Cooperative Agreement Number U58/CCU323067-04 5U58DP3223067 Spirit Health Education (S.H.E.) Circle

Early Detection or Survivorship of Cancer in Underserved Populations

D. Magrini, Project DirectorJudith Bradford, Evaluator

Background African American women have higher rates of

certain illnesses than their Caucasian counterparts. Compared to women in the general population,

sexual minority (lesbian and bisexual) women (SMW) have reported more barriers to healthcare access and higher rates of specific health risks.

In 2001 the Mautner Project received funding from the Susan G. Komen Breast Cancer Foundation to conduct the national Women 2 Women Spirit Health Study.

We used the IOM access model as a conceptual framework to explore these concerns.

We have used Spirit Health Study results, along with best practices and our prior experience in provider education, to develop S.H.E. Circle.

STRUCTURALAvailability

How organizedTransportation

FINANCIALInsurance coverage

Reimbursement levels

Public support

PERSONALAcceptability

CulturalLanguageAttitudesEducation

Income

Visits

Procedures

Appropriateness

Efficacy of treatment

Quality of Providers

Patient Adherence

HEALTH STATUS

MortalityMorbidity

Well-beingFunctioning

EQUITY OF SERVICES

BARRIERS

USE OF SERVICES

MEDIATORS

OUTCOMES

A Model for Monitoring Access

Millman M , Ed. Access to Health Care in America. Committee on Monitoring Access to Personal Health Care Services. Institute of Medicine. 199332

Research Question and Methods

Are African American sexual minority women at increased health risks based on their dual minority status?

• Questions were focused on cancer screening behavior, behavioral risk factors, and barriers to accessing health care services.

• Information was distributed through list servs, community organizations, peer networks.

• Multiple methods were used for data collection (web-based and mail-back).

• Responses were anonymous, N=660+, 18 and older.

• Time period: August 2002 – August 2003* Behavioral Risk Factor System, Commonwealth Fund Survey

SPEAK OUT!Black Women 2 Women Spirit Health Study -

Results 93% had at least one established risk factor for breast

cancer: such as family history, smoking, obesity, history of HPV, early menarche, history of benign breast disease, heavy alcohol use.

Only 29% were adherent to all four of the cancer screening methodologies, i.e., mammography (age 40+), breast self-examination (BSE), clinical breast exam (CBE) and Pap Test.

68% of those 40+ did not have an annual mammogram, and 69% did not perform monthly BSE.

40% did not receive yearly CBEs, and 37% did not receive a yearly Pap test.

71% were overweight (BMI above 25) or morbidly obese (BMI above 30), far exceeding national statistics for AA women(38%) and white women (24%).

26% were current smokers compared to 22% of AA women in the general population.

Study results indicated that increased education and support to access cancer screening were needed by this population.

As the first national health education program focused on African American women who partner with women, S.H.E. Circles provide a safe space where African American lesbian and bisexual women can learn about health issues, ask questions, share information, connect with resources, and provide support to each other toward positive change in health behaviors.

Goals of S.H.E Circle

To actively encourage healthy living strategies among same gender loving African American women through:

Cancer Screening (Breast, Cervical,

Colorectal)Healthy Nutrition and ExerciseSmoking CessationStress Management

Program Goals

S.H.E Meetings

• Affirmation/Opening Ritual• Education Discussion

– Screening– Self-Care/Prevention (Cooking, Exercise,

etc.)– Role Plays - Exercise– Games

• Sharing Personal Stories – Support• Parting/Closing Ritual• Homework

Major Accomplishments Spirit Health Education (S.H.E.

Circle) Health Brochures Completed

Curriculum in Final DraftThree Pilot Groups Completed

One Training of Facilitators in South Florida

Three Replication Sites Scheduled for TrainingChicago

PhiladelphiaPittsburgh

Evaluation Methods, Preliminary Findings

Methods• Pre- and immediate-post surveys (will add remote post- in

next phase of project)• Focus groups after last session

Findings from formative evaluation• Quality and relevance of training mode and contents

received consistently excellent ratings.• Participants acknowledged increased stress due to sexual

minority status.• A majority thought that coming out to their providers

would positively impact their health.• Identification of personally and culturally acceptable

approaches to reduce barriers are essential to improve healthcare access and use.

• Behavior change resulted from S.H.E. Circle participation, with implications for improved health outcomes at individual and community levels.

• At the end of the program, virtually all participants knew how to create a healing environment in their lives.

For more information on S.H.E. Circle:

dmagrini@mautnerproject.orghttp://www.shecircle.org/index.php