Dos & Don’ts

Educating African American Men: Dos & Don’ts
Prostate Cancer Communication …
Educating African-American men –
Dos
&
Don’ts
This booklet is developed as a resource for health care providers,
health educators and researchers to assist them in communicating
with African-American men about prostate cancer screening, clinical
trials and treatment.
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Educating African American Men: Dos & Don’ts
This booklet is authored by Folakemi Odedina, PhD1; Nagi Kumar,
PhD; John Scrivens, PhD and Clement K. Gwede, PhD based on the (i)
community dialogue with African American men during the Florida
State-wide African American men Prostate Cancer Forum2 and (ii)
focus group discussions with African American men3. These projects
were funded by the U.S. Army Department of Defense CDMRP
Research Programs DAMD 17-01-1-0055 and W81XWH-04-1-0326.
DISCLAIMER
The information provided in this document is drawn from statements
provided by African American men as a guide for prostate cancer
education and are not endorsed by the U.S. Army Department of
Defense, Florida A&M University or The H Lee. Moffitt Cancer Center &
Research Institute.
1
Corresponding author. Florida A&M University Center for Minority Prostate Cancer, Suite 200
Dyson Pharmacy Building, Tallahassee Fl 32307; (850) 599-3097 (Phone).
2
The African American Men’s Prostate Cancer Forum. Presented by Florida A&M University
Center for Minority Prostate Cancer Training and Research, Tallahassee, Florida. September 1718, 2004.
3
Odedina FT., Scrivens J., Emanuel A., LaRose-Pierre M, Brown J., Nash R. (2004). A
naturalistic study of factors influencing African American men’s prostate cancer screening
behavior. Journal of National Medical Association. Jun; 96(6):780-8.
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Educating African American Men: Dos & Don’ts
One of the two goals specified for the United States Healthy People
2010 is to eliminate health disparities among segments of the
population. This goal is very crucial to the overall health of the nation.
Consequently, to eliminate cancer as a major health problem within the
U.S., it is important to address cancer disparities within the population.
African-Americans carry the most significant burden for cancer in the
U.S. This burden is especially heavy for African American men in the
case of prostate cancer. Although prostate cancer affects men
regardless of their racial group, a disproportionate burden is
experienced by African-American men. From the American Cancer
Society’s 2005 statistics, African American men are 2.4 times more
likely to die of prostate cancer compared with White men. They also
have the highest incidence of prostate cancer compared to other
racial/ethnic groups in the United States.
Some of the reasons that have been noted in the literature for the
prostate cancer disparity seen in the African-American population,
include the fact that (i) African-American men do not have adequate
knowledge about prostate cancer disease, including basic components
of prostate screening; (ii) they are less likely to correctly identify early
symptoms of prostate cancer; (iii) they are more likely to believe pain
is the first symptom of prostate cancer; (iv) they do not know that their
race makes them a high-risk group; (v) they have a poor prostate
cancer survival rate; (vi) they are more likely to present at a later
stage of prostate cancer; (vii) they have higher levels of prostatespecific antigen and (viii) prostate tumors appear to be more
aggressive in African-American men. Since there is no recognizable
symptom for early prostate cancer, informed decisions should be
promoted in at-risk men, especially African-American men, so that
aggressive treatment can be provided to increase their survival rate.
This booklet is developed as a resource for health care providers,
health educators and researchers to assist them in communicating
with African-American men about prostate cancer screening, clinical
trials and treatment. This content is a summary of the direct
statements made by African American men to describe the best and
worst methods for communicating on prostate cancer issues.
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Educating African American Men: Dos & Don’ts
What do African-American men want you to do to
address prostate cancer disparities?
DO….
9 Encourage more doctors to conduct PSA tests.
9 Encourage more people younger than 50 to get PSA
tests.
9 Develop a web site for prostate and colon cancer.
9 Send e-mail bulletins to Black organizations for
distribution to their members.
9 Develop short fact sheets for distribution through Black
organizations at least twice a year.
9 Tie prostate cancer forums or seminars in with other
activities such as sports events.
9 Hold frequent educational forums to educate the
community and promote awareness.
9 Educate more often on prevention activities such as
diet, smoking, drinking etc.
9 Encourage annual screening/checkup.
9 Tailor messages to different age groups and
communities.
9 Clarify myths and misunderstandings about prostate
cancer.
9 Only give messages relevant to the Black community.
9 Provide all the issues in lay terms.
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Educating African American Men: Dos & Don’ts
What do African-American men want to hear from you
about prostate cancer?
DO ….
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Explain the need for a prostate exam.
Discuss how it will affect a man’s life.
Talk about how sex life is affected with prostate cancer
Discuss the chance of surviving prostate cancer.
Talk about the role of diet, nutrition and physical
activities.
Advice on how to fit exercise into one’s busy schedule.
Explain the risk factors for “African” males.
Explain about high-risk activities/exposures.
Talk about scientific findings in this area.
Discuss the positive outcomes and negative outcomes of
getting screened.
Provide good information about the screening
procedure.
Give shocking statistics about prostate cancer.
Provide statistics supporting screening early and
regularly.
Give information about people who have prostate
cancer, especially if they survived.
Provide information about where to go and how to get
to the medical services.
State if one can get prostate cancer regardless of
heredity.
Discuss the seriousness of the disease.
Talk about signs and symptoms of the disease.
Provide information about the cure for the disease.
Provide information about the risk and mortality
differences in other Black men of African descent.
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Educating African American Men: Dos & Don’ts
In providing prostate cancer information to AfricanAmerican men:
DO use channels such as ….
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Internet
Television
Billboard
Flyers
Church
Personal contact
Word of mouth
Community outreach
Street contact in Black neighborhoods
Black radio stations
Gospel stations which target the age group of interest
Black magazines such as Ebony
Black Television stations such as BET
Black hair salons
Black barber shops
Schools (sending information home through children)
Books
Sports events ads
Advertisements at job sites
Goodyear Blimp
Messages in payroll check
Messages in utility bill
Advertisements during big sporting events
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Educating African American Men: Dos & Don’ts
In providing prostate cancer information to AfricanAmerican men:
DO use sources such as ….
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Friends
Family, such as parents, children and siblings
Wife – most important
Prostate cancer survivors
Doctor
Nurse
Specialists who provide second opinions
Knowledgeable and reputable Black doctors
Black men
Black community organizations such as Black Caucus,
NAACP, Urban League
Well known high profile black man who has prostate
cancer and will go public
Pharmaceutical companies
National Cancer Association
Centers for Disease Control and Prevention
Children
God
Ministers
Friends who are health care providers
Black colleges such as Florida A&M University (with a
mission to serve the black community)
Personal doctor
Specialist
Research team
Urologist
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Educating African American Men: Dos & Don’ts
In providing prostate cancer information to African
American men:
DO NOT use sources such as ….
⊗ Non African-American physicians.
⊗ Physician with bad attitude.
⊗ White physician (African-American men believe
that Whites are not concerned about Blacks; may
not provide all information; may not know enough
about Blacks to provide relevant information).
⊗ Family and friends who are not knowledgeable.
⊗ Someone with no knowledge on prostate cancer.
⊗ Prison doctors.
⊗ Non-health care providers.
⊗ Drug companies.
⊗ Law makers, politicians.
⊗ A doctor who rushes patients in and out.
⊗ A doctor who doesn't refer patients to a specialist.
⊗ A person who has never been tested for prostate
cancer.
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Educating African American Men: Dos & Don’ts
To properly educate
prostate cancer:
African-American
men
about
DO NOT ….
⊗ Keep any information away.
⊗ Act as if it is not important.
⊗ Be dishonest about negative effects of testing,
treatment and clinical trials.
⊗ Speak in very technical medical terms.
⊗ Give false information.
⊗ Use messages that are not culturally sensitive.
⊗ Provide information downplaying causes and effects of
prostate cancer
⊗ Discuss information specifying ineffective treatment if
diagnosed.
⊗ Use a message that may indicate that this is another
part of the long list of things attributed to the Black
race.
⊗ Use negative media image of the disease that scares
people.
⊗ Include too much medical jargon in your message.
⊗ Use messages that are too long, for example having to
read about 15 pages of information.
⊗ Use messages such as “If you have prostate cancer, you
will die”.
⊗ Include messages about the rectal exam that causes
fear, embarrassment or stigma of homosexuality.
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Educating African American Men: Dos & Don’ts
What other resources / opportunities will assist African-American men in making
informed decisions about prostate cancer screening?
9 Other health promotion / disease prevention activities. e.g. other
health screening activities
9 Testing required by employer (part of job requirement)
9 Easier procedure for testing, e.g. blood test rather than rectum
9 Knowledge of the seriousness of disease among African
Americans
9 Knowledge of the disease and screening
9 Self interest in screening
9 Ability to ask health care providers the right questions
9 Awareness / Education
9 Reading about the disease, educating oneself
9 Having health insurance
9 Money to see the doctor
9 Free screening
9 Giving incentives for screening
9 Prior contact - knowing somebody who was diagnosed with
prostate cancer
9 In an environment that the individual grew up which will
influence health consciousness
9 Access to health care
9 Availability of testing
9 Transportation
Regular check ups
Screening mandated as part of annual physicals
Knowing the probability of getting prostate cancer
Being health conscious
Reminders from doctors
Fear of getting prostate cancer
Perceived consequences of getting prostate cancer
Knowledge of what will happen if you don't get screened
Realizing how deadly the disease could be
Living in a health conscious environment
Having the signs and symptoms
Fear of premature death
Desire to know if you have it or not
Knowing the benefits of getting checked
Knowing that you are still in good shape
Get the message about screening early
Black neighborhoods have medical team in a van giving free
screening
9 Noting that prostate cancer can run in families
9 Knowing one's own family history
9 Showing how prostate cancer can affect loved ones
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Educating African American Men: Dos & Don’ts
What are the things that may serve as obstacles for African-American men in
making informed decisions about prostate cancer screening?
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Lack of family history gives false sense of not being at risk
Scared of finding out the results
Fear of the disease
Impact on sex life
Discomfort of testing and being violated by the rectal exam
Doctor not willing to answer questions
Lack of awareness or knowledge
Black men having limited contact with the health care system
Black men not seeing doctor regularly
Pattern/history of Parent(s) health promotion/prevention activities
Not comfortable sharing personal information with doctors
Not trusting the procedure
Not trusting the doctor or the health care system
Unhelpful doctor
Unable to read (illiteracy might make you feel uncomfortable
communicating with health care providers)
Individual perception about testing or the disease
Preventing yourself from worrying (may not want to know so that
you don't have to worry)
Denial of your susceptibility
Knowing that African- American men are often noted to be at risk
for many things - out of your control
Lack of self motivation
Ignorance
Time constraints
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Not wanting "to be too white" by being very health conscious
Not having a black doctor
Not having a primary physician
Priorities (e.g. more worried about providing food and
accommodation to the family, health has lower and not immediate
priority)
Black male syndrome (unmanly to complain)
No health discussion among black men
Negative results from previous health screening
Lack of information from doctor
Diversions such as drinking, drugs
Having other disease / Being sick
Lack of money
Unable to take time off work for testing
Fearing a doctor with large hands for the Digital Rectal Exam
Lack of access to healthcare / healthcare facilities
Being complacent
Not taking advantage of opportunities such as the free screening
Services mostly provided by white men (no trust in whites providing
the services)
Other competing focus - such as paying rent, putting food on the
table etc.
Being too proud to admit you can't afford the test
Fear of needles
Fear of positive test result
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Educating African American Men: Dos & Don’ts
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