This qualitative focus group research assessed both AA men’s and women’s current communication practices, barriers, and recommended strategies for PrCA communication. Formative qualitative research is being used increasingly in health disparities research to identify key trends and issues from which to determine public perceptions and knowledge, preferred dissemination strategies, and to conduct message testing (Friedman, Tanwar, Yoho, & Richter, 2010
; Ruff, Alexander, & McKie, 2005
). As participants in formative research, community members become part of and contribute to solutions to community-related concerns and issues.
Being able to communicate about PrCA and make informed decisions about PrCA screening within families and with healthcare providers is critically important given the most recent statement of the U.S. Preventive Services Taskforce. Furthermore, findings from this study have important implications in South Carolina given that mortality-to-incidence ratios (MIRs) for PrCA in this region are significantly higher in AA men than in their EA counterparts; i.e., 58% higher for PrCA (Hébert et al., 2009
This was one of few studies to include AA women in formative research about PrCA screening decision making (Friedman et al., 2012). AA women are typically health information seekers for their families and influence men’s health and cancer decisions. Other research has demonstrated older AA men’s reliance on immediate female family members for monitoring their health needs and answering medical questions (Friedman et al., 2009b
; Levinson et al., 2005
). Thus, spouses and partners are an important audience for the delivery of PrCA messages. Further, including AA women in this research was essential for understanding and addressing all perceived barriers preventing AA men from discussing PrCA with family and healthcare providers. Findings revealed important similarities and differences in emergent themes between men’s and women’s groups. AA men and women agreed upon the primary barriers preventing men from discussing PrCA, but they had different perspectives on their relative importance. For example, women more often mentioned masculinity as a barrier while men discussed their fear of talking about cancer. Also, if women are correct in their opinion about the inverse relationship between a man’s age and his receptivity to discussing screening (and related issues) it could have important public health consequence as screening in older men is generally futile (von Eschenbach, 1996
While focus group discussions revealed that men typically discussed PrCA with significant others more often than with healthcare providers, the men expressed that they did not necessarily feel comfortable having such conversations with women and they preferred to talk about PrCA with their doctors. This finding supports other prostate cancer communication research conducted in the South showing that AA men reported having discussions about the advantages and disadvantages of PrCA screening with their doctors (Ross, Powe, Taylor, & Howard, 2008
). However, some qualitative research in South Carolina demonstrated that doctors were not considered key sources of cancer prevention information (Friedman et al., 2009b
). Nonmedical sources most likely to influence men’s health decisions and behaviors were family members and community leaders. Because men may be consulting with family and community for cancer decision making, future research and interventions should consider a team approach to decision making. Other interviews conducted with AA men about PrCA screening decisions have revealed the importance of social support (e.g., spouse, family, church community) and sharing testimonials with family and friends during the decision making process (McFall et al., 2009
AA men and women provided similar recommendations for PrCA education locations and strategies. The focus groups and subsequent education sessions were held at a local library. While the library location was convenient for participants, recommendations were made for alternate cancer education venues. The church was mentioned most often by both male and female participants as a potential partner and location for PrCA education programs. Faith-based settings have been effective for engaging AAs in other communities in healthy behaviors and are considered a culturally appropriate strategy for reaching communities for whom spirituality may play an important role in making health decisions (Drake, Shelton, Gilligan, & Allen, 2010
; Friedman, Hooker, Wilcox, Burroughs & Rheaume, in press
; Holt, Wynn, & Darrington, 2009a
; Holt, Wynn, Litaker, Southward, Jeames, & Schulz, 2009b
; Holt, Wynn, Southward, Litaker, Jeames, & Schulz, 2009c
; Mayo et al., 2009
). Barbershops also were recommended by both men and women. They have been considered a successful and culturally appropriate venue for recruiting AA men into health programs (Linnan et al., 2010; Releford, Frencher Jr., Yancey, & Norris, 2010
) and for PrCA education with AA men (Luque, Rivers, Gwede, Kambon, Green, & Meade, 2011
). Interventions in community-based settings have demonstrated significant improvements in PrCA knowledge, increased likelihood of discussing screening with a physician, and/or increased screening decision self-efficacy (for example, Holt et al., 2009b
; Luque et al., 2011
; Wray, Vijaykumar, Jupka, Zellin, & Shahid, 2011).
The most commonly mentioned strategies for encouraging communication and decision making about PrCA screening were involving church members and pastors in PrCA education, word-of-mouth and face-to-face discussions, radio advertisements, and involving women.
Engaging the faith-based community in PrCA education was strongly recommended by both AA men and women. Connecting with AA men through word of mouth also was a key strategy suggested by participants. Use of word of mouth to promote health messages has been recommended by AA men in other health behavior research (Friedman et al., 2009a
; Friedman et al., 2009c
) and is considered an effective strategy for recruiting AA community members into behavioral interventions (King et al, 2010
). Although radio and mass media outlets have been recommended for reaching a large audience base with health and PrCA messages as demonstrated elsewhere (Friedman et al., in press
; Sanders Thompson, Talley, Caito, & Kreuter, 2009
), television was mentioned least often in both men’s and women’s groups. This finding is similar to other research in which community members perceived that watching too much television for health promotion purposes could be a major barrier to engaging in healthy behaviors (Friedman et al., 2009c
). Examining both active and inactive AA men’s perceptions about how to market a physical activity to AA men of their age, more inactive men recommended media promotion (e.g., television public service announcements) and none of the older active men suggested television as a promotional channel (Friedman et al., in press
This qualitative study has some limitations. The relatively small sample consisted of self-selected AA men and women from one southern U.S. state. Convenience samples are not representative of entire populations; however, it was not intended that focus groups findings be generalized to all AA groups in the state, in other regions of the South, or other racial/ethnic groups.
Findings informed strategies for improving prostate communication in South Carolina. Specifically, this study provided important recommendations for the design, implementation, and evaluation of a culturally appropriate PrCA and informed decision making education intervention for both AA men and women in South Carolina. It guided the development of a four-module pilot PrCA education intervention that involved 56 AA men and women (Friedman et al., 2012). Findings also will inform future examinations of cancer screenings and health and cancer decision making among AA families that considers social and cultural values and practices (Briss et al., 2004
). Research on the feasibility of training both AA women and clergy to educate AA men about PrCA will be an important next step. Finally, knowledge from this research is likely to be useful to understanding the decision making process related to cancer screening behaviors as well as treatment (e.g., active surveillance) with potential connections to other health decisions.