An Awareness Program Empowering Decision Making About Prostate Cancer Among African-American Males: An Urban/Rural Initiative supported by a grant from the Health Care Financing Administration # 20-90853/3,

The goal of the project is to empower African-American males to make their decisions regarding prostate cancer screening and treatment. The methodology involves the development of a manual to train lay persons, some of whom are prostate cancer survivors, to implement educational sessions, in workshop format to African-American males and their significant others and family members. The expected results of the educational intervention are as follows:

1. Increased awareness of issues relating to prostate cancer screening and treatment among African-American adults in two target areas (one of which was a rural area in the State of Delaware, and the other was the City of Philadelphia in Pennsylvania);
2. Demonstration of the improved feelings of empowerment for decision making about prostate cancer screening and treatment;
3. Information on comparison data on outcomes of an educational intervention program on prostate cancer for a group of rural and for a group of urban African-American adults;
4. Tested training materials to prepare lay trainers for empowerment training at the community level in the African-American community;

Dr. Virginia J. Smith and Dr. B. Marshall Henderson Co-Principal Investigators for the proposed project served as co-principal investigators for the part of the pilot program that was conducted by Lincoln University. This project is operated in partnership with Delaware State University, for implementation of the rural workshops. During the first year of the HCFA funded project, a training manual (Appendix A)was developed for lay trainers who were responsible for conducting workshops sponsored by community based organizations, religious organizations, labor unions/professional organizations, and advocacy groups. Also during the first year, these lay trainers were trained to use the manual, including administering pre-post tests. A participant handout packet (Appendix B) was developed providing a summary of the materials presented in the workshops. To date, approximately 1200 persons have participated in community workshops.

Ninety eight percent of the participants were African-American. General information about the participants is as follows:

Information about health practices of preliminary sample are as follows:

Data analysis is in the preliminary stage. The preliminary results of pre-post test of knowledge about prostate cancer issues showed that the average pre test score was 60 points. The average post test score was 79 points. The percentage increase in knowledge as determined by the pre post test was 32%. This percentage increase is generally confined to 4 questions that address information about screening and diagnosis.

Post session interviews with a small sample of participants yielded data that can be organized around three general themes as follows:

Reactions to Sessions and Perceived Benefit

Although there were varying degrees of enthusiasm, all participants felt that some benefits had been obtained. Sample statements and comments include:

"I 'm glad that I came to this."

"This was really great information, because there was a lot of this that I didn't know about."

"It was good, serious information, but there was also some humor that helped to get it across."

"It really helped to hear the experiences of men who have had to deal with prostate cancer and to know about some of the good and bad decisions that they made."

Learnings and Insights

All of the participants took something substantive away from the sessions. This new information and/or insight covered areas having to do with the disease process, causal factors, treatment, and lifestyle. Sample statements are as follows:

"I had thought that prostate cancer affected very old men. I didn't think that I would have anything to worry about and I never thought about screening."

"I didn't know that I should find out whether or not my uncles had ever had prostate cancer. I don't think so, but I should check it out."

"For some reason, it shocked me to find out that there were so many doctors with prostate cancer."

Motivation and Action

Many of the participants indicated that they were ready to take action and make changes because of what they had learned in the sessions. Some of the comments to this effect include:

"I'm going to see my doctor immediately and make sure that I have frequent screenings, even if the insurance plan won't cover them all, and I'll have to pay myself."

"I have a responsibility to my children and need to be aware of this for their sake."

"I always avoided the rectal examination but now I know that I have to have that and the PSA. I'd better make sure that happens."

"This is information that I think I should pass on to my doctor, especially the high risk for Black men."

Preliminary conclusions are that many African-American men are not aware of their risk for prostate cancer, and an educational intervention can empower these men about decision making for testing and treatment options. Limitations and problems with the pilot that were identified so far include:

• Some men stay away from workshops such as those provided because they would prefer a more private setting for obtaining information about this subject.
  
  
• Scheduling was difficult and often the number of persons expected far exceed the number that actually attended the sessions.
  
  
• The data collected from the participants did not include information on risk for prostate cancer.