selected by Cluster sample. Study

participants are f patients from two clinics, both located in Los Angeles county (California) in the

city of Long Beach. The clinics will be determined by investigator selection. Selection criteria

for the two clinics was whether they served considerable percentages of patients who were both

low-income and Hispanic. The clinics will meet the criteria, as each served medically under-

served patients from the Family PACT (Planning Access Care Treatment) program and the Every

Woman Counts program, addressing the disparity in access to health care for the uninsured,

destitute, and working poor. The Two clinics are Long Beach, The Childrens Clinic and Long

Beach Comprehensive Health Center all in the 90813 zip code.

Experimental Design:

For the program We can fight this, breast cancer program, Classical experimental design

was the ideal way to go. The design of the study was a posttest-only control group experiment.

Participants were randomized into an intervention group or a control group. Those in the

intervention group viewed a mammogram video, and received a brochure and written handout

based on the health belief model variables, while participants in the control group received no
 6

education until after completing the posttest. Both groups took the posttest, obtained by in-

person interview.

Background and Significance

Breast Cancer is one of the leading cancer deaths among poor women. Women of the

age of 40 are recommended to obtain a minimum of one mammogram every year. (CDC, 2016)

Minorities such as Hispanic, African, and Asian tend to be the most affected by breast cancer.

This is due to the fact that minorities exhibit poor regular mammogram screening participation,

and then are diagnosed with later stages of breast cancer. In this particular paper I will be aiming

at increasing mammogram screening among Hispanic women ages 40-69 in California, in the

LA county area. To be even more specific I will be focusing on the city of Long Beach. The

most common cause of death from cancer among Hispanic women in the United States is breast

cancer. According to the CDC, in 2012, 41,150 women in the United States died from breast

cancer. In the LA county 1,179 women died of breast cancer in 2012 (American Cancer Society,

2012). The number of deaths in the United States was 21.5 per 100,000 women per year based

on 2009-2013 over the entire population. Compared to Hispanics being 14.5 2009-2013 number

of deaths per 100,000 persons by race/ ethnicity. (NIH, 2013)

According to the National cancer institute approximately 12.3 percent of women will be

diagnosed with female breast cancer at some point during their lifetime, based on 2010-2012

data from the American Cancer Society. The number of new breast cancer cases per 100,000

persons by race/ ethnicity which in this case is Hispanics its 92.4 (NIH, 2013) Prevalence of

This Cancer. In 2013, there were an estimated 3,053,450 women living with female breast

cancer in the United States. (NIH) Pinning down the cost is a difficult endeavor.
 7

The average cost of care for breast cancer in women age 65 and older is $23,078 for

initial treatment and $2,207 for continuing treatment, making it one of the less-expensive

cancers to treat, according to data from the (National Cancer Institute Oct 3, 2015). The

projections were based on the most recent data available on cancer incidence, survival, and costs

of care. In 2010, medical costs associated with cancer were projected to reach $124.6 billion,

with the highest costs associated with breast cancer ($16.5 billion), (NIH, 2011) The initial

Annualized Mean Net Costs of Care by Age, Gender and Phase of Care (Per Patient). Costs in

2010 US Dollars 108,168 (NIH, 2015)

Critical Review on similar programs:

A lot of research was done, and many interventions that have been successful in the past

were found. Ten peer-reviewed articles that successfully increase the usage of mammogram

screening among Hispanic women were gathered and analyzed. Most of the programs found

consisted of the Health belief model. For example in an article called Closing the Gap in

Mammogram Screening. (Deavenport, Modeste, Marshak, & Neish, 2011) The main purpose

of this program was to examine whether targeted cancer prevention education based on the

Heath Belief model can helped influence mammogram screening and influence low-income

Hispanic women obtain mammograms. The intervention was for a period of six weeks. Two

days per week for 3 hours. . The experimental intervention contained audiovisual and written

media. The program consisted of intervention and control group. The intervention group got to

view a mammogram video and received brochures and written handouts based on the Health

Belief Model, while the control group received no education. At the end of the program the rates

of mammogram usage increased and this was determined by a pre and posttest questionnaire.

Cultivando La Salud: A Breast and Cervical Cancer Screening Promotion Program,

 8

(Fernandez, Gonzales, Tortolero-Luna, Williams & Saavedra-Embesi, 2009) is another program

that used the HBM. The sessions lasting 1 to 2 hours each, consisted of a presentation and

discussion using the Cultivando la Salud materials. Cultivando Salud materials were

presentations and discussions in Spanish set up by the Lay health workers were the main people

working in the program. The reason why Lay health workers were chosen to deliver the

program because of their unique ability to reach personal contact with the community. The pre

and posttests also helped calculate that the program was successful. Lay health workers were

expected to educate women and motivate them to obtain a mammogram screening. One mother

main thing Lay health workers had to do was offer practical assistance that can help the

Hispanic women find access to mammogram screening. In the intervention A Promotora

administered group education intervention, (Nuo, Martinez, Harris, & Garcia, 2011) they also

used Lay health type of workers except in this case they were called promotoras. Also, this

intervention consisted of the The Social Cognitive Theory. This program consisted of two-hour

group sessions hosted by a trained Promotora; it was a yearlong intervention. Classes were

about breast cancer prevention and included general information about breast cancer and

explaining what a breast cancer screening is. Eating right to reduce cancer was also covered

along with topics such as self-esteem and a description of community resources for health care

and screening. The classes were both in Spanish and English given from the trained Promotoras.

Each Promotora had 3- 12 women in a group. At the end of the results the participants that

attended the intervention group actually showed in increase in obtaining mammogram screening

then the usual care group that did not receive much education. Breaking down barriers Breast

cancer(Warren, Wessel, Londoo, & Warren, 2006) is another program that was successful and

the class activities were in Spanish and English just like in the previous intervention. Almost
 9

more then half percent of the women were 55 years of age or older and all were Hispanic. This

intervention was a little longer then the other interventions listed above, this intervention was

six years long. The class sessions were every one Saturday per month. Participant recruitment

occurred through the distribution of brochures at churches, schools, health fairs and other

organization involving the Hispanic community. This program consisted of pre and posttest as

well and the HBM. Por La Vida Model Intervention, (Navarro, Senn, McNicholas, Kaplan &

Ropp, 2006) was a thirty-six lay community workers (consejeras) also known as counselors

were recruited and trained to conduct educational group sessions. Each consejera was to recruit

approximately 14 peers from the community to participate in the program. This intervention is

similar too Cultivando la Salud. There was a control group and intervention group. The classes

were twelve weeks long. There was a pre and posttest. The pre and posttests were surveys that

asked question about their knowledge of breast cancer and about mammogram screening. In the

article Increasing mammography (Avis, N. Smith, K, Link, C, & Goldman, M. (2004). ages

50-70 were in the intervention which consisted of education through video tape. This

Intervention is based from the health believe model therefore similar to most intervention yet

different because it a videotape watching in class. Pre and post test were part of it as well. In

Health Beliefs ( Deavenport Alexis, 2010) there was two focus groups and consisted on the

HBM just like previous interventions. One focus group in English other one in Spanish ages 43-

73. Used post and pre test did a lot of class discussions. In Correlates of Mammography

Screening (Richard, C Palmer 2006) Women must be 50 years or older used the HBM. Was a 5

year intervention 2 hours a day 2 days a week. Breast and Cervical Cancer,( Latoya, 2002)

Women 50-74 Used the HBM it was a cancer screening program cultural appropriate.

Community outreach helps increase mammogram screening. This last article Acculturation and
 10

breast (A S OMalley 2006) was different because its a 18-74 years old not as accurate as

others.

Linking goals and objectives to Theoretical Model

Based on the literature review it seems that the Health Believe Model would be the best

model to use. Therefore, the theory will utilized for this program is the Health Believe Model. It

seems that the components really help with increasing mammogram usage among Hispanic

women. The Health Belief Model consist of four components, Perceived Susceptibility,

Perceived Severity, Perceived Benefits and Perceived Barriers

The program will be six weeks long and approximately two hours long and one day a

week. The class will be offered in both English and Spanish. Class will consist of breast cancer

awareness, healthy diets to prevent cancer and why it is important to obtain a mammogram. Yet,

The main goal of the program is to increase mammogram screening among Hispanic women in

Los Angeles county. The Health Belief Model will be followed through the whole program.

Perceived Susceptibility is defined as an assessment of the risk of a certain population getting

about the condition. In The We can fight this, breast cancer program, addresses Perceived

Susceptibility by educating the Hispanic women statistics of Hispanic women risk of the

obtaining breast cancer compared to other populations. This part of the program will be taught

the first week of the program. Perceived Severity is defined as an assessment of the seriousness

of the condition, and its potential consequences. In this case Hispanic women will get education

on how serious and complicated it can get if one is detected with breast cancer late because lack

of mammogram screening. Perceived Severity will be taught during the second and third week of

the program. Education for this will be based on lecture, for example discussion and writing on a

white board. Education will consist of active participation and a minimal use of Power Points.
 11

The main goal is to keep participates entertain and active in class. There will be models shown to

the participants of how breast look when affected with breast cancer. Participants will also get

brochures and information in both Spanish and English. The brochures will address through the

whole program, it will be explained how bad the consequences will be if Hispanic women do not

obtain mammogram-screening exam. For example the risk of getting breast cancer and how

expensive it is to treat it and how hard it is to live with it. Breast cancer Symptoms and pain

details after will be covered. I would have the participants involved in-group discussions and

hand on activities like using breast model to learn how to do self-breast exams and food models.

Lastly I would like this program to enforce physical activity. Perceived Benefits is defined as an

assessment of the positive consequences of adopting the behavior which in this case would be

women obtaining a mammogram exam at least every two years. Perceived benefits will be

addressed by discussion as well during the last two weeks of the program. Along with other

information about health, for examples living a longer life breast cancer free. Flyers in Spanish

and English will be given. Eating healthy to prevent cancer and other diseases and doing physical

activity to stay healthy videos will be shown in class. A way to implement physical activity

would be to have the participants participate in breast cancer walks, activities to help participants

get involved and fully understand that it is important to obtain a mammogram. Joining walks to

support cancer walks to help support women suffering from breast cancer. The last component of

the Health Belief model is Perceive Barriers, which is an assessment of the influences that

discourage adoption of the promoted behavior. In this program the some Perceived Barriers

might be willingness to attend the program. Some women may have strong cultural belief about

obtaining mammograms. Embarrassment of having to expose breast in order to obtain

mammograms may be an issue to. Work schedule problems and childcare can also be another
 12

barrier. That is why I will be making sure that the information given in the program is culturally

appropriate. Lay health workers would be some people that I would hire to help with the

program. In other interventions, it seemed that Lay health workers helped a lot with teaching and

making the participants feel confortable. Lay health workers can be volunteers that will be

trained on breast cancer and helping to increase mammogram screening among Hispanic women.

Hypotheses:

The We can fight this, Breast cancer program will begin January 1, 2017 and will end

July 1, 2017. In this program, the experimental group to be able to increase their knowledge on

the importance of obtaining a mammogram screening. The changes should be starting to occur at

6 months at posttest. There should be change in knowledge, attitude and behavior. Knowledge

should increase by 25 % measured by a self-reported questionnaire in post test questions. [6-15]

Participants attitudes towards obtaining a mammogram screening should also increase by at least

20% also measured in a self reported questionnaire in post test questions [16-26] Lastly, the

behavior of the participants actually going out of their way on their own to go obtain a

mammogram screening should increase as well. The behavior should increase at least 10% also

by a self-reported questionnaire in the post test questions [27-35] Change will always be

measured by doing a pre and poste test. There will also be follow ups. Follow ups will consist of

phone calls and one on one interviews.

Program Population and Method of Sample selection:

For this program, the participants must be Hispanic women, must all be living in

Los Angeles county (California), in the City of Long Beach. All participants must be 40-69 years
 13

old. Participants can speak English or Spanish. Hispanic women must be low-income residents at

200% or below the federal poverty level (California Department of Health Services [CDHS]

Education level has to be high school diploma or less, no college educated women are accepted.

This population may also have an immigration status or be second generation Hispanic

Americans. To enter the program participants must have no prior history of breast cancer. Must

also be Women attending local free health clinics in long beach.

We can fight this, increase breast cancer screening for Hispanic women program planners

will attain a list of free clinics in Long beach. Experimental and comparison groups will

determine based on geographical location of the clinics through Long Beach California. This part

is very important in order to protect against the diffusion threat to internal validity.

Representative sample will be selected by Cluster sample. Study participants will be patients

from two clinics, both located in Los Angeles county (California) in the city of Long Beach. The

clinics will be determined by investigator selection. Selection criteria for the two clinics is

whether they served considerable percentages of patients who were both low-income and

Hispanic. The clinics will meet the criteria, as each served medically under- served patients from

the Family PACT (Planning Access Care Treatment) program and the Every Woman Counts

program, addressing the disparity in access to health care for the uninsured, destitute, and

working poor. Both programs provided various health services at no cost to low-income residents

at 200% or below the federal poverty level (California Department of Health Services [CDHS],

2006. Two clinics in Long Beach that meet these calcifications are The Childrens Clinic and

Long Beach Comprehensive Health Center all in the 90813 zip code.

In order to calculate the sample size, significance (alpha) will be set to

( 0.05). This point average ensures that there is a 95 percent confidence in the results from the
 14

post-test data analysis. For the We can fight this, increase breast cancer screening for Hispanic

women program type one error is defined as the probability value (P) which is greater than the

significance (0.05) but failure to reject null hypothesis. Power level (beta) of this program is

(0.80) based off alpha (0.05) and type two error is defined as P value less then or equal too

significance (0.05) but reject the null hypothesis. The effect sixe is equal to 0.25. utilizing power

level significance and effect size, sample size is calculated using a chart n=220 participants. This

number reflects both participants in the experimental and control group.

Design of experimental methodology:

There are multiple approaches to address the threats to the internal validity. For my

program Classical experimental design would be best. The design of the study was a posttest-

only control group experiment. Participants were randomized into an intervention group or a

control group. Those in the intervention group viewed a mammogram video, and received a

brochure and written handout based on the health belief model variables, while participants in

the control group received no education until after completing the posttest. Both groups took the

posttest, obtained by in-person interview, which assessed health beliefs and mammogram

intentions. Randomization occurred by half-day of the week (morning or afternoon). Each half-

day was 3 hours of either intervention or control at one clinic for 2 days per week and at the

other clinic for 2 days per week. Each day, there were about 6 to 10 women who were eligible to

participate. To meet a desired sample size of 220 participants, or 110 per group, each clinic

received a total of 24 half-day periods, 15 for the intervention group and 15 for the control group

for a period of 6 weeks. Before any data were collected, a university institutional review board

approved this study. There were three parts to data collection: focus groups, pilot testing, and the
 15

primary study. First, two focus groups, with a total of 12 participants, were conducted in English

and Spanish to identify the perceptions of low-income Hispanic women related to breast cancer

and mammogram screening to target the written handout to the HBM variables. The focus groups

were also conducted to determine if any additional items, particularly low-income Hispanic

womens perceived barriers toward screening, needed to be added to the posttest questionnaire.

The findings of the focus groups indicated that changes in the posttest questionnaire were not

needed. We did, how- ever, learn that women were interested in learning about obtaining free

mammograms, and thus changed the written handout to include a phone number they could call

for more information. Second, pilot tests were conducted in both English and Spanish to examine

the validity and reliability of the HBM scales for use among low-income Hispanic women. We

pilot-tested a total of 31 posttest questionnaires at each clinic: 14 in English and 20 in Spanish.

We conducted a greater number of pilot tests in Spanish as previous research demonstrated that

some of the scales, when translated and pilot-tested in Spanish, had lower reliability scores

(Esteva et al., 2007). Our pilot test results demonstrated, however, that both the English and

Spanish versions of the scales were accurate and consistent. The HBM constructs were well rep-

resented by the items in the scale and accurately reflected beliefs of the focus group participants,

indicating good con- tent validity. All study participants gave informed consent prior to data

collection to participate in pilot testing and the primary study. Bilingual research assistants were

trained to recruit, screen, educate, and interview the participants. Because some women

demonstrated low literacy, data were collected via interview only. This minimized data collection

bias by allowing women to answer questions in the same manner, promoting participation, and

decreasing the potential for missing data. Before providing the posttest questionnaire, we verified

that participants were Hispanic women, ages 40 years or older, with no history of breast cancer.
 16

In addition, to meet the income inclusion criteria, participants from both clinics were eligible for

both the Family PACT program and Californias Every Woman Counts program, which offers

free mammogram screening. Eligibility for both programs included the follow- ing requirements:

participants did not have insurance, had insurance but couldnt cover the costs, had a high

deductible. What I will do to address the threats to internal validity that the design cannot control

is.

Operationalization of Concepts:

The data collection will only be gathered by face-to-face interview. The reason why I

believe this method works better for my population is because my populations are older adults

40-69. I will be contacting the participants by phone to schedule and interview and get feedback.

This method will be more convenient for my population and easier for me to get feedback. The

pre and post test will be very similar, it will be questions. Some questions asked will be about

Intention/ behavior. Three items were used to measure intention, the main outcome variable, on a

5-point Likert-type scale (1 = strongly disagree, 5 = strongly disagree): I plan to get a

mammogram in the next year, I will try to get a mammogram in the next year, and I intend to

get a mammogram in the next year. Using Ajzens (2006) recommendations for measuring

intention, the items described the intended behavior in terms of target, action, context, and time.

The items were placed toward the beginning, middle, and end of the questionnaire to determine

whether participants would provide different responses to each question. Cronbachs alpha was .

87, indicating excellent consistency across the three items. The Revised Susceptibility, Benefits

and Barriers Scale for Mammography Screening was used to measure perceived susceptibility,

benefits, and barriers (Champion, 1999). The RSBB Scale uses a 5-point Likert-type scale (1 =
 17

strongly disagree, 5 = strongly agree), containing three items for perceived susceptibility, five

items for perceived benefits, and 11 items for perceived barriers. The Cronbachs alphas for

perceived susceptibility, benefits, and barriers were .76, .74, and .84, respectively. The

Seriousness Scale for Breast Cancer Screening Behaviors contained seven items used to measure

perceived severity on a 5-point Likert-type scale (1 = strongly disagree, 5 = strongly agree; The

Self-Efficacy Scale for Mam- mography was used to measure the HBM construct of self-efficacy

for mammogram screening on a 5-point Likert- type scale (1 = strongly disagree, 5 = strongly

agree; Champion, Skinner, & Menon, 2005). Permission for use of this scale was obtained from

John Wiley & Sons, Inc. Each item in the Self-efficacy Scale was changed to address participants

in the first person, rather than in the third person, to maintain uniformity with other items in the

post- test study questionnaire. Cronbachs alpha for the 10-item scIndependent variables and

covariates. Covariates measured included ability to speak English, birthplace, education, health

insurance, breast cancer lifetime risk, family history of breast cancer, mammogram history, and

internal control for mammogram screening..

Formative Evaluation Methods: Pilot Testing Procedures

Pilot tests were conducted in both English and Spanish to examine the validity

and reliability of the Health Belief Model scales for use among low-income Hispanic women. In

order to conduct a useful pilot test , program directors of the We can fight this, increase breast

cancer screening for Hispanic women program will seek out opinions of program component

recruiting methods, methods from individuals and experts of this particular community. Content

experts will consist of other program directors of similar programs that work to increase

mammogram screening among Hispanic women. These experts are crucial in approving the

components of the program and evaluating as to whether they believed from their previous
 18

experience if the We can fight this, increase breast cancer screening for Hispanic women

program will be effective or not. Content experts in the field will be contacted via telephone to

schedule appointments so that the program can be presented to them by program directors.

Experts in the field and those who are setting experts, will also consist of law enforcement,

teachers of continuation schools, guidance counselors and probation officers. These experts have

a lot of day to day contact with adolescents and are able to determine if the program will be

effective. Experts in the field and or considered content experts, include therapists who have

spent time working with adolescents with behavioral problems, troubled youth and families of

low SES. They will provide critiques and evaluations of the programs proposed home-based

therapy component. Population experts on Hispanic women are also very valuable in the pilot

test because they are the ultimate resource in approving all translated items from English to

Spanish, as well as ensuring that the program is culturally appropriate.

Community input will be gathered through community forums that will consist of

directed discussion about breast cancer and obtaining a mammogram screening test. These

community forums will begin with meetings at the clinics. The women participating will provide

insight as to what type of behaviors they are presenting when it comes to mammogram

screenings as well as help to We can fight this, increase breast cancer screening for Hispanic

women program is intensive enough to combat these problem behaviors.

Process Evaluation:

How We can fight this, increase breast cancer screening for Hispanic women program

monitor that might program is reaching the target population is by Making sure that the

participants follow the qualifications of the program. All the information given to them will be
 19

age appropriate. During class sessions there will be observations to make sure all the participants

are women and Hispanic. There will be a sign sheet so all-participant can sign in every time they

attend class. Sign in sheets will help me monitor is the participants are attending class on regular

basis. Lay health workers will be the main ones working the programs. The agenda will have to

shown to make sure that whats suppose to be covered is session is covered. Also, since the

participants will be doing activities, the worksheets will be rated to see how much they are

learning in the program. It will be clearly monitored if each activity is implemented as outlined.

The budget of the program will always be on check to make sure the correct amount of money is

being used as necessary.

Timeline:

Activity Month 1 Month 2 Month 3 Month 4 Month 5 Month 6

Needs Assessment X
 20

Program X
development
Pilot Testing X X

Sampling

Pretest X

Program
Implementation
Process Evaluation X X X X

Posttest X

Data Analysis R X

Report writing X

Appendix

For Pre /Post Test

experimenter
use only: mark
one.
Experimental
 21

1. How old are you? ______

2. What is your ethnicity? _______

3. What your economic status? _____

4. Are you a male or a female? _______

5. Are you a resident of Long Beach California? _____

For the following question use this scale to answer the questions. In a scale from 1-5 (1 =
strongly disagree, 5 = strongly agree)

6. I know what Breast Cancer is ______

7. I know what a mammogram is ______

8. I know how to protect myself from breast cancer ____

9. I know what causes breast Cancer______

10. I know where to go to obtain a free mammogram screening _____

11. I know the importance of obtaining a mammogram screening _____

12. I know the side affects of potentially having breast cancer ______

13. I know how to do a self breast exam ______

14. I know what the consequences are if diagnosed with breast cancer ______

15. I know how severe breast cancer is to my population ______

 22

For the following questions mark the answer that best represents how you feel about
obtaining a mammogram screening

16. I am scared to obtain a mammogram screening

A: True
B: False
17. I am very excited to get a mammogram screening
A: True
B: False
18. I am worried about being diagnosed with breast cancer
A: True
B: False
19. I am capable of finding transportation to my nearest clinic
A: True
B: False
20. I feel I know so much about Breast Cancer
A: True
B: False:
21. I feel I may be at risk of obtaining Breast Cancer
A: True
B: False
22. I like learning about breast cancer awareness
A: True
B: False
23. I want to learn about how to prevent breast cancer
A. True
B. False
24. I want to know what breast cancer is
A: True
B: False
25. I want to know the preventive factors of breast cancer
A: True
B: False
26. I think that I am not at risk of getting breast Cancer
A: True
B: False

For the following question use this scale to answer the questions. In a scale from 1-5 (1 =
strongly disagree, 5 = strongly agree)

27. I plan to get a mammogram in the next year ______

28. I will try to get a mammogram in the next year ______

29. I intend to get a mammogram in the next year _______
 23

30. I am signed up to get a mammogram in the next couple weeks _____

31. I am going to register to get a mammogram screening test _________

32. I will not be getting a mammogram screening _______

33. I will explain to the others the importance of mammogram screening ______

34. I will be obtaining a mammogram screening test every year _________

35. I will be obtaining a mammogram screening every two years ________

Consent Form

DESCRIPTION: You are invited to participate in a research study on increasing mammogram

screening among Hispanic women. From the information collected and studied in this project we
hope to learn more about breast cancer among Hispanic women, including factors that may affect
the development and progression of this condition among Hispanic Women.

PROCEDURES: With your permission, we would like to collect health information about you,
including information about you (age, economic status ect.) We would like to collect this
information about you before and after you finish the program. This study does not involve any
treatment; just the collection and study of your knowledge about the importance of obtaining
mammogram screening.

RISKS AND BENEFITS: There are no anticipated risks associated with this study. You will
not receive any direct benefit from participation. We cannot and do not guarantee or promise
that you will receive any benefits from this study.

TIME INVOLVEMENT: Your participation in this study will not require more time from you
other than for the initial visit where this study is explained to you. If you agree to participate, we
will ask for you to attend the program on the days required for the 6-month period.
 24

PAYMENTS: You will not be paid to participate in this study.

PARTICIPANTS RIGHTS: If you have read this form and have decided to participate in this
project, please understand your participation is voluntary and you have the right to withdraw
your consent or discontinue participation at any time without penalty or loss of benefits to which
you are otherwise entitled.
The results of this research study may be presented at scientific or professional meetings or
published in scientific journals. However, your identity will not be disclosed.

If applicable: You have the right to refuse to answer particular questions.

References:

Aldridge, M. , Daniels, J. , & Jukic, A. (2006). Mammograms and healthcare access among us
hispanic and non-hispanic women 40 years and older. Family & Community Health, 29(2), 80-
88.

Austin, L. , Ahmad, F. , McNally, M. , & Stewart, D. (2006). Breast and cervical cancer
screening in hispanic women: A literature review using the health belief model. Women's Health
Issues, 12(3), 122-128

Avis, N. , Smith, K. , Link, C. , & Goldman, M. (2006). Increasing mammography screening

among women over age 50 with a videotape intervention. Preventive Medicine, 39(3), 498-506.

Breast cancer: Prevention and control. (n.d.). Retrieved May 10, 2016, from
http://www.who.int/cancer/detection/breastcancer/en/index1.htm

Cancer costs projected to reach at least $158 billion in 2020. (n.d.). Retrieved May 09, 2016,
from http://www.cancer.gov/news-events/press-releases/2011/CostCancer2020

Cancer Prevalence and Cost of Care Projections. (n.d.). Retrieved May 09, 2016, from
https://costprojections.cancer.gov/annual.costs.html

Center of Disease and Control Prevention . (2016). Breast Cancer Retrieved from
http://www.cdc.gov/cancer/breast/index.htm
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Deavenport, A. , Modeste, N. , Marshak, H. , & Neish, C. (2011). Closing the gap in

mammogram screening: An experimental intervention among low-income hispanic women in
community health clinics. Health Education & Behavior, 38(5), 452-461.

Fernandez, M. , Gonzales, A. , Tortolero-Luna, G. , Williams, J. , Saavedra-Embesi, M. , et al.

(2009). Effectiveness of cultivando la salud: A breast and cervical cancer screening promotion
program for low-income hispanic women. American Journal of Public Health, 99(5), 936-943.

Navarro, A. , Senn, K. , McNicholas, L. , Kaplan, R. , Ropp, B. , et al. (2006). Por la vida model
intervention enhances use of cancer screening tests among latinas. American Journal of
Preventive Medicine, 15(1), 32-41.

Marshak, H. , Neish, C. , Deavenport, A. , & Modeste, N. (2010). Health beliefs of low-income

hispanic women: A disparity in mammogram use. American Journal of Health Studies, 25(2), 92.

Nuo, T. , Martinez, M. , Harris, R. , & Garca, F. (2011). A promotora-administered group

education intervention to promote breast and cervical cancer screening in a rural community
along the u.s.-mexico border: A randomized controlled trial. Cancer Causes & Control, 22(3),
367-374.

Palmer, R. , Fernandez, M. , Tortolero-Luna, G. , Gonzales, A. , & Mullen, P. (2006). Correlates

of mammography screening among hispanic women living in lower rio grande valley
farmworker communities. Health Education & Behavior, 32(4), 488-503.

Surveillance, Epidemiology, and End Results Program. (n.d.). Retrieved May 09, 2016, from
http://seer.cancer.gov/statfacts/html/breast.html

Warren, A. , Wessel, L. , Londoo, G. , & Warren, R. (2009). Breaking down barriers to breast
and cervical cancer screening: A university-based prevention program for latinas. Journal of
Health Care for the Poor and Underserved, 17(3), 512-521.
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