Learning community model overcomes cultural barriers to breast cancer awareness

Breast cancer myths, access to care, discomfort with health care providers, language, time constraints, and health insurance coverage. These barriers were identified by women from Peru, Haiti, Brazil, and El Salvador during the development of a Learning Community (LC) breast health program that sought to better understand the cultural barriers in the community surrounding Mount Auburn Hospital in Cambridge, Massachusetts.

Violeta Alvarez, RN, BSN, OCN®, and colleagues reported that focus groups with women from the community—who spoke Spanish, Portuguese, and Haitian Creole in the home—yielded the following information: women believed “some” of their families and friends knew about breast cancer screening and had annual mammograms; pain was the #1 sign of breast cancer; fear was the main reason not to have a mammogram; and access, including insurance, was problematic.

Based on these responses and on the literature, an LC was designed to develop immigrant women's capacity to serve as peer breast cancer screening leaders and help the hospital staff plan future community interventions, Alvarez said during the Oncology Nursing Society 36th Annual Congress. Nurses, a social worker, community outreach specialists, mammography technicians, and community leaders created the content for the LC.

Ten immigrant women attended the 12-hour LC program, which included a focus on causes of breast cancer, screening, healthy lifestyle, risk, signs and symptoms, and mammography. Based on these sessions, evidence-based teaching tools consistent with the participant's reading level were developed. Following each session, cultural barriers were identified using the participant's questions, discussions, and evaluations.

After the LC program, students presented the information to 80 of their peers. Surveys were conducted to evaluate the overall program; demographic data included age, years in the United States, language(s) spoken, country of origin, and insurance status. By the end of the sessions, participants were willing to share their learning with peers and felt more comfortable sharing ideas and feelings with health care providers.

Navigating the health care system is stressful, Alvarez pointed out, and immigrant women have added stresses as they confront language and economic issues. Myths and homeland experiences also affect their approach to Western medicine. For example, for immigrant women before the LC, the words associated with breast cancer were all associated with morbidity: “death,” “hair loss,” and “motherless children.” To encourage screening and prevention behavior, “breast cancer” needs to be connected with hope, and the belief that early detection results in improved outcomes. The LC model is a way to understand culture and develop relationships while teaching breast health outside traditional settings, she concluded.
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