Abstract
African American women diagnosed with breast cancer where this study was completed have significantly worse outcomes than Caucasian women. The purpose of this study was to prevent and manage chronic disease in AABCS. Partnering with the community to deliver interdisciplinary group intervention had a significant impact on changing health behaviors and risk factors to prevent and manage chronic conditions and reduce health disparities among AABCS.
Primary Author and Speaker: Julie Hunley
Contributing Authors: Phyllis Holder, Yvonne Greer
African American (AA) women diagnosed with breast cancer where this study was completed have significantly worse (OR=1.55) disease outcomes than Caucasian women (Beyer, et al., 2016). Neighborhoods are hyper-segregated, and residents are less active and more obese with higher levels of food insecurity than residents in other state counties (County Rankings and Roadmaps, 2018). AA premature all cause adult death is more than double that of Caucasians in the same county (County Rankings and Roadmaps, 2018).
Occupational therapists (OTs) routinely deliver services to this high-risk population when individuals are in medical crises. Increasingly, OTs work as interdisciplinary team members to manage the needs of individuals with multiple chronic conditions (Leland, Fogelberg, Halle, & Mroz, 2017). Determining a distinct role for OT is an important step in emerging practice models in order to shift from crisis to disease management. The purpose of this study was to promote AA breast cancer survivorship and chronic disease prevention and management. Educational experiences with engaged community members led to changes in health behaviors amid significant health disparities.
This was a quasi-experimental study embedded in participant action research (Baum, MacDougall, & Smith, 2006) and was a joint effort between a university-based occupational therapy investigator and an AA community breast cancer survivor group led by a registered nurse. Other team members included a registered dietician, and a yoga instructor. The AA community survivor group recruited study participants who were then screened by the investigator for study eligibility. Inclusion criteria were the following: African American, female, and breast cancer history.
The intervention included goal setting, nutrition, and yoga. Sessions were bi-weekly from January-May 2017. There were 15 participants who ranged from 51-75 years old and were 1 to 15 years post diagnosis. All participants reported chronic conditions in addition to breast cancer. Session experiences were designed to build: Sisterhood for health promotion, disease management and support; individual and group health promotion through goal-setting to manage chronic disease, healthy family nutrition and meal planning skills, and family integrated yoga practice. Height, weight, waist circumference, and balance were collected at baseline. Weight and waist measurements occurred at each session. Balance was collected again at the last session. Paired t-tests were run with SPSS to determine intervention efficacy.
Findings support the promotion of AA breast cancer survivorship through health promotion and chronic disease management. Reducing body fat as measured by weight loss (p=.029) and waist circumference reduction (p=.002) were important markers of metabolic improvement to reduce disease risk Increased balance (p=.003) was an indicator of increased capacity for occupational engagement through physical activity. All participants demonstrated 6 yoga postures from memory and prepared healthy meals for the final study session. Participants reported healthy diets and motivation to continue healthy nutrition and activity. Achieving these goals demonstrated increased capacity for long-term health behavioral change.
A community-based, interdisciplinary group health promotion and chronic disease management intervention significantly reduced health risk factors in AA breast cancer survivors living amidst health disparities. Goal setting facilitated by OTs can lead interdisciplinary intervention success. Group service delivery can have a significant impact on changing health behaviors to prevent and manage chronic conditions and reduce health disparities among AA breast cancer survivors.
Beyer KM, Zhou Y, Matthews K, et al. Breast and colorectal cancer survival disparities in southeastern Wisconsin. WMJ : official publication of the state medical society of Wisconsin. 2016;115(1):17-21.
County Health Rankings & Roadmaps (2018), Retrieved online 06/07/2018 http://www.countyhealthrankings.org/app/wisconsin/2018/rankings/milwaukee/county/outcomes/overall/snapshot
Leland, N. E., Fogelberg, D. J., Halle, A. D., & Mroz, T. M. (2017). Health Policy Perspectives—Occupational therapy and management of multiple chronic conditions in the context of health care reform. American Journal of Occupational Therapy, 71, 7101090010. https://doi.org/10.5014/ajot.2017.711001
Baum, F., MacDougall, C., & Smith, D. (2006). Participatory action research. Journal of Epidemiology and Community Health, 60(10), 854–857. http://doi.org/10.1136/jech.2004.028662