Evaluation of the Helping You Take Care of Yourself .../media/publications/pdfs/...Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research

Evaluation of the Helping You Take

Care of Yourself Curriculum 2009-

2010

Final Report

September 23, 2011

Mindy Lipson Melanie Besculides Ebo Dawson-Andoh Nicholas Redel

Contract Number: PRF06 (02) (formerly ST2H191)

Mathematica Reference Number: 06339

Submitted to: Heather Nelson Director of Community Health Services Women’s Health Network & Men’s Health Partnership Care Coordination Program Massachusetts Department of Public Health 250 Washington Street, 4th Floor Boston, MA 02108 Submitted by: Mathematica Policy Research P.O. Box 2393 Princeton, NJ 08543-2393 Telephone: (609) 799-3535 Facsimile: (609) 799-0005 Project Director:

Evaluation of the Helping You Take

Care of Yourself Curriculum 2009-

2010

September 23, 2011

Mindy Lipson Melanie Besculides Ebo Dawson-Andoh Nicholas Redel

Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research

iii

CONTENTS

I INTRODUCTION ............................................................................................. 1 II METHODS ...................................................................................................... 7

A. Quantitative Methods .............................................................................. 8

1. Data Collection ................................................................................... 8 2. Data Entry, Cleaning, and Coding ....................................................... 8 3. Data Analysis ..................................................................................... 9

B. Qualitative Methods ............................................................................... 10

1. Data Collection ................................................................................. 10 2. Data Analysis ................................................................................... 13

III RESULTS ...................................................................................................... 15

A. Project Implementation ......................................................................... 15

1. Recruitment of CBOs ........................................................................ 15 2. Training CBO Educators .................................................................... 15 3. Relationship with CMAHEC ............................................................... 23

B. Project Reach ......................................................................................... 23

1. Recruiting Workshop Participants ..................................................... 24 2. Conducting Workshops .................................................................... 25 3. Description of Workshop Participants ............................................... 26 4. Preventative Health Behaviors ........................................................... 29

C. Project Effectiveness (Knowledge Improvement Among Workshop

Participants) .......................................................................................... 50

1. Knowledge of Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health ................................................................................. 50

2. Satisfaction with the Education ......................................................... 56 D. Project Maintenance (Evaluation of Longer-Term Effect of Program) ...... 57

1. Information Learned and Shared ....................................................... 57 2. Informed Decision Making with Providers ......................................... 58 3. Knowledge Posttest .......................................................................... 63

E. Limitations ............................................................................................ 63


iv

CONTENTS (continued)

IV RECOMMENDATIONS AND CONCLUSION ...................................................... 65

A. Implementation (CBO Recruitment and Training) ................................... 65

B. Reach (Number of People Educated) ...................................................... 66 C. Effectiveness (Knowledge Improvement) ................................................ 66

D. Maintenance (Longer-term Effect of the Program) .................................. 67

E. Conclusion ............................................................................................ 68

REFERENCES ................................................................................................. 69 APPENDIX A: DATA COLLECTION FORMS APPENDIX B: INTERVIEW AND FOCUS GROUPS PROTOCOLS APPENDIX C: SOLICITATION FOR APPLICATIONS APPENDIX D: DEMOGRAPHIC CHARACTERISTICS OF WORKSHOP

PARTICIPANTS, BY REGION OF TRAINING APPENDIX E: DEMOGRAPHIC CHARACTERISTICS OF WORKSHOP

PARTICIPANTS BY HEALTH UNIT APPENDIX F: PRE- AND POSTTEST KNOWLEDGE BY QUESTION AND BY

GENDER, AGE, RACE/ETHNICITY, AND EDUCATION


v

TABLES

1 Massachusetts Health Quality Partners (MHQP) 2007-2008 Adult Preventive Care Recommendations .................................................................................. 2

2 Helping You Take Care of Yourself Topics by Health Unit ................................ 3

3 Sample of Changes Made to Demographic Form ............................................. 5

4 Data Collection Methods ................................................................................ 7

5 Number of Education Units Given by Health Topic .......................................... 8

6 Description of Community-Based Organizations that Participated in the Qualitative Evaluation ................................................................................... 11

7 Characteristics of CHWs ............................................................................... 16

8 Breast, Cervical, Cardiovascular, Colorectal, and Prostate Knowledge on the Pretests and Posttests, by Demographic Characteristics of CHWs ................. 19

9 Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health Knowledge, by Pretest and Posttest Questions Among CHWs ........................................... 21

10 Capacity Reached by Health Unit .................................................................. 24

11 Characteristics of Workshop Participants ...................................................... 28

12 Receipt of Mammograms Among Female Workshop Participants Over Age 40, by Demographic Characteristics .............................................. 31

13 Receipt of Pap Smears Among Female Workshop Participants, by Demographic Characteristics ................................................................... 34

14 Receipt of Blood Cholesterol Check Among Workshop Participants, by Demographic Characteristics ................................................................... 37

15 Receipt of Blood Stool Test Among Workshop Participants Over Age 50, by Demographic Characteristicsa .................................................................. 41

16 Receipt of Sigmoidoscopy/Colonoscopy Among Workshop Participants Over Age 50, by Demographic Characteristics .............................................. 42

17 Receipt of Digital Rectal Exams (DRE) Among Male Workshop Participants Over Age 40, by Demographic Characteristics .............................................. 46

18 Receipt of Prostate-Specific Antigen (PSA) Tests Among Male Workshop Participants Over Age 40, by Demographic Characteristics ........................... 47


vi

TABLES (continued)

19 Discussion About Prostate Cancer Early Detection or Screening with Health Care Provider Among Male Workshop Participants Over Age 40, by Demographic Characteristics ........................................................................ 48

20 Breast, Cervical, Cardiovascular, Colorectal, and Prostate Knowledge on the Pretests and Posttests by Demographic Characteristics of Workshop Participants .................................................................................................. 51

21 Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health Knowledge, by Pretest and Posttest Questions Among Workshop Participants ................. 54

22 Summary of Responses to Evaluation Questions Among Workshop Participants .................................................................................................. 56

23 Prostate Health Screening Behaviors After Attending Workshop by Screening Behaviors Before Attending Workshop .......................................................... 59

24 Person Who Made Decision for Workshop Participant to Receive Prostate Cancer Screening ......................................................................................... 61


vii

FIGURES

1 Flow Chart of Project Implementation and Evaluation ..................................... 6

2 Breast Health Screening Behaviors Among Women Over Age 40 in the United States, Massachusetts, and Participating CBOs .................................. 32

3 Cervical Health Screening Behaviors Among Women in the United States, Massachusetts, and Participating CBOs ......................................................... 35

4 Cardiovascular Health Screening Behaviors Among Men in the United States, Massachusetts, and Participating CBOs ......................................................... 38

5 Cardiovascular Health Screening Behaviors Among Women in the United States, Massachusetts, and Participating CBOs .................................. 39

6 Colorectal Health Screening Behaviors Among Individuals Over Age 50 in the United States, Massachusetts, and Participating CBOs ....................... 43

7 Prostate Health Screening Behaviors Among Men Over Age 40 in the United States, Massachusetts, and Participating CBOs ................................. 49


1

I. INTRODUCTION

Disease prevention and early detection are cornerstones of public health. When disease occurs, early detection and treatment can decrease morbidity and mortality. State and national organizations and task forces have developed guidelines for early screening for many conditions, including cardiovascular disease and breast, cervical, colorectal, and prostate cancers. For instance, the Centers for Disease Control and Prevention (CDC) recommend routine monitoring of cardiovascular disease risk factors such as high blood pressure and cholesterol (Centers for Disease Control and Prevention 2009). The Massachusetts Health Quality Partners (MHQP) echo this recommendation stating that blood pressure should be checked at all medical encounters and cholesterol assessed every five years. They also recommend routine measurement of body mass index to screen for overweight and eating disorders (Massachusetts Health Quality Partners Adult Preventative Care Recommendations, 2008). Routine screening for many cancers is also suggested; the U.S. Preventive Services Task Force recommends population-based screening for colon and rectum cancer, female breast cancer, and uterine/cervical cancer (Henley et al. 2010). Currently, population-based screening for prostate cancer is not recommended because the benefits of routine screening have not yet been proven to outweigh the potential harms (U.S. Preventive Services Task Force 2008). Rather, it is recommended that men make an informed decision with their health care providers about testing (U.S. Preventive Task Force 2008; American Cancer Society 2010; Centers for Disease Control and Prevention 2010). Table 1 displays MHQP's preventive care recommendations for adults. As shown in the table, the age at which screening should commence, the types of tests used, and the frequency of testing are affected by factors such as family history of disease and previous screening results.

To educate the public about the importance of prevention and screening, the Massachusetts

Department of Public Health (MDPH) developed the Helping You Take Care of Yourself curriculum in 2006. In particular, the curriculum was targeted towards Massachusetts’ underserved populations in an effort to raise their rates of preventative health screening. Initially, the curriculum had two units—breast health and cervical health. A cardiovascular health unit was added in 2007, and colorectal and prostate health units were added in 2009. The curriculum was designed as a “train-the-trainer” model, whereby community-based organizations (CBOs) were trained to carry out educational workshops with members of their community. Each unit of the curriculum consists of PowerPoint presentations, notes, and anatomical models. The curriculum has been translated into Spanish and Portuguese. The topics covered in each unit are listed in Table 2.


2

Table 1. Massachusetts Health Quality Partners (MHQP) 2007-2008 Adult Preventive Care Recommendations

Cancer Recommendations

Cancer Type Recommended Screening Breast Ages 18-39: Starting at age 20, clinical breast exam and self-exam

Ages 40-49: Clinical breast exam and self-exam instruction. Annual mammography at discretion of clinician/patient.

Ages 50-64: Clinical breast exam and self-exam instruction. Annual mammography.

Ages 65+: Clinical breast exam and self-exam instruction. Annual mammography through age 69; > age 70 at clinician/patient discretion.

Cervical (Pap Test and Pelvic Exam)

Ages 18-64: Initiate Pap test and pelvic exam at 3 years after first sexual intercourse or by age 21. Every 1-3 years depending on risk factors.

Ages 65+: Every 1-3 years at clinician discretion.

Colorectal Ages 18-49: Not routine except for patients at high risk. Ages 50+: Colonoscopy at age 50 and then every 10 years, or annual fecal

occult blood test (FOBT) plus sigmoidoscopy every 5 years, or sigmoidoscopy every 5 years, or double-contrast barium enema every 5 years or annual FOBT. Screening after age 80 at clinician/patient discretion.

Ages 50+: Digital Rectal Exam (DRE). Offer PSA screening at clinician/patient discretion.

Prostate Ages 18-39: Prostate cancer screening not routine. Ages 40-49: Digital Rectal Exam (DRE) for patients at high risk for prostate

cancer. PSA screening in high-risk patients at clinician/ patient discretion.

Other Recommendations

Disease Recommended Screening

Cardiovascular Adults of all ages:

Body mass index (BMI): Screen for overweight and eating disorders. Consult the CDC’s growth and BMI charts (www.cdc.gov/nccdphp/dnpa/bmi/index.htm). Ask about body image and dieting patterns.

Hypertension: At every acute/nonacute medical encounter and at least once every 2 years.

Cholesterol: Screen if not previously tested. Screen every 5 years with fasting lipoprotein profile (total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride).

Source: Massachusetts Health Quality Partners Adult Preventive Care Recommendations, 2008.


3

Tab

le 2

. H

elp

ing

You T

ake

Car

e of

Yours

elf

Top

ics

by H

ealt

h U

nit

Brea

st H

ealth

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rvic

al H

ealth

Ca

rdio

vasc

ular

Hea

lth

Colo

rect

al H

ealth

Pr

osta

te H

ealth

Br

east

ana

tom

y

W

hat i

s br

east

can

cer?

Be

nign

bre

ast

cond

ition

s

Ri

sk fa

ctor

s fo

r bre

ast

canc

er

Si

gns

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reas

t pr

oble

ms

Br

east

can

cer

dete

ctio

n m

etho

ds

Fe

mal

e re

prod

uctiv

e an

atom

y

Wha

t is

cerv

ical

ca

ncer

?

Wha

t is

HPV

?

Risk

fact

ors

for

HPV

and

cer

vica

l ca

ncer

Pap

test

HPV

test

W

hat i

s ca

rdio

vasc

ular

di

seas

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H

eart

att

ack

war

ning

sig

ns

St

roke

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gns

H

eart

dis

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an

d st

roke

risk

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ctor

s

Eatin

g an

d liv

ing

“hea

rt h

ealth

y”

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owin

g yo

ur

num

bers

(c

hole

ster

ol,

trig

lyce

rides

, bl

ood

pres

sure

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ucos

e, h

eigh

t, w

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t)

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lon

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tion

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?

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fact

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oble

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lyps

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reen

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ale

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land

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t is

pros

tate

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cer?

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fact

ors

for p

rost

ate

canc

er

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gns

and

sym

ptom

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pr

osta

te p

robl

ems

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larg

ed p

rost

ate

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osta

te c

ance

r scr

eeni

ng


4

At the project’s inception, MDPH regional Outreach Specialists educated community members using the curriculum. In 2007, in an effort to expand the project’s reach, MDPH contracted with Mathematica Policy Research to administer funds to CBOs to carry out education using the curriculum. To date, there have been three phases of education: Phase 1—February 2007 through June 2007; Phase 2—August 2007 through November 2008; and Phase 3—August 2009 through May 2010. In Phases 1 and 2, CBOs were selected to participate in the project by MDPH regional Outreach Specialists based on their expertise and ties with target members of their communities. In Phase 3, CBOs applied to participate in the project through a competitive Solicitation for Applications process. Also in Phase 3, MDPH contracted with the Central Massachusetts Area Health Education Center (CMAHEC) to train CBOs to use the curriculum. This change was made in response to staffing reassignments within MDPH. Mathematica has evaluated Phases 1 and 2 of the project (Trebino et al. 2008; Besculides et al. 2010) and the rest of this report focuses on Phase 3.

In Phase 3, Mathematica contracted with 26 CBOs, 25 of which carried out education.1 Some

CBOs had participated in previous phases of the project and some were newly funded. Before holding workshops with community members, community health workers (CHWs) from each CBO attended a three-hour orientation training and topic-specific trainings led by CMAHEC. Topic-specific trainings were day-long sessions that covered one or two topics. CMAHEC provided ongoing technical assistance to programs on the curriculum as requested and provided data collection forms.

For each CBO, Mathematica developed a memorandum of understanding (MOU) that

described the project and outlined expectations for participation. The MOUs specified the number of people the CBO agreed to educate for each health unit and, in some cases, also specified a target population (such as black men). CBOs could only carry out education in units that were specified in their MOUs. The MOUs further stated that organizations would be paid $30 per unit (breast, cervical, cardiovascular, colorectal, or prostate health) for each person educated for whom complete data were submitted. Specifically, CBOs were contracted to collect data using four standardized forms: (1) a pretest of knowledge, (2) an identical posttest of knowledge, (3) a demographic form, and (4) an evaluation.

Data collection forms were modified slightly from versions used in previous phases of the

project to incorporate suggestions made by CHWs and participants during the previous project evaluations. For example, multilevel questions on education, health insurance, length of time since last mammogram, and length of time since last Pap smear were combined into single questions. Table 3 demonstrates one of the changes made to the demographic form that is representative of other modifications.

1 One CBO signed an MOU but did not hold any workshops because it shifted its attention to responding to the

needs of people affected by the 2010 earthquake in Haiti.


5

Table 3. Sample of Changes Made to Demographic Form

Questions in Previous Phase Updated Question

Have you ever had a mammogram? Yes No

If yes, when was your most recent mammogram?

Less than 1 year ago 1 – 3 years ago 4 – 5 years ago More than 5 years ago

A mammogram is an x-ray of each breast to look for breast cancer. When was your most recent mammogram?

Within the past year (anytime less than 12 months ago)

Within the past 2 years (1 year but less than 2 years ago)

Within the past 3 years (2 years but less than 3 years ago)


5 or more years ago I have never had a mammogram

In addition, the updated demographic form included a question on gender and questions on

colorectal and prostate health to reflect the addition of these units. The pre- and posttests for the cardiovascular health units were also changed to replace a problematic question. Last, additional response options were added to some questions that were identified as confusing in the previous phase of the project. For example, for a question related to country of birth, the updated demographic form added “One of the US Territories (Puerto Rico, Guam, American Samoa, US Virgin Islands, Mariana Islands, Solomon Islands)” to clarify which countries should be classified as the U.S. territories. Data collection forms are included in Appendix A.

Mathematica analyzed the data to describe the population served, assess health screening behaviors, determine baseline knowledge, assess whether the educational workshops improved knowledge, and assess satisfaction with the education. We also analyzed data from CBO CHWs that were collected during the CMAHEC training sessions to understand their demographic characteristics and assess their knowledge of the educational units before and after receiving training. To supplement the analysis of data collected during educational workshops, Mathematica conducted a qualitative evaluation of the prostate health unit. We focused on the prostate health unit for two reasons. First, our previous evaluation covered the breast, cervical, and cardiovascular health units (Besculides et al. 2010). Second, MDPH’s Comprehensive Cancer Prevention and Control Program, which provides partial funding for this project, receives CDC funding to reduce prostate cancer disparities among African American men in Massachusetts. One of the program’s objectives is to increase the number of black, non-Hispanic men who have discussed prostate cancer early detection with their health care providers. The qualitative evaluation helped assess whether men have had these discussions and the barriers to seeking care.

This report summarizes the findings from Mathematica’s evaluation. The report organizes our findings along four dimensions: (1) project implementation, (2) reach, (3) effectiveness, and (4) maintenance. This organization is loosely based on the RE-AIM framework, which assesses Reach, Effectiveness/Efficacy, Adoption, Implementation, and Maintenance of public health interventions to determine program impact (Glasgow et al. 1999). Figure 1 summarizes the flow of project implementation and evaluation. An overarching goal of this report is to identify ways to improve the project for future phases.


6

Figure 1. Flow Chart of Project Implementation and Evaluation

Project Effectiveness

Project Reach

Project Implementation

Maintenance

CBOs selected by CMAHEC/MDPH

MOUs executed between Mathematica and CBOs

CHWs trained by CMAHEC

Data forms for CHWs sent to Mathematica and entered

(demographic, pretest, posttest, evaluation forms)

Qualitative information on prostate health unit collected and analyzed from selected CBOs CMAHEC staff person interviewed CHWs interviewed

Data analyzed on knowledge gained and evaluation of all educational sessions (pretest, posttest, and

evaluation forms)

Focus groups with prostate health workshop participants conducted and data analyzed to assess

behavior change and maintenance of knowledge

Community members recruited and educated by CBOs

Data forms for those educated sent to Mathematica and entered (demographic, pretest, posttest, evaluation forms)

Data analyzed on population served (demographic form)


7

II. METHODS

To evaluate the effectiveness of the Helping You Take Care of Yourself curriculum and identify areas for program improvement, Mathematica collected and analyzed quantitative data from all participating CBOs and qualitative data from a subset of CBOs that held prostate health workshops. The quantitative component of the evaluation involved the analysis of (1) data forms completed by CBO CHWs during the workshops they attended with CMAHEC, and (2) data forms completed by workshop participants. The qualitative component of the evaluation involved the analysis of information gathered through interviews with CBO CHWs, focus groups with men educated by CBOs, and an interview with CMAHEC. Table 4 provides an overview of the data collection methods used in both the quantitative and qualitative components of the evaluation. In the Quantitative Methods section below, we describe the data collection and data analysis methods in greater detail. Table 4. Data Collection Methods

Data Collection Method Description of Respondents Timing of Data Collection

Quantitative Evaluation

Forms completed by CBO CHWs Demographic form Pretest Posttest

76 CHWs trained to educate members of their community in at least one of the following educational units:

Breast health Cervical health Cardiovascular health Colorectal health Prostate health

June 2009-January 2010

Forms completed by workshop participants

Demographic form Pretest Posttest Evaluation form

2,806 workshop participants educated in at least one of the following educational units:

Breast health Cervical health Cardiovascular health Colorectal health Prostate health

August 2009-May 2010

Qualitative Evaluation

Interviews with CBO CHWs 11 CHWs from 10 CBOs who educated men in the prostate health unit

August 2010-September 2010

Focus groups with men educated by CBOs in the prostate health unit

25 men from four CBOs September 2010-October 2010

Interview with CMAHEC 1 person November 2010


8

A. Quantitative Methods

1. Data Collection

Twenty-five CBOs held 376 workshops with members of their community covering one or two units of education per workshop. CBOs submitted data for 2,806 unique workshop participants, who received 4,617 education units. Table 5 illustrates the number of education units given by health topic.

Table 5. Number of Education Units Given by Health Topic

Health topic Number of CBOs Conducting

Workshops (N = 25) Number of Education Units

(N = 4,617)

Breast health 16 851 Cervical health 15 654 Cardiovascular health 16 1,382 Colorectal health 13 821 Prostate health 21 909

Source: Analysis of data collected from workshop participants.

As noted above, CBOs were contracted to submit a demographic, pretest, posttest, and evaluation form for each workshop participant. Demographic forms were printed with unique identification numbers and CHWs or participants wrote the corresponding identification number on pre- and posttest forms. Evaluation forms were anonymous. After collating a set of forms for a participant, CBOs submitted completed forms to Mathematica. When a set of forms was not complete (that is, was missing a demographic, pretest, posttest, or evaluation form), Mathematica contacted CHWs and supervisors at CBOs to attempt to obtain the missing form(s).

2. Data Entry, Cleaning, and Coding

CBOs mailed data collection forms to Mathematica in batches that included a cover sheet for each workshop. Mathematica staff entered the data into an Access database that had been developed by MDPH at the beginning of the project and had been modified by Mathematica when educational units were added or forms were updated. After data entry was complete, Mathematica staff conducted a 10 percent validation check to ensure that data had been entered accurately.

When the data were determined to be complete and validated, Mathematica converted the

Access data into SAS data sets. Demographic, pretest, and posttest data, and information on workshop date, location, and CHW were merged for all participants, creating one record for each date that a participant was educated using the curriculum. Evaluation forms remained separate from the other forms. Each record was assigned a unique identifier composed of a combination of the identification number printed on the demographic form and the session identification number that was assigned to the workshop.


9

To prepare the data for further analysis, Mathematica staff identified participants with multiple records in the data set to flag individuals who had attended a workshop in the same unit multiple times.2 In these cases, we retained the data from the first training and eliminated data from subsequent trainings. After the completion of this process, each workshop participant had one set of data for each educational unit in which he or she attended a workshop. An individual may have had multiple records with different unique identifiers if he or she had attended multiple workshops covering different units on multiple dates, but these cases were flagged so that the demographic data would only be counted once in analysis.

Next, the data set was cleaned using methods developed in earlier phases of this project (see

Besculides et al. 2010 and Trebino et al. 2008 for details). However, because of changes to the structure of the project and data collection forms, we made the following modifications for this phase of analysis:

Coding of gender. The inclusion of men in the project necessitated that the data be

cleaned by gender. If breast or cervical health unit data forms were completed by men or prostate health unit data forms were completed by women, they were eliminated. In cases where the gender field had not been filled, Mathematica assessed the following fields to attempt to code the participant’s gender:

- First name associated with a record

- Presence of responses to gender-specific questions on the demographics form, such as questions relating to mammograms, Pap smears, digital rectal exams (DREs), or prostate-specific antigen (PSA) tests

- Presence of education data for the breast, cervical, and prostate health units

Using a combination of these fields, a gender determination was made for the vast majority of participants who did not self-report their gender. However, there were ultimately nine records where gender could not be recoded.

Coding of race and ethnicity. Participants who self-identified as non-Hispanic but then wrote “Hispanic” in the race field were recoded as being Hispanic. Their race was then coded as other.

3. Data Analysis

The data analysis process included the following three steps: (1) analyzing the demographic forms to describe the population served by the program, (2) assessing changes in knowledge before and after the educational workshops, and (3) examining satisfaction with the education (see Trebino et al. [2008] for further details on the analytic methods).

2 Name, date of birth, and city of residence were the main fields used to determine if two records belonged to the

same individual. If date of birth was missing in one of the two records that had other matching identifying information, the records were not considered to be the same person (there were 18 instances of this). In addition, 245 records that lacked a first and/or last name could not be included in the de-duplication process. As a result, the number of unique people educated may be a slight overestimate.


10

To assess the population served by the program, we ran frequencies on responses to questions related to breast, cervical, cardiovascular, colorectal, and prostate screening tests. Then, we ran cross-tabs of the health behavior questions with select demographic variables (gender when applicable, age, race/ethnicity, health insurance status, and education) to determine whether behaviors varied by demographic group. Chi-squared tests were used to assess the significance of differences within each demographic group. In addition, to serve as a benchmark comparison, we ran frequencies on the receipt of mammograms, Pap smears, blood cholesterol tests, blood stool tests, DREs, and PSA tests using data from the Behavioral Risk Factor Surveillance System (BRFSS). We calculated 95 percent confidence intervals to determine whether workshop participants received these tests in proportions significantly different from the nationwide and overall Massachusetts population.

To assess knowledge of breast, cervical, cardiovascular, colorectal, and prostate health before and after the educational workshops, responses on the pre- and posttests were examined. The pre- and posttests contained five questions each. Each test was scored on a five-point scale for which a score of 0 indicates that the participant responded incorrectly to all test questions and a score of 5 indicates that the participant responded correctly to all test questions. To determine whether knowledge changed as a result of attending the educational workshop, we calculated mean pre- and posttest scores for all participants. Additionally, we calculated the percentage of participants who increased their scores between the pre- and posttests. Paired t-tests were used to assess the significance of the change among those who completed both the pre- and posttests.

B. Qualitative Methods

1. Data Collection

To assess the implementation and effectiveness of the newly developed prostate health unit of the Helping You Take Care of Yourself curriculum, Mathematica conducted a qualitative evaluation of this unit. The qualitative evaluation included interviews with 11 CHWs who educated men using the prostate curriculum, four focus groups composed of men who had attended the prostate workshops, and an interview with CMAHEC (see Table 6 for a list of CBOs that participated in this component of the evaluation). The qualitative evaluation was designed to collect data about the following topic areas:

Background information about the CHWs leading the workshops

Quality of the training and support provided by CMAHEC

Quality of the curriculum and materials used to train the CBO CHWs and educate workshop participants

Ease of data collection and submission

Outcomes of the workshop, including maintenance of knowledge, discussions with health care providers, and receipt of prostate screening


11

Table 6. Description of Community-Based Organizations That Participated in the Qualitative Evaluation

CBO # Educated Across All

Unitsa

Prostate Unit People Interviewed As Part of Qualitative Evaluation

CBO Held Focus Group

# Educated

# in Target Population

% in Target Populationb

Akwaaba Health Initiative 159 84 83 98.8 1 CHW Apostolic Holiness House of Prayer 11 11 11 100.0 1 CHW Brockton Neighborhood Health Center 302 89 56 62.9 1 CHW √Cambridge Health Alliance 523 116 31 26.7 1 CHW Greater Springfield Pro-Am Basketball League 34 34 34 100.0 1 CHW √Health Imperatives 35 35 32 91.4 1 CHW Lee B. Revels Scholarship and Mentoring Foundation 40 40 39 97.5 1 CHW √Massachusetts Community Health Services 58 58 56 96.6 1 CHW √St. John’s Congregational Church 13 13 13 100.0 1 CHW

Whittier Street Health Center 117 65 50 76.9 2 CHWs

Source: Analysis of data collected from workshop participants. aSome CBOs participated in only the prostate unit of this project; other CBOs educated people in multiple units. bMen were classified as being part of the target population for the prostate unit if they self-identified as black, African American, African, Cape Verdean, Haitian Creole, or some type of multiracial or multiethnic group that includes one of the previously named groups.

To collect information about these topics, Mathematica developed semi-structured protocols for the different groups of respondents: CBO CHWs, focus group participants, and CMAHEC. The protocols can be found in Appendix B. Twelve CBOs were selected to participate in the qualitative evaluation based on the target population they reached. Specifically, we sought to recruit CBOs that educated men who self-identified as black, African American, African, Cape Verdean, Haitian Creole, or a type of multiracial or multiethnic group that includes one of the previously named groups. We primarily selected CBOs that educated more than 30 men, in hopes that they would be able to recruit enough men for a focus group. We also selected a few CBOs in Springfield, Massachusetts, whose CHWs had close ties with black men in the community and in most cases were part of the community themselves.


12

Interviews with CHWs at CBOs

For each CBO, Mathematica used the quantitative data to identify the CHW who had conducted the majority of workshops composed of men in the target population. At one CBO, two CHWs educated an approximately equal number of men in the target population; we interviewed both CHWs at this CBO. CMAHEC provided entrée to CBOs by sending an email explaining the purpose and importance of the evaluation and asking for their participation. Mathematica followed up by email and later by phone if necessary to schedule the interviews. CHWs from all CBOs that we reached agreed to a telephone interview; however, we were unable to reach one CHW despite multiple contact attempts. Ultimately, 11 CHWs from 10 CBOs were interviewed. Interviews lasted approximately one hour.

The interviewers asked CBO CHWs about their backgrounds and how they got involved in the

project, the training led by CMAHEC, the curriculum, the experiences they had recruiting and educating men, and the data collection and submission process. The male CHWs from the Springfield CBOs were also asked about their experiences with and barriers to having a discussion with a health care provider about prostate screening. This information helped us better understand and refine the topics for discussion in focus groups. At the end of interviews with CHWs, we asked CHWs from eight CBOs whether they were willing and able to organize a focus group of men who had attended prostate workshops run by their CBO.3 All of these CHWs indicated that they were willing to consider organizing a focus group.

Focus Groups

After completing the interviews with CHWs, Mathematica staff followed up with the eight CBOs to try to schedule focus groups with men who had attended the prostate workshops. Although all eight CBOs indicated that they were willing to consider organizing a focus group, only four CBOs actually did so. Obstacles to organizing focus groups included scheduling them and recruiting men who had many competing demands. CBOs were asked to recruit 10 to 12 men for the focus groups and to choose a location that would be convenient for the men. In order to facilitate recruitment, Mathematica offered all CBOs a list of men they had educated who belonged to MDPH’s target demographic group for the prostate health unit. Three CBOs used this list to recruit focus group participants; the fourth CBO had tracked workshop participants and recruited men without the assistance of Mathematica. After each focus group, we sent the CHW or CBO (depending on the preference of the organization) an honorarium payment of $250 for their efforts in recruiting participants and organizing the logistics for the focus group.

Focus groups were held at times that were convenient for the participants. All focus groups

lasted about an hour and a half. Mathematica provided focus group participants with a $25 gift card to Walmart and a snack or meal. Across the four CBOs, 25 men participated in the focus groups, which ranged in size from three to nine men, with an average of six participants.

3 CBOs were recruited for focus groups based on the number of men they had educated in MDPH’s target

population for the prostate health unit.


13

A male Mathematica staff member who identifies culturally with the participants facilitated all of the focus groups in English. The facilitator used a semi-structured protocol to guide the discussion. The protocol covered topics such as recruitment for the workshop, quality of the workshop, experiences with and barriers to having a discussion with a health care provider about prostate screening, and comfort with the data collection forms. In addition, men who attended the focus groups were asked to complete a quantitative data collection form, composed of two sections. The first section included the questions asked on the pre- and posttests during the workshops to assess maintenance of knowledge from the workshops. The second section asked participants about their behavior related to prostate health screening, including receipt of care both before and after attending the prostate health workshops. Using name and workshop location, we were able to link data from 19 of the focus group participants with pre- and posttest data from prostate health workshop participants. We believe that men who could not be linked did not put their names on the original demographic forms.

Interview with CMAHEC

After the culmination of interviews with CHWs and workshop participants, Mathematica staff interviewed the CMAHEC staff person responsible for training CBOs and providing them with technical assistance. This interview lasted approximately one hour. The interview was conducted by phone using a semi-structured protocol and covered topics such as recruitment of CBOs, training CBO educators, contact with CBOs including technical assistance provided by CMAHEC, and feedback on project curriculum and materials from CHWs. In addition to participating in the telephone interview, CMAHEC provided Mathematica with informal feedback on the implementation of the project throughout its course. 2. Data Analysis

After completing the interviews with CHWs and focus groups with workshop participants, Mathematica staff members who participated in the qualitative data collection efforts reviewed notes from the interviews and focus groups. They organized responses into a data abstraction tool that mapped related questions across the three protocols into thematic areas. Then all participating staff members met to discuss key themes identified during all modes of qualitative data collection. This information was synthesized into a comprehensive set of notes that facilitated further analysis and integration with quantitative data.

The quantitative data collected during the focus groups were entered into an Excel file and

converted to a SAS data set. Then, using name and training location, this data set was merged with the education data collected at the workshops. Mean scores for the pretest, posttest, and focus group posttest were calculated and compared. In addition, mean changes of score between the focus group and pre- and posttests were calculated. Last, we analyzed responses to questions assessing preventative prostate health behaviors before and after workshop attendance.


15

III. RESULTS

The combination of quantitative data collected from workshop participants and qualitative information from interviews and focus groups facilitated a well-rounded evaluation of the project. Below, we present the main evaluation findings and limitations in the following areas: project implementation, project reach, project effectiveness, maintenance (longer-term effect of the program), and limitations of the analysis. A. Project Implementation

Based on the qualitative data, project implementation was fairly smooth. Together, MDPH and CMAHEC were able to successfully recruit CBOs. In addition, through training and technical assistance, CMAHEC built strong relationships with CBO supervisors and CHWs. The following sections describe key findings related to the recruitment of CBOs, the process of training CBO educators, and the relationship between CMAHEC and CBOs.

1. Recruitment of CBOs

As part of an effort to professionalize this phase of the project, CBOs were recruited through a Solicitation for Applications. In April 2009, the solicitation was distributed to CBOs that were part of MDPH’s professional network across the state (see Appendix C for the text of the solicitation). A committee composed of MPDH staff, CMAHEC staff, and community stakeholders reviewed the proposals and selected CBOs for funding. CBO applications were assessed for fit with project goals and demonstrated capacity to conduct health education. The majority of CBOs that applied to participate in the project were funded. After the initial set of CBOs was awarded funding, there was still money available to educate more men in the prostate unit. A second solicitation was therefore issued to recruit additional CBOs to participate in only the prostate health unit; three CBOs were funded through this solicitation. Despite this addition of CBOs, the desired prostate health capacity was not attained and five additional CBOs were funded to ensure that there was equitable distribution of prostate health funds across the state.

2. Training CBO Educators

After CBOs were notified that they had received funding through this project, their CHWs were required to attend training sessions led by CMAHEC. All CHWs had to attend an orientation session, which reviewed the scope of the project, provided guidance on facilitating workshops, and instructed CHWs on the requirements for data submission. In addition, CHWs attended separate health-unit-specific trainings. The breast and cervical health units were taught together, as were the cardiovascular and colorectal health units. The prostate health unit was taught alone. CBOs were not permitted to begin offering workshops until educators had been trained. According to CMAHEC sign-in sheets, 90 CBO staff members were trained to conduct workshops in at least one of the health topics. Mathematica received demographic, pre- and posttest data for 76 (84 percent) of these CHWs. As shown in Table 7, among these CHWs, almost 70 percent were trained in the prostate health unit, more than half were trained in the cardiovascular (57 percent), colorectal (53 percent), or cervical (52 percent) health units, and just under half (49 percent) were trained in the breast health unit. The vast majority (80 percent) of CHWs were trained in more than one unit.


16

Table 7. Characteristics of CHWs

N = 76 %

Units of Education

Units of Traininga Breast health 37 48.7Cervical health 39 51.3Cardiovascular health 43 56.6Colorectal health 40 52.6Prostate health 53 69.7

Number of Units of Training

1 15 19.72 19 25.03 23 30.34 5 6.65 14 18.4

Demographic Characteristics

Gender Male 24 31.6Female 52 68.4Unknown 0 0.0

Age

Under 40 31 40.840-64 42 55.365 and over 2 2.6Unknown 1 1.3

Race/Ethnicityb

White 7 9.2Black 28 36.8Asian 5 6.6Hispanic 29 38.2Other 6 7.9Unknown 1 1.3

Language of Demographic Form

English 76 100.0Spanish 0 0.0Portuguese 0 0.0

Country of Birth

Born in United States 24 31.6Born in U.S. territories 9 11.8Born in other country 40 52.6

Less than 1 year in United States 0 0.0 1-5 years in United States 4 10.0 More than 5 years in United States 29 72.5 Unknown length of time in United States 7 17.5

Unknown 3 4.0 Health Insurance

Yes 75 98.7Through an employer 56 74.7 Through purchase 1 1.3 Medicare 1 1.3 Medicaid, MassHealth, and so on 13 17.3 Free Care or Safety Net 0 0.0 Other 4 5.3

Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Table 7 (continued)

17

N = 76 % No 0 0.0Unknown 1 1.3

Education Less than high school 0 0.0High school or equivalent 7 9.2Training program 6 7.9College 61 80.3Other 1 1.3Unknown 1 1.3

Source: Analysis of data collected from CHWs. aCHWs could be trained in more than one unit.

bRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.

Demographic Characteristics of CHWs

All trainings led by CMAHEC were given in English. As shown in Table 7, the majority of CHWs were female (68 percent) and between ages 40 and 64 (55 percent). The most common racial and ethnic groups among CHWs were Hispanic and black (38 percent and 37 percent, respectively). More than half of the CHWs were born outside of the United States (53 percent), with almost three-quarters of this group (73 percent) having lived in the United States for more than five years. CHWs were highly educated; approximately 80 percent had attended at least some college, and all of the CHWs responding reported that they had attained at least a high school education. All but one CHW reporting having health insurance (99 percent); the remaining CHW did not respond to the insurance question (1 percent). Of those with health insurance, three-quarters received it from their employer. CHWs’ Knowledge of Health Units

Table 8 presents CHWs’ knowledge of breast, cervical, cardiovascular, colorectal, and prostate health before and after completing the training session with CMAHEC. Baseline knowledge was high; for all units, the average pretest score was above 4.20 on a five-point scale. Changes in knowledge based on the results of paired t-tests among CHWs completing both the pre- and posttest for each unit are as follows:

Breast health. Baseline knowledge of breast health was higher than any other unit; the

CHWs’ average score was 4.8 on a five-point scale. After the training, the average score among CHWs was 5.0 (rounded), which was not a statistically significant improvement (p < 0.05). Seventeen percent of CHWs increased their score from pretest to posttest.

Cervical health. There was a significant increase in cervical health scores between the pretest and posttest (p < 0.05). Before training, CBO educators attending the cervical health unit training scored an average of 4.3 on a five-point scale, which was the lowest baseline score of any unit. After being trained, their average score increased to 5.0 (rounded). Half of CHWs improved their scores in this unit.


18

Cardiovascular health. Among CHWs, pretest scores for the cardiovascular health unit were second highest (after the breast health unit). Before training, CBO educators averaged a score of 4.7 on a five-point scale. Their average score increased to 4.9 after completing training, which was a statistically significant improvement (p < 0.05). More than one-quarter of CHWs improved their score in this unit after receiving training.

Colorectal health. CHWs attending colorectal health training scored an average of 4.5 on a five-point scale on the pretest. After the training, their score improved to an average of 4.9, which was a significant increase (p < 0.05). In this unit, 43 percent of CHWs improved their score between pre- and posttest.

Prostate health. At pretest, CHWs scored an average of 4.3 out of a five-point scale for the prostate health unit. After training, their average score increased to 4.6. Although this increase was significant (p < 0.05), it was the lowest posttest score of any unit. Twenty-nine percent of CHWs increased their prostate health score between pre- and posttest.

Table 9 displays the percentage of CHWs correctly answering each of the pre- and posttest questions. For most questions, the percentage of CHWs responding correctly increased between pre- and posttest; however, for a few questions the percentage either remained the same or decreased slightly (between 2 and 3 percent in all cases). At posttest, 23 out of the 25 total questions across all units were answered correctly by over 90 percent of CHWs. The two questions that were answered incorrectly most frequently were both part of the prostate health unit. Over 20 percent of CHWs provided an incorrect answer to the question, “Starting at the age of 65, men should start talking to their doctor about testing for prostate cancer,” (false). In addition, approximately 14 percent of CHWs responded incorrectly to the question, “Difficulty or pain during urination are signs of prostate problems” (true). In the future, the prostate training for CBO educators may want to focus more on these topics to ensure that they are conveyed clearly to workshop participants.

19


Tab

le 8

. Bre

ast

, Cerv

ical,

Card

iovasc

ula

r, C

olo

rect

al,

and

Pro

state

Know

led

ge o

n t

he P

rete

sts

and

Post

test

s, b

y D

em

og

rap

hic

Chara

cteri

stic

s of

CH

Ws

Br

east

Can

cer

Cerv

ical

Can

cer

Card

iova

scul

ar H

ealth

Pret

est

Post

test

%

with

In

crea

sed

Scor

e

Pret

est

Post

test

%

with

In

crea

sed

Scor

e

Pret

est

Post

test

%

with

In

crea

sed

Scor

e

N

Aver

age

Scor

e N

Av

erag

e Sc

ore

N

Aver

age

Scor

e N

Av

erag

e Sc

ore

N

Aver

age

Scor

e N

Av

erag

e Sc

ore

Tota

l C

om

ple

ting B

oth

Pre

- a

nd

Post

test

s 36

4.

81

36

4.97

16

.7

38

4.29

38

4.

97**

50

.0

43

4.67

43

4.

91**

27

.9

Tota

l C

om

ple

ting E

ith

er

Test

36

4.

81

37

4.89

n.

a.

39

4.23

38

4.

97

n.a.

43

4.

67

43

4.91

n.

a.

Gend

er

M

ale

3 5.

00

3 5.

00

0.0

4 3.

75

4 5.

00

75.0

10

4.

60

10

5.00

40

.0

Fem

ale

33

4.79

34

4.

88

18.2

35

4.

29

34

4.97

47

.1

33

4.70

33

4.

88

24.2

Un

know

n 0

n.a.

0

n.a.

n.

a.

0 n.

a.

0 n.

a.

n.a

0 n.

a.

0 n.

a.

n.a.

A

ge

Un

der

40

17

4.82

17

5.

00

17.7

17

4.

18

17

4.94

70

.6

21

4.57

21

4.

86

33.3

40

-64

18

4.78

19

4.

79

16.7

21

4.

24

20

5.00

35

.0

20

4.75

20

4.

95

25.0

65

and

ove

r 1

5.00

1

5.00

0.

0 1

5.00

1

5.00

0.

0 2

5.00

2

5.00

0.

00

Unkn

own

0 n.

a.

0 n.

a.

n.a.

0

n.a.

0

n.a.

n.

a 0

n.a.

0

n.a.

n.

a.

Race

/ Eth

nic

ity

a

W

hite

3

4.33

3

5.00

66

.7

3 4.

33

3 5.

00

66.7

5

5.00

5

5.00

0.

00

Blac

k 11

5.

00

11

5.00

0.

0 10

4.

40

10

4.90

40

.0

10

4.40

10

4.

80

50.0

As

ian

3 4.

67

3 4.

67

33.3

3

3.33

3

5.00

10

0.0

3 4.

67

3 5.

00

33.3

H

ispa

nic

14

4.71

15

4.

80

21.4

17

4.

24

16

5.00

50

.0

23

4.74

23

4.

91

21.7

O

ther

5

5.00

5

5.00

0.

0 6

4.33

6

5.00

33

.3

2 4.

50

2 5.

00

50.0

Un

know

n 0

n.a.

0

n.a.

n.

a.

0 n.

a.

0 n.

a.

n.a

0 n.

a.

0 n.

a.

n.a.

Ed

uca

tion

Le

ss th

an h

igh

scho

ol

0 n.

a.

0 n.

a.

n.a.

0

n.a.

0

n.a.

n.

a.

0 n.

a.

0 n.

a.

n.a.

H

igh

scho

ol/e

quiv

alen

t 4

4.75

4

5.00

25

.0

3 4.

00

3 5.

00

66.7

5

4.60

5

4.80

40

.0

Trai

ning

pro

gram

4

4.50

4

5.00

50

.0

4 4.

00

4 5.

00

50.0

4

4.75

4

4.75

25

.0

Colle

ge

28

4.86

29

4.

86

10.7

32

4.

28

31

4.97

48

.4

34

4.68

34

4.

94

26.5

O

ther

0

n.a.

0

n.a.

n.

a 0

n.a.

0

n.a.

n.

a 0

n.a.

0

n.a.

n.

a Un

know

n 0

n.a.

0

n.a.

n.

a 0

n.a.

0

n.a.

n.

a 0

n.a.

0

n.a.

n.

a

Tab

le 8

(con

tin

ued

)

20


Co

lore

ctal

Can

cer

Pros

tate

Can

cer

Pr

etes

t Po

stte

st

% w

ith

Incr

ease

d Sc

ore

Pret

est

Post

test

%

with

Incr

ease

d Sc

ore

N

Av

erag

e Sc

ore

N

Aver

age

Scor

e N

Av

erag

e Sc

ore

N

Aver

age

Scor

e T

ota

l C

om

ple

ting

Both

Pre

-

and

Post

test

s 40

4.

45

40

4.90

**

42.5

51

4.

31

51

4.57

* 29

.4

T

ota

l C

om

ple

ting E

ith

er

Test

40

4.

45

40

4.90

n.

a.

52

4.27

52

4.

58

n.a.

Gend

er

Mal

e 9

4.56

9

4.78

33

.3

21

4.33

21

4.

62

35.0

Fe

mal

e 31

4.

42

31

4.94

45

.2

31

4.23

31

4.

55

25.8

Un

know

n 0

n.a.

0

n.a.

n.

a 0

n.a.

0

n.a.

n.

a

Ag

e

Unde

r 40

19

4.

32

19

5.00

63

.2

21

4.14

20

4.

50

35.0

40

-64

19

4.53

19

4.

79

26.3

30

4.

37

30

4.63

26

.7

65 a

nd o

ver

2 5.

00

2 5.

00

0.0

1 4.

00

1 4.

00

0.0

Unkn

own

0 n.

a.

0 n.

a.

n.a

0 n.

a.

1 5.

00

0.0

R

ace

/Eth

nic

ity

a

Whi

te

5 4.

80

5 5.

00

20.0

4

4.50

4

4.50

25

.0

Blac

k 6

4.33

6

4.67

50

.0

19

4.21

18

4.

72

38.9

As

ian

3 4.

33

3 5.

00

66.7

3

3.67

3

4.33

66

.7

His

pani

c 23

4.

43

23

4.96

43

.5

22

4.41

22

4.

59

18.2

O

ther

3

4.33

3

4.67

33

.3

4 4.

00

4 4.

00

25.0

Un

know

n 0

n.a.

0

n.a.

n.

a 0

n.a.

1

5.00

0.

0

Ed

uca

tion

Less

than

hig

h sc

hool

0

n.a.

0

n.a.

n.

a 0

n.a.

0

n.a.

n.

a H

igh

scho

ol o

r eq

uiva

lent

4

4.25

4

4.75

50

.0

4 4.

00

4 4.

50

50.0

Tr

aini

ng p

rogr

am

4 4.

50

4 5.

00

50.0

5

4.40

5

4.40

0.

0 Co

llege

32

4.

47

32

4.91

40

.6

42

4.31

41

4.

61

29.3

O

ther

0

n.a.

0

n.a.

n.

a 1

3.00

1

4.00

10

0.0

Unkn

own

0 n.

a.

0 n.

a.

n.a

0 n.

a.

1 5.

00

0.0

So

urce

: An

alys

is o

f dat

a co

llect

ed fr

om C

HW

s.

Not

e: T

he fi

rst r

ow o

f the

tabl

e sh

ows

stat

istic

s fo

r CH

Ws

who

com

plet

ed b

oth

the

pret

est a

nd th

e po

stte

st o

f a u

nit.

A pa

ired

t-te

st w

as c

ondu

cted

for

thes

e CH

Ws

in e

ach

unit

of t

he c

urric

ulum

to

dete

rmin

e w

heth

er t

he in

crea

se in

ave

rage

sco

res

was

sta

tistic

ally

sig

nific

ant.

Beca

use

the

sam

ple

size

s w

ere

smal

l, pa

ired

t-te

sts

wer

e no

t co

nduc

ted

for

indi

vidu

al d

emog

raph

ic g

roup

s.

a Rac

e an

d H

ispa

nic

ethn

icity

wer

e co

mbi

ned

for

this

ana

lysi

s be

caus

e 12

per

cent

of

His

pani

c w

orks

hop

part

icip

ants

did

not

ide

ntify

the

ir ra

ce,

and

55 p

erce

nt o

f H

ispa

nic

wor

ksho

p pa

rtic

ipan

ts m

arke

d th

e ot

her

race

cat

egor

y on

the

ir de

mog

raph

ic f

orm

. O

f th

e pa

rtic

ipan

ts t

hat

mar

ked

othe

r ra

ce,

man

y w

rote

“H

ispa

nic”

into

the

fre

e re

spon

se

field

.

*Po

stte

st s

core

is s

igni

fican

tly d

iffer

ent f

rom

pre

test

sco

re a

t the

.05

leve

l, tw

o-ta

iled

test

.

**Po

stte

st s

core

is s

igni

fican

tly d

iffer

ent f

rom

pre

test

sco

re a

t the

.01

leve

l, tw

o-ta

iled

test

.

n.a.

= n

ot a

pplic

able

.


21

Table 9. Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health Knowledge, by Pretest and Posttest Questions Among CHWs

Pretest Posttest

% Change

N = # Answering Correctly

% Answering Correctly



Question (Correct Response)

Breast Health Unit (N = 36)

1. If you have a lump in your breast, you absolutely have breast cancer (false) 36 100.0 36 100.0 0.0

2. Starting at the age of 40, you should get a mammogram once a year (true) 35 97.2 35 97.2 0.0

3. Mammograms cause breast cancer (false) 36 100.0 36 100.0 0.0

4. As women get older, their risk of breast cancer increases (true) 34 94.4 36 100.0 5.9

5. You should have a clinical breast exam done by a health care provider every 5 years (false) 32 88.9 36 100.0 12.5

Cervical Health Unit (N = 38)

1. If you get an abnormal Pap test, it means you have cervical cancer (false) 38 100.0 38 100.0 0.0

2. Women should get their first Pap test at age 21 or three years after they become sexually active (true) 25 65.8 38 100.0 52.0

3. Cervical cancer is preventable through routine screening (true) 36 94.7 38 100.0 5.6

4. Getting a positive HPV test means you have cervical cancer (false) 35 92.1 37 97.4 5.7

5. Most women have been exposed to the Human Papilloma Virus (HPV) (true) 29 76.3 38 100.0 31.0

Cardiovascular Health Unit (N = 43)

1. Men and women have the exact same heart attack warning signs (false) 29 67.4 40 93.0 37.9

2. Quitting smoking can help reduce the risk for cardiovascular disease (true) 43 100.0 43 100.0 0.0

3. LDL (bad) cholesterol can clog your blood vessels and cause damage to your heart and brain (true) 43 100.0 43 100.0 0.0

Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research Table 9 (continued)

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Pretest Posttest

% Change





4. If someone shows one of the symptoms of a stroke, the most important thing to do is call 911 right away (true) 43 100.0 43 100.0 0.0

5. High blood pressure forces your heart to work harder than normal and raises your risk for heart attack and stroke (true) 43 100.0 42 97.7 -2.3

Colorectal Health Unit (N = 40)

1. Eating foods high in fat is a risk factor for colorectal cancer (true) 35 87.5 40 100.0 14.3

2. All people should begin getting screened for colorectal cancer at the age of 30 years (false) 31 77.5 40 100.0 29.0

3. Colorectal cancer can develop without signs over a long period of time without being noticed (true) 39 97.5 39 97.5 0.0

4. Screening is the only way for someone to know if they have colorectal cancer (true) 35 87.5 40 100.0 14.3

5. A polyp found on colonoscopy will always be cancer (false) 38 95.0 37 92.5 -2.6

Prostate Health Unit (N = 51)

1. Men are more likely to get prostate cancer when they are younger (false) 49 96.1 48 94.1 -2.0

2. Starting at the age of 65, men should start talking to their doctor about testing for prostate cancer (false) 35 68.6 40 78.4 14.3

3. Men of African descent are at high risk for getting prostate cancer (true) 48 94.1 51 100.0 6.3

4. Difficulty or pain during urination are signs of prostate problems (true) 44 86.3 44 86.3 0.0

5. PSA test results are typically higher in men with prostate cancer (true) 44 86.3 50 98.0 13.6

Source: Analysis of data collected from CHWs.


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Satisfaction with Training Sessions

CHWs interviewed as part of the qualitative evaluation were generally satisfied with the training given by CMAHEC. Overall, CHWs felt comfortable leading workshops after receiving training. However, they offered a few suggestions for improving the quality of the training sessions. First, CHWs expressed a desire for the training to cover additional depth. CHWs would have liked to be able to answer some of the more difficult questions on their own instead of referring workshop participants to health care providers. Second, a few CHWs suggested that it would have been helpful to have separate training sessions for people with different amounts of prior health education experience. In particular, CHWs who had less experience in health education wished that the training sessions had included more opportunities for conducting dry runs of giving presentations. Third, a few CHWs recommended that, given the long field period, it would have been helpful if CMAHEC had offered a refresher training session in the middle of the project.

3. Relationship with CMAHEC

CHWs were very enthusiastic when asked about their relationship with CMAHEC. Aside from conducting the training sessions for educators, CMAHEC was available throughout the course of the project for technical assistance regarding the curriculum and administrative matters.4 Primarily, CBOs contacted CMAHEC to obtain more data collection forms, to send session sign-in sheets, and to notify them of upcoming workshops. To a lesser extent, CBOs asked CMAHEC staff for advice on recruitment and to report problems with the translation of the forms. Most CBOs were in contact with CMAHEC at some point during the course of the project.

B. Project Reach

During the project, a total of 2,806 unique individuals were educated by CBOs across the six regions of Massachusetts. The project was effective in reaching individuals who had not before been educated using the curriculum. Comparison of the quantitative data from earlier phases of this project indicate that very few individuals educated during this phase of the project had been educated as part of this project previously, suggesting that CBOs that had previously participated in the project had not saturated their communities.5

Although almost 3,000 people were reached by the education, the majority of CBOs were not

able to attain their approved participant capacity for the project. Mathematica was contracted to administer funds to CBOs for conducting 7,423 units of education. At the end of the project, CBOs had given only 4,617 education units, of which 4,416 were eligible for reimbursement,6 meaning that, in total, they achieved only 60 percent of the contracted project capacity. As a whole, CBOs had more success reaching capacity when they were educating women than when educating men. Table 10 shows the number of educational units conducted and eligible for reimbursement, the

4 Mathematica provided CBOs with technical assistance related to data collection and data submission.

5 Specifically, of female workshop participants in this phase, four had been educated in three units during an earlier phase, eight had been educated in two units previously, and nine had been educated in one unit earlier.

6 An educational unit was only eligible for reimbursement when a CBO submitted a complete set of forms.


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number of units CBOs were contracted to complete, and the percentage of capacity met, by health topic and gender.

Table 10. Capacity Reached, by Health Unita

Educational Unit Number of Units

Conducted Number of Units

Contracted Percentage of

Capacity Reached

Total 4,416 7,423 59.5

Breast health (women) 818 1,198 68.3

Cervical health (women) 665 1,188 56.0

Cardiovascular health (women) 818 1,122 72.9

Cardiovascular health (men) 508 969 52.4

Colorectal health (women) 472 797 59.2

Colorectal health (men) 329 588 56.0

Prostate health (men) 806 1,561 51.6 Source: Analysis of data collected from workshop participants. aData that were not eligible for reimbursement are not included in this table.

CHWs suggested a variety of reasons for this shortfall. First, the CBOs did not always have sufficient infrastructure to recruit the approved number of participants. In at least one instance, CBO supervisors set the target number of workshop participants without consulting CHWs about the feasibility of this target. Within CBOs, only a limited number of CBOs were trained to lead workshops, and many CHWs were also participating in other grants. As a result, they had a limited amount of time to devote to recruitment for this project. Second, some CBOs that worked primarily with the Haitian community had their work disrupted when an earthquake struck Haiti in January 2010. These CBOs diverted their attention from this project and focused much of their organizations’ efforts on aiding Haiti. Third, with regard to recruitment for the prostate curriculum, CBOs noted that men, as opposed to women, are particularly difficult to recruit for health education, especially given the sensitive nature of prostate health. One CHW noted that in order to reach his target number of participants for a workshop, he had to recruit twice as many men. Overall, it was most difficult for CBOs to reach people in their communities who were not affiliated with any community groups.

Quantitative and qualitative analysis of data collected during this project suggest that: (1) CHWs

felt that the Helping You Take Care of Yourself curriculum and materials were effective education tools, (2) the curriculum reached a diverse population, and (3) the population educated by CBOs generally received preventative health screenings less often than the greater Massachusetts population (fewer differences were found between participants and the national population). Key findings related to participants’ recruitment, education, demographic characteristics, and preventative health behaviors are described below.

1. Recruiting Workshop Participants

CBOs employed a variety of strategies to recruit workshop participants. Often, CBOs combined recruiting participants from existing contacts and conducting outreach activities in their communities. Common strategies included the following:


25

Group Meetings. Many CBOs incorporated workshops into meetings of existing community groups, such as church groups, clubs, or sports teams.

Individual Contacts. Some CBOs used existing telephone or email lists of community members with whom they had previous contact to recruit workshop participants.

Public Outreach. Some CBOs reported that they conducted outreach through print or radio media, including techniques such as flyers, radio advertisements, and public service announcements. These CBOs mentioned churches, liquor stores, and community soccer games as successful locations for recruitment.

To increase the likelihood of targeted community members’ attending workshops, CBOs often employed several techniques. For workshops that were not offered as part of meetings of existing groups, CBOs noted that reminders often helped increase workshop attendance. For example, CBOs sometimes contacted potential workshop participants by phone or email to remind them of upcoming workshops. One CBO that recruited with flyers had interested community members write their name and phone number at the bottom of the workshop advertisement so that they could remind them about the workshop. Some CBOs also mentioned that incentives were helpful in increasing workshop attendance. Examples of incentives provided by CBOs include food, babysitting, and small gifts, such as t-shirts and key chains. However, many CBOs suggested that a monetary stipend would better increase workshop attendance. CHWs who educated men in the prostate health unit noted that it was often effective to contact the wives of targeted workshop participants as part of recruitment. Wives were often able to convince their husbands that attending a prostate health workshop was worthwhile.

2. Conducting Workshops

CHWs used the Helping You Take Care of Yourself curriculum and materials developed by MDPH to educate health workshop participants. Workshop location, size, and length often varied by CBO.

Workshop Characteristics

CBOs held workshops in a variety of venues, including at their organization’s location, churches, community centers, halfway houses, housing developments, restaurants, and people’s homes. Across all CBOs, the number of participants per workshop ranged from one to 53. CHWs reported that the ideal workshop size was 10 to 20 participants. This size was small enough to answer all participants’ questions, but large enough to facilitate a meaningful conversation.

Prostate health CHWs reported that workshops ranged in length from 15 minutes to two hours.

Length of workshops often varied by the number of participants and whether an ad hoc translation of the presentation and data collection forms was needed. For the prostate health unit, CHWs conducted workshops in English, Portuguese, and Spanish, and performed ad hoc translations of the workshop and corresponding materials into Cape Verdean Creole, Haitian Creole, French, and several African languages.


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Curriculum and Workshop Materials

At the training sessions led by CMAHEC, CHWs received the workshop curriculum and PowerPoint presentations developed by MDPH, which included some graphics. CHWs who conducted workshops in the prostate health unit reported that, overall, the curriculum was written clearly, presented an appropriate amount of information at the right level of difficulty, and addressed an important topic. Many prostate CHWs mentioned that, although they were comfortable leading workshops after the training with CMAHEC, they also conducted additional research about the topic before leading workshops in order to increase their knowledge and prepare for potential questions. Although CHWs and focus groups participants were positive about the prostate curriculum, they did offer some suggestions for improvement. First, some CHWs suggested that the curriculum could better motivate participants if it were tailored to specific racial or ethnic groups. Since there are large racial and ethnic disparities in prostate cancer incidence and mortality (National Cancer Institute 2008), this information could help make participants’ risk for cancer more salient. Second, CHWs thought it would be helpful if the curriculum included more concrete recommendations relating to screening. Focus group participants would have liked the curriculum to include information about obtaining insurance since preventative health screening is often tied to insurance status.

CHWs were generally satisfied with the workshop materials. The CHWs and focus group

participants noted that the diagram of the prostate gland was particularly useful in helping men understand the anatomical facts about prostate cancer and why screening tests like the DRE are needed. Accordingly, they believed that workshop participants would benefit from additional visual aids, such as videos and graphics. The CHWs occasionally modified the workshop materials in ways that they thought would motivate the people in their communities. At least one CHW supplemented the PowerPoint presentation with additional information about the incidence and burden of prostate cancer, risk factors, and racial and ethnic disparities. Another CHW noted that having a prostate cancer survivor speak to the workshop participants was an effective complement to the workshops. CHWs also mentioned that they would have liked to have had access to materials that they could give to participants as they were leaving the workshop to reinforce the key messages.

3. Description of Workshop Participants

Table 11 presents the demographic characteristics of people who were educated using the Helping You Take Care of Yourself curriculum. Appendices D and E provide additional breakdowns of demographic characteristics of workshop participants by region (Appendix D) and health unit (Appendix E). Overall, 2,806 people participated in at least one workshop, of whom 1,251 (45 percent) were male, 1,546 (55 percent) were female, and nine were of unknown gender. Participants attended 4,617 units and almost half (48 percent) attended multiple education units. The workshop participants represented a diverse population with the following characteristics:

Age. The project targeted people ages 40 to 64; however, approximately 18 percent of workshop participants were below age 40 and 11 percent were above age 65. Overall, the age of workshop participants ranged from 16 to 99, of which the mean age was 49.5.

Race, Ethnicity, and Language. With regard to race and ethnicity, Hispanics composed the largest percentage of workshop participants (43 percent), followed by blacks (27 percent), whites (15 percent), other racial/ethnic groups (8 percent), and Asians (5 percent). Two percent of the project population did not report their race or


27

ethnicity. For the prostate health unit, which MDPH targeted to a specific group of men, 53 percent of men educated were black and 66 percent identified as part of the project’s target population (data not shown). More than half of workshop participants (51 percent) completed data collection forms that were printed in English, while 31 percent completed forms in Spanish and 17 percent completed forms in Portuguese. It is important to note that, although forms may have been completed in English, education may have been held in a different language for which there were no forms.7 CHWs typically read the forms aloud as participants completed them and offered one-on-one help as needed.

Country of Birth. Workshop participants also varied by their country of birth. Almost half of workshop participants (47 percent) indicated that they were born outside of the United States mainland and territories, of whom approximately half (49 percent) had been in the United States for more than five years. There was a substantial amount of missing data related to country of birth (12 percent) and length of time in the United States among foreign-born workshop participants (37 percent). CHWs interviewed as part of the qualitative evaluation attributed this gap in data to the fact that many workshop participants were not legal residents of the United States, and these participants were uncomfortable providing information that they perceived to be related to their immigration status.

Health Insurance. The vast majority of workshop participants (86 percent) had some sort of health insurance, including insurance provided by an employer, individual purchase, Medicare, Medicaid, and Safety Net. Of participants with insurance, approximately half received their coverage through Medicaid, indicating that the project reached a high percentage of people of a low socioeconomic status. Nine percent of workshop participants reported that they did not have health insurance, and 5 percent did not indicate their insurance status.

Educational Attainment. There was also considerable variation among workshop participants with regard to educational attainment. More than one-third of workshop participants did not complete high school, while 26 percent of workshop participants were high school graduates, and 29 percent had attended at least some college. The remainder of participants had completed another type of education or did not report their educational attainment.

Region. Workshops were held in all six regions of Massachusetts—Boston, Central, Metrowest, Northeast, Southeast, and West. The number of workshop participants by region ranged from 288 in the Northeast region to 576 in the Central region. Further breakdown of the demographic characteristics of workshop participants by region is displayed in Appendix D.

7 We know from the prostate evaluation, for example, that ad hoc translations were made for many languages but

forms were completed in English.


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Table 11. Characteristics of Workshop Participants

Total

N = 2,806 %

Units Of Education

Units of Education Totala 4,617 100.0 Breast cancer 851 27.0 Cervical cancer 654 20.8 Cardiovascular disease 1,382 43.9 Colorectal cancer 821 26.1 Prostate cancer 909 28.9

Number of Units of Education Receivedb

1 1,456 51.9 2 1,038 37.0 3 171 6.1 4 143 5.1

Demographic Characteristics

Gender Male 1,251 44.6 Female 1,546 55.1 Unknown 9 0.3

Age

Under 40 497 17.7 40-64 1,951 69.5 65 and over 318 11.3 Unknown 40 1.4

Race/Ethnicityc

White 410 14.6 Black 770 27.4 Asian 146 5.2 Hispanic 1,208 43.1 Other 214 7.6 Unknown 58 2.1

Form Language

English 1,439 51.3 Spanish 879 31.3 Portuguese 488 17.4

Country of Birth

Born in United States 774 27.6 Born in U.S. territories 389 13.9 Foreign 1311 46.7

<1 Year in United States 36 2.8 1-5 Years in United States 152 11.6 >5 Years in United States 643 49.1 Unknown length of time spent in United States 480 36.6

Unknown 332 11.8 Health Insurance

Yes 2,424 86.4 Through an employer 646 26.7 Through purchase 104 4.3


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Total

N = 2,806 % Medicare 169 7.0 Medicaid, MassHealth, etc. 1,203 49.6 Free Care or Safety Net 233 9.6 Other 69 2.9

No 246 8.8 Unknown 136 4.8

Education

Less than high school 994 35.4 High school or equivalent 741 26.4 Training program 141 5.0 College 817 29.1 Other 39 1.4 Unknown 74 2.6

Source: Analysis of data collected from workshop participants. a This total refers to the number of educational units received by participants, not the number of unique project

participants. b Because male workshop participants were approved to receive education in only three units (cardiovascular,

colorectal, and prostate health) and female workshop participants were approved to receive education in only four units (breast, cervical, cardiovascular, and colorectal health), it was possible for a workshop participant to receive a maximum of only four units of education. CHWs could be trained in any of the five units regardless of their gender.

c Race and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.

4. Preventative Health Behaviors

Early and regular screening can lead to a decrease in mortality from certain cancers. To assess the rate of screening among workshop participants, all participants were asked about their previous screening behaviors related to breast, cervical, cardiovascular, colorectal, and prostate health. Screening behaviors varied by demographic characteristics. To facilitate comparison of health behaviors between the workshop participants and the overall Massachusetts and national populations, the questions and response categories matched those in CDC’s BRFSS.8 For each disease, we analyzed screening behaviors by two key measures: (1) percentage of workshop participants who received screening within the past year and (2) percentage of workshop participants who were never screened. The time frame of one year was chosen to help determine the proportion of workshop participants who receive preventative care annually. In addition, since screening recommendations vary by age, health history, and other risk factors for many of the health topics covered by this project, it is impossible to analyze workshop participants’ data in complete accordance with MHQP guidelines, so instead we chose to assess the percentage of each population that was never screened.

8 As noted above, on the demographics form multilevel questions were condensed into a single question based on

feedback from earlier rounds of this project. In this analysis, data from workshop participants were manipulated to match the format of the BRFSS data.


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Breast Health

Table 12 displays the receipt of mammograms among female workshop participants, by demographic characteristic. The chi-squared tests indicate that there were significant differences among participants in the receipt of mammograms by age group, racial and ethnic categories, and health insurance status, but not by educational attainment. Findings include the following:

Age. Women ages 40 to 64 were significantly more likely than those over age 64 to

have received a mammogram in the past year (62 percent versus 48 percent).

Race and Ethnicity. In comparison to the other racial/ethnic categories, it appears that Hispanics were most likely to have received a mammogram in the past year (70 percent) and least likely to have never received a mammogram (5 percent).

Insurance Status. Workshop participants without health insurance appeared to be almost half as likely to have received a mammogram in the past year (34 percent versus 62 percent) and approximately five times as likely to have never received a mammogram (25 percent versus 5 percent) as participants with health insurance.

Figure 2 shows breast health screening behavior among workshop participants and comparable women in Massachusetts and nationally who participated in BRFSS.


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Table 12. Receipt of Mammograms Among Female Workshop Participants Over Age 40, by Demographic Characteristics

Most Recent Mammogram (%)

N

<1 Year Ago

1-2 Years Ago

2-3 Years Ago

3-5 Years Ago

≥5 Years Ago Never Unknown

Total 1,252 59.5 17.2 6.4 2.5 3.3 5.8 5.4 Age**

40-64 1,046 61.9 16.7 6.4 2.4 2.2 6.4 4.065 and over 206 47.6 19.4 6.3 2.9 8.7 2.9 12.1

Race/Ethnicitya**

White 231 49.8 20.8 9.5 5.6 8.2 4.8 1.3Black 185 51.4 14.6 8.6 1.1 4.3 9.2 10.8Asian 92 58.7 22.8 5.4 0.0 2.2 9.8 1.1Hispanic 632 69.6 13.3 4.9 2.1 1.3 4.7 4.1Other 99 36.4 33.3 6.1 3.0 4.0 6.1 11.1Unknown 13 38.5 15.4 0.0 0.0 0.0 0.0 46.2

Health Insurance**

Yes 1,163 61.5 17.5 6.3 2.3 3.4 5.3 3.7No 47 34.0 17.0 12.8 8.5 0.0 25.5 2.1Unknown 42 33.3 7.1 2.4 0.0 2.4 0.0 54.8

Education

Less than high school 539 54.7 18.9 8.7 1.9 3.5 6.3 5.9

High school or equivalent 300 62.7 16.7 6.3 3.0 3.0 4.7 3.7

Training program 49 63.3 16.3 6.1 2.0 2.0 6.1 4.1

College 326 65.3 16.3 3.1 2.8 3.4 6.4 2.8Other 19 52.6 10.5 5.3 10.5 5.3 5.3 10.5Unknown 19 42.1 0.0 0.0 0.0 0.0 0.0 57.9

Source: Analysis of data collected from workshop participants. a Race and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants

did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.

*Differences in the receipt of mammograms across categories are statistically significant at the .05 level.

**Differences in the receipt of mammograms across categories are statistically significant at the .01 level.

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33

Cervical Health

Table 13 presents information related to the receipt of Pap smears among female workshop participants. There were significant differences among participants in the receipt of Pap smears by age group, race and ethnicity, and insurance status, but not by educational attainment. Findings include the following:

Age. Data collected by CBOs suggest that women ages 65 and older were almost half as

likely as women under 65 to have received a Pap smear within the past year (31 percent versus 58 percent). Women under age 40 were most likely to have never received a Pap smear (12 percent).

Race and Ethnicity. Hispanic women were most likely to have received a Pap smear in the past year (64 percent) and Asian women were most likely to report never having a Pap smear (13 percent).

Insurance Status. Women without health insurance were less likely to have received Pap smears in the past year (37 percent versus 56 percent) and more likely to have never received a Pap smear (18 percent versus 4 percent) than were those with insurance.

Figure 3 shows cervical health screening behavior among workshop participants and comparable women in Massachusetts and nationally who participated in BRFSS.


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.

Table 13. Receipt of Pap Smears Among Female Workshop Participants, by Demographic Characteristics

Most Recent Pap Smear (%)

N

<1 Year Ago

1-2 Years Ago

2-3 Years Ago

3-5 Years Ago


Total 1,546 53.6 19.1 6.4 3.6 5.8 4.8 6.7 Age**

Under 40 278 62.6 13.7 3.6 1.8 1.1 12.2 5.040-64 1,046 56.3 20.7 7.6 3.5 4.9 2.6 4.465 and over 206 30.6 18.9 4.9 6.8 17.0 6.3 15.5Unknown 16 18.8 12.5 0.0 0.0 0.0 0.0 68.8

Race/Ethnicitya**


Health Insurance**

Yes 1,416 55.9 19.7 6.6 3.4 5.9 4.2 4.3No 67 37.3 19.4 6.0 10.4 7.5 17.9 1.5Unknown 63 19.0 6.3 3.2 1.6 1.6 3.2 65.1

Education

Less than high school 623 48.6 20.1 7.1 4.5 7.4 5.9 6.4

High school or equivalent 377 52.3 21.5 6.1 3.2 5.3 5.6 6.1



Source: Analysis of data collected from workshop participants. aRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.

*Differences in the receipt of Pap smears across categories are statistically significant at the .05 level. **Differences in the receipt of Pap smears across categories are statistically significant at the .01 level.

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36

Cardiovascular Health

Table 14 displays the receipt of blood cholesterol screening among workshop participants by demographic characteristic. Chi-squared tests indicate that there were significant differences in the receipt of blood cholesterol screening by gender, age group, racial and ethnic categories, insurance status, and educational attainment. Findings include the following:

Gender. Female workshop participants were significantly more likely than male

participants to report having had their blood cholesterol checked in the past year (59 percent versus 46 percent). Accordingly, male participants were more likely than females (22 percent versus 10 percent) to have never received blood cholesterol screening.

Age. Likelihood of receiving a blood cholesterol check in the past year increased by age categories. Workshop participants who were 65 and over were most likely to be screened in the past year (62 percent), while participants under age 40 were least likely (43 percent).

Race and Ethnicity. In comparison to the other racial and ethnic categories, it appears that Hispanics were most likely to have had their blood cholesterol checked in the past year (58 percent). Black workshop participants were most likely to report never having been screened (21 percent).

Insurance Status. Workshop participants with health insurance were more than three times as likely as participants without health insurance to have had their blood cholesterol checked in the past year (59 percent versus 17 percent), while those without health insurance were more than four times as likely to have never had a blood cholesterol screening compared to participants with health insurance (53 percent versus 12 percent).

Educational Attainment. Workshop participants who had completed at least some college were most likely to have undergone blood cholesterol screening in the past year (61 percent).

Figures 4 and 5 show cardiovascular health screening behavior among male and female workshop participants, respectively, and comparable BRFSS participants in Massachusetts and nationally.


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Table 14. Receipt of Blood Cholesterol Check Among Workshop Participants, by Demographic Characteristics

Most Recent Blood Cholesterol Check (%)

N <1 Year

Ago 1-2 Years

Ago 2-5 Years

Ago >5 Years

Ago Never Unknown Total 2,806 53 15.5 5.7 4.7 15.5 5.6 Gender**

Male 1,251 46.1 14.3 5.9 6.2 22.1 5.3Female 1,546 58.9 16.5 5.6 3.4 10.2 5.4Unknown 9 11.1 0 0 0 0 88.9

Age**

Under 40 497 43.1 14.3 4.6 5.2 28.2 4.640-64 1,951 54.9 15.6 6.3 4.9 14.2 465 and over 318 62.3 17.9 4.1 2.8 5 7.9Unknown 40 10 2.5 5 0 2.5 80

Race/Ethnicitya**

White 410 54.4 21.5 7.1 3.9 9.8 3.4Black 770 48.7 14.7 5.3 6.4 20.6 4.3Asian 146 58.2 17.8 8.2 0.7 12.3 2.7Hispanic 1,208 58.4 13.4 5.4 4.5 14.2 4.1Other 214 43.5 20.1 6.5 3.3 19.6 7Unknown 58 12.1 3.4 0 6.9 5.2 72.4

Health Insurance**

Yes 2,424 58.8 16.8 5.7 4.3 11.9 2.6No 246 17.1 9.3 8.5 10.2 52.8 2Missing 136 14.7 3.7 2.2 0.7 11.8 66.9

Education**

Less than high school 994 51.1 18.1 5.4 3.6 17.5 4.2High school or equivalent 741 51.4 13.1 6.6 6.5 17.5 4.9Training program 141 53.9 11.3 11.3 9.9 10.6 2.8College 817 60.5 16.2 4.7 3.4 12.1 3.2Other 39 41 17.9 2.6 7.7 25.6 5.1Unknown 74 17.6 2.7 4.1 2.7 8.1 64.9


*Differences in the receipt of blood cholesterol checks across categories are statistically significant at the .05 level. **Differences in the receipt of blood cholesterol checks across categories are statistically significant at the .01 level.

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39



40

Colorectal Health

Tables 15 and 16 display participants’ health behaviors related to screening for colorectal cancer. Chi-squared tests indicate that there were significant differences in the receipt of blood stool tests by age group, racial and ethnic categories, and insurance status (Table 15). There was no significant difference in the likelihood of undergoing a blood stool test by gender or educational attainment. In addition, receipt of sigmoidoscopies or colonoscopies differed significantly by age and health insurance; however, no significant differences were found in the rate of sigmoidoscopies and colonoscopies by gender, race and ethnicity, and educational attainment. Findings include the following:

Age. Workshop participants between ages 50 and 64 were more likely than participants

age 65 and over to have never received a blood stool test (41 percent versus 31 percent) or sigmoidoscopy or colonoscopy (37 percent versus 31 percent).

Race and Ethnicity. White workshop participants were the most likely to report never having taken a blood stool test (43 percent). No racial/ethnic differences were found for sigmoidoscopy or colonoscopy.

Insurance Status. Workshop participants with health insurance were more than twice as likely to report having taken a blood stool test within the past year as participants without health insurance (29 percent versus 13 percent) and almost half as likely to have never received a blood stool test (38 percent versus 66 percent). While the percentages of participants with and without health insurance who had undergone a sigmoidoscopy or colonoscopy within the past year were similar (24 percent versus 22 percent), the percentages of participants with and without health insurance who had never received one of these tests differed widely (34 percent versus 65 percent).

Figure 6 shows colorectal health screening behavior among workshop participants and comparable BRFSS participants in Massachusetts and nationally.


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Table 15. Receipt of Blood Stool Test Among Workshop Participants Over Age 50, by Demographic Characteristicsa

Most Recent Blood Stool Check (%)

N

<1 Year Ago

1-2 Years Ago

2-3 Years Ago

3-5 Years Ago

>5 Years Ago Never Unknown

Total 1,152 27.8 12.3 5.4 4.8 5.6 38.4 5.7 Gender

Male 493 28.2 13.0 3.9 5.1 6.3 38.9 4.7Female 658 27.5 11.9 6.5 4.6 5.2 38.0 6.4Unknown 1 0.0 0.0 0.0 0.0 0.0 0.0 100.0

Age*

50-64 834 28.3 11.3 5.3 4.1 5.6 41.1 4.365 and over 318 26.4 15.1 5.7 6.6 5.7 31.1 9.4

Race/Ethnicityb**

White 205 22.9 11.7 3.9 6.8 6.8 42.9 4.9Black 328 23.5 15.2 6.4 5.5 9.1 36.0 4.3Asian 97 29.9 14.4 5.2 6.2 6.2 36.1 2.1Hispanic 425 31.1 10.4 5.4 4.0 3.5 40.0 5.6Other 81 35.8 11.1 6.2 0.0 0.0 37 9.9Unknown 16 37.5 6.3 0.0 0.0 0.0 6.3 50.0

Health Insurance**

Yes 1,037 29.2 13.1 5.9 4.7 6.0 37.8 3.3No 68 13.2 8.8 1.5 4.4 2.9 66.2 2.9Unknown 47 17.0 0.0 0.0 6.4 2.1 10.6 63.8

Education

Less than high school 464 32.3 11.9 5.6 3.9 2.8 38.4 5.2High school or equivalent 282 23.0 11.7 5.0 6.0 8.2 40.4 5.7Training program 44 22.7 11.4 6.8 4.5 11.4 38.6 4.5College 317 26.5 13.9 6.0 5.4 7.3 37.5 3.5Other 19 15.8 21.1 0.0 0.0 5.3 47.4 10.5Unknown 26 30.8 3.8 0.0 3.8 0.0 19.2 42.3

Source: Analysis of data collected from workshop participants. aThe demographic form asked participants to classify their age as under 40, between 40 and 64, or over 64. Actual ages were calculated using date of birth and workshop date. Any participants who identified as being between 40 and 64 but did not provide a date of birth were excluded from this table, because we could not determine whether they were age 50 or older. bRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.

*Differences in the receipt of blood stool tests across categories are statistically significant at the .05 level. **Differences in the receipt of blood stool tests across categories are statistically significant at the .01 level.


42

Table 16. Receipt of Sigmoidoscopy/Colonoscopy Among Workshop Participants Over Age 50, by Demographic Characteristics

Most Recent Sigmoidoscopy/Colonoscopy (%)

N

<1 Year Ago

1-2 Years Ago

2-3 Years Ago

3-5 Years Ago

5-10 Years Ago

>10 Years Ago Never Unknown

Total 1,152 23.1 16.1 8 7.3 3.5 1.3 35.4 5.4 Gender

Male 493 25.6 15.6 8.5 6.7 2.8 1.0 35.5 4.3Female 658 21.3 16.4 7.6 7.8 4.0 1.5 35.3 6.2Unknown 1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0

Age*

50-64 834 24.6 15.3 7.6 7.3 3.2 0.7 37.1 4.265 and over 318 19.2 17.9 9.1 7.2 4.1 2.8 31.1 8.5

Race/Ethnicityb

White 205 18.0 16.1 7.3 9.3 5.4 0.0 40.0 3.9Black 328 21.3 17.1 8.2 7.6 4.9 2.4 33.5 4.9Asian 97 17.5 21.6 8.2 5.2 2.1 1.0 44.3 0.0Hispanic 425 28.9 14.4 8.7 7.3 2.1 0.9 32.9 4.7Other 81 21.0 13.6 4.9 3.7 2.5 2.5 39.5 12.3Unknown 16 12.5 18.8 6.3 6.3 0.0 0.0 6.3 50.0

Health Insurance**

Yes 1,037 24.0 17.1 8.4 8.1 3.8 1.5 34.1 3.1No 68 22.1 7.4 4.4 0.0 0.0 0.0 64.7 1.5Unknown 47 4.3 6.4 4.3 0.0 2.1 0.0 21.3 61.7

Education

Less than high school 464 23.5 17.7 7.3 5.4 1.9 1.3 38.6 4.3High school or equivalent 282 20.9 13.8 9.6 8.9 5.0 1.8 34.4 5.7Training program 44 18.2 6.8 6.8 13.6 0.0 2.3 43.2 9.1College 317 26.5 17.7 8.2 8.2 5.0 0.9 30.6 2.8Other 19 10.5 21.1 0.0 5.3 0.0 0.0 57.9 5.3Unknown 26 15.4 3.8 7.7 3.8 3.8 0.0 19.2 46.2

Source: Analysis of data collected from workshop participants. a The demographic form asked participants to classify their age as under 40, between 40 and 64, or over 64.

Actual ages were calculated using date of birth and workshop date. Any participants who identified as being between 40 and 64 but did not provide a date of birth were excluded from this table, because we could not determine whether they were age 50 or older.

b Race and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.

*Differences in the receipt of sigmoidoscopies/colonoscopies across categories are statistically significant at the .05 level.

** Differences in the receipt of sigmoidoscopies/colonoscopies across categories are statistically significant at the .01 level.

43



44

Prostate Health

To assess screening behavior related to prostate cancer, male workshop participants were asked about their receipt of digital rectal exams (DREs) and prostate-specific antigen (PSA) tests. Table 17 displays the receipt of DREs and Table 18 shows the receipt of PSA tests among men over 40.9 In addition, in response to recent changes in prostate screening recommendations, male workshop participants were asked whether they had discussed prostate cancer early detection or screening with a health care provider. These data are reported in Table 19. Chi-squared tests indicate that there were significant differences in the occurrence of a discussion about prostate cancer early detection or screening with providers and the receipt of both prostate cancer screening tests by age group, racial and ethnic categories, insurance status, and educational attainment. Findings include the following:

Age. Male workshop participants age 65 and over were more likely than those ages 40 to

64 to have discussed prostate cancer early detection or screening (62 percent versus 47 percent). In addition, those over 65 were more likely to have received a DRE (38 percent versus 25 percent) and/or PSA test (36 percent versus 25 percent) in the past year and less likely to have never received these screenings (21 percent versus 39 percent and 27 percent versus 48 percent for DRE and PSA test, respectively).

Race and Ethnicity. White men were the most likely to report having discussed prostate cancer early detection or screening with a provider (58 percent). Additionally, they were most likely to report having received a DRE and/or PSA test in the past year (43 percent and 38 percent for DRE and PSA test, respectively) and least likely to have never received one of these tests (27 percent and 40 percent for DRE and PSA test, respectively). Asian men were least likely to report discussing prostate cancer early detection or screening with a provider (17 percent) and to report never having either test (64 percent and 69 percent for DRE and PSA test, respectively). The prostate health screening behaviors of black men were in between those of white and Asian men; 54 percent of black men reported discussing prostate cancer early detection or screening with a provider. However, only 24 percent of black men had received a DRE in the past year, and 25 percent had received a PSA in that timeframe. In addition, 36 percent of black men reported that they never received a DRE, and 44 percent had never received a PSA test.

Insurance Status. Workshop participants with health insurance were almost three times as likely as participants without insurance to report discussing prostate cancer early detection or screening with a health care provider (63 percent versus 23 percent) and were twice as likely to report being screened in the past year 33 percent versus 11 percent for DRE, and 33 percent versus 14 percent for PSA test).

9 In accordance with MHQP recommendations, in this section, data related to prostate cancer screening were only

analyzed for men over age 40.


45

Educational Attainment. As the education level of participants increased, they were more likely to report having discussed prostate cancer early detection or screening with a provider.

Figure 7 shows prostate health screening behavior among workshop participants and comparable BRFSS participants in Massachusetts and nationally.


46

Table 17. Receipt of Digital Rectal Exams (DREs) Among Male Workshop Participants Over Age 40, by Demographic Characteristics

Percentage with Most Recent DRE

N

<1 Year Ago

1-2 Years Ago

2-3 Years Ago

3-5 Years Ago


Total 1,016 26.7 10.6 5.0 4.2 4.6 37.3 11.5 Age*

40-64 904 25.3 10.7 5.1 4.2 4.6 39.3 10.765 and over 112 37.5 9.8 4.5 4.5 4.5 21.4 17.9

Race/Ethnicitya**


Health Insurance**

Yes 847 33.2 13.1 5.3 2.5 6.6 29.5 9.8No 126 11.1 4.8 3.2 5.6 3.2 64.3 7.9Unknown 43 7.0 0.0 2.3 0.0 0.0 25.6 65.1

Education*

Less than high school

319 22.9 7.2 4.4 3.8 4.4 44.2 13.2

High school or equivalent

292 24.3 13.4 5.8 4.1 3.4 41.4 7.5



Discussed Prostate Screening with Provider**

Yes 491 46.0 16.1 6.5 6.1 5.9 17.1 2.2No 309 10.7 6.5 4.9 4.2 4.2 67.0 2.6Don't know/ not sure 105 5.7 6.7 2.9 0.0 3.8 75.2 5.7

Unknown 111 5.4 1.8 0.9 0.0 0.9 8.1 82.9 Source: Analysis of data collected from workshop participants. aRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.

*Differences in the receipt of DREs across categories are statistically significant at the .05 level. **Differences in the receipt of DREs across categories are statistically significant at the .01 level.


47

Table 18. Receipt of Prostate-Specific Antigen (PSA) Tests Among Male Workshop Participants Over Age 40, by Demographic Characteristics

Most Recent PSA (%)

N

<1 Year Ago

1-2 Years Ago

2-3 Years Ago

3-5 Years Ago


Total 1,016 26.0 8.6 3.7 1.8 2.5 45.2 12.3 Age**

40-64 904 24.8 8.5 3.7 1.8 2.3 47.5 11.565 and over 112 35.7 8.9 4.5 1.8 3.6 26.8 18.8

Race/Ethnicitya**


Health Insurance**

Yes 847 32.8 11.1 3.7 1.2 2.9 38.1 10.2No 126 13.5 4.8 3.2 0.8 3.2 66.7 7.9Unknown 43 7.0 0.0 2.3 0.0 0.0 27.9 62.8

Education**


319 22.9 6.9 2.2 2.8 2.5 49.5 13.2

High school or equivalent

292 21.6 9.2 4.8 1.4 1.4 51.7 9.9



Discussed Prostate Screening with Provider**

Yes 491 46.6 13.8 6.1 3.1 3.5 23.4 3.5No 309 9.1 4.5 1.9 1.0 2.3 78.3 2.9Don't know/ not sure 105 1.9 3.8 1.9 0.0 1.0 84.8 6.7

Unknown 111 4.5 0.9 0.0 0.0 0.0 11.7 82.9 Source: Analysis of data collected from workshop participants. aRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.

*Differences in the receipt of PSA tests across categories are statistically significant at the .05 level. **Differences in the receipt of PSA tests across categories are statistically significant at the .01 level.


48

Table 19. Discussion About Prostate Cancer Early Detection or Screening with Health Care Provider Among Male Workshop Participants Over Age 40, by Demographic Characteristics

Discussed Prostate Cancer Early Detection or Screening with Provider (%)

N Yes No Don't Know/

Not Sure Unknown Total 1,016 48.3 30.4 10.3 10.9 Age**

40-64 904 46.7 31.6 11.3 10.465 and over 112 61.6 20.5 2.7 15.2

Race/Ethnicitya**

White 124 58.1 20.2 8.1 13.7Black 454 54.0 25.8 10.1 10.1Asian 36 16.7 50.0 30.6 2.8Hispanic 302 46.4 34.8 7.0 11.9Other 89 29.2 47.2 16.9 6.7Unknown 11 18.2 18.2 18.2 45.5

Health Insurance**

Yes 847 63.1 24.2 4.1 8.6No 126 23.0 42.1 27.0 7.9Missing 43 14.0 25.6 4.7 55.8

Education**


319 35.1 40.8 13.5 10.7

High school or equivalent 292 47.6 33.6 10.6 8.2

Training program 61 59.0 14.8 11.5 14.8

College 313 62.0 20.4 5.1 12.5 Other 12 33.3 33.3 25.0 8.3Unknown 19 31.6 21.1 26.3 21.1


*Differences in the rate of discussion about prostate cancer early detection or screening across categories are statistically significant at the .05 level. **Differences in the rate of discussion about prostate cancer early detection or screening across categories are statistically significant at the .01 level.

49



50

C. Project Effectiveness (Knowledge Improvement Among Workshop Participants)

Analysis of quantitative data suggests that all units of the curriculum were effective in increasing knowledge among workshop participants and workshop participants were satisfied with the education they received. Below, we present key findings related to project effectiveness in the following topic areas: (1) demonstrated knowledge of breast, cervical, cardiovascular, colorectal, and prostate health; and (2) satisfaction with the workshops.

1. Knowledge of Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health

Pre- and posttest data suggest that knowledge increased after a workshop for all units of the curriculum (breast, cervical, cardiovascular, colorectal, and prostate health) (Table 20). For all units, average increases in scores were significant at the p < 0.01 level based on paired t-tests, suggesting the curriculum is effective at increasing knowledge. Findings include the following:

Breast Health. For those attending breast health workshops, average scores increased

significantly between the pretest and posttest, rising from 3.9 to 4.6 on a five-point scale, with 48 percent of breast health workshop participants increasing their scores.

Cervical Health. Average scores increased from 3.6 to 4.6 among cervical health workshop participants, with 60 percent of participants experiencing increases in scores between the pretest and posttest.

Cardiovascular Health. For cardiovascular health workshop participants, average scores increased from 4.1 to 4.7, with 56 percent of participants showing increases.

Colorectal Health. Average scores increased from 3.3 to 4.5 between the pretest and posttest among colorectal workshop participants, with 65 percent of participants exhibiting increases.

Prostate Health. Average scores increased from 3.6 to 4.3 among prostate health workshop participants, with 48 percent of participants increasing their knowledge.

Increases in scores were seen universally across gender, age, race/ethnicity, and education groups for all units of the curriculum. As expected, pre- and posttest scores were lower for workshop participants than they were for the CHWs who led the workshops in all units of the curriculum.

Notably, average pretest scores were highest for the cardiovascular health unit. This may reflect

that the cardiovascular health questions were easier than those for other units, that baseline knowledge of cardiovascular health is higher (perhaps due to state and national public health efforts), or both.


51

Tab

le 2

0.

Bre

ast

, C

erv

ical,

Card

iovasc

ula

r,

Colo

rect

al,

and

Pro

state

K

now

led

ge

on

the

Pre

test

s and

Post

test

s,

by

Dem

og

rap

hic

C

hara

cteri

stic

s of

Work

shop

Part

icip

ants

Br

east

Can

cer

Cerv

ical

Can

cer

Card

iova

scul

ar H

ealth

Pr

etes

t Po

stte

st

% w

ith

Incr

ease

d Sc

ore

Pret

est

Post

test

%

with

In

crea

sed

Scor

e

Pret

est

Post

test

%

with

In

crea

sed

Scor

e

N

Aver

age

Scor

e N

Av

erag

e Sc

ore

N

Aver

age

Scor

e N

Av

erag

e Sc

ore

N

Aver

age

Scor

e N

Av

erag

e Sc

ore

Tota

l C

om

ple

ting

Both

Pre

-

and

Post

test

s 83

2 3.

90

832

4.60

**

47.8

63

0 3.

57

630

4.61

**

60.2

1,

319

4.14

1,

319

4.73

**

55.6

T

ota

l C

om

ple

ting

Eit

her

Test

84

0 3.

89

843

4.59

n.

a.

643

3.58

64

1 4.

61

n.a.

1,

340

4.14

1,

361

4.66

n.

a.

Gend

er

M

ale

0 n.

a.

0 n.

a.

n.a.

0

n.a.

0

n.a.

n.

a.

511

4.12

52

3 4.

59

54.3

Fe

mal

e 84

0 3.

89

843

4.59

47

.8

643

3.58

64

1 4.

61

60.2

82

3 4.

16

830

4.71

56

.2

Unkn

own

0 n.

a.

0 n.

a.

n.a.

0

n.a.

0

n.a.

n.

a.

6 3.

67

8 4.

88

83.3

A

ge

Un

der

40

136

4.15

13

8 4.

71

46.3

94

4.

03

91

4.70

43

.3

255

4.16

25

6 4.

68

49.2

40

-64

577

3.86

57

7 4.

55

47.9

45

0 3.

59

450

4.66

62

.5

900

4.13

91

7 4.

64

57.1

65

and

ove

r 11

8 3.

69

118

4.58

50

.0

92

3.11

92

4.

23

63.7

16

9 4.

20

170

4.74

57

.8

Unkn

own

9 4.

33

10

4.80

37

.5

7 3.

43

8 4.

88

83.3

16

4.

19

18

4.78

46

.7

Race

/ Eth

nic

ity

a

W

hite

11

8 3.

63

118

4.60

54

.2

85

3.31

82

4.

84

77.5

25

8 4.

34

271

4.68

48

.1

Blac

k 13

6 3.

82

138

4.30

42

.6

112

3.88

11

2 4.

43

39.6

22

6 4.

14

226

4.65

51

.1

Asia

n 71

4.

25

71

4.86

49

.3

63

3.33

63

4.

38

61.9

82

4.

11

81

4.85

63

.8

His

pani

c 44

6 3.

98

449

4.63

45

.9

314

3.66

31

4 4.

72

61.2

67

9 4.

06

686

4.62

57

.7

Oth

er

54

3.35

52

4.

58

64.7

55

3.

25

55

4.36

72

.2

75

4.24

74

4.

85

64.4

Un

know

n 15

4.

13

15

4.53

33

.3

14

3.57

15

4.

20

46.2

20

4.

10

23

4.65

68

.4

Ed

uca

tion

Le

ss th

an

high

sc

hool

37

5 3.

74

376

4.55

51

.1

303

3.32

30

1 4.

49

65.4

50

3 4.

03

505

4.71

64

.8

Hig

h sc

hool

/ eq

uiva

lent

20

0 3.

95

202

4.60

47

.0

140

3.72

13

8 4.

62

57.4

36

7 4.

11

378

4.62

52

.7

Trai

ning

pr

ogra

m

33

3.73

33

4.

61

60.6

33

3.

91

33

4.79

54

.5

63

4.33

62

4.

48

42.6

Co

llege

19

8 4.

15

197

4.70

41

.3

147

3.94

14

7 4.

81

53.5

36

3 4.

31

370

4.67

47

.8

Oth

er

14

3.71

14

4.

57

57.1

5

4.00

5

4.80

60

.0

16

3.88

15

4.

73

60.0

Un

know

n 20

3.

90

21

4.14

29

.4

15

3.33

17

4.

41

57.1

28

4.

21

31

4.71

55

.6

Tab

le 2

0 (c

onti

nue

d)


52

Co

lore

ctal

Can

cer

Pros

tate

Can

cer

Pr

etes

t Po

stte

st

% w

ith

Incr

ease

d Sc

ore

Pret

est

Post

test

%

with

In

crea

sed

Scor

e

N

Aver

age

Scor

e N

Av

erag

e Sc

ore

N

Aver

age

Scor

e N

Av

erag

e Sc

ore

Tota

l C

om

ple

ting B

oth

Pre

- a

nd

Post

test

s 78

2 3.

33

782

4.46

**

64.8

86

3 3.

59

863

4.33

**

48.4

Tota

l C

om

ple

ting

Eit

her

Test

79

1 3.

32

812

4.43

n.

a.

889

3.60

88

3 4.

32

n.a.

Gend

er

Mal

e 33

9 3.

25

347

4.29

59

.7

889

3.60

88

3 4.

32

48.4

Fe

mal

e 44

8 3.

37

460

4.53

68

.6

0 n.

a.

0 n.

a.

n.a.

Un

know

n 4

3.25

5

4.40

75

.0

0 n.

a.

0 n.

a.

n.a.

Ag

e

Unde

r 40

14

0 3.

68

140

4.52

54

.3

141

3.65

13

6 4.

46

54.5

40

-64

585

3.25

60

2 4.

42

65.8

66

8 3.

58

666

4.32

48

.2

65 a

nd o

ver

57

3.14

60

4.

30

77.2

68

3.

63

69

4.10

42

.4

Unkn

own

9 3.

33

10

4.70

87

.5

12

3.92

12

4.

17

22.2

Race

/Eth

nic

ity

a

Whi

te

139

3.40

14

3 4.

56

68.8

75

3.

73

79

4.58

50

.7

Blac

k 90

3.

21

94

4.07

56

.8

460

3.70

45

5 4.

28

43.0

As

ian

71

3.39

73

4.

86

80.3

19

3.

89

19

4.89

66

.7

His

pani

c 39

8 3.

38

407

4.44

60

.7

233

3.47

22

9 4.

20

50.0

O

ther

82

2.

99

83

4.17

69

.1

83

3.19

82

4.

60

67.5

Un

know

n 11

3.

00

12

4.42

10

0.0

19

3.58

19

4.

05

53.3

Ed

uca

tion

Less

than

hig

h sc

hool

32

8 3.

08

331

4.48

74

.5

243

3.08

24

3 4.

21

62.2

H

igh

scho

ol o

r eq

uiva

lent

21

2 3.

32

221

4.38

63

.3

269

3.58

26

9 4.

33

48.7

Tr

aini

ng p

rogr

am

36

3.50

42

4.

12

55.6

52

3.

62

52

4.25

43

.1

Colle

ge

190

3.71

19

2 4.

49

52.4

28

6 4.

06

280

4.46

37

.2

Oth

er

9 3.

44

9 4.

33

55.6

14

3.

57

14

4.14

42

.9

Unkn

own

16

3.19

17

4.

18

60.0

25

3.

52

25

3.96

52

.4

Sour

ce:

Anal

ysis

of d

ata

colle

cted

from

wor

ksho

p pa

rtic

ipan

ts.

Not

e:

The

first

row

of

the

tabl

e sh

ows

stat

istic

s fo

r w

orks

hop

part

icip

ants

who

com

plet

ed b

oth

the

pret

est

and

the

post

test

of

a un

it. A

pai

red

t-te

st w

as

cond

ucte

d fo

r th

ese

part

icip

ants

in e

ach

unit

of t

he c

urric

ulum

to

dete

rmin

e w

heth

er t

he in

crea

se in

ave

rage

sco

res

was

sta

tistic

ally

sig

nific

ant.

Beca

use

the

sam

ple

size

s w

ere

smal

l, pa

ired

t-te

sts

wer

e no

t con

duct

ed fo

r in

divi

dual

dem

ogra

phic

gro

ups.

a R

ace

and

His

pani

c et

hnic

ity w

ere

com

bine

d fo

r th

is a

naly

sis

beca

use

12 p

erce

nt o

f H

ispa

nic

wor

ksho

p pa

rtic

ipan

ts d

id n

ot id

entif

y th

eir

race

, an

d 55

per

cent

of

His

pani

c w

orks

hop

part

icip

ants

mar

ked

the

othe

r ra

ce c

ateg

ory

on t

heir

dem

ogra

phic

for

m. O

f th

e pa

rtic

ipan

ts t

hat

mar

ked

othe

r ra

ce, m

any

wro

te “

His

pani

c” in

to

the

free

res

pons

e fie

ld.

*Pos

ttes

t sco

re is

sig

nific

antly

diff

eren

t fro

m p

rete

st s

core

at t

he .0

5 le

vel,

two-

taile

d te

st.

**Po

stte

st s

core

is s

igni

fican

tly d

iffer

ent f

rom

pre

test

sco

re a

t the

.01

leve

l, tw

o-ta

iled

test

.

n.a.

= n

ot a

pplic

able

.


53

Table 21 shows the percentage of workshops participants who correctly answered each of the pre- and posttest questions. In general, questions that asked about recommended ages for screening were more challenging than other questions. Below, we describe the questions that participants were most likely to answer incorrectly, by health unit:

Breast Health. For the breast health unit, the pre- and posttest question most often

answered incorrectly was, “You should have a clinical breast exam done by a healthcare provider every 5 years” (false, see Table 1 for screening recommendations). As shown in Table 21, 42 percent of participants answered this question incorrectly at pretest. Although the percentage who answered the question correctly increased by 39 percent between pre- and posttest, 20 percent of workshop participants still answered the question incorrectly at posttest. Notably, this was also the breast health question that CBO CHWs found most challenging.

Cervical Health. The cervical health pretest question most commonly answered incorrectly initially was, “Getting a positive HPV test means you have cervical cancer” (false). In the pretest, 42 percent of people answered this question incorrectly. Knowledge improved greatly for this question; only 9 percent of participants answered incorrectly on the posttest, a 56 percent increase in knowledge.

Cardiovascular Health. “Men and women have the exact same heart attack warning signs” (false) was the pretest question most often answered incorrectly for the cardiovascular health unit. It also had the fewest correct responses among all the questions across all the units. Overall, 63 percent of people answered this question incorrectly at pretest. This question was also the cardiovascular health question that CHWs had the most trouble with on the pretest. Knowledge on this question improved 130 percent among workshop participants between pre- and posttest; however, 15 percent still answered incorrectly on the posttest.

Colorectal Health. The colorectal health unit question that was most likely to be answered incorrectly by workshop participants on the pretest was, “All people should begin getting screened for colorectal cancer at the age of 30 years old” (false, see Table 1 for screening recommendations). Altogether, 60 percent of people answered this question incorrectly. Another challenging question was “A polyp found on a colonoscopy will always be cancer” (false); 45 percent of people answered this question incorrectly at pretest. Knowledge improved greatly between pre- and posttest for both of these questions; however, 17 percent still answered each of these incorrectly at posttest.

Prostate Health. For the prostate health unit, the pre- and posttest question answered incorrectly most often was, “Starting at the age of 65, men should start talking to their doctor about prostate cancer” (false, see Table 1 for recommendations). As shown in Table 21, 48 and 29 percent answered this question incorrectly on the pre- and posttests, respectively.

A more detailed breakdown of pre- and posttest knowledge by question and demographic characteristics can be found in Appendix F.


54

Table 21. Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health Knowledge, by Pretest and Posttest Questions Among Workshop Participants

Pretest Posttest

% Change





Question (Correct Response)

Breast Health Unit (N = 832)

1. If you have a lump in your breast, you absolutely have breast cancer (false) 676 81.3 801 96.3 18.5

2. Starting at the age of 40, you should get a mammogram once a year (true) 779 93.6 815 98.0 4.6

3. Mammograms cause breast cancer (false) 684 82.2 786 94.5 14.9

4. As women get older, their risk of breast cancer increases (true) 623 74.9 756 90.9 21.3

5. You should have a clinical breast exam done by a health care provider every 5 years (false) 479 57.6 666 80.0 39.0

Cervical Health Unit (N = 630)

1. If you get an abnormal Pap test, it means you have cervical cancer (false) 483 76.7 602 95.6 24.6

2. Women should get their first Pap test at age 21 or 3 years after they become sexually active (true) 468 74.3 576 91.4 23.1

3. Cervical cancer is preventable through routine screening (true) 532 84.4 603 95.7 13.3

4. Getting a positive HPV test means you have cervical cancer (false) 367 58.3 571 90.6 55.6

5. Most women have been exposed to the Human Papilloma Virus (HPV) (true) 398 63.2 552 87.6 38.7

Cardiovascular Health Unit (N = 1,319)

1. Men and women have the exact same heart attack warning signs (false) 487 36.9 1,120 84.9 130.0

2. Quitting smoking can help reduce the risk for cardiovascular disease (true) 1,249 94.7 1,289 97.7 3.2

3. LDL (bad) cholesterol can clog your blood vessels and cause damage to your heart and brain (true) 1,232 93.4 1,295 98.2 5.1


55

Pretest Posttest

% Change





4. If someone shows one of the symptoms of a stroke the most important thing to do is call 911 right away (true) 1,272 96.4 1,252 94.9 -1.6

5. High blood pressure forces your heart to work harder than normal and raises your risk for heart attack and stroke (true) 1,224 92.8 1,287 97.6 5.1

Colorectal Health Unit (N = 782)

1. Eating foods high in fat is a risk factor for colorectal cancer (true) 600 76.7 747 95.5 24.5

2. All people should begin getting screened for colorectal cancer at the age of 30 years old (false) 311 39.8 650 83.1 109.0

3. Colorectal cancer can develop without signs over a long period of time without being noticed (true) 634 81.1 747 95.5 17.8

4. Screening is the only way for someone to know if they have colorectal cancer (true) 628 80.3 692 88.5 10.2

5. A polyp found on colonoscopy will always be cancer (false) 428 54.7 650 83.1 51.9

Prostate Health Unit (N = 863)

1. Men are more likely to get prostate cancer when they are younger (false) 680 78.8 769 89.1 13.1

2. Starting at the age of 65, men should start talking to their doctor about testing for prostate cancer (false) 446 51.7 611 70.8 37.0

3. Men of African descent are at high risk for getting prostate cancer (true) 679 78.7 826 95.7 21.6

4. Difficulty or pain during urination are signs of prostate problems (true) 653 75.7 738 85.5 13.0

5. PSA test results are typically higher in men with prostate cancer (true) 644 74.6 792 91.8 23.0

Source: Analysis of data collected from workshop participants.


56

2. Satisfaction with the Education

Table 22 shows the quantitative results of the participants’ evaluation of the workshops. The vast majority (97 percent) of workshop participants said they would recommend the workshop to family or friends. Moreover, 96 percent rated the workshop as either “good” or “excellent” and 96 percent rated their workshop group leader as “good” or “excellent.” Satisfaction by workshop unit was not assessed because many people received education in multiple units in one day and filled out a single evaluation form.

Table 22. Summary of Responses to Evaluation Questions Among Workshop Participants

Question Frequency

(N = 3,281)a Percentage

Would you suggest that your family or friends come to this health session?

Yes 3,175 96.8No 61 1.9Unknown 45 1.4

Overall, how would you rate this health session?Excellent 2,039 62.2Good 1,117 34.0Average 65 2.0Fair 23 0.7Poor 2 0.1Unknown 35 1.1

Overall, how would you rate the group leader?Excellent 2,162 65.9Good 990 30.2Average 66 2.0Fair 18 0.6Poor 1 0.0Unknown 44 1.3

Source: Analysis of data collected from workshop participants. aThe evaluation forms were anonymous and not linked to individual participants. As a result, evaluation forms could not be de-duplicated, and the denominator for this table represents all evaluation forms received.

Below are a few quotes from workshop participants’ evaluation forms that illustrate their satisfaction with the workshops:

“Yes I loved it and I learned a lot. I would like to return, and bring friends.”

“The meeting was great. I understood everything clearly. I am so glad that I came. I don't have any suggestion, but I wish more people will come because it is very important to learn and educate ourselves about cancer myths, appointments etc.”

“Thank you for the program because it helps us to understand the dangerous diseases in order to protect our health. I learned a lot. Thank you very much! “

“My suggestion is that you should never stop from giving these courses. They are super important - I was very happy for efforts made to educate the women in the community.”


57

The findings from our qualitative assessment of the prostate health unit confirm that the education was effective and participants left the workshops satisfied. The CHWs and focus group participants we spoke with reported that the workshops were clear and that men were excited to receive the information. One focus group participant noted, “My dad never went to the doctor, so I like the idea of taking the message out to the public instead of waiting for people to go to their doctors.” Some men reported being happy to get the information for free. Men also reported that they liked seeing how much they learned from the pre- to the posttest.

D. Project Maintenance (Evaluation of Longer-Term Effect of Program)

The goal of health education is to increase awareness and improve knowledge, ideally over the long term. In an effort to assess the longer-term effects of this program, focus group participants were asked (1) to summarize what they learned from the prostate health workshops and state whether they shared what they learned with others; (2) to report if they spoke with a health care provider about prostate health after the workshop and describe why or why not; and (3) to complete the knowledge posttest again.

1. Information Learned and Shared

Men who participated in the focus group retained a substantial amount of information about early prostate cancer screening and early detection. In particular, these participants reported learning about:

Prevalence of prostate cancer

Factors that affect risk for prostate cancer such as race, genes, environment, and age

Symptoms of prostate problems and prostate cancer

Treatability of prostate cancer when caught early

Ways of being more proactive about screening

In speaking about being proactive about screening, one focus group participant remarked, “Usually men think because they feel healthy, they don't need to go to the doctor or get screened. But this session made me realize that this [prostate cancer] is serious.” Overall, focus group participants demonstrated an understanding of the burden of prostate cancer, especially among black men, and the importance of seeking care even if they feel healthy. They noted that changing behavior is difficult given the stigma associated with being screened and discussed the importance of bringing men together to talk about the issue, dispel myths, and share screening experiences.

Focus group participants reported sharing the information they learned with family and friends.

In some cases, the sharing of information helped start family conversations about health history. Many focus group participants noted that their friends and family wanted to attend the workshops; however, others reported friends and family brushed off the information. Men noted that people are scared of prostate cancer but that is also very hard to convince people about the importance of taking preventive health actions.


58

2. Informed Decision Making with Providers

A major goal of the prostate health unit is to make men feel comfortable having informed discussions with health care providers about prostate health and prostate cancer screening. There was a general consensus among the men we spoke with that attending the prostate health workshops helped them feel more comfortable in having these conversations. One focus group participant remarked “…you’re more open to ask questions because you have more of an idea of what it is and you’re not intimidated. A lot of people don’t want to hear the worst of a situation but being prepared and knowing the information, which is what the workshop did, you’re better off talking to your doctor knowing what to ask rather than being blind about it. You’re more comfortable with the doctor about what it is or what it can be.”

As shown in Table 23, of the 19 focus group participants whom we were able to link to data

from prostate health workshops, 11 had discussed prostate cancer with a provider prior to attending a prostate health workshop. Many of these men cited their awareness of their risk for prostate cancer as a reason for discussing the issue with a provider. For example, one participant wrote, “I am over 40 and African American. [This is a] high risk group.” Multiple respondents cited risk factors of age, race, or family history as reasons for discussions. The eight men who had not talked to a health care provider about prostate cancer screening before the workshop named a variety of reasons for not talking with a provider, including not having insurance, not thinking they were at risk for prostate cancer, not thinking that prostate cancer was that bad, not thinking that getting screened for prostate cancer was worthwhile, and not feeling comfortable talking about this subject with a provider (data not shown).

The workshop may have prompted men to have informed discussions with providers. As

shown in Table 23, three of the eight focus group participants (38 percent) who had not talked to a provider before the workshop did so after the workshop. In addition, three of the seven participants (43 percent) who had not been screened for prostate cancer before the workshop were screened after; a fourth was waiting for his next doctor’s appointment to be screened. Of the three participants who were only screened after the workshop, all made the decision to get screened on their own (data not shown). In contrast, six of 11 participants (55 percent) who had been screened prior to the workshop reported being involved in the decision making process; 27 percent made the decision themselves and 27 percent made the decision together with a provider (Table 24). Eight men were screened both before and after the workshop. Of these eight, 63 percent reported being involved in the decision to be screened before the workshop (38 percent made the decision themselves and 25 percent made the decision together with a provider) and 88 percent reported being involved after the workshop (50 percent made the decision themselves and 38 percent made the decision with a provider). These results suggest that the workshop may help men become involved in the decision-making process for prostate cancer screening.

59


Tab

le 2

3. P

rost

ate

Healt

h S

creenin

g B

ehavio

rs A

fter

Att

end

ing W

ork

shop

by S

creen

ing

Behavio

rs B

efo

re A

tten

din

g W

ork

shop

Aft

er

Work

shop

Tota

l (n

= 1

9)

Befo

re W

orks

hop

Had

not

talk

ed w

ith

heal

thca

re p

rovi

der

and

had

not

bee

n sc

reen

ed (n

= 6

)a

Had

talk

ed to

he

alth

care

pro

vide

r,

but h

ad n

ot b

een

scre

ened

(n =

2)

Had

not

talk

ed to

he

alth

care

pro

vide

r,

but h

ad b

een

scre

ened

(n =

2)

Had

talk

ed to

he

alth

care

pro

vide

r an

d ha

d be

en

scre

ened

(n =

9)

n %

n %

n %

n %

n %

Had

con

vers

atio

n w

ith h

ealth

car

e pr

ovid

er a

bout

pro

stat

e ca

ncer

or

scre

enin

g fo

r pr

osta

te c

ance

r

Yes

9 47

.4

3 50

.0

1 50

.0

0 0.

0 5

55.6

N

o 7

36.8

2

33.3

0

0.0

2 10

0.0

3 33

.3

Blan

k 3

15.8

1

16.7

1

50.0

0

0.0

1 11

.1

O

f par

ticip

ants

who

did

not

talk

to a

pr

ovid

er a

bout

pro

stat

e ca

ncer

or

scre

enin

g fo

r pr

osta

te c

ance

r, re

ason

s fo

r not

talk

ing

to a

pro

vide

rb (n

= 7

)

D

idn’

t hav

e a

prov

ider

or

regu

lar

plac

e to

get

car

e 1

14.3

1

50.0

-- -

---

0 0.

0 0

0.0

Did

n’t h

ave

insu

ranc

e or

cou

ldn’

t af

ford

to s

ee a

pro

vide

r 0

0.0

0 0.

0 -- -

---

0 0.

0 0

0.0

Did

n’t t

hink

they

wer

e at

risk

for

pros

tate

can

cer

2 28

.6

1 50

.0

-- - --

- 0

0.0

1 33

.3

Did

n’t t

hink

get

ting

pros

tate

can

cer

was

that

bad

1

14.3

0

0.0

-- - --

- 1

50.0

0

0.0

Did

n’t t

hink

get

ting

scre

ened

for

pros

tate

can

cer w

as w

orth

whi

le

0 0.

0 0

0.0

-- - --

- 0

0.0

0 0.

0 D

idn’

t fee

l com

fort

able

talk

ing

abou

t thi

s w

ith a

pro

vide

r 1

14.3

0

0.0

-- - --

- 1

50.0

0

0.0

Oth

er

2 28

.6

0 0.

0 -- -

---

0 0.

0 2

66.7

Blan

k 0

0.0

0 0.

0 -- -

---

0 0.

0 0

0.0

W

as s

cree

ned

for

pros

tate

can

cer

Yes

11

57.9

2

33.3

1

50.

0 1

50.0

7

77.8

N

o

7 36

.8

3 5

0.0

1 5

0.0

1 50

.0

2 22

.2

Blan

k 1

5.3

1 16

.7

0 0.

0 0

0.0

0 0.

0

Tab

le 2

3 (

conti

nued

)

60


Aft

er

Work

shop

Tota

l (n

= 1

9)

Befo

re W

orks

hop

Had

not

talk

ed w

ith

heal

thca

re p

rovi

der

and

had

not

bee

n sc

reen

ed (n

= 6

)a

Had

talk

ed to

he

alth

care

pro

vide

r,

but h

ad n

ot b

een

scre

ened

(n =

2)

Had

not

talk

ed to

he

alth

care

pro

vide

r,

but h

ad b

een

scre

ened

(n =

2)

Had

talk

ed to

he

alth

care

pro

vide

r an

d ha

d be

en

scre

ened

(n =

9)

n %

n %

n %

n %

n %

Of p

artic

ipan

ts w

ho w

ere

not s

cree

ned

for

pros

tate

can

cer,

reas

ons

for n

ot

gett

ing

scre

ened

b (n

= 7

)

D

idn’

t hav

e a

prov

ider

or

regu

lar

plac

e to

get

car

e 0

0.0

0 0.

0 0

0.0

0 0.

0 0

0.0

Did

n’t h

ave

insu

ranc

e or

cou

ldn’

t af

ford

to s

ee a

pro

vide

r 0

0.0

0 0.

0 0

0.0

0 0.

0 0

0.0

Did

n’t t

hink

they

wer

e at

risk

2

28.6

1

33.3

1

100.

0 0

0.0

0 0.

0 D

idn’

t thi

nk p

rost

ate

canc

er w

as

that

bad

0

0.0

0 0.

0 0

0.0

0 0.

0 0

0.0

Did

n’t t

hink

get

ting

scre

ened

was

w

orth

whi

le

0 0.

0 0

0.0

0 0.

0 0

0.0

0 0.

0 D

idn’

t fee

l com

fort

able

get

ting

scre

ened

1

14.3

0

0.

0 0

0.0

1 10

0.0

0 0.

0 D

idn’

t wan

t to

find

out s

cree

ning

re

sults

0

0.0

0 0.

0 0

0.0

0 0.

0 0

0.0

Oth

er

2

28.6

1

33.3

0

0.0

0 0.

0 1

50.0

Bl

ank

2 28

.6

1 33

.3

0 0.

0 0

0.0

1 50

.0

Sour

ce:

Anal

ysis

of d

ata

colle

cted

from

focu

s gr

oup

part

icip

ants

. a O

ne p

artic

ipan

t in

dica

ted

that

bef

ore

the

wor

ksho

p, h

e ha

d no

t ta

lked

with

a h

ealth

car

e pr

ovid

er a

bout

pro

stat

e ca

ncer

or

scre

enin

g fo

r pr

osta

te

canc

er a

nd d

id n

ot a

nsw

er w

heth

er h

e ha

d be

en s

cree

ned

for

pros

tate

can

cer.

He

is in

clud

ed in

this

tabl

e as

hav

ing

not b

een

scre

ened

. b P

artic

ipan

ts c

ould

mar

k al

l res

pons

es th

at a

pplie

d. A

s a

resu

lt, p

erce

ntag

es m

ay n

ot a

dd u

p to

100

per

cent

.

61


Tab

le 2

4. P

ers

on W

ho M

ad

e D

eci

sion

for

Work

shop P

art

icip

ant

to R

ece

ive P

rost

ate

Cance

r Sc

reenin

g

Pa

rtic

ipan

ts S

cree

ned

Befo

re o

r Aft

er W

orks

hop

Part

icip

ants

Scr

eene

d Be

fore

and

Aft

er W

orks

hop

Be

fore

Att

endi

ng P

rost

ate

Hea

lth W

orks

hop

(n =

11)

Afte

r At

tend

ing

Pros

tate

Hea

lth

Wor

ksho

p (n

= 1

1)

Befo

re A

tten

ding

Pro

stat

e H

ealth

Wor

ksho

p (n

= 8

)

Afte

r At

tend

ing

Pros

tate

Hea

lth

Wor

ksho

p (n

= 8

)

n

% n

% n

% n

% Pa

rtic

ipan

t 3

27.3

763

.63

37.5

450

.0H

ealth

car

e pr

ovid

er

3 27

.31

9.1

2 25

.01

12.5

Part

icip

ant

and

heal

th

care

pr

ovid

er to

geth

er

3 27

.3

3 27

.3

2 25

.0

3 37

.5

Oth

er

1 9.

10

0.0

0 0.

00

0.0

Blan

k 1

9.1

00.

01

12.5

00.

0 So

urce

: An

alys

is o

f dat

a co

llect

ed fr

om fo

cus

grou

p pa

rtic

ipan

ts.

Not

e:

Thre

e fo

cus

grou

p pa

rtic

ipan

ts w

ere

scre

ened

onl

y be

fore

att

endi

ng a

pro

stat

e he

alth

wor

ksho

p, a

nd a

n ad

ditio

nal

thre

e fo

cus

grou

p pa

rtic

ipan

ts w

ere

scre

ened

onl

y af

ter

atte

ndin

g a

pros

tate

hea

lth w

orks

hop.

Eig

ht fo

cus

grou

p pa

rtic

ipan

ts w

ere

scre

ened

bot

h be

fore

and

af

ter a

tten

ding

a p

rost

ate

heal

th w

orks

hop.


62

Given the sensitive nature of the topic, focus group participants were asked to describe barriers to talking with providers about prostate health for themselves or their peers. They mentioned:

Lack of trust in the medical system. Distrust of the medical system was mentioned

repeatedly among focus group participants. One man noted “We have had bad experiences, culturally, with the medical profession and that experience carries across generations.” The Tuskegee trials were mentioned as one reason for this distrust.

Misinformation. Focus group participants discussed many myths they had heard about prostate cancer and screening tests (particularly the DRE) and remarked that misinformation is a barrier for many men in seeking care. One man remarked:

“There is a lot of misinformation about the digital exam. Why are they doing it? Will it turn you into whatever, a homosexual? This [misinformation] drives negative behavior.”

Another recalled: “Before I had my first screening, I asked the doctor some frank questions, which probably seemed silly to the doctor but I was serious because I had received so much misinformation over the years. I asked, ‘Is there any chance you could damage something inside me?’”

Fear of tests or results. Men noted that there is substantial fear about the screening tests, somewhat related to misinformation. They also stated that men are afraid of the results. In speaking about fear of being tested, one focus group participant mentioned, “Yeah, because they’re too ‘macho’ you know? But when they die, there’s no more machismo. It’s too late.”

Feeling healthy. Focus group participants said that feeling healthy prevents men from seeking care because of the attitude that, if a man feels healthy, he must be healthy and does not need to see a doctor. One man remarked “You're young and strong and you think nothing's going to happen to you.”

Cost of care. A few focus group participants expressed that uncertainty about the cost of tests and treatment was a barrier. One man also noted fear of not being able to obtain insurance in the future if he received a positive screening result.

Comfort with the provider. Men reported that their level of comfort with a health care provider affects their willingness to seek care. They mentioned three factors that affect comfort level: (1) the provider’s background and familiarity, (2) mutual respect between patient and provider, and (3) the provider’s gender, as follows:

- Provider background and familiarity. Men discussed the racial, ethnic, and cultural differences between themselves and the health care providers in their neighborhoods as a barrier to care. One man stated: “I think that it would be nice to have someone from a similar perspective, maybe we might be comfortable with someone who looks like [us].” Another remarked, “When the majority of the health providers aren’t from the community, some men aren’t as receptive to it—it’s not the message, it’s the messenger.” The importance of the messenger was


63

also mentioned by CHWs we spoke with. One CHW noted: “Men would rather see a provider they know or have a connection with than go into a clinic, which is a…public forum for their private health issues. For men that do have access [to healthcare], the messenger is really an important motivator in convincing them of the importance of prostate health.”

- Respect. Focus group participants noted that a provider who respects them can make them comfortable with an uncomfortable health topic. Men wanted to have ownership over their health, and being respected by their provider helped them achieve this feeling.

- Gender. Focus group participants noted that the gender of a provider could make them more or less comfortable in being screened; some men said they would feel more comfortable being screened by a male provider and others preferred a female provider. From our data, we could not discern whether preference for a male or female provider varied by race, ethnicity, or any other factors.

3. Knowledge Posttest

At the start of each focus group, men were asked to complete the knowledge posttest and we linked these results with the pre- and posttest results completed during the workshop. The average score at the focus group was 4.21 on a five-point scale. This value is slightly higher than the average pretest score of 4.16 for these participants but lower than their average score on the posttest completed immediately after the workshop (4.41); thus, some knowledge was maintained 5 to 12 months after the workshops, although the improvement is not significant (p < 0.05) (data not shown).

E. Limitations

One limitation of the quantitative analysis is related to the evaluation forms. Many workshop participants were educated in multiple units of the curriculum. In some cases, people were educated in two units of the curriculum in a single day. These individuals may have filled out a single evaluation form covering both units of the curriculum or separate evaluation forms for each unit. Other people were educated in different units of the curriculum on different days and completed separate evaluation forms for each unit. Because evaluation forms were not linked to the other forms (in an effort to promote honest evaluations of the workshops), all evaluation forms were included in the analysis.

A second limitation of the analysis is related to the qualitative evaluation. The qualitative

analysis was based on information gathered from 10 CBOs and 25 men who attended prostate health workshops and were able to participate in focus groups. The focus group participants had higher pre- and posttest scores on average than the entire group of men who attended prostate health workshops, suggesting men in the focus groups are not representative of all men who attended prostate health workshops. It is therefore unclear whether the information gathered can be generalized to other men attending prostate health workshops, and what information is generalizable to all participants educated. However, many of the recommendations to improve the workshops that were identified through the qualitative evaluation were not specific to prostate health and may be applicable to the other units.


64

A third limitation is the high percentage of missing data among workshop participants. Questions about country of birth and prostate health screening had particularly high rates of missing data; all questions related to these two topics had greater than 10 percent missing data. Missing data related to country of birth and length of time in the United States limited our ability to fully identify the reach of the project. With regard to prostate health screening, missing data lessened the comparability of our data to BRFSS data and limited our ability to obtain a complete overview of workshop participants’ likelihood of receiving prostate health screening.


65

IV. RECOMMENDATIONS AND CONCLUSION

This evaluation identified several successes of the project as well as some areas for improvement that can inform future project phases. Below we summarize some of these successes and areas for improvement along the dimensions of implementation, reach, effectiveness, and maintenance.

A. Implementation (CBO Recruitment and Training)

Twenty-five CBOs were successfully recruited and trained to carry out workshops in the five units of the curriculum. The CHWs who conducted the workshops had a high level of baseline knowledge, which was improved further through the training process. Although CHWs were overwhelmingly satisfied with the training, the following strategies might improve the training:

Modify training based on background. CBO CHWs came to the training with

different levels of experience conducting health education; however, the training did not account for background. Adapting the training to consider previous experience is recommended. One way to accomplish this would be to hold separate trainings for people based on health education experience (that is, one training for experienced health educators and one for CHWs with less health education experience). Although the content of the curriculum could be consistent between the two trainings, the training for less experienced CHWs could provide more details on how to facilitate a workshop and offer more opportunities for role playing. An alternative strategy to separate trainings would be to pair experienced health educators with less experienced CHWs during a joint training and have teams practice role playing, with the experienced health educators mentoring the less experienced CHWs. A third strategy would be to provide a supplemental training via conference call after the initial training to less experienced CHWs or those who self-identify as wanting more training.

Re-organize presentation notes to complement the slides. The current curriculum includes slides and notes as separate documents. It was suggested that because of this, CHWs may skip the notes and only use the slides to lead their workshops. It would be beneficial to integrate the notes and slides to increase the likelihood of the CHWs using the notes when they conduct workshops.

Focus data collection training on problematic questions. Name, country of birth, length of time in the United States, and date of birth are the questions most often left blank on the data collection forms. Emphasizing the importance of these fields and explaining how they are used in analysis and program improvement efforts could help CHWs feel comfortable answering workshop participants’ questions regarding these data fields and might improve data completeness.

Offer refresher training. For some CBOs, substantial time passed between training and workshops. Refresher courses (in person or via conference call) could be used to remind CHWs of the key health education messages for each unit, answer questions that have arisen during workshops, and discuss recurrent data issues.

Provide more information on outreach strategies. Although CBOs were funded in part because they had ties to their communities, some encountered problems recruiting workshop participants. Including sample outreach strategies in the binder that CHWs


66

receive and discussing these strategies during the initial training could lessen this problem. Successful outreach strategies could also be shared among CHWs during refresher trainings.

B. Reach (Number of People Educated)

CBOs educated 2,806 unique people across the five units of the curriculum. Despite this effort, the majority of CBOs were not able to attain their approved capacity. The following strategies may help improve program reach:

Develop realistic targets. To increase the likelihood of CBOs reaching their capacity,

working with CBOs CHWs responsible for recruiting workshop participants instead of CBO supervisors to identify realistic targets should be considered.

Expand age eligibility criteria. CBOs often had close ties with community members who were outside the age range they were permitted to recruit. Expanding the age eligibility criteria, for example to 30, could expand program reach. Allowing CBOs to recruit younger populations might also improve program effectiveness, as younger people may be more easily able to change their preventative health behaviors.

Recruit men through their spouses. Several CHWs we spoke with mentioned recruiting men for the prostate health workshops by going through their spouses. One remarked “Perhaps the best way to promote prostate health is to involve women and to promote it more in the media (much in the same way that breast cancer awareness has saturated the culture).”

Provide incentives to participants. Many CBOs found that providing incentives such as food or babysitting helped improve attendance.

Consider renaming sessions on taboo topics. CBOs may have trouble recruiting participants for workshops due to the sensitive nature and cultural taboos of certain health topics. Many CBOs reported this to be an issue for the prostate unit. At least one CBO recruited participants to a “men’s health workshop” instead of using the name “prostate health.” This tactic could be applied more broadly.

C. Effectiveness (Knowledge Improvement)

All units of the curriculum were effective in improving knowledge and increases occurred universally across gender, race/ethnicity, and education groups. Workshop participants and CBO CHWs recommended the following strategies, which might make the education even more successful:

Make workshops more engaging. Workshops could better engage participants by including videos, story sharing, games, and quizzes. This change might improve knowledge retention.

Tailor the curriculum to target populations. Tailoring the curriculum to workshop participants might make the health topic more salient and motivate participants to take action. This could entail providing cancer incidence, death statistics, and screening rates by racial/ethnic group.


67

Have cancer survivors attend workshops. When feasible, having cancer survivors attend workshops and tell their stories could make the education more relevant and help motivate participants, especially if participants can relate to the survivors (culturally, for example).

Have medical professionals attend workshops. CHWs were told to refer workshop participants to their providers when they could not answer questions, but this response frustrated some workshop participants who were eager for answers. In particular, questions related to clinical recommendations and treatment were especially problematic. Having a health care provider present would alleviate this problem, although it may be infeasible. Alternatively, giving CBOs lists of frequently asked questions and answers by health unit and providing training on these questions to CBO CHWs might be effective. Referrals to clinicians may still be needed in some cases, and CBOs should consider developing lists of local health care providers for referral.

Place a stronger emphasis on screening recommendations and next steps. In general, questions that asked about recommended ages for screening were among the most challenging for participants. This is not surprising, given recent changes in recommendations for prostate screening and controversy around the breast cancer screening guidelines. Spending more time on screening recommendations and developing a wallet card with screening recommendations should be considered for future workshops. Providing participants with clear next steps was also suggested, particularly for the prostate unit.

Provide materials for participants to take home. Workshop participants are given a large amount of information in a short time. Having materials to refer to at home might help them absorb and retain the information longer. These materials could include a summary of the key points of the presentation as well as talking points to facilitate discussions with providers.

D. Maintenance (Longer-Term Effect of the Program)

Focus group participants were able to describe key themes from the prostate workshops such as the importance of having an informed discussion with a provider about prostate health, suggesting some knowledge was maintained over time. We know, however, from repeat posttests, that some knowledge was lost. We also know that at the focus groups, men had many unanswered questions, some of which had been covered in the workshops. Questions that arose repeatedly were:

Reasons why prostate cancer disproportionately affects black men

Steps men can take to prevent prostate cancer (such as, what role can exercise play in prevention)

Recommended timing of screening for prostate cancer

Cost of screening tests

More details about the screening tests (which tests are needed and what they entail) and interpretation of test results


68

Treatment for the disease and the treatment’s side effects (particularly sexual side effects if the prostate is removed)

Adding these topics to the prostate health curriculum or placing more emphasis on them should be considered in future iterations of the project. E. Conclusion

This quantitative and qualitative evaluation revealed that CBOs successfully expanded the reach of the curriculum and educated a diverse population in Massachusetts. The curriculum was effective in improving breast, cervical, cardiovascular, colorectal, and prostate health knowledge, at least in the short term. Although the curriculum was well implemented and effective, the evaluation identified many areas for improvement. Specific recommendations were made to improve the education’s implementation, reach, effectiveness, and maintenance. Many of the recommendations are currently being put into action, such as working with CBOs to develop realistic targets for recruitment and finding videos to supplement the curriculum. Other recommendations can feasibly be adopted before the next phase of the project commences in the coming months.


69

REFERENCES

American Cancer Society (ACS). “American Cancer Society Guidelines for the Early Detection of Cancer.” ACS, 2010. [http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer]. Accessed December 1, 2010.

American Urological Association (AUA). “Prostate Specific Antigen Best Practice Statement 2009 Update.” AUA, 2009. [http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf]. Accessed December 8, 2010.

Besculides, M., L. Trebino, S. Jones, and J. Kim. “Assessment of the Train the Trainer Project Using the Helping You Take Care of Yourself Curriculum.” Princeton, NJ: Mathematica Policy Research, 2010.

Centers for Disease Control and Prevention (CDC). “Heart Disease Prevention: What You Can Do.” CDC, 2009. [http://www.cdc.gov/HeartDisease/what_you_can_do.htm]. Accessed January 25, 2011.

Centers for Disease Control and Prevention (CDC). “Prostate Cancer, Informed Decision Making: How to Make a Personal Health Care Choice.” CDC, 2010. [http://www.cdc.gov/cancer/prostate/informed_decision_making.htm]. Accessed December 1, 2010.

Glasgow, R.E., T.M. Vogt, and S.M. Boles. “Evaluating the Public Health Impact of Health Promotion Interventions: The RE-AIM Framework.” American Journal of Public Health, vol. 89, no. 9, 1999, 1322-1327.

Henley, S.J., J.B. King, R.R. German, L.C. Richardson, and M. Plescia. “Surveillance of Screening-Detected Cancers (Colon and Rectum, Breast, and Cervix)—United States, 2004–2006. Morbidity and Mortality Weekly, vol. 59(SS09), November 26, 2010, pp. 1-25. [http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5909a1.htm?s_cid=ss5909a1_e]. Accessed December 1, 2010.

Massachusetts Health Quality Partners (MHQP). “2007/8 Adult Preventative Care Recommendations.” MHQP, 2008. [http://www.mhqp.org/guidelines/preventivePDF/MHQP_Adult_DeskGuides07-08.pdf]. Accessed March 17, 2011.

National Cancer Institute (NCI). “Cancer Health Disparities.” NCI, 2008. [http://www.cancer.gov/cancertopics/factsheet/disparities/cancer-health-disparities#9]. Accessed January 25, 2011.

Trebino, L., K. Hourihan, and M. Besculides. “Assessment of the Initial Phase of the Train the Trainer Project Using the Helping You Take Care of Yourself Curriculum.” Princeton, NJ: Mathematica Policy Research, 2008.


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U.S. Preventive Services Task Force. “Screening for Prostate Cancer Recommendations Statement August 2008.” U.S. Preventive Services Task Force, 2008. [http://www.uspreventiveservicestaskforce.org/uspstf08/prostate/prostaters.htm]. Accessed December 1, 2010.

APPENDIX A

DATA COLLECTION FORMS

Date:__________ Location:____________

Light green

8/09

Helping You Take Care of Yourself – Health Education Session

Demographics Form

1. Name: ___________________________ 2. Sex:

Female

3. What is your date of birth? ____month ____day ____year

4. How old are you? under 40

40-64

65 and over

5. What city or town do you live in? __________________________

6. Were you born in….

One of the 50 states or the District of Columbia

One of the US territories (Puerto Rico, Guam, American Samoa, US Virgin Islands, Mariana

Islands, Solomon Islands)

Some other country →How old were you when you first moved to the United States?

___ Age ___Don’t know

7. Are you Latino/Hispanic?

No

Yes →Which one of these groups best describes you?

Brazilian

Cuban

Dominican

Mexican, Chicano, Mexican American

Puerto Rican

Some other Hispanic or Latino origin (please specify): ___________________

8. What is your race? (you may check more than one) Are you….. Alaska Native or American Indian

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White

Other (please specify): ___________________

9. What is the highest grade or level of school you have finished?

I didn’t go to school

8th Grade or less

Some high school but did not graduate

High School graduate or GED

Training Program

College

Other: (please specify): __________________

For Internal Use ONLY

Organization Name

_________________________

Trainer Name

_________________________

A.3


Date:__________ Location:____________

Light green

8/09

10. What type of health care coverage (insurance) do you use to pay for most of your medical care? Is

it coverage through:

Your employer or someone else’s employer

A plan that you or someone else buys

Medicare

Medicaid, MassHealth, CommonHealth or MassHealth HMOs offered through Neighborhood

Health Plan, Fallon Community Health Plan, Boston Medical Center HealthNet or Network

Health or Commonwealth Care

Free Care or Safety Net

Other (please specify): ___________________

I don’t have any health coverage (insurance)

Health Questions (for women and men):

11. Blood cholesterol is a fatty substance found in the blood. About how long has it been since you

last had your blood cholesterol checked?




5 or more years ago

I have never had my blood cholesterol checked

12. A blood stool test is a test that may use a special kit at home to determine whether the stool

contains blood. When was your most recent blood stool test using a home kit?





5 or more years ago

I have never had a blood stool test using a home kit

13. Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the

colon for signs of cancer or other health problems. When was your most recent sigmoidoscopy or

colonoscopy?






10 or more years ago

I have never had a sigmoidoscopy or colonoscopy

A.4


Date:__________ Location:____________

Light green

8/09

WOMEN ONLY Health Questions

14. A mammogram is an x-ray of each breast to look for breast cancer. When was your most recent

mammogram?





5 or more years ago

I have never had a mammogram

15. A Pap test (smear) is a test for cancer of the cervix. When was your most recent Pap test?




Within the past 5 years (3years but less than 5 years ago)

5 or more years ago

I have never had a Pap test

MEN ONLY Health Questions

16. Have you ever discussed prostate cancer early detection or screening with your healthcare

provider?

Yes

No

Don’t know / Not sure

17. A digital rectal exam is an exam in which a doctor, nurse or other health professional places a

gloved finger into the rectum to feel the size, shape, and hardness of the prostate gland. When

was your most recent digital rectal exam (DRE)?





5 or more years ago

I have never had a DRE

18. A Prostate-Specific Antigen test, also called a PSA test, is a blood test used to check men for

prostate cancer. When was your most recent prostate specific antigen (PSA) test?





5 or more years ago

I have never had a PSA test

A.5


ID number:______________ Date: _________________

Location: _________________

Pink paper

5/09


Pre-test

Breast Health and Breast Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree

with the statement.

1. If a woman discovers a lump in her breast, she absolutely has breast cancer………….YES NO

2. Starting at the age of 40, women should get a mammogram once a year……………..YES NO

3. Mammograms cause breast cancer……………………………….………………….…YES NO

4. As women get older, their risk of breast cancer increases…………………….…….…YES NO

5. Women need to have a clinical breast exam done by a healthcare provider

every five years…………………………………………………………………………YES NO


Organization Name

_________________________

Trainer Name

_________________________

A.6


ID number:______________ Date: _________________

Location: _________________

Lavender paper

12/09

Post-test

Breast Health and Breast Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree

with the statement.

1. If a woman discovers a lump in her breast, she absolutely has breast cancer………….YES NO

2. Starting at the age of 40, women should get a mammogram once a year……………..YES NO

3. Mammograms cause breast cancer……………………………….………………….…YES NO

4. As women get older, their risk of breast cancer increases…………………….…….…YES NO

5. Women need to have a clinical breast exam done by a healthcare provider

every five years…………………………………………………………………………YES NO


Organization Name

_________________________

Trainer Name

_________________________

A.7


ID number:______________ Date: _________________

Location: _________________

Pink paper

5/09


Pre-test

Cervical Health and Cervical Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree

with the statement.

1. If a woman has an abnormal Pap test, it means she has cervical cancer………..……..YES NO

2. Women should get their first Pap tests at age 21 or three years after they

become sexually active…………………………………………………………………YES NO

3. Cervical cancer is preventable through routine screening.…………………………….YES NO

4. When a woman gets a positive HPV test, it means she has cervical

cancer…..………….………………………………………………………………..….YES NO

5. Most women have been exposed to the Human Papilloma Virus (HPV) ……………..YES NO


Organization Name

_________________________

Trainer Name

_________________________

A.8


ID number:______________ Date: _________________

Location: _________________

Lavender paper

12/09


Post-test

Cervical Health and Cervical Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree

with the statement.

1. If a woman has an abnormal Pap test, it means she has cervical cancer………..……..YES NO

2. Women should get their first Pap tests at age 21 or three years after they

become sexually active…………………………………………………………………YES NO

3. Cervical cancer is preventable through routine screening.…………………………….YES NO

4. When a woman gets a positive HPV test, it means she has cervical

cancer…..………….………………………………………………………………..….YES NO

5. Most women have been exposed to the Human Papilloma Virus (HPV) ……………..YES NO


Organization Name

_________________________

Trainer Name

_________________________

A.9


ID number:______________ Date: _________________

Location: _________________

Pink paper

5/09


Pre-test

Cardiovascular Health and Disease Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree

with the statement.

1. Men and women have the exact same heart attack warning signs.…...……………...YES NO

2. Quitting smoking can help reduce the risk for cardiovascular disease……………….YES NO

3. LDL (bad) cholesterol can clog the blood vessels and cause damage to

the heart and brain…….……………………………………………………………...YES NO

4. If someone shows one of the symptoms of a stroke the most important

thing to do is call 911 right away..…………………………………...………………YES NO

5. High blood pressure forces the heart to work harder than normal and

raises the risk for heart attack and stroke……………………………………………..YES NO


Organization Name

_________________________

Trainer Name

_________________________

A.10


ID number:______________ Date: _________________

Location: _________________

Lavender paper

5/09


Post-test

Cardiovascular Health and Disease Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree

with the statement.

1. Men and women have the exact same heart attack warning signs.…...……………...YES NO

2. Quitting smoking can help reduce the risk for cardiovascular disease……………….YES NO

3. LDL (bad) cholesterol can clog the blood vessels and cause damage to

the heart and brain…….……………………………………………………………...YES NO

4. If someone shows one of the symptoms of a stroke the most important

thing to do is call 911 right away..…………………………………...………………YES NO

5. High blood pressure forces the heart to work harder than normal and

raises the risk for heart attack and stroke……………………………………………..YES NO


Organization Name

_________________________

Trainer Name

_________________________

A.11


ID number:______________ Date: _________________

Location: _________________

Pink paper

8/09


Pre-test

Colorectal Health and Colorectal Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree

with the statement.

1. Eating foods high in fat is a risk factor for colorectal cancer………………………….YES NO

2. All people should begin getting screened for colorectal cancer at the age

of 30 years old……………………………………………………………...………….YES NO

3. Colorectal cancer can develop without signs over a long period of time

without being noticed………………………………………………………………….YES NO

4. Screening is the only way for someone to know if they have colorectal cancer………YES NO

5. A polyp found on colonoscopy will always be cancer…………………………………YES NO


Organization Name

_________________________

Trainer Name

_________________________

A.12


ID number:______________ Date: _________________

Location: _________________

Lavender paper

8/09


Post-test

Colorectal Health and Colorectal Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree

with the statement.

1. Eating foods high in fat is a risk factor for colorectal cancer………………………….YES NO

2. All people should begin getting screened for colorectal cancer at the age

of 30 years old……………………………………………………………...………….YES NO

3. Colorectal cancer can develop without signs over a long period of time

without being noticed………………………………………………………………….YES NO

4. Screening is the only way for someone to know if they have colorectal cancer………YES NO

5. A polyp found on colonoscopy will always be cancer…………………………………YES NO


Organization Name

_________________________

Trainer Name

_________________________

A.13


ID number:______________ Date: _________________

Location: _________________

Pink paper

6/09


Pre-test

Prostate Health and Prostate Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree

with the statement.

1. Men are more likely to get prostate cancer when they are younger………..………….YES NO

2. Starting at the age of 65, men should start talking to their doctor about

testing for prostate cancer………………………………………………………………YES NO

3. Men of African descent are at high risk for getting prostate cancer……………………YES NO

4. Difficulty or pain during urination are signs of prostate problems……………………YES NO

5. PSA test results are typically higher in men with prostate cancer ……………………YES NO


Organization Name

_________________________

Trainer Name

_________________________

A.14


ID number:______________ Date: _________________

Location: _________________

Lavender paper

6/09


Post-test

Prostate Health and Prostate Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree

with the statement.

1. Men are more likely to get prostate cancer when they are younger………..………….YES NO

2. Starting at the age of 65, men should start talking to their doctor about

testing for prostate cancer………………………………………………………………YES NO

3. Men of African descent are at high risk for getting prostate cancer……………………YES NO

4. Difficulty or pain during urination are signs of prostate problems……………………YES NO

5. PSA test results are typically higher in men with prostate cancer ……………………YES NO


Organization Name

_________________________

Trainer Name

_________________________

A.15


Date:_____________

Location:_____________

Light blue paper

5/09


Participant Evaluation

Please take a minute to let us know how you liked this health education session.

1. Would you suggest that your family or friends come to this health session?

Yes No

2. Overall, how would you rate this health session?

Poor Fair Average Good Excellent

1 2 3 4 5

3. Overall, how would you rate the group leader?

Poor Fair Average Good Excellent

1 2 3 4 5

4. Do you have any ideas about how to make the sessions

better?_______________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Thank you for filling out this form! Please pass it in before you leave.


Organization Name

_________________________

Trainer Name

_________________________

A.16


APPENDIX B

INTERVIEW AND FOCUS GROUP PROTOCOLS

B.3

Interview Guide for Community Organization Trainers (Project 6339)

Name of Trainer: Organization: Phone Number: Date of Discussion: Interviewer: Hi, my name is [NAME] and I am with Mathematica Policy Research, Inc. We are working with the Massachusetts Department of Public Health (MDPH) to evaluate the Train the Trainer project, including the Helping You Take Care of Yourself prostate curriculum, data collection forms, and the how the program was incorporated into your organization. As part of the evaluation, we are talking to the staff at CMAHEC, trainers at community organizations who used the prostate curriculum, and men who were educated in the prostate unit. I am hoping to talk with you about your experiences with the project. Your input will help us improve the program. Our conversation should take about an hour. Do you still have time to talk now? [if not, reschedule a time] As we talk today, please keep in mind that you don’t have to answer any questions that

make you uncomfortable. Everything you say will be kept confidential and we will not use your name in our reports.

Before I begin asking questions about the Train the Trainer project, I would first like to get some background information about you.

1. How/When did you first become involved with [ORGANIZATION NAME]?

2. What kind of work did you do prior to working at [ORGANIZATION NAME]?

3. Did you have previous training on prostate cancer? If so, can you please tell me about that training/background?

4. How did you become involved in the Train the Trainer project? Now I would like to ask you a little bit about your experience with the CMAHEC prostate training and your thoughts on the curricula.

5. When you were being trained by Dr. Phil Wood and Alex DePalo, what did you

think about the amount of information presented to you during the prostate training you received? (too much, too little, just about right).

B.4

6. Were the training materials that Dr. Wood used clear and easy to understand

a. [if they were trained in more than one unit] How would you compare the quality of the prostate training and materials to the other units you were trained in?

7. Following the prostate training, did you feel prepared to educate men on

prostate cancer? [we are trying to get at comfort level when they first started] a. If yes, what was most helpful in preparing you? b. If not, what would you have liked to learn to help you feel better

prepared? 8. Do you have any suggestions for improving the training process? 9. How much time elapsed between the time that you were trained on prostate

cancer and the time when you offered the first prostate workshop to men in the community?

10. Did you feel comfortable calling Alex at CMAHEC if you had questions about the

project or needed support? a. Did you contact Alex for anything? Please explain. b. [If they contacted her] did she help you work through the issue you were

having?

The next questions I would like to ask you are about recruiting and educating men. Recruiting

11. How did you or your organization go about recruiting men for the prostate workshops you held?

a. [if not answered] Were you involved in recruiting?

i. If yes, what role did you play in the recruitment? b. What challenges did you face in recruiting men?

i. [for organizations that conducted workshops in multiple units] Was the prostate unit more challenging to recruit for than other units?

c. Was there anything that facilitated recruitment? d. Were men reminded about the prostate workshops? If so, how? e. Did most people that you recruited for the prostate workshops actually

attend them? If not, why? What did you do to address non-attendance?

12. Were you able to educate all of men who wished to participate? If not, why not? (probe: were language barriers an issue)

B.5

Educating

13. About how many prostate workshops did you hold? f. About how many men were educated per workshop? Did you think this

number of participants was manageable? If not, what should it be?

14. What languages did you conduct workshops in?

15. Briefly describe a typical workshop that you held.

16. What aspects of the workshop do you feel went particularly well? Why?

17. What aspects of the workshop do you think were challenging? Why?

18. How did men respond to the prostate workshops? (Probes: Did they seem interested/Were they excited about what they were learning?)

19. Where did you hold the workshops?

g. Were the workshops received differently at various locations? If so, please explain.

20. What would you do to improve the workshop?

Now I would like to ask you a few questions about the workshop curricula and the data collection forms.

21. During the workshops you held, did you encounter any problems with the educational materials? (probe: which materials?)

a. What were the most common problems? b. Were the problems/questions different among different demographic groups

(age, education level, language, income, etc).

22. Do you have any ideas for how to improve the education materials? If so, please explain.

23. During each workshop men were supposed to complete 4 forms: a demographic

form, a pre-test of knowledge, a post-test of knowledge, and an evaluation form. Were there any questions that made people uncomfortable? How did you handle this?

B.6

The final set of questions I would like to ask is about submitting data in order to get paid for educating men.

24. Please describe the process you followed for submitting the forms you collected from men to Mathematica (demographic, pre-test, post-test, evaluation forms)?

a. How did you collect and organize the forms after the workshops? b. How did you prepare to submit the forms to Mathematica? Who

submitted the forms? c. Was there any aspect of this process that was challenging? If so, please

explain. d. What would you do differently to improve data collection and submission

to make it easier for you?

25. Would you participate in the project again? h. If no, why not?

26. Is there anything else you want to share about the program, working with Alex,

the training materials, or the workshop itself? Ask about focus groups: recruit 10-12 African American men aged 40+ to participate in a focus group (goal is to have 8-10 show up). Will receive $250 for work recruiting. Men will receive $25 gift card and a meal.

Those are all of the questions I have for you today. Is there anything that I didn’t ask that I should have asked? Do you have any questions for me? As I sort through what you have told me I may think of one or two follow-up questions or points of clarification. If this happens, would you mind if I call you again? Thanks so much for your time.

Focus Group Guide for Community Men attending a Prostate Health Education Session of the Helping You Take Care of Yourself Curricula/Train the Trainer Project

Preparation

As men enter the room

introduce yourself

ask their name and invite them to have refreshments

ask them to complete the post-test and questionnaire before the session begins

Introduction

As I mentioned, my name is ________ and I have ______with me.

We are from Mathematica Policy Research, an independent research company in Princeton, NJ

We were hired by the Massachusetts Department of Public Health to gather information about the prostate health workshop that was offered [name of org].

We are talking with lots of different people involved in the program, including the people who conducted the trainings and men like you who were educated to understand what worked well, and what may need to be changed to improve future workshops. So, in that way, you will help design future workshops.

Everything you say during today’s session will be kept confidential. That means that we will never use your name in our reports or discuss our conversation today with the organizations who trained you. It is important for you to be open and honest. There are no right or wrong answers. We have scheduled about 1 hour for this discussion.

I am giving you a gift certificate [for the local supermarket, or similar store] to show our appreciation for the time you are spending with us today. [pass these around and have them complete sign in sheet/receipt-first names are ok].

Does anyone have any questions?

B.7

My colleague ___________ is going to do his best to take notes as we talk. But as you can imagine, at times it will be difficult to keep up with everything that is said. Therefore, we would like to tape the discussion to make sure we do not miss anything anyone says. This way,_____________ [name of note taker] will be able to listen to the recording and make sure that everything he wrote was accurate. It would be helpful if you could try to speak one at a time, loudly, and clearly. I want to reassure you that no one outside of the Mathematica research team will have access to these tapes and they will be stored in a locked file.

We have a number of topics we want to discuss. At times, I may need to move the conversation along to be sure we cover everything.

Again, there are no right or wrong answers. People may disagree and that’s OK. Please feel free to speak your mind. We want to hear both positive and negative comments, whatever you want to share.

We know that some of these topics can be difficult to discuss, so if you feel more comfortable sharing something in a written form, or discussing this with us after the session, we can do that as well.

**********START TAPE************* ********************************* First, I would like to go around the room and have everyone introduce themselves, just first names. Recruitment 1. How did you find out about the workshop on prostate health?

2. What made you decide to go to the workshop?

3. Was this the first time you attended a workshop on prostate health?

4. Had you received information on prostate health from another person such as a relative, a friend or a healthcare provider?

Content of the Workshop and Quality of Presenter 5. Please tell me about some of the things you learned in the prostate health workshop

you attended through [name organization]?

6. What did you like the most about the workshop?

7. What did you like the least about the workshop?

8. Was there anything you would have liked to learn about that was not included in the workshop? Please explain.

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9. Was the information clear and easy to understand?

10. Was the presenter knowledgeable about prostate health?

11. Did you share the information you learned during the prostate workshop with any of your friends and family? Please explain.

12. Would you tell a friend to go to the workshop? Why/why not?

Outcomes of the Workshop Next I’d like to talk about experiences you have had in going to a healthcare provider to

discuss prostate health or screening for prostate cancer and then to talk about reasons why you may not go.

First:

13. Would anyone like to share an experience they had in going to see a healthcare provider to discuss prostate health, for example, symptoms of an enlarged prostate, or to discuss screening for cancer?

(note: people may say they talked to a doctor, nurse, health educator, patient navigator, case manager or some other professional about prostate health, please keep track of who they talked to)

14. What made you go talk to a healthcare provider?

a. Did you go talk to a healthcare provider before the workshop?

b. How did the workshop influence your decision to go talk to a healthcare provider? Please explain.

15. Did you feel prepared (like you had enough information) to talk with the healthcare provider about prostate health or about getting screened for prostate cancer? Can you explain what made you feel prepared?

16. Is there anything that would have made your visit with the healthcare provider better?

Now let’s talk about not going to a healthcare provider.

17. Would anyone like to share the reasons they have not gone to a healthcare provider to discuss prostate health or screening for prostate cancer? (probe: no perceived risk for getting prostate cancer, don’t believe prostate cancer is that bad, no perceived value of screening, no provider, no insurance, not comfortable with screening tests)

(note: a myth around screening is that if a man screens a man the act is homosexual)

B.9

18. Let’s imagine that you have five minutes to talk to a healthcare provider about prostate health or screening for prostate cancer.

a) What would you ask or want to know? (probe: e.g., whether/when/where to get screened, am I at risk for prostate cancer, how effective is prostate cancer screening for saving lives, the pros and cons of prostate cancer screening, what happens after I am screened and I find out that I have prostate cancer)

b) What would make you feel comfortable talking with a healthcare provider about prostate health or screening for prostate cancer? (probe: reassurance from the healthcare provider about the effectiveness of prostate cancer screening, more knowledge about symptoms to look for)

c) What in particular would make you uncomfortable during a visit?

[If time permits] Forms You were asked to fill out several forms during the workshop. One form asked about your

age, education, and race/ethnicity. Another was a short quiz (like the one you filled out when you walked in today) that you took before and after the workshop. And then you filled out an evaluation form. (show the forms)

19. Did any questions on the forms make you feel uncomfortable? (probe: which questions) If yes, did you tell the presenter? What did they say?

20. How would you make the forms better in the future?

Other. We are almost done. I just have just a few questions left.

21. What other types of health education would be helpful to you?

22. Is there anything else that we haven’t talked about that you want to share?

23. Do you have any questions for me?

(note: please remind men that you are open to talking after the session if anyone wants to talk. If they have health questions, refer them to the CBO. Thank participants.)

B.10

Interview Guide for Springfield Men Community Organization Trainers (Project 6339)

Name of Trainer: Organization: Phone Number: Date of Discussion: Interviewer: Hi, my name is [NAME] and I am with Mathematica Policy Research, Inc. We are working with the Massachusetts Department of Public Health (MDPH) to evaluate the Train the Trainer project, including the Helping You Take Care of Yourself prostate curriculum, data collection forms, and the how the program was incorporated into your organization. As part of the evaluation, we are talking to the staff at CMAHEC, trainers at community organizations who used the prostate curriculum, and men who were educated in the prostate unit. I am hoping to talk with you about your experiences with the project. Your input will help us improve the program. Our conversation should take about an hour. Do you still have time to talk now? [if not, reschedule a time] As we talk today, please keep in mind that you don’t have to answer any questions that

make you uncomfortable. Everything you say will be kept confidential and we will not use your name in our reports.

Before we begin, do you have any questions? The first questions I have are about how you became involved in the Train the Trainer Project. Recruitment

1. How did you find out about the training for the workshops on prostate health?

2. Why did you decide to participate in the training? (probe: part of work requirements, out of interest)

3. Was this the first time you attended a training workshop on prostate health?

4. What experiences, if any, have you had providing health education before you attended the training?

Content and Format of the Trainings 5. Was any of the information presented during the prostate health training given by

Dr. Phil Wood confusing? (probe: was the information clear and easy to understand)

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6. Prostate health is a sensitive topic. Was there anything that made you feel uncomfortable about the training?

7. What did you like the most about the workshop?

8. What did you like the least about the workshop?

9. Did you share the information you learned during the prostate workshop with any of your friends and family? Please explain.

10. Did you feel comfortable leading a workshop on prostate health after attending the training with Dr. Phil Wood? Please explain.

a. If no, what would have helped you to feel better prepared? (probe: were there materials that you would have liked but didn’t have; was there anything you would have liked to learn about that was not included in the workshop)

Participant Experiences Next, I want to talk about the prostate workshops you held for men.

11. How did you recruit men to come to the prostate health workshops you held?

a. Did you have trouble recruiting participants? Please explain.

12. How did the men in your prostate health workshops respond to the information you presented? (probe: what were some of the participants’ reactions, were they comfortable with the topics, were they glad to have the information)?

13. Did the men participate in discussions?

14. Did men talk about what they might do with the information they got during your workshop? What types of things did they say they’d do? (probe: talk to a provider about prostate health, get screened, tell family/friends)

Outcomes of the Workshop I’d like to switch topics now to talk about experiences you have had in going to a healthcare

provider to discuss prostate health or screening for prostate cancer. Then I’d like to talk about reasons why you or other men may not go.

First:

15. Have you ever talked with a healthcare provider about prostate health, for example, symptoms of an enlarged prostate, or to discuss prostate cancer screening?

a. If yes, please tell me about that experience?

b. If no, go to question 22.

B.12

[note: people may say they talked to a doctor, nurse, health educator, patient navigator, case manager or some other professional about prostate health, please keep track of who they talked to]

16. What made you go talk to a healthcare provider?

a. Did you go talk to a healthcare provider before the training?

b. How did the training influence your decision to go talk to a healthcare provider? Please explain.

17. Did you feel prepared (like you had enough information) to talk with the healthcare provider about prostate health or about getting screened for prostate cancer? Can you explain what made you feel prepared?

18. Is there anything that would have made your visit with the healthcare provider better?

Now let’s talk about not going to a healthcare provider.

If he has not talked with a provider:

19. Can you share the reasons you have not gone to a healthcare provider to discuss prostate cancer or screening for prostate cancer? (probe: no perceived risk for getting prostate cancer, don’t believe prostate cancer is that bad, no perceived value of screening, no provider, no insurance, not comfortable with screening tests)

Let’s imagine that you have five minutes to talk to a healthcare provider about prostate health or screening for prostate cancer.

20. What would you ask or want to know? (probe: e.g., whether/when/where to get screened, am I at risk for prostate cancer, how effective is prostate cancer screening for saving lives, the pros and cons of prostate cancer screening, what happens after I am screened and I find out that I have prostate cancer)

21. What would make you feel comfortable talking with a healthcare provider about prostate health or screening for prostate cancer? (probe: reassurance from the healthcare provider about the effectiveness of screening, more knowledge about symptoms to look for)

If he has talked with a provider:

22. Can you share the reasons why you believe that men in your community may not visit a healthcare provider to discuss prostate cancer or screening for prostate cancer? (probe: no perceived risk for getting prostate cancer, don’t believe prostate cancer is that bad, no perceived value of screening, no provider, no insurance, not comfortable with screening tests)

B.13

Let’s imagine that a man in your community had five minutes to talk to a healthcare provider about prostate health or screening for prostate cancer.

23. What do you think he would ask or want to know? (probe: e.g., whether/when/where to get screened, am I at risk for prostate cancer, how effective is prostate cancer screening for saving lives, the pros and cons of prostate cancer screening, what happens after I am screened and I find out that I have prostate cancer)

24. What might make him feel comfortable talking with a healthcare provider about prostate health or screening for prostate cancer? (probe: reassurance from the healthcare provider about the effectiveness of screening, more knowledge about symptoms to look for)

For all men:

25. What in particular would make you uncomfortable during a visit?

Other. We are almost done.

26. Is there anything else that we haven’t talked about that you want to share?

27. Are there any questions I should have asked but didn’t?

28. Do you have any questions for me?

As I sort through what you have told me I may think of one or two follow-up questions or points of clarification. If this happens, would you mind if I call you again?

Thanks so much for your time.

B.14

Name:_______________________

Helping You Take Care of Yourself – Health Education Session Post-test

Prostate Health and Prostate Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree with the statement.

1. Men are more likely to get prostate cancer when they are younger………..……………………………..YES NO

2. Starting at the age of 65, men should start talking to their doctor about testing

for prostate cancer……………………………………………………………..…………………………………………………..YES NO

3. Men of African descent are at high risk for getting prostate cancer……………….……………………….YES NO

4. Difficulty or pain during urination are signs of prostate problems…………………………………………..YES NO

5. PSA test results are typically higher in men with prostate cancer …………………………………………..YES NO

B.15

Additional Questions

6. Before you attended the prostate health workshop through [name of organization] had you ever talked

to a healthcare provider about prostate cancer or screening for prostate cancer?

Yes

If yes, please explain why you decided to talk with a healthcare provider:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

No

If no, please check all the reasons why you did not talk with a healthcare provider:

I didn’t have a provider or regular place to get care I didn’t have insurance or couldn’t afford to see a provider I didn’t think I was at risk for prostate cancer I didn’t think getting prostate cancer was that bad I didn’t think getting screened for prostate cancer was worthwhile I didn’t feel comfortable talking about this with a provider Other (please explain):_____________________________________________________

7. Before you attended the prostate health workshop through [name of organization] were you ever screened for prostate cancer?

Yes

If yes, how did you make the decision to get screened for prostate cancer?

I made the decision myself My health care provider made the decision for me My health care provider and I made the decision together Other people made the decision for me (specify who: __________________ )

No

If no, what were your reasons for not getting screened before the workshop (check all that apply)?

B.16

I didn’t have a provider or regular place to get care I didn’t have insurance or couldn’t afford to see a provider I didn’t know where to go to get screened I didn’t think it was important to get screened I didn’t feel comfortable getting screened I didn’t want to find out the screening results Other (please explain):_____________________________________________________

8. After you attended the prostate health workshop through [name of organization] did you talk to a healthcare provider about prostate cancer or screening for prostate cancer?

Yes

If yes, please explain why you decided to talk with a healthcare provider:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

No

If no, please check all the reasons why you decided not to talk with a healthcare provider:

I didn’t have a provider or regular place to get care I didn’t have insurance or couldn’t afford to see a provider I didn’t think I was at risk for prostate cancer I didn’t think getting prostate cancer was that bad I didn’t think getting screened for prostate cancer was worthwhile I didn’t feel comfortable talking about this with a provider Other (please explain):_____________________________________________________

9. After you attended the prostate health workshop through [name of organization] were you screened for prostate cancer?

Yes

If yes, how did you make the decision to get screened for prostate cancer?

I made the decision myself My health care provider made the decision for me My health care provider and I made the decision together Other people made the decision for me (specify who: __________________ )

No

If no, what were your reasons for not getting screened after the workshop (check all that apply)?

B.17

I didn’t have a provider or regular place to get care I didn’t have insurance or couldn’t afford to see a provider I didn’t think I was at risk for prostate cancer I didn’t think getting prostate cancer was that bad I didn’t think getting screened for prostate cancer was worthwhile I didn’t feel comfortable getting screened I didn’t want to find out the screening results Other (please explain):_____________________________________________________

Thank you for your time!

B.18

Interview Guide for CMAHEC (Project 6339)

CBO Recruitment

1. How did you recruit or bring CBOs on board?

a. What were the successes/challenges to the approach?

b. What would you do differently in the future?

2. When CBOs applied to be part of the project did they state who would be

carrying out the education?

a. If yes, how did you consider previous health education experience in

selecting CBOs?

3. How important do you think previous health education experience is in

successfully carrying out the workshops?

4. What problems arose in working with CBOs (e.g., getting them to reach

targets, not speaking to right person at the org)

Training

5. In speaking with CBO trainers it seems people entered the training with

varying levels of knowledge. How did the training handle these different

knowledge bases (if at all)?

a. Did you observe differences in knowledge by CBO type (e.g., church

vs. health center)?

b. Would you do any differently to address differences in knowledge

during trainings in the future (probe: different trainings)?

6. What were trainers taught about how to collect the information on the forms.

For example, were they taught to walk through the questions, to put the

questions up on the screen and read them, or to hand out the forms and

then answer questions as they arose?

7. How did the training address the content of the forms (in particular, the demographics form)? For example, were the questions reviewed one by one?

8. What feedback did people give about the training?

9. How would you improve the training process?

10. What feedback did people give about the materials/curricula?

11. How would you improve the materials/curricula?

B.19

Contact with CBOs

12. After the trainings, what types of things did CBOs contact you about? (probe:

get more forms, problems with form translation, recruitment advice)

13. Did this vary by any factors such as previous relationships with the CBO or

trainer or with the trainer's previous health education experience?

14. Did you attend any of the workshops held by CBOs? Please describe

15. Do you have anything else to add about the recruiting process, training

process, the materials, or the program in general?

B.20

APPENDIX C

SOLICITATION FOR APPLICATIONS

C.3

Solicitation for Applications for The Community Train the Trainer Project FY09 - FY10

on behalf of the Massachusetts Department of Public Health

1. Contact Information:

Application Contact Person: Joanne L. Calista Title: The Community Train the Trainer Project

Address: Central Massachusetts Area Health Education Center, Inc.

35 Harvard Street, Suite 300 Worcester, MA 01609

Telephone: 508-756-6676 Ext. 10

Email: [email protected]

The Massachusetts Department of Public Health’s (MDPH) Women’s Health Network (WHN), Men’s Health Partnership (MHP) and the Massachusetts Comprehensive Cancer Prevention and Control Program (MCCPCP) are seeking community based organizations to provide health education sessions to community members utilizing the Helping You Take Care of Yourself Curriculum that focuses on breast, cervical, prostate, cardiovascular, and colorectal health. Over the course of FY10 (July 2009 through June 2010), approximately $240,000 will be paid to community based organizations across Massachusetts to provide community health education to women and men aged 40 to 64 from priority populations through trained Community Health Workers (CHWs). 2. Project Background The Women’s Health Network, in collaboration with the Men’s Health Partnership and the Massachusetts Comprehensive Cancer Control and Prevention Program developed the Helping You Take Care of Yourself Curriculum to address the need for accurate, appropriate and current information about women’s and men’s health issues in diverse communities across the Commonwealth. This curriculum consists of units about Breast Health, Cervical Health, Prostate Health, Cardiovascular Health and Colorectal Health. Recognizing the diversity of languages, cultures, literacy and education levels throughout Massachusetts, the curriculum is available in several languages including English, Portuguese and Spanish and provides several options for presenting the health units (e.g., PowerPoint presentations, flipcharts, models, etc.). Developed as a “train the trainer” model, the Helping You Take Care of Yourself Curriculum was designed to train Community Health Workers, employed by community based organizations, on women’s


C.4

and men’s health topics, with the intention that the CHWs would, in turn, educate their communities about these issues. 3. FY09 - FY10 Project Through this application process, community based organizations (CBOs) will be selected to train community members, (of the priority populations identified on pages 11 and 12 of this application), in the areas of breast, cervical, prostate, cardiovascular, and colorectal health. The MDPH has contracted with the Central Massachusetts Area Health Education Center, Inc. to train the CHWs employed by qualifying CBOs, to educate community members in one or more of these identified health topics. Please refer to the MDPH definition of a Community Health Worker in Appendix A of this application. 4. Program Requirements Community based organizations selected through this application process will agree to the following:

• Sign a Memorandum of Understanding (MOU) with Mathematica Policy Research, Inc. Mathematica Policy Research, Inc. has been contracted by MDPH to establish the Memoranda of Understanding with each of the qualifying CBOs to collect project data, to process payment to the CBOs, and to maintain and analyze the data collected by this project. The MOU will include denotation of the following:

o Terms of agreement, including: The start and end date of the MOU.

o Scope of Work and Payment, including: The number of community members in the selected

population(s) the CBO has agreed to educate; The health topic(s) that will be covered for each population; The maximum amount of funding from Mathematica Policy

Research, Inc.; The time frame in which the trainings will be conducted; Requirements for scheduling training and tracking participants; Requirements for receiving payment.

o Points of contact.

• Send Community Health Worker(s), who are employees of the CBO, to a two-four day curriculum training (the length of the training depends upon the number of health topics for which the CBO proposes to educate.) and any follow-up or refresher trainings as determined necessary, by MDPH, during the course of this


C.5

project. The trainings will be conducted by the Central Massachusetts Area Health Education Center, Inc. at locations throughout the Commonwealth.

• Hold educational sessions for groups of community members about breast, cervical, prostate, cardiovascular, and/or colorectal health, conducted by the Community Health Worker(s) trained through this initiative, for the designated groups of women and/or men in their community for which they have been approved through this application process and is described in their Memorandum of Understanding with Mathematica Policy Research, Inc. Community members cannot be educated in more than two topics in a given day.

• Provide a completed packet of data forms to Mathematica Policy Research, Inc.

for each community member trained. The packet of data forms include the following:

o Demographic sheet; o Pre-test; o Post-test; o Evaluation.

5. Reimbursement: Community based organizations selected through this application will be provided payment of $30 for a completed packet of the 4 forms listed above for each educated community member as delineated in the Memorandum of Understanding with Mathematica Policy Research, Inc. If a community member is educated in more than one unit, the CBO will be paid $30 for each unit of education for which they submit completed packets of forms. For instance, if a community member is educated in breast and cervical health units and has two completed sets of forms, the CBO will be paid $60. Community participants cannot be educated in more than two units in a given day.


C.6

6. Project Application and Instructions for Submission of Responses:

Application: • Complete the required application coversheet Sections A and B found on pages

6 and 7 of this solicitation. • Write a project narrative answering questions 1 – 10 outlined on pages 8 and 9.

Using single spaced standard 12 point font, please do not exceed 9 pages (including the coversheet pages).

Submission:

• Submit an original application with 6 copies. • Faxed applications are NOT acceptable. • Applications may be submitted anytime during the application period. • Applications submitted after the deadline will not be reviewed.

Responses must be submitted to:

Central Massachusetts Area Health Education Center, Inc. 35 Harvard Street, Suite 300 Worcester, MA 01609 Attn: Joanne L. Calista

Deadline for Responses Deadline Date: May 4, 2009 Deadline Time: 12:00 pm (noon)

Proposals must be received at the address above by the deadline date and time. Evaluation:

Proposals will be evaluated based on the applicant’s project narrative and the need of the population they plan to educate.

Preference will be given to applications containing the following elements: • Demonstrated experience working with CHWs; • Demonstrated experience providing health education to community members; • Demonstrated experience working with the specific priority populations the

applicant proposes to work; • Demonstrated organizational capacity to complete all project activities, including

data collection requirements.

In an effort to ensure that an equitable representation of populations will be educated across all geographic regions of the Commonwealth, applicants may not be awarded the full capacity (number of community members to be educated) they request.


C.7

For selected applicants, the number, populations, and geographic regions identified in your proposal will be specified in your Award Notification and subsequent Memorandum of Understanding (MOU) established with Mathematica Policy Research, Inc.

For a timeline of the application process and project implementation, please see Appendix C on page 13.


C.8

Solicitation for Applications for The Community Train the Trainer Project FY09 - FY10

on behalf of the Massachusetts Department of Public Health

Section A In the section below, please provide us with your organization’s contact information. Name and address of Organization: Tax ID Number (TIN): Name of organization’s authorized signatory: Phone number: Email address: Name of project contact person: Phone number: Email address: Section B In the tables found on page 6 of this solicitation, please list with which target population(s) you would be interested in working (Who and Where columns). Please refer to Appendix B for guidelines in identifying underserved populations. Additionally, estimate the number of women and/or men from each group your organization could realistically educate in a 10 month period. Please indicate on which health topics you plan to educate these communities. Who Who is the target population you will be educating? What is their gender, race/ethnicity, nationality, language, rural/ urban, etc? Where What cities/towns do they live in? Health Topics Breast Health / Cancer Cervical Health / Cancer Prostate Health / Cancer Colorectal Health / Cancer Cardiovascular Health / Disease


C.9

Community Women to be Educated

Community Men to be Educated

Who Where

Health Topic

# of Women

1.

2.

3.

4.

5.

Who Where Health Topic # of Men 1.

2.

3.

4.

5.


C.10

Project Narrative: (Questions 1-10: Please do not exceed 7 pages single spaced 12 point font.):

1) Describe how the proposed program will link with the mission statement for your agency. Attach a copy of your agency’s current mission statement.

2) Describe your organization’s experience working with and/or conducting outreach or education to the priority population(s) you have proposed to educate.

3) If you have proposed to educate a population(s) that is not listed as an MDPH-designated priority population in Appendix B, please describe why this group is underserved and in need of community health education.

4) Describe your organization’s experience providing health related education or training.

5) Describe your organization’s experience employing and/or working with Community Health Workers.

6) Please identify the Community Health Worker(s), employed, or who are contracted by your organization, who would be conducting the activities of this initiative. Note: If you will be utilizing more than one CHW in this initiative, please complete the following information for EACH CHW:

Name: ____________________________ %FTE_____________ CHW experience working with the identified Priority Population(s):

CHW language capacity working with this Priority Population(s):

Prior Training Received: (Please list all relevant trainings in which this CHW participated):

Is this CHW a graduate of any of the following training programs?

• The Boston Public Health Commission’s Community Health Education Center (CHEC) Yes________ No_______ Year Completed ______

• The Lowell Community Health Center’s Community Health Education Center (CHEC) Yes________ No_______ Year Completed ______

• The Central Massachusetts Area Health Education Center’s Outreach Worker Training

Institute (OWTI) Yes________ No_______ Year Completed ______

• OWTI/ MDPH Care Coordination Patient Navigation Training? Yes________ No_________ Year Completed ______

• Other CHW training program? Name of program:_______________________ Yes________ No_________ Year Completed ______


C.11

• Other CHW training program? Name of program:_______________________

Yes________ No_________ Year Completed ______

If this CHW is not an employee of your organization, please indicate in what capacity and length of time that your organization has worked with this CHW:

7) Describe your organization’s experience working with the Women’s Health Network,

Men’s Health Partnership and/or the Massachusetts Comprehensive Cancer Prevention and Control Program.

8) Describe how your organization will implement this project. Please include a

description of how you will recruit community members to attend the education sessions and in which language(s) you will hold the sessions, and a timeline for implementation.

9) Describe your plan to ensure the quality of the educational sessions.

10) What are the challenges that your organization anticipates in conducting this

educational initiative? How do you plan to overcome these challenges? Supporting Information (required): Please attach a copy of your organization’s Form 990 or most recent audited financial statement.


C.12

Appendix A. Community Health Worker (CHW) Definition A CHW is a public health outreach professional who applies his or her unique understanding of the experience, language and/or culture of the populations he or she serves in order to carry out at least one of the following roles:

• bridging/culturally mediating between individuals, communities and health and human services, including actively building individual and community capacity;

• providing culturally appropriate health education and information; • assuring that people get the services they need; • providing direct services, including informal counseling and social support; and • advocating for individual and community needs.1

1 Community Health Worker Task Force. (April 2002). Policy Statement on Community Health Workers. Massachusetts, Massachusetts Department of Public Health


C.13

Appendix B. Priority Populations MDPH has identified the following priority populations, by geographic regions, listed below. The priority populations are based upon statewide surveillance and reporting.2 Although we have identified the following populations, representing specific ethnic and racial groups, we recognize that your organization may work with additional underserved and in need populations not specifically identified below. These groups could potentially include additional racial/ethnic groups, persons living in isolated rural geographic areas, and/or persons who face specific occupational, behavioral, or socioeconomic factors related to breast, cervical, prostate, colorectal cancers and/or cardiovascular disease. The review committee welcomes applications from entities that work with any of these additional populations. Geographic Regions and Priority Populations Men and Women ages 40 – 64 Boston Region

• Asian • Black, non-Hispanic • Hispanic • Portuguese-speaking

Central Region

• Asian – Worcester • Black, non-Hispanic – Worcester • Hispanic – Worcester, Southbridge, Fitchburg and Milford • Portuguese-speaking – Worcester and Milford

Metrowest Region

• Asian – Quincy • Black, non-Hispanic – Cambridge • Hispanic – Cambridge, Framingham, Somerville and Waltham • Portuguese-speaking – Framingham, Cambridge and Somerville

Northeast Region • Asian – Lowell, Lynn, and Malden • Black, non-Hispanic – Lowell, Lynn and Medford • Hispanic – Lawrence, Methuen, Lynn, Salem and Peabody • Portuguese-speaking – Lowell, Lynn and Gloucester

2 Cancer Incidence and Mortality in Massachusetts, 2001-2005: Statewide Report and Cancer in Massachusetts by Race Ethnicity, 2004-2004


C.14

Southeast Region

• Asian – Attleboro, Fall River and New Bedford • Black, non-Hispanic – Brockton • Hispanic – Brockton, Attleboro, Fall River and New Bedford • Portuguese-speaking – Fall River, New Bedford, Cape Cod and the Islands

Western Region

• Asian – Springfield • Black, non-Hispanic – Springfield • Hispanic – Holyoke, Springfield, Northampton/Amherst, and Pittsfield • Rural – Ware/Palmer, Greater Greenfield, North Quabin, Great Barrington,

Pittsfield, North Adams, Williamsburgh, Worthington, Cummington and Chesterfield


C.15

Appendix C. Approximate Project Timeline (subject to change)

CHW- Community Health Worker CM AHEC – Central Massachusetts Area Health Education Center, Inc. CBO – Community Based Organization MDPH – Massachusetts Department of Public Health MOU – Memorandum of Understanding MPR – Mathematic Policy Research, Inc.

Activity Time Frame Responsible Parties Solicitation Released April 14, 2009 CM AHEC Solicitation Responses Due

May 4, 2009 CBOs

CBOs Selected May 18, 2009 MDPH/ CM AHEC MOU drafted, with numbers of trainees, priority populations, and geographic regions specified

May 18 – 29, 2009 MPR

MOUs Signed May 18-June 5, 2009 CBOs Trainings for Community Health Workers employed by the CBOs conducted

June 5 – June 30, 2009 (Training will be offered in two-three regions in MA.) Additional trainings will be held in FY 10.

CBOs and CM AHEC

CHWs Conduct Trainings as described in MOU

Upon completion of CM AHEC training, through May 2010.

CBOs

MDPH Train the Trainer Data Forms submitted to MPR for each participant trained

On a rolling basis (within 30 days of completion of education sessions) through April, 2010.

CBOs

CBOs receive payment for participants trained

Quarterly through May, 2010 (upon submission of completed data to Mathematica)

MPR


.

APPENDIX D

DEMOGRAPHIC CHARACTERISTICS OF WORKSHOP PARTICIPANTS, BY REGION OF TRAINING

Evaluation of the H

elping You Take Care of Y

ourself Curriculum 2009-2010

Mathematica Policy Research


D.3

Dem

og

rap

hic

Ch

ara

cteri

stic

s o

f W

ork

sho

p P

art

icip

an

ts, b

y R

eg

ion

of

Tra

inin

g

Bo

ston

(n =

450

) Ce

ntra

l

(n =

576

) M

etro

wes

t

(n

= 4

82)

Nor

thea

st

(n =

288

) So

uthe

ast

(n =

561

) W

est

(n

= 4

49)

Char

acte

ristic

s n

% n

% n

% n

% n

% n

% G

en

der

Mal

e 18

8 41

.8

340

59.0

19

5 40

.5

93

32.3

23

2 41

.4

203

45.2

Fe

mal

e 26

1 58

.0

236

41.0

28

2 58

.5

194

67.4

32

7 58

.3

246

54.8

Un

know

n 1

0.2

0 0.

0 5

1.0

1 0.

3 2

0.4

0 0.

0

Ag

e

Unde

r 40

13

1 29

.1

93

16.1

13

2 27

.4

25

8.7

74

13.2

42

9.

4 40

-64

289

64.2

45

9 79

.7

294

61.0

24

6 85

.4

355

63.3

30

8 68

.6

65 a

nd o

ver

27

6.0

19

3.3

46

9.5

8 2.

8 12

1 21

.6

97

21.6

Un

know

n 3

0.7

5 0.

9 10

2.

1 9

3.1

11

2.0

2 0.

4

Race

/Eth

nic

ity

Whi

te

27

6.0

52

9.0

65

13.5

18

6.

3 13

4 23

.9

114

25.4

Bl

ack

89

19.8

27

1 47

.0

116

24.1

0

0.0

162

28.9

13

2 29

.4

Asia

n 5

1.1

81

14.1

28

5.

8 0

0.0

2 0.

4 30

6.

7 H

ispa

nic

310

68.9

14

6 25

.3

225

46.7

26

1 90

.6

113

20.1

15

3 34

.1

Oth

er

14

3.1

16

2.8

36

7.5

0 0.

0 13

3 23

.7

15

3.3

Unkn

own

5 1.

1 10

1.

7 12

2.

5 9

3.1

17

3.0

5 1.

1

Fo

rm L

an

gu

ag

e

Engl

ish

144

32.0

47

5 82

.5

238

49.4

9

3.1

264

47.1

30

9 68

.8

Span

ish

306

68.0

98

17

.0

59

12.2

23

9 83

.0

37

6.6

140

31.2

Po

rtug

uese

0

0.0

3 0.

5 18

5 38

.4

40

13.9

26

0 46

.3

0 0.

0

Co

un

try o

f Bir

th

Born

in U

SA

99

22.0

18

4 31

.9

99

20.5

24

8.

3 11

5 20

.5

253

56.3

Bo

rn in

US

Terr

itorie

s 11

0 24

.4

60

10.4

24

5.

0 32

11

.1

44

7.8

119

26.5

Fo

reig

n 19

0 42

.2

270

46.9

2

87

59.5

1

97

68.

4 3

10

55.3

57

12

.7

< 1

yea

r in

US

8

4.2

8 3

.0

4 1.

4 10

5.

1 5

1.6

1

1.8

1-5

year

s in

US

38

20

.0

22

8.2

35

12.2

25

12

.7

26

8.4

6

10.5

>

5 y

ears

in

US

90

47.4

13

3 49

.3

144

50.2

13

5 68

.5

106

34.2

35

61

.4

Unkn

own

num

ber

of

year

s in

US

54

28.4

10

7 39

.6

104

36.2

27

13

.7

173

55.8

15

26

.3

Unkn

own

51

11.3

62

10.8

72

14

.9

35

12.

2 92

16

.4

20

4.5


D.4

Bo

ston

(n =

450

) Ce

ntra

l

(n =

576

) M

etro

wes

t

(n

= 4

82)

Nor

thea

st

(n =

288

) So

uthe

ast

(n =

561

) W

est

(n

= 4

49)

Char

acte

ristic

s n

% n

% n

% n

% n

% n

% H

ealt

h

Insu

ran

ce

Yes

415

92.2

45

5 79

.0

396

82.2

24

0 83

.3

495

88.2

42

3 94

.2

No

12

2.7

99

17.2

60

12

.4

33

11.5

35

6.

2 7

1.6

Unkn

own

23

5.1

22

3.8

26

5.4

15

5.2

31

5.5

19

4.2

Ed

uca

tio

n

Less

than

hig

h sc

hool

15

3 34

.0

181

31.4

14

4 29

.9

121

42.0

28

8 51

.3

107

23.8

H

igh

scho

ol o

r eq

uiva

lent

11

7 26

.0

175

30.4

14

5 30

.1

65

22.6

12

1 21

.6

118

26.3

Tr

aini

ng

prog

ram

17

3.

8 45

7.

8 17

3.

5 8

2.8

36

6.4

18

4.0

Colle

ge

147

32.7

14

8 25

.7

157

32.6

80

27

.8

90

16.0

19

5 43

.4

Oth

er

8 1.

8 12

2.

1 5

1.0

4 1.

4 5

0.9

5 1.

1 Un

know

n 8

1.8

15

2.6

14

2.9

10

3.5

21

3.7

6 1.

3 So

urce

: An

alys

is o

f dat

a co

llect

ed fr

om w

orks

hop

part

icip

ants

APPENDIX E

DEMOGRAPHIC CHARACTERISTICS OF WORKSHOP PARTICIPANTS, BY HEALTH UNIT

Evaluation of the H

elping You Take Care of Y

ourself Curriculum 2009-2010

Mathematica Policy Research


E.3

Dem

og

rap

hic

Ch

ara

cteri

stic

s o

f W

ork

sho

p P

art

icip

an

ts b

y H

ealt

h U

nit

Br

east

Hea

lth

Cerv

ical

Hea

lth

Card

iova

scul

ar H

ealth

Co

lore

ctal

Hea

lth

Pros

tate

Hea

lth

n %

n %

n %

n %

n %

T

ota

l 85

1 10

0.0

654

100.

0 13

82

100.

0 82

1 10

0.0

909

100.

0

Gen

der

Mal

e n.

a.

n.a.

n.

a.

n.a.

53

3 38

.6

351

42.8

90

9 10

0.0

Fem

ale

851

100.

0 65

4 10

0.0

841

60.9

46

5 56

.6

n.a.

n.

a.

Unkn

own

n.a.

n.

a.

n.a.

n.

a.

8 0.

6 5

0.6

n.a.

n.

a.

A

ge

Unde

r 40

13

8 16

.2

95

14.5

25

7 18

.6

142

17.3

14

3 15

.7

40-6

4 58

2 68

.4

457

69.9

93

3 67

.5

608

74.1

68

0 74

.8

65 a

nd o

ver

120

14.1

93

14

.2

173

12.5

60

7.

3 71

7.

8 Un

know

n 11

1.

3 9

1.4

19

1.4

11

1.3

15

1.7

R

ace

/Eth

nic

ity

Whi

te

118

13.9

87

13

.3

271

19.6

14

4 17

.5

79

8.7

Blac

k 13

8 16

.2

113

17.3

22

9 16

.6

96

11.7

46

8 51

.5

Asia

n 71

8.

3 63

9.

6 83

6.

0 73

8.

9 20

2.

2 H

ispa

nic

451

53.0

31

9 48

.8

699

50.6

41

1 50

.1

234

25.7

O

ther

55

6.

5 56

8.

6 76

5.

5 84

10

.2

85

9.4

Refu

sed/

Unkn

ow

n 18

2.

1 16

2.

4 24

1.

7 13

1.

6 23

2.

5

Fo

rm l

an

gu

ag

e

Engl

ish

381

44.8

30

0 45

.9

597

43.2

30

1 36

.7

631

69.4

Sp

anis

h 30

1 35

.4

192

29.4

45

6 33

.0

332

40.4

16

6 18

.3

Port

ugue

se

169

19.9

16

2 24

.8

329

23.8

18

8 22

.9

112

12.3

Co

un

try o

f Bir

th

Born

in U

SA

158

18.6

10

9 16

.7

291

21.1

16

3 19

.9

375

41.3

Bo

rn in

US

Terr

itorie

s 15

5 18

.2

93

14.2

20

0 14

.5

99

12.1

94

10

.3

Fore

ign

437

51.4

37

8 57

.8

754

54.6

4

88

59.4

3

12

34.

3 <

1 Y

ear

in U

S 10

2.

3 4

1.1

18

2.4

13

2.7

13

4.2

1-5

Year

s in

US

47

10

.8

39

10.3

83

11

.0

59

12.

1 43

13

.8

Mor

e th

an 5

ye

ars

in U

S 21

7 49

.7

182

48.

2 37

0 49

.1

240

49.2

16

4 52

.6

Unkn

own

leng

th o

f tim

e sp

ent i

n US

16

3 37

.3

153

40.5

2

83

37.5

17

6 36

.1

92

29.5


E.4

Br

east

Hea

lth

Cerv

ical

Hea

lth

Card

iova

scul

ar H

ealth

Co

lore

ctal

Hea

lth

Pros

tate

Hea

lth

n %

n %

n %

n %

n %

Unkn

own

101

11.9

7

4 11

.3

137

9.9

71

8

.7

128

14.1

Healt

h i

nsu

ran

ce

Yes

763

89.7

60

0 91

.7

1221

88

.4

732

89.2

71

1 78

.2

No

44

5.2

30

4.6

114

8.2

59

7.2

142

15.6

Un

know

n 44

5.

2 24

3.

7 47

3.

4 30

3.

7 56

6.

2

Ed

uca

tio

n

Less

than

hig

h sc

hool

37

9 44

.5

306

46.8

51

6 37

.3

334

40.7

24

8 27

.3

Hig

h sc

hool

or

equi

vale

nt

202

23.7

14

2 21

.7

379

27.4

22

3 27

.2

273

30.0

Tr

aini

ng

prog

ram

33

3.

9 33

5.

0 64

4.

6 42

5.

1 53

5.

8 Co

llege

19

9 23

.4

150

22.9

37

5 27

.1

195

23.8

29

2 32

.1

Oth

er

14

1.6

5 0.

8 16

1.

2 9

1.1

14

1.5

Unkn

own

24

2.8

18

2.8

32

2.3

18

2.2

29

3.2

Sour

ce:

Anal

ysis

of d

ata

colle

cted

from

wor

ksho

p pa

rtic

ipan

ts

n.a.

= n

ot a

pplic

able

APPENDIX F

PRE- AND POSTTEST KNOWLEDGE BY QUESTION AND BY GENDER, AGE, RACE/ETHNICITY, AND EDUCATION


F.3

Pre

test

an

d P

ost

test

Kn

ow

led

ge b

y G

en

der

Br

east

Can

cer

Cerv

ical

Can

cer

Card

iova

scul

ar H

ealth

Pr

etes

t (N

= 8

40)

Post

test

(N

= 8

43)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

641

) Po

stte

st

(N =

643

) %

with

In

crea

sed

Scor

e

Pret

est

(N =

1,3

40)

Post

test

(N

= 1

,361

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

% A

nsw

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

Questi

on 1

To

tal

68

1

81

.1

81

1

96

.2

18

.7

49

5

77

.0

61

3

95

.6

24

.2

49

7

37

.1

11

34

8

3.3

1

24

.6

Gen

der

M

ale

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

198

38.7

42

0 80

.3

107.

3 Fe

mal

e 68

1 81

.1

811

96.2

18

.7

495

77.0

61

3 95

.6

24.2

29

7 36

.1

707

85.2

13

6.0

Unkn

own

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

2 33

.3

7 87

.5

162.

5

Questi

on 2

To

tal

78

7

93

.7

82

5

97

.9

4.5

4

79

7

4.5

5

85

9

1.3

2

2.5

1

26

9

94

.7

13

06

9

6.0

1

.3

Gen

der

M

ale

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

483

94.5

49

1 93

.9

-0.7

Fe

mal

e 78

7 93

.7

825

97.9

4.

5 47

9 74

.5

585

91.3

22

.5

781

94.9

80

7 97

.2

2.5

Unkn

own

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

5 83

.3

8 10

0.0

20.0

Questi

on 3

To

tal

69

1

82

.3

79

5

94

.3

14

.6

54

5

84

.8

61

3

95

.6

12

.8

12

52

9

3.4

1

31

3

96

.5

3.3

Gen

der

M

ale

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

472

92.4

49

3 94

.3

2.1

Fem

ale

691

82.3

79

5 94

.3

14.6

54

5 84

.8

613

95.6

12

.8

776

94.3

81

2 97

.8

3.8

Unkn

own

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

4 66

.7

8 10

0.0

50.0

Questi

on 4

To

tal

62

8

74

.8

76

6

90

.9

21

.5

37

8

58

.8

58

1

90

.6

54

.2

12

91

9

6.3

1

29

1

94

.9

-1

.5

Gen

der

M

ale

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

488

95.5

50

6 96

.7

1.3

Fem

ale

628

74.8

76

6 90

.9

21.5

37

8 58

.8

581

90.6

54

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797

96.8

77

7 93

.6

-3.3

Un

know

n n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

6

100.

0 8

100.

0 0.

0

Questi

on 5

To

tal

48

0

57

.1

67

0

79

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39

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40

7

63

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56

2

87

.7

38

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12

42

9

2.7

1

30

4

95

.8

3.4

Gen

der

M

ale

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

463

90.6

48

8 93

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3.0

Fem

ale

480

57.1

67

0 79

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39.1

40

7 63

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562

87.7

38

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774

94.0

80

8 97

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3.5

Unkn

own

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

n.a.

n.

a.

5 83

.3

8 10

0.0

20.0

So

urce

: An

alys

is o

f dat

a co

llect

ed fr

om w

orks

hop

part

icip

ants

n.a.

= n

ot a

pplic

able


F.4

Pre

test

an

d P

ost

test

Kn

ow

led

ge b

y G

en

der

(co

nti

nu

ed

)

Co

lore

ctal

Can

cer

Pros

tate

Can

cer

Pr

etes

t (N

= 7

91)

Post

test

(N

= 8

12)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

889

) Po

stte

st

(N =

883

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

Quest

ion 1

T

ota

l 6

05

7

6.5

7

69

9

4.7

2

3.8

7

00

7

8.7

7

85

8

8.9

1

2.9

Gen

der

Mal

e 25

3 74

.6

328

94.5

26

.7

700

78.7

78

5 88

.9

12.9

Fe

mal

e 34

9 77

.9

436

94.8

21

.7

n.a.

n.

a.

n.a.

n.

a.

n.a.

Un

know

n 3

75.0

5

100.

0 33

.3

n.a.

n.

a.

n.a.

n.

a.

n.a.

Quest

ion 2

T

ota

l 3

14

3

9.7

6

69

8

2.4

1

07

.5

45

9

51

.6

62

4

70

.7

36

.9

Gen

der

Mal

e 13

9 41

.0

275

79.3

93

.3

459

51.6

62

4 70

.7

36.9

Fe

mal

e 17

4 38

.8

390

84.8

11

8.3

n.a.

n.

a.

n.a.

n.

a.

n.a.

Un

know

n 1

25.0

4

80.0

22

0.0

n.a.

n.

a.

n.a.

n.

a.

n.a.

Quest

ion 3

T

ota

l 6

41

8

1.0

7

77

9

5.7

1

8.1

7

00

7

8.7

8

43

9

5.5

2

1.2

Gen

der

Mal

e 26

5 78

.2

327

94.2

20

.6

700

78.7

84

3 95

.5

21.2

Fe

mal

e 37

2 83

.0

445

96.7

16

.5

n.a.

n.

a.

n.a.

n.

a.

n.a.

Un

know

n 4

100.

0 5

100.

0 0.

0 n.

a.

n.a.

n.

a.

n.a.

n.

a.

Quest

ion 4

T

ota

l 6

36

8

0.4

7

12

8

7.7

9

.1

67

5

75

.9

75

5

85

.5

12

.6

Gen

der

Mal

e 26

2 77

.3

298

85.9

11

.1

675

75.9

75

5 85

.5

12.6

Fe

mal

e 37

1 82

.8

410

89.1

7.

6 n.

a.

n.a.

n.

a.

n.a.

n.

a.

Unkn

own

3 75

.0

4 80

.0

6.7

n.a.

n.

a.

n.a.

n.

a.

n.a.

Quest

ion 5

T

ota

l 4

30

5

4.4

6

69

8

2.4

5

1.6

6

63

7

4.6

8

10

9

1.7

2

3.0

Gen

der

Mal

e 18

4 54

.3

260

74.9

38

.0

663

74.6

81

0 91

.7

23.0

Fe

mal

e 24

4 54

.5

405

88.0

61

.7

n.a.

n.

a.

n.a.

n.

a.

n.a.

Un

know

n 2

50.0

4

80.0

60

.0

n.a.

n.

a.

n.a.

n.

a.

n.a.

So

urce

: An

alys

is o

f dat

a co

llect

ed fr

om w

orks

hop

part

icip

ants

n.a.

= n

ot a

pplic

able


F.5

Pre

test

an

d P

ost

test

Kn

ow

led

ge b

y A

ge

Br

east

Can

cer

Cerv

ical

Can

cer

Card

iova

scul

ar H

ealth

Pr

etes

t (N

= 8

40)

Post

test

(N

= 8

43)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

641

) Po

stte

st

(N =

643

) %

with

In

crea

sed

Scor

e

Pret

est

(N =

1,3

40)

Post

test

(N

= 1

,361

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

Quest

ion 1

Tota

l 6

81

8

1.1

8

11

9

6.2

1

8.7

4

95

7

7.0

6

13

9

5.6

2

4.2

4

97

3

7.1

1

13

4

83

.3

12

4.6

Ag

e

Unde

r 40

125

91.9

13

6 98

.6

7.2

82

87.2

89

97

.8

12.1

95

37

.3

207

80.9

11

7.0

40-6

4 46

8 81

.1

554

96.0

18

.4

355

78.9

42

9 95

.3

20.8

33

2 36

.9

766

83.5

12

6.4

65 a

nd o

ver

80

67.8

11

1 94

.1

38.8

52

56

.5

87

94.6

67

.3

60

35.5

14

5 85

.3

140.

2 Un

know

n 8

88.9

10

10

0.0

12.5

6

85.7

8

100.

0 16

.7

10

62.5

16

88

.9

42.2

Quest

ion 2

Tota

l 7

87

9

3.7

8

25

9

7.9

4

.5

47

9

74

.5

58

5

91

.3

22

.5

12

69

9

4.7

1

30

6

96

.0

1.3

Ag

e

Unde

r 40

130

95.6

13

6 98

.6

3.1

71

75.5

82

90

.1

19.3

24

1 94

.5

249

97.3

2.

9 40

-64

541

93.8

56

4 97

.7

4.3

338

75.1

41

6 92

.4

23.1

85

3 94

.8

873

95.2

0.

4 65

and

ove

r 10

7 90

.7

115

97.5

7.

5 66

71

.7

79

85.9

19

.7

162

95.9

16

6 97

.6

1.9

Unkn

own

9 10

0.0

10

100.

0 0.

0 4

57.1

8

100.

0 75

.0

13

81.3

18

10

0.0

23.1

Quest

ion 3

Tota

l 6

91

8

2.3

7

95

9

4.3

1

4.6

5

45

8

4.8

6

13

9

5.6

1

2.8

1

25

2

93

.4

13

13

9

6.5

3

.3

Age

Un

der 4

0 12

5 91

.9

134

97.1

5.

6 86

91

.5

86

94.5

3.

3 23

9 93

.7

249

97.3

3.

8 40

-64

468

81.1

54

0 93

.6

15.4

37

7 83

.8

438

97.3

16

.2

838

93.1

88

1 96

.1

3.2

65 a

nd o

ver

90

76.3

11

1 94

.1

23.3

77

83

.7

81

88.0

5.

2 16

1 95

.3

165

97.1

1.

9 Un

know

n 8

88.9

10

10

0.0

12.5

5

71.4

8

100.

0 40

.0

14

87.5

18

10

0.0

14.3

Quest

ion 4

Tota

l 6

28

7

4.8

7

66

9

0.9

2

1.5

3

78

5

8.8

5

81

9

0.6

5

4.2

1

29

1

96

.3

12

91

9

4.9

-1

.5

Age

Un

der 4

0 10

3 75

.7

130

94.2

24

.4

70

74.5

85

93

.4

25.4

24

7 96

.9

245

95.7

-1

.2

40-6

4 42

4 73

.5

518

89.8

22

.2

263

58.4

41

0 91

.1

55.9

86

7 96

.3

866

94.4

-2

.0

65 a

nd o

ver

94

79.7

10

8 91

.5

14.9

39

42

.4

78

84.8

10

0.0

161

95.3

16

4 96

.5

1.3

Unkn

own

7 77

.8

10

100.

0 28

.6

6 85

.7

8 10

0.0

16.7

16

10

0.0

16

88.9

-1

1.1

Quest

ion 5

Tota

l 4

80

5

7.1

6

70

7

9.5

3

9.1

4

07

6

3.3

5

62

8

7.7

3

8.5

1

24

2

92

.7

13

04

9

5.8

3

.4

Age

Un

der 4

0 82

60

.3

114

82.6

37

.0

70

74.5

86

94

.5

26.9

23

9 93

.7

247

96.5

2.

9 40

-64

326

56.5

45

2 78

.3

38.7

28

2 62

.7

405

90.0

43

.6

824

91.6

87

3 95

.2

4.0

65 a

nd o

ver

65

55.1

96

81

.4

47.7

52

56

.5

64

69.6

23

.1

165

97.6

16

6 97

.6

0.0

Unkn

own

7 77

.8

8 80

.0

2.9

3 42

.9

7 87

.5

104.

2 14

87

.5

18

100.

0 14

.3

Sour

ce:

Anal

ysis

of d

ata

colle

cted

from

wor

ksho

p pa

rtic

ipan

ts


F.6

Pre

test

an

d P

ost

test

Kn

ow

led

ge b

y A

ge (

con

tin

ued

)

Co

lore

ctal

Can

cer

Pros

tate

Can

cer

Pr

etes

t (N

= 7

91)

Post

test

(N

= 8

12)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

889

) Po

stte

st

(N =

883

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

Quest

ion 1

T

ota

l 6

05

7

6.5

7

69

9

4.7

2

3.8

7

00

7

8.7

7

85

8

8.9

1

2.9

Ag

e

Un

der 4

0 12

2 87

.1

134

95.7

9.

8 11

5 81

.6

125

91.9

12

.7

40-6

4 42

9 73

.3

571

94.9

29

.3

527

78.9

59

4 89

.2

13.1

65

and

ove

r 48

84

.2

54

90.0

6.

9 49

72

.1

55

79.7

10

.6

Unkn

own

6 66

.7

10

100.

0 50

.0

9 75

.0

11

91.7

22

.2

Quest

ion 2

T

ota

l 3

14

3

9.7

6

69

8

2.4

1

07

.5

45

9

51

.6

62

4

70

.7

36

.9

Age

Unde

r 40

74

52.9

12

7 90

.7

71.6

77

54

.6

111

81.6

49

.5

40-6

4 21

9 37

.4

489

81.2

11

7.0

348

52.1

46

4 69

.7

33.7

65

and

ove

r 18

31

.6

44

73.3

13

2.2

31

45.6

44

63

.8

39.9

Un

know

n 3

33.3

9

90.0

17

0.0

3 25

.0

5 41

.7

66.7

Quest

ion 3

T

ota

l 6

41

8

1.0

7

77

9

5.7

1

8.1

7

00

7

8.7

8

43

9

5.5

2

1.2

Ag

e

Un

der 4

0 12

4 88

.6

131

93.6

5.

6 11

1 78

.7

130

95.6

21

.4

40-6

4 46

0 78

.6

579

96.2

22

.3

524

78.4

63

9 95

.9

22.3

65

and

ove

r 49

86

.0

57

95.0

10

.5

53

77.9

63

91

.3

17.1

Un

know

n 8

88.9

10

10

0.0

12.5

12

10

0.0

11

91.7

-8

.3

Quest

ion 4

T

ota

l 6

36

8

0.4

7

12

8

7.7

9

.1

67

5

75

.9

75

5

85

.5

12

.6

Age

Unde

r 40

109

77.9

12

8 91

.4

17.4

10

2 72

.3

112

82.4

13

.8

40-6

4 47

2 80

.7

523

86.9

7.

7 49

9 74

.7

570

85.6

14

.6

65 a

nd o

ver

47

82.5

53

88

.3

7.1

63

92.6

62

89

.9

-3.0

Un

know

n 8

88.9

8

80.0

-1

0.0

11

91.7

11

91

.7

0.0

Quest

ion 5

T

ota

l 4

30

5

4.4

6

69

8

2.4

5

1.6

6

63

7

4.6

8

10

9

1.7

2

3.0

Ag

e

Un

der 4

0 86

61

.4

113

80.7

31

.4

109

77.3

12

9 94

.9

22.7

40

-64

322

55.0

49

6 82

.4

49.7

49

1 73

.5

610

91.6

24

.6

65 a

nd o

ver

17

29.8

50

83

.3

179.

4 51

75

.0

59

85.5

14

.0

Unkn

own

5 55

.6

10

100.

0 80

.0

12

100.

0 12

10

0.0

0.0

Sour

ce:

Anal

ysis

of d

ata

colle

cted

from

wor

ksho

p pa

rtic

ipan

ts


F.7

Pre

test

an

d P

ost

test

Kn

ow

led

ge b

y R

ace

an

d E

thn

icit

y

Br

east

Can

cer

Cerv

ical

Can

cer

Card

iova

scul

ar H

ealth

Pr

etes

t (N

= 8

40)

Post

test

(N

= 8

43)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

641

) Po

stte

st

(N =

643

) %

with

In

crea

sed

Scor

e

Pret

est

(N =

1,3

40)

Post

test

(N

= 1

,361

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

Quest

ion 1

T

ota

l 6

81

8

1.1

8

11

9

6.2

1

8.7

4

95

7

7.0

6

13

9

5.6

2

4.2

4

97

3

7.1

1

13

4

83

.3

12

4.6

Ra

ce/

Ethn

icity

Whi

te

100

84.7

11

4 96

.6

14.0

65

76

.5

81

98.8

29

.2

117

45.3

23

0 84

.9

87.2

Bl

ack

113

83.1

13

0 94

.2

13.4

95

84

.8

105

93.8

10

.5

94

41.6

18

4 81

.4

95.7

As

ian

50

70.4

69

97

.2

38.0

42

66

.7

60

95.2

42

.9

24

29.3

75

92

.6

216.

4 H

ispa

nic

369

82.7

43

6 97

.1

17.4

23

9 76

.1

298

94.9

24

.7

225

33.1

55

8 81

.3

145.

5 O

ther

38

70

.4

49

94.2

33

.9

45

81.8

55

10

0.0

22.2

29

38

.7

67

90.5

13

4.2

Refu

sed/

Un

know

n 11

73

.3

13

86.7

18

.2

9 64

.3

14

93.3

45

.2

8 40

.0

20

87.0

11

7.4

Quest

ion 2

T

ota

l 7

87

9

3.7

8

25

9

7.9

4

.5

47

9

74

.5

58

5

91

.3

22

.5

12

69

9

4.7

1

30

6

96

.0

1.3

Ra

ce/

Ethn

icity

Whi

te

105

89.0

11

5 97

.5

9.5

62

72.9

76

92

.7

27.1

25

1 97

.3

258

95.2

-2

.1

Blac

k 12

3 90

.4

133

96.4

6.

6 82

73

.2

93

83.0

13

.4

207

91.6

21

3 94

.2

2.9

Asia

n 71

10

0.0

70

98.6

-1

.4

45

71.4

49

77

.8

8.9

79

96.3

79

97

.5

1.2

His

pani

c 42

2 94

.6

440

98.0

3.

6 22

9 72

.9

299

95.2

30

.6

645

95.0

66

3 96

.6

1.7

Oth

er

51

94.4

52

10

0.0

5.9

48

87.3

53

96

.4

10.4

69

92

.0

72

97.3

5.

8 Re

fuse

d/

Unkn

own

15

100.

0 15

10

0.0

0.0

13

92.9

15

10

0.0

7.7

18

90.0

21

91

.3

1.4

Quest

ion 3

T

ota

l 6

91

8

2.3

7

95

9

4.3

1

4.6

5

45

8

4.8

6

13

9

5.6

1

2.8

1

25

2

93

.4

13

13

9

6.5

3

.3

Race

/ Et

hnic

ity

W

hite

90

76

.3

113

95.8

25

.6

67

78.8

80

97

.6

23.8

25

0 96

.9

259

95.6

-1

.4

Blac

k 10

7 78

.7

117

84.8

7.

8 99

88

.4

101

90.2

2.

0 20

4 90

.3

215

95.1

5.

4 As

ian

66

93.0

69

97

.2

4.5

60

95.2

59

93

.7

-1.7

80

97

.6

79

97.5

0.

0 H

ispa

nic

378

84.8

43

5 96

.9

14.3

26

7 85

.0

303

96.5

13

.5

625

92.0

66

4 96

.8

5.2

Oth

er

37

68.5

47

90

.4

31.9

40

72

.7

55

100.

0 37

.5

75

100.

0 74

10

0.0

0.0

Refu

sed/

Un

know

n 13

86

.7

14

93.3

7.

7 12

85

.7

15

100.

0 16

.7

18

90.0

22

95

.7

6.3

Quest

ion 4

T

ota

l 6

28

7

4.8

7

66

9

0.9

2

1.5

3

78

5

8.8

5

81

9

0.6

5

4.2

1

29

1

96

.3

12

91

9

4.9

-1

.5

Race

/ Et

hnic

ity

W

hite

86

72

.9

107

90.7

24

.4

44

51.8

82

10

0.0

93.2

25

3 98

.1

264

97.4

-0

.7


F.8

Br

east

Can

cer

Cerv

ical

Can

cer

Card

iova

scul

ar H

ealth

Pr

etes

t (N

= 8

40)

Post

test

(N

= 8

43)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

641

) Po

stte

st

(N =

643

) %

with

In

crea

sed

Scor

e

Pret

est

(N =

1,3

40)

Post

test

(N

= 1

,361

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

Blac

k 10

2 75

.0

116

84.1

12

.1

81

72.3

10

1 90

.2

24.7

21

7 96

.0

223

98.7

2.

8 As

ian

59

83.1

68

95

.8

15.3

36

57

.1

53

84.1

47

.2

78

95.1

80

98

.8

3.8

His

pani

c 33

4 74

.9

414

92.2

23

.1

188

59.9

28

9 92

.0

53.7

64

9 95

.6

628

91.5

-4

.2

Oth

er

33

61.1

46

88

.5

44.8

22

40

.0

44

80.0

10

0.0

74

98.7

74

10

0.0

1.4

Refu

sed/

Un

know

n 14

93

.3

15

100.

0 7.

1 7

50.0

12

80

.0

60.0

20

10

0.0

22

95.7

-4

.3

Quest

ion 5

T

ota

l 4

80

5

7.1

6

70

7

9.5

3

9.1

4

07

6

3.3

5

62

8

7.7

3

8.5

1

24

2

92

.7

13

04

9

5.8

3

.4

Race

/ Et

hnic

ity

W

hite

47

39

.8

94

79.7

10

0.0

43

50.6

78

95

.1

88.0

25

0 96

.9

258

95.2

-1

.8

Blac

k 74

54

.4

97

70.3

29

.2

77

68.8

96

85

.7

24.7

21

3 94

.2

215

95.1

0.

9 As

ian

56

78.9

69

97

.2

23.2

27

42

.9

55

87.3

10

3.7

76

92.7

80

98

.8

6.6

His

pani

c 27

2 61

.0

355

79.1

29

.6

227

72.3

29

3 93

.3

29.1

61

4 90

.4

657

95.8

5.

9 O

ther

22

40

.7

44

84.6

10

7.7

24

43.6

33

60

.0

37.5

71

94

.7

72

97.3

2.

8 Re

fuse

d/

Unkn

own

9 60

.0

11

73.3

22

.2

9 64

.3

7 46

.7

-27.

4 18

90

.0

22

95.7

6.

3 So

urce

: An

alys

is o

f dat

a co

llect

ed fr

om w

orks

hop

part

icip

ants


F.9

Pre

test

an

d P

ost

test

Kn

ow

led

ge b

y R

ace

an

d E

thn

icit

y (

con

tin

ued

)

Co

lore

ctal

Can

cer

Pros

tate

Can

cer

Pr

etes

t (N

= 7

91)

Post

test

(N

= 8

12)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

889

) Po

stte

st

(N =

883

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

Questi

on 1

To

tal

60

5

76

.5

76

9

94

.7

23

.8

70

0

78

.7

78

5

88

.9

12

.9

Race

/ Et

hnic

ity

Whi

te

120

86.3

13

6 95

.1

10.2

64

85

.3

76

96.2

12

.7

Blac

k 62

68

.9

81

86.2

25

.1

354

77.0

39

8 87

.5

13.7

As

ian

47

66.2

72

98

.6

49.0

15

78

.9

18

94.7

20

.0

His

pani

c 30

9 77

.6

386

94.8

22

.2

204

87.6

20

2 88

.2

0.7

Oth

er

61

74.4

82

98

.8

32.8

49

59

.0

76

92.7

57

.0

Refu

sed/

Un

know

n 6

54.5

12

10

0.0

83.3

14

73

.7

15

78.9

7.

1

Questi

on 2

To

tal

31

4

39

.7

66

9

82

.4

10

7.5

4

59

5

1.6

6

24

7

0.7

3

6.9

Ra

ce/

Ethn

icity

W

hite

42

30

.2

122

85.3

18

2.4

50

66.7

63

79

.7

19.6

Bl

ack

43

47.8

74

78

.7

64.8

26

9 58

.5

331

72.7

24

.4

Asia

n 31

43

.7

72

98.6

12

5.9

9 47

.4

18

94.7

10

0.0

His

pani

c 16

1 40

.5

328

80.6

99

.2

84

36.1

12

7 55

.5

53.8

O

ther

33

40

.2

62

74.7

85

.6

39

47.0

73

89

.0

89.5

Re

fuse

d/

Unkn

own

4 36

.4

11

91.7

15

2.1

8 42

.1

12

63.2

50

.0

Questi

on 3

To

tal

64

1

81

.0

77

7

95

.7

18

.1

70

0

78

.7

84

3

95

.5

21

.2

Race

/ Et

hnic

ity

Whi

te

119

85.6

14

1 98

.6

15.2

46

61

.3

74

93.7

52

.7

Blac

k 65

72

.2

86

91.5

26

.7

402

87.4

43

4 95

.4

9.1

Asia

n 62

87

.3

71

97.3

11

.4

19

100.

0 19

10

0.0

0.0

His

pani

c 33

2 83

.4

391

96.1

15

.2

160

68.7

21

8 95

.2

38.6

O

ther

53

64

.6

78

94.0

45

.4

58

69.9

81

98

.8

41.4

Re

fuse

d/

Unkn

own

10

90.9

10

83

.3

-8.3

15

78

.9

17

89.5

13

.3

Questi

on 4

To

tal

63

6

80

.4

71

2

87

.7

9.1

6

75

7

5.9

7

55

8

5.5

1

2.6

Ra

ce/


F.10

Co

lore

ctal

Can

cer

Pros

tate

Can

cer

Pr

etes

t (N

= 7

91)

Post

test

(N

= 8

12)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

889

) Po

stte

st

(N =

883

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

Et

hnic

ity

Whi

te

120

86.3

12

4 86

.7

0.4

59

78.7

73

92

.4

17.5

Bl

ack

62

68.9

76

80

.9

17.4

33

4 72

.6

367

80.7

11

.1

Asia

n 64

90

.1

71

97.3

7.

9 15

78

.9

19

100.

0 26

.7

His

pani

c 32

7 82

.2

361

88.7

8.

0 18

8 80

.7

209

91.3

13

.1

Oth

er

54

65.9

71

85

.5

29.9

64

77

.1

71

86.6

12

.3

Refu

sed/

Un

know

n 9

81.8

9

75.0

-8

.3

15

78.9

16

84

.2

6.7

Questi

on 5

To

tal

43

0

54

.4

66

9

82

.4

51

.6

66

3

74

.6

81

0

91

.7

23

.0

Race

/ Et

hnic

ity

Whi

te

72

51.8

12

9 90

.2

74.2

61

81

.3

76

96.2

18

.3

Blac

k 57

63

.3

66

70.2

10

.9

343

74.6

41

6 91

.4

22.6

As

ian

37

52.1

69

94

.5

81.4

16

84

.2

19

100.

0 18

.8

His

pani

c 21

6 54

.3

341

83.8

54

.4

172

73.8

20

6 90

.0

21.9

O

ther

44

53

.7

53

63.9

19

.0

55

66.3

76

92

.7

39.9

Re

fuse

d/

Unkn

own

4 36

.4

11

91.7

15

2.1

16

84.2

17

89

.5

6.3

Sour

ce:

Anal

ysis

of d

ata

colle

cted

from

wor

ksho

p pa

rtic

ipan

ts


F.11

Pre

test

an

d P

ost

test

Kn

ow

led

ge b

y E

du

cati

on

Level

Br

east

Can

cer

Cerv

ical

Can

cer

Card

iova

scul

ar H

ealth

Pr

etes

t (N

= 8

40)

Post

test

(N

= 8

43)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

641

) Po

stte

st

(N =

643

) %

with

In

crea

sed

Scor

e

Pret

est

(N =

1,3

40)

Post

test

(N

= 1

,361

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

Quest

ion 1

Tota

l 6

81

8

1.1

8

11

9

6.2

1

8.7

4

95

7

7.0

6

13

9

5.6

2

4.2

4

97

3

7.1

1

13

4

83

.3

12

4.6

Ed

ucat

ion

Le

ss th

an

high

sch

ool

267

71.2

35

6 94

.7

33.0

21

0 69

.3

289

96.0

38

.5

146

29.0

42

6 84

.4

190.

6 H

igh

scho

ol

or e

quiv

alen

t 17

3 86

.5

198

98.0

13

.3

112

80.0

12

9 93

.5

16.8

13

3 36

.2

302

79.9

12

0.5

Trai

ning

pr

ogra

m

30

90.9

33

10

0.0

10.0

31

93

.9

31

93.9

0.

0 30

47

.6

47

75.8

59

.2

Colle

ge

184

92.9

19

2 97

.5

4.9

128

87.1

14

3 97

.3

11.7

16

8 46

.3

317

85.7

85

.1

Oth

er

12

85.7

14

10

0.0

16.7

5

100.

0 5

100.

0 0.

0 6

37.5

15

10

0.0

166.

7 Un

know

n 15

75

.0

18

85.7

14

.3

9 60

.0

16

94.1

56

.9

14

50.0

27

87

.1

74.2

Quest

ion 2

Tota

l 7

87

9

3.7

8

25

9

7.9

4

.5

47

9

74

.5

58

5

91

.3

22

.5

12

69

9

4.7

1

30

6

96

.0

1.3

Ed

ucat

ion

Le

ss th

an

high

sch

ool

351

93.6

36

8 97

.9

4.6

217

71.6

26

8 89

.0

24.3

47

5 94

.4

493

97.6

3.

4 H

igh

scho

ol

or e

quiv

alen

t 18

9 94

.5

196

97.0

2.

7 10

8 77

.1

128

92.8

20

.2

346

94.3

36

1 95

.5

1.3

Trai

ning

pr

ogra

m

30

90.9

31

93

.9

3.3

26

78.8

31

93

.9

19.2

61

96

.8

57

91.9

-5

.1

Colle

ge

185

93.4

19

5 99

.0

5.9

111

75.5

13

6 92

.5

22.5

34

7 95

.6

351

94.9

-0

.8

Oth

er

13

92.9

14

10

0.0

7.7

5 10

0.0

5 10

0.0

0.0

14

87.5

14

93

.3

6.7

Unkn

own

19

95.0

21

10

0.0

5.3

12

80.0

17

10

0.0

25.0

26

92

.9

30

96.8

4.

2

Quest

ion 3

Tota

l 6

91

8

2.3

7

95

9

4.3

1

4.6

5

45

8

4.8

6

13

9

5.6

1

2.8

1

25

2

93

.4

13

13

9

6.5

3

.3

Educ

atio

n

Less

than

hi

gh s

choo

l 29

7 79

.2

359

95.5

20

.6

248

81.8

28

2 93

.7

14.5

46

7 92

.8

494

97.8

5.

4 H

igh

scho

ol

or e

quiv

alen

t 16

7 83

.5

191

94.6

13

.2

123

87.9

13

3 96

.4

9.7

337

91.8

36

4 96

.3

4.9

Trai

ning

pr

ogra

m

25

75.8

30

90

.9

20.0

28

84

.8

33

100.

0 17

.9

61

96.8

58

93

.5

-3.4

Co

llege

17

5 88

.4

186

94.4

6.

8 12

9 87

.8

143

97.3

10

.9

348

95.9

35

3 95

.4

-0.5

O

ther

12

85

.7

13

92.9

8.

3 5

100.

0 5

100.

0 0.

0 14

87

.5

14

93.3

6.

7 Un

know

n 15

75

.0

16

76.2

1.

6 12

80

.0

17

100.

0 25

.0

25

89.3

30

96

.8

8.4

Quest

ion 4

Tota

l 6

28

7

4.8

7

66

9

0.9

2

1.5

3

78

5

8.8

5

81

9

0.6

5

4.2

1

29

1

96

.3

12

91

9

4.9

-1

.5

Educ

atio

n


F.12

Br

east

Can

cer

Cerv

ical

Can

cer

Card

iova

scul

ar H

ealth

Pr

etes

t (N

= 8

40)

Post

test

(N

= 8

43)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

641

) Po

stte

st

(N =

643

) %

with

In

crea

sed

Scor

e

Pret

est

(N =

1,3

40)

Post

test

(N

= 1

,361

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

n =

#

Answ

erin

g Co

rrec

tly

%

Answ

erin

g Co

rrec

tly

Less

than

hi

gh s

choo

l 28

7 76

.5

340

90.4

18

.2

151

49.8

26

6 88

.4

77.3

48

2 95

.8

475

94.1

-1

.8

Hig

h sc

hool

or

equ

ival

ent

144

72.0

18

3 90

.6

25.8

85

60

.7

124

89.9

48

.0

352

95.9

35

8 94

.7

-1.3

Tr

aini

ng

prog

ram

22

66

.7

30

90.9

36

.4

23

69.7

32

97

.0

39.1

62

98

.4

60

96.8

-1

.7

Colle

ge

152

76.8

18

3 92

.9

21.0

11

1 75

.5

141

95.9

27

.0

353

97.2

35

4 95

.7

-1.6

O

ther

6

42.9

11

78

.6

83.3

2

40.0

4

80.0

10

0.0

14

87.5

14

93

.3

6.7

Unkn

own

17

85.0

19

90

.5

6.4

6 40

.0

14

82.4

10

5.9

28

100.

0 30

96

.8

-3.2

Quest

ion 5

Tota

l 4

80

5

7.1

6

70

7

9.5

3

9.1

4

07

6

3.3

5

62

8

7.7

3

8.5

1

24

2

92

.7

13

04

9

5.8

3

.4

Educ

atio

n

Less

than

hi

gh s

choo

l 20

2 53

.9

286

76.1

41

.2

179

59.1

24

7 82

.1

38.9

45

5 90

.5

493

97.6

7.

9 H

igh

scho

ol

or e

quiv

alen

t 11

6 58

.0

161

79.7

37

.4

93

66.4

12

4 89

.9

35.3

33

9 92

.4

360

95.2

3.

1 Tr

aini

ng

prog

ram

16

48

.5

28

84.8

75

.0

21

63.6

31

93

.9

47.6

59

93

.7

56

90.3

-3

.6

Colle

ge

125

63.1

17

0 86

.3

36.7

10

0 68

.0

144

98.0

44

.0

350

96.4

35

2 95

.1

-1.3

O

ther

9

64.3

12

85

.7

33.3

3

60.0

5

100.

0 66

.7

14

87.5

14

93

.3

6.7

Unkn

own

12

60.0

13

61

.9

3.2

11

73.3

11

64

.7

-11.

8 25

89

.3

29

93.5

4.

8 So

urce

: An

alys

is o

f dat

a co

llect

ed fr

om w

orks

hop

part

icip

ants


F.13

Pre

test

an

d P

ost

test

Kn

ow

led

ge b

y E

du

cati

on

Level

(co

nti

nu

ed

)

Co

lore

ctal

Can

cer

Pros

tate

Can

cer

Pr

etes

t (N

= 7

91)

Post

test

(N

= 8

12)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

889

) Po

stte

st

(N =

883

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

Questi

on 1

T

ota

l 6

05

7

6.5

7

69

9

4.7

2

3.8

7

00

7

8.7

7

85

8

8.9

1

2.9

Ed

ucat

ion

Less

than

hig

h sc

hool

25

5 77

.7

320

96.7

24

.4

168

69.1

21

4 88

.1

27.4

H

igh

scho

ol o

r eq

uiva

lent

14

7 69

.3

208

94.1

35

.7

216

80.3

23

3 86

.6

7.9

Trai

ning

pr

ogra

m

31

86.1

35

83

.3

-3.2

45

86

.5

47

90.4

4.

4 Co

llege

15

2 80

.0

183

95.3

19

.1

243

85.0

25

9 92

.5

8.9

Oth

er

8 88

.9

8 88

.9

0.0

12

85.7

12

85

.7

0.0

Unkn

own

12

75.0

15

88

.2

17.6

16

64

.0

20

80.0

25

.0

Questi

on 2

T

ota

l 3

14

3

9.7

6

69

8

2.4

1

07

.5

45

9

51

.6

62

4

70

.7

36

.9

Educ

atio

n

Le

ss th

an h

igh

scho

ol

103

31.4

26

7 80

.7

156.

9 85

35

.0

159

65.4

87

.1

Hig

h sc

hool

or

equi

vale

nt

94

44.3

18

2 82

.4

85.7

15

0 55

.8

204

75.8

36

.0

Trai

ning

pr

ogra

m

15

41.7

34

81

.0

94.3

23

44

.2

29

55.8

26

.1

Colle

ge

94

49.5

16

5 85

.9

73.7

18

3 64

.0

203

72.5

13

.3

Oth

er

4 44

.4

8 88

.9

100.

0 6

42.9

13

92

.9

116.

7 Un

know

n 4

25.0

13

76

.5

205.

9 12

48

.0

16

64.0

33

.3

Questi

on 3

T

ota

l 6

41

8

1.0

7

77

9

5.7

1

8.1

7

00

7

8.7

8

43

9

5.5

2

1.2

Ed

ucat

ion

Less

than

hig

h sc

hool

25

2 76

.8

317

95.8

24

.7

166

68.3

22

5 92

.6

35.5

H

igh

scho

ol o

r eq

uiva

lent

17

3 81

.6

212

95.9

17

.6

204

75.8

25

8 95

.9

26.5

Tr

aini

ng

prog

ram

31

86

.1

39

92.9

7.

8 44

84

.6

51

98.1

15

.9

Colle

ge

164

86.3

18

4 95

.8

11.0

25

4 88

.8

275

98.2

10

.6

Oth

er

6 66

.7

9 10

0.0

50.0

12

85

.7

13

92.9

8.

3 Un

know

n 15

93

.8

16

94.1

0.

4 20

80

.0

21

84.0

5.

0

Questi

on 4


F.14

Co

lore

ctal

Can

cer

Pros

tate

Can

cer

Pr

etes

t (N

= 7

91)

Post

test

(N

= 8

12)

% w

ith

Incr

ease

d Sc

ore

Pret

est

(N =

889

) Po

stte

st

(N =

883

) %

with

In

crea

sed

Scor

e

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

n =

#

Answ

erin

g Co

rrec

tly

% An

swer

ing

Corr

ectly

T

ota

l 6

36

8

0.4

7

12

8

7.7

9

.1

67

5

75

.9

75

5

85

.5

12

.6

Educ

atio

n

Le

ss th

an h

igh

scho

ol

260

79.3

30

4 91

.8

15.9

17

2 70

.8

206

84.8

19

.8

Hig

h sc

hool

or

equi

vale

nt

166

78.3

19

1 86

.4

10.4

19

6 72

.9

227

84.4

15

.8

Trai

ning

pr

ogra

m

30

83.3

31

73

.8

-11.

4 35

67

.3

44

84.6

25

.7

Colle

ge

159

83.7

16

6 86

.5

3.3

244

85.3

24

9 88

.9

4.2

Oth

er

8 88

.9

7 77

.8

-12.

5 8

57.1

8

57.1

0.

0 Un

know

n 13

81

.3

13

76.5

-5

.9

20

80.0

21

84

.0

5.0

Questi

on 5

T

ota

l 4

30

5

4.4

6

69

8

2.4

5

1.6

6

63

7

4.6

8

10

9

1.7

2

3.0

Ed

ucat

ion

Less

than

hig

h sc

hool

14

0 42

.7

275

83.1

94

.6

157

64.6

21

9 90

.1

39.5

H

igh

scho

ol o

r eq

uiva

lent

12

3 58

.0

175

79.2

36

.5

197

73.2

24

4 90

.7

23.9

Tr

aini

ng

prog

ram

19

52

.8

34

81.0

53

.4

41

78.8

50

96

.2

22.0

Co

llege

13

6 71

.6

164

85.4

19

.3

236

82.5

26

4 94

.3

14.3

O

ther

5

55.6

7

77.8

40

.0

12

85.7

12

85

.7

0.0

Unkn

own

7 43

.8

14

82.4

88

.2

20

80.0

21

84

.0

5.0

Sour

ce:

Anal

ysis

of d

ata

colle

cted

from

wor

ksho

p pa

rtic

ipan

ts

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