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Trained community health promoters i. Changes in general cancer knowledge, breast cancer screening practices, and intentions to be screened among participants from baseline to follow-up were measured using McNemar's N LATINAS,house wives for marginal homogeneity to evaluate the effectiveness of the parties. The average age of the sample was Participation in home-based group educational interventions delivered by promotoras may be associated with improved breast cancer screening practices among Hispanic women.

H ispanic women in the United States have a lower incidence of breast cancer than non-Hispanic white women. Hispanic women tend to be diagnosed with breast cancer at more advanced stages of disease than non-Hispanic white women. The U. Hispanic women face a variety of barriers to having their first mammogram and to receiving regular breast cancer screening every 1—2 years.

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N LATINAS,house wives Compared with non-Hispanic white women, Hispanic women may lack access to preventive services, 9 given lower income and more limited health insurance coverage. Task Force on Community Preventive Services has recommended implementation of breast cancer screening interventions involving the use of client reminders, small media materials, one-on-one education, and reduction of structural barriers and out-of-pocket costs, as outlined in their Community Guide. Further, there is insufficient evidence from the existing literature for the Task Force to determine if client-oriented group educational interventions are effective for improving breast cancer screening rates either for Hispanic women or for others, as study findings have been inconclusive.

Group educational interventions for cancer screening are defined by the Task Force as interventions that provide information about the reasons for and benefits of cancer screening and ways to overcome barriers to screening.

They are delivered in a lecture or interactive format.

A trained layperson or health educator uses slide presentations and role modeling to inform, encourage, and motivate participants to receive cancer screening. A broad spectrum of groups, settings, educators, and topics can be N LATINAS,house wives. To help address some of the gaps in the current mammography intervention literature with respect to the effectiveness of group educational mammography interventions, specifically those targeted toward Hispanic women, a home-based group educational intervention led by trained health promoters from the community i.

The intervention met the Task Force's definition of a group educational intervention but was delivered in a unique setting, the home.

The breast cancer home health parties were conducted as part of a larger cancer prevention study in this community aimed at evaluating several different culturally appropriate, targeted interventions to promote preventive strategies, enhance knowledge and awareness, and increase cancer screening rates in the community. Our objectives were to deliver a home-based group educational intervention addressing the topics of general cancer and breast cancer-specific awareness and screening and to measure the impact of the intervention on a target population of Hispanic women between the ages of 40 and 79, as these women N LATINAS,house wives age-eligible to receive mammography.

The impact of the intervention was measured by comparing responses to items from surveys administered preintervention and postintervention assessing general cancer knowledge, breast cancer screening practices, and intentions to be screened.

We hypothesized that the intervention would lead to improvements in general cancer knowledge, breast cancer screening practices, and intentions to be screened. N LATINAS,house wives

Mexican settlement in the Yakima Valley has been a relatively recent phenomenon that began with the enactment of the Bracero Program — after World War II when there was a high demand for agricultural labor in the United States. Under the program, more than 35, Mexican laborers came to Washington State to work under contract. Given this demographic profile, this community was N LATINAS,house wives ideal setting in which to carry out a promotora -led home health party intervention.

Home health parties can provide a safe environment for underserved populations to receive health information. In areas where deportation is a concern, home-based education may alleviate fears and build trust by bringing information and resources into the home.

Delivering an intervention in this type of setting can overcome commonly faced barriers of transportation and child care. Home health parties have been used ly by the investigators in this community to provide education on a variety of health topics, and community members have been receptive to their use. The use of the promotora in this setting was also N LATINAS,house wives to facilitate participants' discussion of health issues, as the promotoras were trained health educators from the participants' own communities who spoke and understood their language and understood the potential cultural barriers to breast cancer screening.

In general, promotoras serve as a bridge between healthcare providers and groups who lack access to adequate care.

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They provide social support for the target population and assist community members in engaging in preventive behaviors. For our breast cancer home health party intervention, residents in the community were invited to participate in cancer prevention home health parties led by the promotoraswho recruited participants at community meetings, through display tables at N LATINAS,house wives and community events, and from various other locations in the community. Community members who were interested in hosting a party at their homes were recruited first and were asked to invite family, friends, and relatives to attend the home health party.

Any interested community members were eligible to host a party. All party attendees who were interested in participating in our evaluation were asked to an informed consent before participating in the party and completed baseline questionnaires assessing demographic N LATINAS,house wives, general cancer knowledge, and breast cancer screening practices and intentions. Participants also agreed to be contacted 6 months after the home health party to complete a follow-up questionnaire by telephone.

Individuals who did not consent forms to participate in the evaluation piece were still welcome to attend the parties but were not asked to complete the surveys. During the breast cancer home health parties, the promotoras led the breast cancer discussions, informed participants about cancer in general and mammography screening, and provided other breast cancer-related information.

Trained bilingual interview staff in the Yakima Valley followed up with participants 6 months after their home health party had taken place. At that time, participants were asked to complete telephone interviews to assess their general cancer knowledge, beliefs, screening practices, and intentions after the intervention.

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Telephone interviews were conducted in Spanish or English according to the preference of the participant. Promotoras went to the homes of participants who were unable to complete the follow-up survey by telephone. A total of 23 breast cancer home health parties were held in the Lower Yakima Valley between April and Septemberand an average of 4 people range 3—8 attended each party. Although they N LATINAS,house wives not the intended target of the intervention, men N LATINAS,house wives eligible to attend the home health parties with their wives or loved ones, as we did not wish to exclude anyone who was interested in learning more about cancer in general or breast cancer specifically.

All participants who ed consent forms completed the baseline questionnaire before the home health party, which assessed their general cancer knowledge and beliefs. Female participants between the ages of 40 and 79 years were asked to complete a separate baseline questionnaire to assess their breast cancer screening awareness and practices.

A total of 87 women completed the breast cancer baseline questionnaire, and of those, 77 women completed the follow-up questionnaire approximately 6 months after baseline. Of these 77 women, 2 were excluded from the final analysis because they were under the age of 40 ages 38 and 39and 1 was excluded because she did not report her age. An additional 4 women were excluded from the analysis because of incomplete information on N LATINAS,house wives of mammography, yielding a final sample of 70 women for the evaluation.

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As indicated, the home health parties consisted of guided discussions about breast cancer that took place in an informal setting i. The promotoras were community members in Yakima Valley who were trained in general health education and in breast cancer education specifically by bilingual Fred Hutchinson Cancer Research Center staff located in Sunnyside, Washington.

The breast cancer home health parties were meant to encourage participants N LATINAS,house wives learn about breast cancer and to better understand methods of prevention and screening. The sessions addressed the following topic areas: What is cancer?

What is breast cancer? Who is at risk? How can the risk of cancer be reduced?

What types of breast cancer screening are available? What is mammography?

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What types of treatments are available for breast cancer? Specific content of the slide presentation included definitions of cancer and breast cancer specifically, a breakdown of established risk factors for breast cancer, a description of potential ways to reduce breast cancer risk including maintaining a healthy weight, eating a healthy diet, exercising, avoiding smoking, and lowering alcohol consumptionan introduction to breast cancer screening what methods of screening are available, and who is eligible to N LATINAS,house wives screeningand finally, an introduction to the main types of breast cancer treatment, including surgery, radiation, chemotherapy, and hormonal therapy.

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Flip charts and visual displays were used in the educational session to supplement the slide presentation. Participants were encouraged to ask questions and to discuss issues or concerns with promotoras and other participants. A resource guide was provided for all participants with information about where to receive a mammogram locally at no cost or at a reduced cost. Promotoras N LATINAS,house wives assisted in making appointment for the mammograms if the participants asked for assistance. Presentations and discussions were held in the participants' preferred language, and written materials that were distributed were bilingual and appropriate for those with low literacy levels.

Table 1 outlines the content and flow of our promotora -led breast cancer home health party intervention. The baseline general cancer N LATINAS,house wives questionnaire asked women about healthcare access, general cancer knowledge, and demographic characteristics. The baseline breast cancer-specific questionnaire asked women about history of breast cancer screening practices and intentions to be screened in the future.

The follow-up questionnaire asked women similar questions about healthcare access, general cancer knowledge, and history of breast cancer screening practices and intentions to be screened. Reponses to specific questions that were asked both at baseline and at follow-up were compared to assess the impact of the intervention on general cancer knowledge, breast cancer screening N LATINAS,house wives, and intentions to be screened. At the end of the follow-up survey, participants were also asked to evaluate the breast cancer home health party they had attended.

General cancer knowledge items assessed at both baseline and follow-up asked participants to indicate whether they agreed or disagreed with the following statements: A tumor is always cancerous. A cancer that has not spread to other parts of the body has a good chance for control or cure.

Women were asked to report on a variety of breast cancer screening practices at both baseline and follow-up, including: Have you ever had a mammogram?

As we were also interested in whether the intervention empowered women to discuss mammography with their doctors, we developed our own question to ask before and after the intervention: Have you ever asked a doctor to give you a mammogram? Finally, women were asked at both baseline and follow-up to answer the question: Are you considering having a mammogram within the next few months? This item was also adapted from the HINTS survey 4042 and, similar to the questions on breast cancer screening practices, has been used in other research with underserved populations.

Descriptive statistics were used to profile the sample with respect to demographic characteristics at baseline and with respect to general cancer beliefs, breast cancer screening practices, and intentions to be screened at both baseline and follow-up 6 months postintervention. A total of 70 women between the ages of 40 and 79 with complete information on mammography who participated in the breast cancer home health parties completed both baseline and 6-month follow-up questionnaires. Table 2 shows the demographic characteristics of the sample at baseline.

The mean age of the N LATINAS,house wives was Nearly half of the sample reported they had attended at least one home health party in the past before their attendance at the breast cancer home health party. No ificant change was observed from baseline to follow-up with respect to the belief that a N LATINAS,house wives is always cancerous Table 3. There was a ificant increase from baseline to follow-up in the proportion of women who reported they had ever had a mammogram Table 4.

The majority also reported they had learned something new about breast cancer from the presentation, and nearly all rated the presentation as good or excellent not shown. The use of promotoras to educate Hispanic populations about health issues is becoming an increasingly common method of intervention delivery.

Our can be compared with some of the research that has involved the use of promotoras within the Hispanic population. In their program entitled Companeros en la SaludLopez and Castro 23 delivered a church-based, culturally tailored N LATINAS,house wives prevention intervention to Hispanic women in Arizona and used promotoraswho recruited participants from their communities, taught cancer prevention classes, and facilitated cancer screening activities. The overall intervention effect was nonificant with respect to improving mammography screening.

However, compared with participation in a control group involving a noncancer mental health program, participation in the cancer intervention component was positively associated with cancer prevention knowledge postintervention.

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In contrast to our N LATINAS,house wives, however, which was delivered in the home setting in the presence of friends and family members, this program was delivered through classes held at church sites. Similarly, Hall et al. Participants in the intervention arm performed better on a breast cancer knowledge test administered postintervention than did women in a control group who had received a nutrition education program. A pretest of breast cancer knowledge was not administered to either group, so changes in knowledge from pretest to posttest could not be evaluated.

In addition to improvements in awareness of the potential for cancer risk reduction, our study demonstrated a ificant increase between baseline and follow-up in the proportion of women who reported ever having a mammogram.