Bittencourt Lorna, Scarinci Isabel C
University of Alabama at Birmingham, Division of Preventive Medicine, 1720 2nd Ave. S, MT 609, Birmingham, AL, USA.
Health Promot Int. 2019 Feb 1;34(1):95-101. doi: 10.1093/heapro/dax058.
Although it has been show that early detection through mammograms is the most effective way to reduce breast cancer mortality, breast cancer is the leading cause of cancer deaths among women worldwide with survival rates being even lower in low- and middle-income countries as compared to high-income countries. Despite the availability of breast cancer screening programs in Brazil through the public health system, some women do not participate in these programs due to structural and/or inter/intrapersonal barriers. The Community Health Worker (CHW) model is a promising approach to reach these women who have not been reached through other efforts. This paper describes a participatory approach for capacity building of CHWs to promote breast cancer screening among low-income women 50 years of age and older in a southern city in Brazil as a combined effort between two academic institutions, the municipal health care system, and a local non-profit organization. The capacity building program consisted of an 8-hour training focusing on knowledge (e.g., breast cancer and screening) and skills (e.g., communication skills, basic principles of behavior change) to promote breast cancer screening among community members. Pre- and post-test questionnaires assessed changes in breast cancer knowledge and self-perceived knowledge and confidence (N=44). There was a significant increase in objective knowledge regarding breast cancer overall, risk factors, and behavior change strategies between pre- and post-test. There was also a significant increase in self-perceived knowledge and confidence, items related to knowledge about breast cancer, breast cancer early detection methods, and the ability to solve problems between pre- and post-test as well as a significant increase in their confidence to motivate women to get a mammogram. Overall, this study demonstrates the importance of welldeveloped capacity building programs to promote breast cancer screening among health care professionals, especially those with limited educational attainment, such as CHWs.
尽管乳房X光检查早期发现是降低乳腺癌死亡率的最有效方法，但乳腺癌仍是全球女性癌症死亡的主要原因，与高收入国家相比，低收入和中等收入国家的生存率更低。尽管巴西通过公共卫生系统提供了乳腺癌筛查项目，但由于结构和/或人际/个人内部障碍，一些女性并未参与这些项目。社区卫生工作者（CHW）模式是一种有前景的方法，可以覆盖那些通过其他努力未能触及的女性。本文描述了一种参与式方法，用于对社区卫生工作者进行能力建设，以促进巴西南部一个城市中50岁及以上低收入女性的乳腺癌筛查，这是两个学术机构、市医疗保健系统和当地一个非营利组织的联合努力。能力建设项目包括一个8小时的培训，重点是知识（如乳腺癌和筛查）和技能（如沟通技巧、行为改变的基本原则），以促进社区成员的乳腺癌筛查。前后测试问卷评估了乳腺癌知识以及自我认知的知识和信心方面的变化（N = 44）。在测试前后，关于乳腺癌总体、风险因素和行为改变策略的客观知识有显著增加。在测试前后，自我认知的知识和信心、与乳腺癌知识、乳腺癌早期检测方法以及解决问题能力相关的项目也有显著增加，并且他们激励女性进行乳房X光检查的信心也显著增加。总体而言，本研究证明了完善的能力建设项目对于促进医疗保健专业人员，尤其是像社区卫生工作者这样教育程度有限的人员进行乳腺癌筛查的重要性。
