Research Statement Study Goals and Objectives Project Impact or ...

Research Statement
The specific aim of this research study is to measure the effect of using a culturally appropriate intervention called
“Save Our Breasts” Breast Health Forum on African American women’s breast cancer beliefs and intentions to engage in
mammography screening.
Study Goals and Objectives
1. Recruit approximately 75 African American (AA) women over 35 years of age to engage in the study using
community based participatory recruitment strategies.
2. Test a culturally appropriate intervention, “Save Our Breasts” Breast Health Forum that provides information on key
epidemiological factors, myths, barriers to, and facilitators of breast cancer screening. This intervention will include
AA breast cancer survivors’ personal testimonies, prose, poetry, photographs, and quotations. Breast health
knowledge, beliefs (barriers, benefits, susceptibility), fear, mammography self-efficacy, and intent to screen for
mammography will be measured prior to, immediately after, and three months after the intervention.
3. Enter and analyze data.
4. Disseminate findings through poster presentations and publication.
Project Impact or Significance
Overcoming cancer health disparities is one of the best opportunities we have for eliminating the suffering and death
due to cancer. This research introduces a new culturally appropriate intervention, “Save Our Breasts” Breast Health
Forum, for nurses to use in educating AA women about breast cancer early detection and mammography screening.
Should the intervention be successful, it will increase their intention to have screening mammograms, thus reducing their
chances of breast cancer mortality and reducing breast cancer health disparities. Because of the challenges in recruiting
AA women into breast health studies, there is a need to use culturally appropriate community based participatory
recruitment strategies. If these techniques are successful, this will add to the literature of community based participatory
recruitment methods for AA women. Participating in this project will improve my research skills by enabling me to use
these recruitment methods, assist in presenting a novel breast health intervention, administer surveys, enter and analyze
data, and present research findings.
Literature Review/Background
Health disparities are defined as “differences in the incidence, prevalence, mortality and burden of disease…that exist
among specific population groups in the United States” (National Institutes of Health, 2002-2006). Breast cancer is the
most common cancer in AA women (American Cancer Society (ACS), 2009). The breast cancer mortality rate is higher
than that of all U.S. ethnic groups and AA women are more likely to die from breast cancer at every age (ACS, 2008).
The five-year survival rate is 90 percent for European American women compared to 77 percent for AA women (ACS,
2008). Although many of the multifaceted reasons are beyond the women’s control, recommended screenings can be
controlled. One of the recommended screenings is to have mammograms beginning at age 35 (ACS, 2008). In 2004, 59.4
percent of AA women over 40 reported receiving a mammogram within the past year; in 2005, this figure decreased to
49.9 percent and is likely due to numerous barriers to breast cancer screening (ACS, 2008).
Dr. Gibson completed an integrative review on breast cancer screening barriers in AA women and interventions to
reduce those barriers (2008). This study is a follow up to the paper. Gaps exist in research aimed at culturally appropriate
interventions for AA women that aim to reduce barriers and increase mammography screening. These barriers are
emotional, spiritual/religious, fatalistic, logistic and related to a lack of knowledge by health professionals (Gibson).
Specific barriers to mammography are religious beliefs, lack of knowledge, pain/discomfort experienced during
mammograms, cost, time, accessibility, provider attitude, scheduling conflicts, and inadequate care (Gibson).
It is important for nurses to increase the chance of mammography screening by AA women in recognizing the positive
and negative effects of culturally specific beliefs and myths (Gibson & Hendricks, 2001; Kline, 2007). For breast cancer
education to be successful culturally appropriate interventions must be used, especially in Southern states (Glanz, Croyle,
Chollette, & Pinn, 2003). Numerous psychosocial and spiritual strategies are incorporated in the AA oral tradition of
storytelling. The witnessing of testimonials by credible, attractive survivors is perceived positively by AA women because
they are similar to themselves (Erwin, Spatz, Stotts, Hollenberg, & Deloney, 1996; Williams-Brown, Baldwin, & Bakos,

2002). Poetry and other narrative genres are received well also (Kline, 2007). Multifaceted culturally specific
interventions by health care providers have resulted in significant differences in breast cancer knowledge, beliefs, and
behaviors (Hall, 2005; Kline, 2007). These interventions included teaching that stressed morbidity, mortality, and survival
statistics, susceptibility to breast cancer, breast cancer signs and symptoms, efficacy of treatments, women’s perceptions
of the seriousness of the disease, barriers to and benefits of screening (Hall, 2005; Kline, 2007).
Barriers to recruiting AA women into research studies also exist. Examples include fear, distrust and lack of
knowledge (Office of Research on Women’s Health (ORWH), 2002). In order for successful recruitment it is critical for
researchers to understand the study population and be flexible and open to modifying or adding elements that deliberately
consider the population (ORWH). Additionally, the involvement of AA spiritual institutions is essential to successful
recruitment efforts with AA communities (Meinert, Blehar, Peindl, Neal-Barnett, & Wisner, 2003).
Methodology and Student Responsibilities
My involvement in the study will continue the research begun by Dr. Gibson in the spring of 2009 when she
administered surveys to 35 AA women over 35. A quasi-experimental pre and post-test longitudinal design will be used.
Using convenience sampling AA women over 35 from churches and community organizations will be invited to complete
surveys that measure knowledge, beliefs, fear, mammography self-efficacy, and mammography screening intention prior
to, immediately after, and three months after the “Save Our Breasts” Breast Health Forum. The forum will provide
epidemiological information, breast cancer signs and symptoms, AA breast cancer survivors’ personal testimonies, prose,
poetry, photographs, and quotations. Initially my time will be spent recruiting study participants by meeting with
respected AA church and community leaders to solicit their suggestions and support. I will then plan meetings with AA
women to present the study purpose and impact by using methods as recommended by the leaders. Previous examples
used by Dr. Gibson and community leaders included distributing fliers and sending personal letters of invitation. During
the forum I will assist by facilitating discussions on barriers to breast cancer screening, myths about breast cancer, and
presenting stories of breast cancer survivors. I will administer the surveys before, immediately after, and three months
after the forum, and enter and analyze the data using the Statistical Package of the Social Sciences (SPSS, 17 th edition). I
will present a poster of preliminary findings at The Undergraduate Research Symposium at USC Upstate in March 2010, a
poster at Discovery Day 2010, and write a manuscript for publication into a refereed nursing journal.
Timeline
January-February
Early March
March - April
April - May
Early June
June – early July
Training on the Responsible Conduct of Research and review of articles
Recruitment: meet with community leaders; advertise to recommended AA locations
Submit abstract for poster at The Undergraduate Research Symposium at USC Upstate
Assist with the “Save Our Breasts” Breast Health Forum and administer surveys
Enter and analyze pre/immediately post intervention data and prepare poster presentation
Send reminders, contact women for 3-month post-intervention surveys
Administer 3-month post-intervention surveys
Enter and analyze three-month post-intervention data
Complete manuscript for publication in a refereed nursing journal
Anticipated Results
I anticipate that after the “Save Our Breasts” Breast Health Forum, the AA women responding in the post-test surveys will
have greater breast health knowledge, change in beliefs (greater benefits, fewer barriers, less susceptibility, less fear),
increased mammography self-efficacy, and greater intention to engage in mammography screening. My project outcomes
will include presenting at The Undergraduate Research Symposium at USC Upstate and Discovery Day 2010.
Furthermore I will prepare a manuscript publication in a refereed journal.
Personal Statement
I feel especially connected to the subject of breast cancer research because I have personally known members of my
church family who are AA breast cancer survivors. Through these encounters I have seen the devastation of this disease,
ranging from the effects of chemotherapy to the effects of having to have a mastectomy. As a nursing student I have had
AA breast cancer patients whose prospect of surviving was not as hopeful because the cancer was found at a late stage.
These women did not have recommended screening mammograms. I know numerous AA women who are reluctant to
receive any type of medical care, including breast cancer screening and treatment, because of the stigmas held in the AA
community. I am a senior nursing student with a grade point average of a 3.9 and I have plans to pursue a master’s degree
to be a women’s health nurse practitioner. One of my career goals is to help break the cycle of health disparities and I
believe this research is a first step. I feel passionate about this research. I want to use this opportunity both as a nurse and
a future nurse practitioner, as a way to educate and break down some of the barriers to medical treatment, specifically on
the subject of breast cancer screening by AA women.

References
American Cancer Society (2009). Cancer Facts & Figures for African Americans 2009-2010. Atlanta, GA: Author.
American Cancer Society (2008). Breast Cancer Facts & Figures 2007-2008. Atlanta, GA: Author.
Erwin, D. O., Spatz, T. S., Stotts, R. C., Hollenberg, J. A. & Deloney, L. (1996). Increasing mammography and breast
self-examination in African American women using the Witness Project model. Journal of Cancer Education,
11(4), 210-215.
Gibson, L. (2008). Teaching Strategies to Facilitate Breast Cancer Screening by African American Women. Journal of
National Black Nurses Association, 19(2), 41-48.
Gibson, L., & Hendricks, C. S. (2001).Breast health and culture: Issues for nursing practice. South Carolina Nurse,
October-December, 18-19.
Glanz, K., Croyle, R. T., Chollette, V. Y., & Pinn, V. W. (2003). Cancer-related health disparities in women. American
Journal of Public Health, 93(2), 202-298.
Hall, C. P., Wimberley, P. D., Hall, J. D., Pfriemer, J. T.,Hubbard, E. M., Stacy, A. S., et al. (2005). Teaching breast
cancer screening to African American women in theArkansas Mississippi River Delta. Oncology Nursing Forum,
32(4), 857-863.
Kline, K. N. (2007). Cultural sensitivity and health promotion: Assessing breast cancer education pamphlets
designed for African American women. Health Communication, 21(1), 85-96.
Meinert, J. A., Blehar, M. C., Peindl, K. S., Neal-Barnett, A., Wisner, K. L. (2003). Bridging the gap: Recruitment of
African-American women into mental health research studies. Academic Psychiatry, 27(1), 21-28.
National Institutes of Health. NIH strategic plan and budget to reduce and ultimately eliminate health disparities,
1, fiscal years 2002-2006.
Office of Research on Women’s Health (2002). Outreach notebook for the inclusion, recruitment, and retention of
women and minority subjects in clinical research. Accessed October 1, 2009,
http://orwh.od.nih.gov/inclusion/outreach.pdf.
Williams-Brown, S., Baldwin, D. M., & Bakos, A. (2002). Storytelling as a method to teach African American
women breast health information. Journal of Cancer Education, 17(4), 227-230.

Magellan Scholar BUDGET FORM
Student’s Name:
Student salary Hours Rate Subtotal
Taking classes 150 8 $1,200.00
Not taking classes 80 8 $640.00
Fringe: Student salary * student fringe rate 1
Taking classes $1,200.00 1.05% $12.60
Not taking classes $640.00 8.85% $56.64
Materials/Supplies $927.00
Travel $152.00
TOTAL $2,988.24
Student Salary: Indicate timeframe of student work
Budget Justification
Spring and Summer 2010: 15 weeks; 10 hours/week; Rate = $8.00/hour $1200.00
Fringe: (taking classes) $ 12.60
May – early July 2010: 8 weeks; 10 hours/week; Rate = $8.00/hour $ 640.00
Fringe: (not taking classes) $ 56.64
I will work 10 hours per week during the Spring 2010 semester for 15 weeks – totaling 150 hours. I will complete the
requirements for the Responsible Conduct of Research, review articles, recruit participants, update and assist Dr. Gibson
with the “Save Our Breasts” Breast Health forum presentation, collect, enter, and analyze data from the pre and immediate
post intervention surveys. I will also present two posters at USC Upstate and Discovery Day.
I will work 10 hours per week for 8 weeks from May until early July sending reminders to the participants,
administering the 3-month post intervention surveys, entering and analyzing data. I will complete a manuscript for
publication in a refereed journal by the first week in July.
Materials/Supplies: Indicate quantity and price
Spring 2010: 150 Survey Booklets (75 participants pre/post intervention) $ 375
Recruitment supplies (fliers, invitation letters - envelopes/stamps) 339
Incentives ($1.50 each X 75 women) 113
Posters X 2 (USC Upstate Undergraduate Research Symposium and Discovery Day) 100
Total: $ 927
Travel: Indicate location, purpose of travel, estimate costs.
Spring 2010: 200 miles to recruit/administer surveys in Greenville, Spartanburg counties $ 101
Summer 2010: 100 miles to administer surveys @ .505 $ 51
Total Travel: $ 152