Perspectives of African American, Amish, Appalachian And Latina women on breast and cervical cancer screening: implications for cultural competence.

Low-income and minority women are less likely to be screened for breast and cervical cancer and less likely than others to be diagnosed at an early stage in the cancer's growth. We consulted women and providers to understand how social, economic, and health care environments affect screening among African American, Amish, Appalachian, and Latina women, and to outline possible solutions. Women participated in 31 focus groups. Providers completed a mail survey (n=168) and follow-up interviews (n=12). We identified barriers women face: not always following recommendations; feeling intimidated during appointments; having incorrect information about risks, screening guidelines, and programs; and receiving information in ways they cannot understand or accept. Women indicated a strong desire for accurate information and, like the providers, identified strategies for reducing barriers to screening. In the terms of a social ecological model, our results point to three avenues along which to approach cultural competence: 1) policy, 2) health care provision, and 3) clinical care.

Parent peer education: Lessons learned from a community-based initiative for teen pregnancy prevention.

PURPOSE: The Parent Peer Education program addresses a community-identified need to increase parent-child communication about sexuality, teen pregnancy prevention, and related issues. Community members are trained to lead workshops of peers on how to talk with their children about these topics. METHODS: The program was pilot tested in 1997; three waves of workshops were conducted by 35 parent peer educators for 721 community residents between 1999 and 2002. They focused on providing information, increasing participants' comfort in discussing sexuality, and demonstrating how to use age-appropriate guidebooks. The evaluation used a pre- and post- workshop design. All participants completed a survey before the workshop, and a random sample of 25% responded to a telephone follow-up survey four weeks later. In addition, before the first wave, a random sample telephone survey was conducted of 104 parents in the community. Parent peer educators completed surveys after their training and each workshop. RESULTS: After the workshop, participants were more likely to feel comfortable talking with their children about sexuality-related issues, talk to their children about these issues, discuss multiple topics, recognize the importance of talking with children at an early age, and use the provided guidebooks. Parent peer educators found their training valuable and enjoyed involvement in the program. Lessons learned include strategies for improving program implementation, improving program evaluation, and involving the community. CONCLUSIONS: This program is a promising, low-cost, community-based method of promoting parent-child communication, an important element of teen pregnancy prevention.