Educating African American men about prostate cancer: the barbershop program

American Journal of Health Studies, Fall, 2004 by Luvenia W. Cowart, Betty Brown, Diana J. Biro

Abstract: African American men have the world's highest rates of prostate cancer, with more than twice the mortality of Caucasian Americans. Traditional risk-reduction messages about this disease have not proved effective with African Americans, so two nurse educators forged a university-community coalition in upstate New York to address this public health problem. Working with local health professionals and other interested stakeholders, they developed a culturally competent prostate cancer education program utilizing a non-traditional setting--barbershops--to reach and engage black men. After recruiting six minority barbershop owners in Syracuse, the nurses provided a series of on-site educational sessions, targeting African American males ages 40 and above, to raise prostate cancer awareness and promote healthier behaviors in this population. Project findings and recommendations for educating minorities about health issues are presented.

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Prostate cancer has received a lot of attention in the past ten years, and research has underscored that African American men are especially vulnerable to this disease. But public awareness and health education programs targeted to this population have lagged far behind our medical knowledge, and traditional health messages designed for the general population have not been very effective in reaching minority men to improve prostate cancer outcomes. Mainstream health information often lacks ethnic familiarity and cultural relevance for African Americans, and is difficult for people with low literacy skills to read and understand. In addition, many minority males distrust the healthcare system, have limited access to it, and/or have fears and concerns about prostate cancer and male sexuality.

This case study describes how an innovative, culturally sensitive initiative in this area was designed and implemented through a university-community partnership in central New York State. The article outlines both the challenges and impacts of this program, demonstrating what can be accomplished with limited resources.

BACKGROUND AND SIGNIFICANCE

Prostate cancer is the second leading cause of cancer deaths among men in the United States. In 2004, it is expected that approximately 230,110 new cases of prostate cancer will be diagnosed and 29,900 men will die of the disease (CDC, 2004; ACS, 2004). The American Cancer Society has established a set of risk factors for prostate cancer which identify the at-risk population. Major factors include: age (50 yrs+), race (African American), diet (high fat/low fruits and vegetables), and heredity (father or brother with prostate cancer doubles a man's risk).

Particularly disturbing is the disproportionate representation of African Americans among the patient demographics. African American men have the world's highest incidence of prostate cancer and more than twice the mortality rate of Caucasian men, in part because they tend to be diagnosed at later, more advanced stages of the disease (Jemal, Thomas, Murray & Thun, 2002). Further, African Americans are typically younger, have significantly higher clinical stage, and have more symptoms of the disease when initially diagnosed (Merrill & Lyon, 2000). Researchers are seeking to determine why this group is at higher risk, investigating such factors as socioeconomic status, diet, occupation, and genetic and environmental factors (Chan et al., 2001; Latil et al., 2001; Luscombe et al., 2001; Michaud et al., 2001). For example, since a higher percentage of African American men are poor, less educated, uninsured or underinsured compared with white men, they typically have less access to health care so are less likely to receive information and routine care aimed at prevention, early diagnosis and effective treatment.

Education and early detection modalities such as digital rectal exams and PSA screening programs hold great promise to slow the prostate cancer mortality rate among African American men (Myers, 1999; American Urology Association, 2000), but prostate cancer screening is reported to be low among this group (Plowden, 1999; Steele, Miller, Maylahn, Uhler & Baker, 2000; Ashford et al., 2001). The reasons for this are unclear. Poor knowledge and awareness in the African American community may be one explanation (Wilkinson, List, Sinner, Dai, & Chodak, 2003; Barber et al., 1998; Weinrich, S.P., Boyd, Bradford, Mossa & Weinrich, M., 1998). Other reasons cited include psychological, cultural, resource and health provider barriers (Powe, 1996; Miller, et al. 2001; Nijs, Essink-Bot, DeKoning, Kirkels & Schroder, 2000).

Despite efforts to heighten public awareness and to educate men in general about prostate cancer, not enough has been done to target African American men and their families (Powell, 1997; Cormier, Reid, Kwan, & Litwin, 2003). Leading experts and the American Cancer Society urge more education about prostate cancer in the African American community, and new innovative educational interventions and programming (Myers, 1999; Powell et al., 1999; ACS, 1998). Health initiatives that have been most successful with minorities are usually informed by cultural competence and health literacy issues. Cultural competence means being aware of and responsive to issues of culture, race, ethnicity; gender, age, socioeconomic status and sexual orientation. Low literacy skills in this population must also be taken into account.