A Community Capacity-Enhancement Approach to Breast and Cervical Cancer Screening among Older Women of Color

By 2010, Americans can expect to see changes in community life that are the direct result of negative health status, especially for older people of color (U.S. Department of Health and Human Services, 2000). Although many health behaviors are widely practiced by older adults, people of color report apprehension about using health and medical services (Adams, 1995; Gamble, 1993; Han, Wells, & Primas, 2003; Sullivan et al., 2001). Social workers interested in health promotion should be particularly concerned about this population because trends in cancer mortality over the past two decades show higher rates among women of color than white, non-Hispanic women (Marbella & Layde, 2001; National Center for Health Statistics, 2001; Skinner, Arfken, & Waterman, 2000). Breast cancer is the most common type of cancer in African American women (American Cancer Society, 2001), and cervical cancer, although readily curable if diagnosed and treated early, has remained a noted health problem for this group since the mid-1970s (Ries, Hankey, & Edwards, 1990). Latinos have health profiles similar to those of African Americans (Markides, Rudkin, Angel, & Espino, 1997; Selvin & Brett, 2003), with Latina women being disproportionately affected by cancer-related illnesses (Cardin, Grimes, Jiang, Harrell, & Cano, 2001; Ramirez et al., 2000; Zambrana & Ellis, 1995). Underutilization of Papanicolaou (Pap) smears and clinical breast exams put women of color at risk of cancer morbidity and mortality. This article describes the processes of assessment, engagement, implementation, and evaluation of a research strategy used to enhance the capacity for health behavior change among older women of color. Discussion of experiences from the community and lessons learned provide insight and guidance for effective health promotion research. LITERATURE REVIEW Community Capacity Enhancement Traditionally, communities of color have been considered "hard to reach" for inclusion in health behavior change strategies (Black, Stein, Loveland-Cherry, 2001; Braithwite & Lythcott, 1989), and efforts to address population-specific needs have suffered from the lack of comprehensive planning and relied mostly on a deficit model to inform research and practice (Chaskin, Joseph, & Chipenda-Dansokho, 1997; Morrison et al., 1997). The success of intervention strategies designed to bring about change in these populations depends on public engagement and community partnerships in both research and practice (Delgado, 2000; Ramirez-Valles, 2001). Although social work literature has documented the usefulness of informal networks (Hurdle, 2001) and community partnerships (Lesser, 2000) in reducing mortality rates and increasing the use of health practices, the enhancement of a community's capacity to facilitate the intervention has not been clearly delineated. A community capacity-enhancement approach enables social workers to renew a long-standing tradition of collaboration between professionals and community members, resulting in an empowerment model for strengthening community resources. This is important in the effectiveness of health programs because the sustainability of an intervention depends on the capacity of the residents to bring about the necessary changes (Sellers, Crawford, Bullock, & McKinlay, 1997). Furthermore, interventions are most effective when participants and facilitators are of a shared culture and there is a level of comfort in expressing concerns among themselves (Levy, 1985; Yancey & Walden, 1994). We recognized that tailoring health promotion to the needs, beliefs, and cultural attitudes of women of color hinged on culturally congruent networks (Altpeter, Earp, & Schopler, 1998; Bullock, 2004; Suarez, 1994). Delgado (2000) described the community capacity-enhancement framework as a partnership in which knowledge and expertise of all collaborators are considered complementary, where increased skills and capacity at the community level can enhance utilization of the intervention. …