Dealing with diversity: recruiting churches and women for a randomized trial of mammography promotion.

There is little documentation about the recruitment process for church-based health education programs. In this study, the authors recruit African American, Latino, and white churches and women members (age 50 to 80) for a randomized church-based trial of mammography promotion in Los Angeles County. Efforts to enhance recruitment began 10 months before churches were invited to participate and included a variety of community-based strategies. Subsequently, 45 churches were recruited over a 5-month period through group pastor breakfast meetings and church-specific follow-up. In close collaboration with the 45 churches, the authors administered church-based surveys over 6 months and identified 1,967 age-eligible women who agreed to be contacted by the program team. It was found that an extended resource intensive period of relationship-building and community-based activities were necessary to conduct church-based programs effectively, particularly among older and ethnically diverse urban populations.

Church-based telephone mammography counseling with peer counselors.

Little is published about step-by-step implementation of telephone counseling interventions to promote community-based health activities. This article describes the authors' experience of implementing a church-based telephone mammography counseling intervention with peer counselors representing three principal racial or ethnic groups: African American, Latino, and Anglo (White). Twenty-six women from 12 churches in the Los Angeles area were recruited and trained to deliver the counseling annually over a two-year period to 570 women participants who were recruited from participating churches (n = 15). The counseling sessions were conducted from church-based telephone centers in key geographic locations in our program area. Training and supervision proved challenging: most of the Latino counselors had fewer than seven years of education and spoke only Spanish, while most of the other counselors had at least some college and spoke only English. Culturally specific and small group interactions, role plays, and a more modular approach to training were the most effective ways to enhance counselors' skills. Latina participants' mammography adherence rates were lowest, and their barriers reflected their low socioeconomic status; as Latina counselors shared basic information about mammograms and where to obtain them at little or no cost, the counseling exchanges tended to be nonconflictive and supportive. Black and White participants were generally more knowledgeable and adherent with screening guidelines than Latinas. We found that it was possible to implement this intervention with diverse groups and conclude with lessons learned that may inform others considering such a strategy.

Use of relevancy ratings by target respondents to develop health-related quality of life measures: an example with African-American elderly.

BACKGROUND: Health-related quality of life (HRQOL) instruments assess functioning and well-being. Generic HRQOL measures are intended to be relevant to everyone whereas population-targeted measures are designed to be relevant to a particular population. METHODS: We asked 99 African-American elderly (mean age 72, 33% female, 47% less than high school education) to rate the relevancy of 33 HRQOL items drawn largely from existing instruments. We assessed the reliability of the relevancy ratings across respondents, rank-ordered the items by relevancy, and tested the significance of difference in relevancy ratings for each item compared to the average of all other items. We also examined the associations of the relevancy ratings with sociodemographic and clinical characteristics. RESULTS: The relevancy ratings were reliable (intraclass correlation = 0.71) and relevancy was generally distinct from HRQOL and demographic characteristics. Items assessing spirituality and weight-related health status were rated as significantly more relevant than other types of items. Generic HRQOL items were not rated as highly relevant. CONCLUSIONS: HRQOL measures assessing spirituality and weight-related concepts are important for future studies of HRQOL in African-American elderly. The method of identifying these concepts used in this study should be valuable in developing new measures targeted to other sociodemographically or clinically defined subgroups.