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1.  Antecedents and Mediators of Community Connection in African American Women With Breast Cancer 
Objective
To describe the theory of community connection defined as close relationships with women and men who are members of a neighborhood, a church, a work group, or an organization. Antecedent and mediator variables related to community connection are identified.
Design/methods
A cross-sectional design was used to assess for relationships among theorized antecedents and mediators of community connection in a sample of 144 African American women aged 21 years and older (mean 5 54.9) who had been diagnosed with invasive/infiltrating ductal carcinoma.
Measurement and Analyses
Community connection was measured with the relational health indices-community subscale. Mediator analysis was conducted to assess significance of the indirect effects of the mediator variables, which were fear, breast cancer knowledge, and isolation.
Results
Community connection was found to be associated with three of the four antecedents, cancer stigma, stress, and spirituality, but not associated with fatalism. Effects were mediated primarily through fear and isolation with isolation as was more dominant of the two mediators. Surprisingly, breast cancer knowledge showed no significant mediator role.
Conclusions
The importance of isolation and fear as mediators of community connection is highlighted by this research. The study could serve as a model for other researchers seeking to understand connection in ethnic groups and communities.
PMCID: PMC3302172  PMID: 22329080
African American; breast cancer; community; connection; mediators
2.  Evaluation of Conceptual Framework for Recruitment of African American Patients With Breast Cancer 
Oncology nursing forum  2010;37(3):E160-E167.
Purpose/Objectives
To describe the Heiney-Adams Recruitment Framework (H-ARF); to delineate a recruitment plan for a randomized, behavioral trial (RBT) based on H-ARF; and to provide evaluation data on its implementation.
Data Sources
All data for this investigation originated from a recruitment database created for an RBT designed to test the effectiveness of a therapeutic group convened via teleconference for African American women with breast cancer.
Data Synthesis
Major H-ARF concepts include social marketing and relationship building. The majority of social marketing strategies yielded 100% participant recruitment. Greater absolute numbers were recruited via Health Insurance Portability and Accountability Act waivers. Using H-ARF yielded a high recruitment rate (66%).
Conclusions
Application of H-ARF led to successful recruitment in an RBT. The findings highlight three areas that researchers should consider when devising recruitment plans: absolute numbers versus recruitment rate, cost, and efficiency with institutional review board–approved access to protected health information.
Implications for Nursing
H-ARF may be applied to any clinical or population-based research setting because it provides direction for researchers to develop a recruitment plan based on the target audience and cultural attributes that may hinder or help recruitment.
doi:10.1188/10.ONF.E160-E167
PMCID: PMC2946071  PMID: 20439201
3.  Racial Disparities in Breast Cancer Mortality in a Multi-Ethnic Cohort in the Southeast 
Cancer  2011;118(10):2693-2699.
Background
Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature which examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among BrCA patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients.
Methods
Subjects included 1209 women diagnosed with BrCA between 2000–2002 at a large, local hospital containing a comprehensive breast center. Kaplan Meier survival curves were calculated to determine survival rates among AA and EA women, stratified by disease stage or other prognostic characteristics. Adjusting for various characteristics, Cox multivariable survival models were used to estimate the hazard ratio (HR)
Results
The 5-year overall all-cause mortality survival proportion was ~78% for AA women and ~89% for EA women, p<0.01. In analyses of sub-populations of women with identical disease characteristics, AA women had significantly higher mortality than EA women for the same type of breast cancer disease. In multivariable models, AA women had significantly higher mortality than EA women for both BrCA specific death (HR = 2.41; 1.21–4.79) and all-cause mortality (HR = 1.42; 1.06–1.89).
Conclusion
AA women residing in rural South Carolina had lower survival for breast cancer even after adjustment for disease-related prognostic characteristics.
Impact
These findings support health interventions among AA BrCA patients aimed at tertiary prevention strategies or further down-staging of disease at diagnosis.
doi:10.1002/cncr.26570
PMCID: PMC3269560  PMID: 21953316
Breast Neoplasms; Mortality; African Americans; Health Status Disparities; Tertiary Prevention
4.  Operationalization of community-based participatory research principles across the National Cancer Institute’s Community Network Programs 
American Journal of Public Health  2011;102(6):1195-1203.
Objectives
To examine how the National Cancer Institute-funded Community Network Program (CNP) operationalized principles of community-based participatory research (CBPR).
Methods
Based on our review of the literature and extant CBPR measurement tools, scientists from nine of 25 CNPs developed a 27-item questionnaire to self-assess CNP operationalization of nine CBPR principles.
Results
Of 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles to recognize community as a unit of identity, build on community strengths, facilitate co-learning, embrace iterative processes in developing community capacity, and achieve a balance between data generation and intervention. CNPs varied in extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging community in research dissemination, and striving for sustainability.
Conclusions
Although tool development in this field is in its infancy, findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.
doi:10.2105/AJPH.2011.300304
PMCID: PMC3292685  PMID: 22095340
Cancer disparities; community health; empowerment; health status disparities; indigenous populations; minority health; partnerships; training
5.  Successful subject recruitment for a prostate cancer behavioral intervention trial 
Background
Inadequate participant recruitment, which may lead to unrepresentative study samples that threaten a study’s validity, is often a major challenge in the conduct of research studies.
Purpose
The purpose of this article is to describe the development and implementation of a recruitment plan and evaluate the different recruitment strategies for a prostate cancer behavioral intervention trial.
Methods
Our recruitment plan was based on a framework (The Heiney–Adams Recruitment Model) that we developed, which combines relationship building and social marketing. We evaluated the success of our model using several different recruitment sources including: mailed letters, physician referral, and self-referral.
Results
Recruitment rates ranged from 67% for a support services department mailing to 100% for physician referral. While our original list of contacted patients was comprised of only 13% African American (AA) men, 22% of our recruited participants were AA.
Limitations
One of the strongest barriers to recruitment was strict patient eligibility. Another significant barrier was the lack of electronic records systems to allow for the identification of large numbers of potential participants.
Conclusions
In conclusion, our model incorporating social marketing and relationship building was quite successful in recruiting for a prostate cancer behavioral study, particularly AA participants. In developing strategies, future researchers should attend to issues of staffing, financial resources, physician support, and eligibility criteria in the light of study accrual.
doi:10.1177/1740774510373491
PMCID: PMC2959175  PMID: 20571136

Results 1-5 (5)