Addressing Cultural & Tribal Issues in Breast Cancer

Institution: Turtle Health Foundation
Investigator(s): Linda  Navarro ,  - Marlene  von Friederichs-Fitzwater, Ph.D. -
Award Cycle: 2006 (Cycle 12) Grant #: 12AB-3201 Award: $87,875
Award Type: CRC Pilot Award
Research Priorities
Disparities>Disparities: eliminating the unequal burden of breast cancer

This is a collaboration with: 12AB-3200 -

Initial Award Abstract (2006)

Breast cancer is the second leading cause of cancer death among American Indian women. Deaths from breast cancer could be reduced by more than 30% in American Indian women if current recommendations for screening were followed. American Indian women have the poorest cancer screening rates of any ethnic group, and those with breast cancer have had the lowest 5-year survival rate when compared to other ethnic groups. Research has found that health beliefs were positively associated with breast cancer screening in multivariate analyses. Previous studies have identified the individual and community influences of Native identify on women’s health and their health care decisions. While some efforts have been made to produce materials that are culturally sensitive, they have been text, non-interactive video or computer-based and have not taken an integrative or holistic approach. Building on this theme of “connecting to nativeness,” the UC Davis Cancer Center and the Turtle Health Foundation, Inc., an American Indian nonprofit headquartered in Sacramento, CA, are partnering to undertake this pilot study to determine the usefulness of a culturally-sensitive, interactive, multimedia DVD, that can be used with standard DVD players and TV monitors, to increase awareness and knowledge of breast health and breast cancer risk reduction among American Indian women. We are integrating the principles of indigenous healing (nutrition, exercise/movement, spirituality, etc.) with Western medicine in the development and evaluation of a unique educational/information intervention on breast health and breast cancer risk reduction in a program we’ve entitled the “Mother’s Wisdom Breast Health Program.” A preliminary study by the Co-PIs (with a small grant from the Susan G. Komen Foundation), resulted in the development and testing of a prototype of the DVD program with 50 American Indian women in the Sacramento area. We will use the information from the preliminary study to make any necessary revisions and then fully develop the content areas and script and tape video presentations for testing with 100 American Indian women in California in this pilot study.

The question(s) or central hypotheses of the research in non-technical terms:
Our hypothesis is that American Indian women will be receptive to an educational intervention that is culturally sensitive, interactive and visual, thus, such an intervention will increase their awareness of the importance of breast health and breast cancer risk reduction. Future studies will examine whether such interventions actually change screening behaviors of American Indian women. Specifically, the research questions we are seeking to answer with this proposed project are:
1. What specific strategies and methods work in integrating traditional health and disease beliefs and values with Western medicine in an educational intervention to increase awareness of breast health and breast cancer risk reduction among American Indian women?
2. Will one educational intervention model of breast health and breast cancer risk reduction work across several American Indian tribes in California?
3. Is a DVD format a viable delivery channel for breast health and breast cancer risk reduction information for American Indian women?

The general methodology in non-technical terms: American Indian women will be invited to screenings where they will watch the DVD on a TV monitor and also have an opportunity to test it on laptop computers. They will complete an evaluation of the program and results will compiled, analyzed and shared through journals, professional meetings, tribal health meetings and the media. The results will also provide the data for further research to determine if increasing awareness and knowledge of breast health and breast cancer risk reduction results in lifestyle changes and screening behaviors.

Innovative elements of the project in non-technical terms: So little is known about risk reduction strategies to prevent the incidence of cancer and mortality throughout Indian Country, making this pilot study timely with high translational potential if successful.

Community involvement: An American Indian Advisory Council of 10 women from six tribes will be expanded to represent more tribes in California and the program will be tested and evaluated through American Indian health organizations and tribal health clinics.




Final Report (2009)

The goal of this pilot study is to expand on preliminary research conducted by the academic and community partners by developing and testing a full version of the “Mother’s Wisdom Breast Health Program” informational/educational intervention DVD with 100 American Indian women across tribes in California. The program is based on information gathered from interviews and focus groups with American Indian women and intended to increase knowledge about breast health and breast cancer reduction, reduce psychosocial and psychocultural barriers to mammogram screening, and integrate traditional health and healing beliefs with Western medicine to encourage and support the adoption of healthy lifestyles by American Indian women.

We identified two aims for this pilot study: (1) to use the data obtained from a preliminary Komen-funded study with 50 American Indian women in the greater Sacramento area to develop a full version of the Mother’s Wisdom Breast Health Program on DVD as an intervention to address the psychosocial and psychocultural barriers to breast cancer risk reduction among American Indian women; and (2) to test and evaluate the full version of the Mother’s Wisdom Breast Health Program DVD with 100 American Indian women in California.

Prior to this grant, we established an American Indian Advisory Council in 2005 with 12 American Indian women from eight tribes. The Council meets monthly at a dinner meeting hosted by the UC Davis Cancer Center. The work of the Council is to oversee the development and testing of the Mother’s Wisdom Breast Health Program; identify potential sites for Talking Circles and group discussions of the Program; assist with distribution and testing of the Program; and identify appropriate community gatherings and staff booths and exhibits at American Indian health and education meetings, Pow-Wows, tribal council meetings, etc.

The progress on this grant as of June 1, 2007, has exceeded our original aims. We have recruited and tested the Mother’s Wisdom Breast Health Program DVD with 161 women and have compiled a contact list of over 175 tribes, tribal organizations, and individual women who want to be part of a future longitudinal study on behavior change.

In addition, one of the Council members, Kellie Stevens, designed an original American Indian Ribbon of Life, which was then produced into a removable adhesive Ribbon on a glossy white card with a brief description of the meaning of the feather design and purpose of the Ribbon and distributed throughout the state and beyond. These activities have greatly enhanced awareness of the project throughout the state.