Implications for Reducing Prostate Cancer Disparities: PROCEDURES
This exploratory pilot study collected primary data from African-American male residents in Prince William County, VA. The qualitative research design used focus group interviews to obtain the data. This method is employed extensively to investigate health-related factors, such as knowledge, attitudes, beliefs and behaviors. According to Zarcadoolas, in focus groups, “participants vent their views, respond to each other, and vent some more, offering opinions, prejudices, fears and spontaneous retorts.” Focus groups yield rich data on dynamic beliefs and attitudes of individuals interacting in small groups that quantitative methods do not.
A focus group facilitator uses a standard set of questions to elicit individual responses and discussion within the context of the group. In this environ ment, an interplay of participant responses occurs, allowing for enhanced depth of responses and sharing of a social and emotional context. Participants voice their beliefs, attitudes, and behaviors in their own vocabulary and communication patterns (including slang and colloquialisms). This exchange provides critical insight into understanding specific cultural health patterns of different ethnic and cultural groups. cheap cialis canadian pharmacy
The number of participants in a focus group is important. Too many participants (i.e., greater than 10) could be problematic because participants who are less out-spoken and less assertive may not express their opinions. Those unspoken opinions could either offer different insight or further support the hypothesis.
The setting reflected characteristics (i.e., low SES, low educational attainment, African-American men) typically associated with low utilization of preventive health services, including screening. The participants resided in or near a low-to-moderate income apartment complex. The two focus group sessions were conducted in the complex’s community center (a familiar, neutral and convenient location within walking distance from their homes) and at a local school. Historically, the geographic area was considered rural or semirural. However, due to its proximity to Washington, DC, the area has evolved into a “bedroom community” (a commuter community for those working in the Washington, DC metro area). Therefore, the participants represented a cross-section of men from various geographical backgrounds resulting in data that is not limited to a purely urban or purely rural perspective.
Fifteen African-American men ranging in age from 33^*7 years old participated in the pilot study. The mean age was 40.5 years of age. Although several of the men in the sample fell below the recommended screening age for African-American men, (40 years of age according to the AUA and 45 years of age according to the ACS), prostate health myths and misconceptions are pervasive regardless of age. Therefore, engaging younger members of the target population is justified in order to uncover their knowledge, attitudes, and behaviors, and transform those that would serve as barriers when they reach the age for prostate screening.
The participants either worked in low-wage jobs, were unemployed or disabled. The average household income ranged from $18,000-$ 19,999. Only men who were asymptomatic, had no prior history of prostate cancer, no benign prostate disease, and no other cancers were eligible to participate.
The Prince William County African-American Health Council, a grassroots community-based organization founded to address the health needs of African Americans in the county, conducted the recruitment. The Council designated lay community leaders to recruit study participants. The lay community leaders identified potential participants and briefly discussed the project, either in person or by telephone and referred them to the program director. In addition, potential participants shared the information with other men, resulting in a snowball sampling effect that produced additional participants.
Twenty-five men were invited with the expectation that at least half would actually attend the sessions.
Two focus group sessions were conducted, each lasting approximately two hours. The first session was comprised of six participants, while the second session included nine participants. A cordial, informal atmosphere was created during lunch prior to the session. The trained facilitator was matched to the participants based on gender and ethnicity (i.e., an African-American male conducted the prostate cancer focus groups). erectalis
In order to build trust and credibility, the facilitator opened the session with introductions and a brief explanation of the purpose of the discussion, how it would be conducted, and provided assurance that the discussion would be confidential. The facilitator also emphasized that they would learn during the discussion and the information would be used in developing prostate health education programs to benefit African-American men and their families. Following the overview, participants read and signed informed consent documents.
The discussions opened with an icebreaker question regarding participants’ general health concerns. Subsequent questions addressed: a) prostate health b) prostate cancer screening and treatments, and c) influences on prostate health decisions and behaviors. With permission from the participants, each session was audiotaped. In addition, the moderator used a flip chart to record key statements of the participants that emerged from their free flow of ideas and spontaneous retorts. The participants referred to the flip chart to either reiterate a point that was previously stated by another participant or to check for redundancy. The facilitator used the flip chart only to record participant statements as a reference for their discussion and not to guide the discussion.
Because of the assurance of confidentiality, participants provided open, honest and frank responses. At the conclusion of each session, participants were remunerated $20 each.
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Audiotapes of the focus group discussions were transcribed verbatim. The research team thoroughly read and inductively evaluated the transcripts. Pattern analysis was used to identify and bring together fragments or components of ideas or experiences representing micro units of behavior. The patterns were then used to delineate themes representing macro units of behavior. The thematic analysis extracted central themes that explained multiple aspects of behavior. Thoroughly examining both patterns and themes yielded an in-depth analysis of the issues under investigation.
Tags: African Americans, disparities, health education, myths, prostate cancer