ADDRESSING MULTIPLE BREAST CANCER RISK: METHODS part 2

Behavioral Variables

Food Frequency Questionnaire (FFQ). The FFQ was initially developed for a study with minority families. The FFQ includes 13 categories of food, including: animal protein, vegetable protein, low-fat dairy, high-fat dairy, high-fat snacks, nonwhole grains, whole grains, vegetables, fruits, fast food, desserts, carbonated beverages, and water. Additional questions are asked related to food preparation methods and fat added during cooking or at the table. There are currently no reliability or validity data for this measure.

Breast Self-Examination Proficiency Evaluation. This measure is part of the Breast Health Questionnaires that were developed by our research team for another community risk-reduction program. The interviewer asks the participant to demonstrate on a breast model how they would perform a breast self-exam (BSE). As the woman performs BSE, the interviewer observes and rates the quality of performance based on a rating scale consisting of the following six items: 1) use of pads of three fingers; 2) movement of fin gers in circular motion, in contact with skin at all times; 3) use of deep, medium, and light touch; 4) use of one of two systematic patterns (lateral or bull’s eye); 5) covers whole breast from collarbone to braline, and sternum to underarm; and 6) did you find any lumps in the breast model? If so, how many lumps did you find? There are currently no reliability or validity data for this measure.

Physical Activity. Two questions related to physical activity were posed: 1) On average, how many hours per day do you watch TV?; and 2) Do you currently participate in any regular physical activity designed to improve your physical fitness? If respondents answered “yes,” we then asked questions related to mode, frequency, and duration of activities designed to improve their physical fitness.

Satisfaction Questionnaire. This measure, which contains 15 items, was developed to measure the level of satisfaction with the intervention. Items were queried about participant’s experiences with regard to: satisfaction with the length of the program; components of the intervention, group leaders, and overall program; how the program affected their motivation and confidence to exercise; making healthy eating changes and performing BSE; and sources of motivation (increased awareness, group leaders, group support, and confidence).
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Lifestyle Intervention

The lifestyle intervention was comprised of three 90-minute sessions, during which 30 minutes were spent on dietary and weight-loss strategies, 30 minutes on breast health, and 30 minutes engaged in low-impact aerobic activity. An advanced doctoral student in clinical psychology, as well as a certified aerobics instructor, led the intervention. The intervention was held in the community room of the food co-op in which recruitment took place. On average, 15 women attended each session. The intervention was based on principals of SCT. As such, attention was paid to the cognitive, behavioral, and environmental/cultural aspects of lifestyle changes in diet and physical activity that would lead to weight loss and weight-loss mainte nance, as well as changes in breast health and screening behaviors. For example, time was spent teaching and supporting the use of tools, such as daily self-monitoring of food intake and physical activity, monthly self-monitoring of BSE, reinforcement, modeling, and stimulus control.

In addition to SCT, the intervention also incorporated tenets related to the practice of culturally competent research and treatment. The development of culturally sensitive interventions requires the recognition of the beliefs and practices of the particular social, ethnic, and age group for whom the intervention is being developed; appreciation of the roles these factors play in participants’ lives; and considerate incorporation into the intervention. Based on our previous work in developing lifestyle interventions for African-American women, we focused on food, family, music, social roles and relationships, and spirituality/religion. Tailored cultural considerations included: 1) addressing the importance of food in the African-American culture and ways to integrate this value with healthful eating; 2) augmenting traditional “soul food” recipes to be low fat; 3) incorporating a physical activity component that addressed barriers to regular physical activity (safety, weather, access, time); 4) acknowledging family roles and family resistance to change; 5) providing information on the value of healthful lifestyles for children and spouses; 6) facilitating social support for making changes in dietary and physical activity, and BSE patterns (i.e. group members’ phone list, so women could contact each other to exercise between sessions, identifying members of the community who could serve as role models); 7) incorporating the important role of religion and worship in the lives of these women and how it affected their health perspectives (i.e., handouts with spiritual messages that support healthful living, and group discussions). Objectives for the intervention were to: 1) self-monitor dietary intake, 2) decrease fat consumption, 3) increase fruits and vegetable intake, 4) increase physical activity, 5) improve BSE proficiency, and 6) improve or maintain compliance with regular age-appropriate screening (CBE and mammogram) behaviors.
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Focus Groups. Following the intervention, the women in each intervention group were asked to complete a satisfaction questionnaire and attend a focus group wherein they could offer feedback on the health interview and the intervention. A professional moderator and the principal investigator led the focus groups. The purpose of the satisfaction questionnaire and the focus groups was to learn about the participants’ opinions regarding: 1) completing the health interview; 2) format, content, and cultural appropriateness of the intervention; and 3) how the intervention affected behavior, knowledge, attitudes, and self-efficacy related to diet, physical activity, and BSE.

Data Analysis

All analyses were performed using the SPSS statistical program. Analyses to assess acceptability/ feasibility of the intervention were based primarily on counts and proportions (i.e., the proportion of women in each group who completed the study, average number of sessions, etc.). Univariate analyses of demographic data included frequencies and percentage. Analyses used to estimate the effectiveness of the intervention looked at changes from baseline to postintervention, and baseline to the one-year follow-up using the student’s t-test for continuous variables and the Wilcoxon Signed Ranks Test for dichotomous and categorical measures. Cialis Jelly

Category: Cancer

Tags: African Americans, breast cancer, breast screening behaviors, intervention culture, risk factors, Weight Loss