Promoting breast health: older women's perceptions of an innovative intervention to enhance screening

Aims and objectives.  This study is a continuation of prior funded research in which we tested the use of age and ethnically sensitive video breast health kits to increase knowledge about breast cancer and enhance the screening practices of breast self-examination and mammography among older Caucasian and African-American women. Background.  Breast cancer is the most frequent cancer in women worldwide and accounts for 23% of all cancers. Mammography is currently the best procedure available for mass screening of breast cancer. However, underutilization of mammography is a problem among older women in the United States. Elders are at the greatest risk for developing and dying from breast cancer but they are the least likely group to be screened routinely with mammograms or to practice breast self-examination, particularly if they are African-American. Design.  Participatory qualitative evaluation focus groups were used to assess the overall impact of the video kit intervention programme and to elucidate the quantitative findings of the original study. Methods.  Four focus groups were conducted in two diverse settings with a purposive sample of 23 participants (N = 23). The overall sample was predominantly African-American (87%) with mean age of 71 ± 7.9 years and mean education completed of 12 ± 3.4 years. Results.  Five major themes emerged from group discussions: usability and appeal of the intervention, fear and empowerment, personal relevance and intergenerational sharing, impact on screening behaviours, and story telling. Conclusions.  Analyses suggest that customized media materials constructed especially for older African-American women empowered participants in this sample to action regarding their own breast health. Relevance to clinical practice.  These findings may translate to global populations where risk is increasing but screening programmes are not widely available. Given that older women are historically difficult to access and impact, further design and evaluation of innovative and sensitive educational programmes such as the one described here are recommended.