Doctoral Dissertations

Date of Award

5-2001

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Human Ecology

Major Professor

Robert Kirk

Abstract

The purpose of this investigation was to determine the effectiveness of the Witnessing In Tennessee Project to increase Breast-Self Examination (BSE), Clinical Breast Examination (CBE), and mammography among African American women in the East Tennessee Region. Breast cancer and early detection of the disease is a significant issue for all women. However, this is especially true for minority and older women living in underserved communities. According to Healthy People 2010, one of the major priorities highlights the need for strong, cohesive, and integrated educational and community-based programs for racial and ethnic minorities. There is a need to use interventions specifically designed to meet the age, developmental levels, and culturally, linguistic, and other learning needs of diverse audiences. Also, there is a need to increase partnerships between planned community health promotion programs and community organizations (Healthy People 2010). According to Cancer Outreach Services of Thompson Cancer Survival Center, in Knoxville, Teimessee there was a definite need to reach African American women in impoverished and/or underserved areas, particularly in East Tennessee. Also, there were no known culturally-sensitive breast health programs designed for African American women in the East Tennessee Region. Based on the literature review, the review of the instrument used with the original Witness Project®, and input from professionals in the field of health promotion and disease prevention, a instrument was selected. A baseline and follow-up instrument was used in this study. Both instruments were exactly the same, with the exception of the follow-up instrument having four items specifically addressing the effect of the Witnessing In Tennessee Project. Both instruments included 12 items on mammography, Breast-Self Examination, and Clinical Breast Examination, designed to assess screening practices and 4 items on breast cancer and mammography to assess knowledge. Both instruments included 7 items on opinions about mammography designed to assess attitudes and 7 items on general background information designed to gather data on the participants' characteristics on age, marital status, education, employment, income, and insurance. A multistage clustering technique was used to identify the study population. Initially, 111 African American women participated in the intervention. However, due to age, those participants between the ages of 18 and 34 were omitted because the American Cancer guidelines state that a woman must be at least 35 years of age to have a baseline mammogram. The study population consisted of 87 African American women from the East Tennessee Region. There were eight randomly selected churches, which agreed to host the Witnessing In Tennessee Project. The study population was administered the baseline instrument, exposed to the Witnessing In Tennessee Project, and were administered the one-month follow-up instrument. Frequency counts and percentages were computed from the data and t-test analysis was used to measure change in the post-intervention (SPSS, Version 10.0). The practice of Breast Self-Examination and the receipt of Clinical Breast Examination had an increase in the number of women following the intervention, with 97.7% answering yes to practicing Breast-Self Examination and 93% answering yes to having had a Clinical Breast Examination. The knowledge and attitude levels of the participants changed post-intervention. Overall, knowledge of the participants improved, with >90% of the sample during the follow-up, answering 100% of the knowledge questions correctly. Overall, the attitude scores of the participants concerning mammography improved post-intervention. Based on the study's findings, the following conclusions were made as they relate specifically to the four hypotheses.

  1. Women who participated in Witnessing In Tennessee significantly increased their performance of Breast-Self Examination.
  2. Women who participated in Witnessing In Tennessee significantly increased their receipt of Clinical Breast Examination.
  3. Women who participated in Witnessing In Tennessee did not significantly show an increase in the receipt of mammography.
  4. Women who participated in Witnessing in Tennessee improved their knowledge and attitudes related to breast cancer and screening.

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