The planned number of programs was delivered, but the proportion of study-eligible attendees was lower than predicted. This community-based participatory research approach was largely successful in involving the community served in the development and implementation of the intervention and study.
Background In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children. Objective This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates. Methods This pilot study is conducted in collaboration with a local Women, Infants, and Children (WIC) organization and hospital and prenatal clinics of a local health care network. To engage African American women to enroll in the study, several methods and monitoring processes were explored, including WIC electronic text-based messages sent out to all phones of current WIC recipients (referred to as e-blasts); keyword responses to texts from flyers and posters in local community-based organizations, hospitals, and prenatal clinics; keyword responses using electronic links posted in established Facebook groups; and snowball recruitment of other pregnant women by current participants through Facebook. Once enrolled, participants were randomized to 2 study conditions: (1) an intervention group receiving messages about breast cancer risk reduction and breastfeeding or (2) a control group receiving breastfeeding-only messages. Data were obtained through electronic monitoring, SurveyMonkey, qualitative responses on Facebook, focus groups, and interviews. Results More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages. Conclusions This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool. Trial Registration ClinicalTrials.gov NCT03680235; https://clinicaltrials.gov/ct2/show/NCT03680235
Background Bladder cancer is one of the top 10 most common cancers in the United States. Most bladder cancers (70%-80%) are diagnosed at early stages as non–muscle-invasive bladder cancer (NMIBC), which can be removed surgically. However, 50% to 80% of NMIBC cases recur within 5 years, and 15% to 30% progress with poor survival. Current treatments are limited and expensive. A wealth of preclinical and epidemiological evidence suggests that dietary isothiocyanates in cruciferous vegetables (Cruciferae) could be a novel, noninvasive, and cost-effective strategy to control NMIBC recurrence and progression. Objective The aim of this study is to develop a scalable dietary intervention that increases isothiocyanate exposure through Cruciferae intake in NMIBC survivors. Methods We worked with a community advisory board (N=8) to identify relevant factors, evidence-based behavior change techniques, and behavioral theory constructs used to increase Cruciferae intake in NMIBC survivors; use the PEN-3 Model focused on incorporating cultural factors salient to the group’s shared experiences to review the intervention components (eg, the saliency of behavioral messages); administer the revised intervention to community partners for their feedback; and refine the intervention. Results We developed a multicomponent intervention for NMIBC survivors consisting of a magazine, tracking book, live telephone call script, and interactive voice messages. Entitled POW-R Health: Power to Redefine Your Health, the intervention incorporated findings from our adaptation process to ensure saliency to NMIBC survivors. Conclusions This is the first evidence-based, theoretically grounded dietary intervention developed to reduce bladder cancer recurrence in NMIBC survivors using a systematic process for community adaptation. This study provides a model for others who aim to develop behavioral, community-relevant interventions for cancer prevention and control with the overall goal of wide-scale implementation and dissemination.
BACKGROUND Bladder cancer is one of the top 10 most common cancers in the US. Most bladder cancer (70-80%) is diagnosed at early stages as non-muscle invasive bladder cancer (NMIBC), which can be removed surgically. However, 50-80% of NMIBC recurs within 5 years, and 15-30% progresses with poor survival. Current treatment is limited and expensive. A wealth of preclinical and epidemiologic evidence suggests that dietary isothiocyanates (ITCs) in cruciferous vegetables (Cruciferae) could be a novel, non-invasive, and cost-effective strategy to control NMIBC recurrence and progression. Yet a scalable dietary intervention that increases ITC exposure through Cruciferae intake in NMIBC survivors has not been developed. OBJECTIVE This paper will describe a systematic process through which a dietary intervention for bladder cancer survivors was developed that can serve as a model for others who aim to develop evidence-based behavioral interventions for cancer prevention. METHODS We used a systematic process to adapt evidence-based dietary interventions into a Cruciferae intervention for NMIBC survivors. We 1) identified relevant factors, evidence-based behavioral techniques, and behavioral theory constructs used to increase cruciferae intake in NMIBC survivors; 2) used the PEN-3 model to review the intervention’s components (e.g. saliency of behavioral messages); 3) administered the revised intervention to community partners for their feedback; and 4) refined the intervention based on Step 3. RESULTS We developed a multi-component intervention for NMIBC survivors consisting of a magazine, tracking book, a live phone-call script, and interactive voice messages (IVR). Entitled “POW-R Health: Power to Redefine Your Health”, the intervention incorporated findings from our adaptation process to ensure saliency to NMIBC survivors. CONCLUSIONS This is the first evidence-based, theoretically grounded dietary intervention developed to reduce bladder recurrence in NMIBC survivors using a systematic process for community adaptation. This study provides a model for others who aim to develop behavioral, community-relevant interventions for cancer prevention/control, with the overall goal of wide-scale implementation and dissemination.
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