Breast cancer awareness through community-based health education and communication

Migrant Health Newsline, Sept-Oct, 2008 by Robin Lewy

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Marta practiced the breast self-exam (BSE) each month because she knew that early detection could improve a woman's chances for surviving the disease. However, when she discovered a lump in her breast, the thought of cancer overwhelmed her with fear. As a result, she avoided spending time with her family. When she missed a big gathering, her family became concerned and confronted her. Marta explained to them that further screenings confirmed she did not have breast cancer, but she remains vigilant.

With a new awareness, she uses her testimony to teach her female relatives about the importance of early detection. She also educates them by modeling the BSE and emphasizing detection through clinical exams and screenings. Although Marta is fictional, her story was created through a compilation of true events and real people. But despite her fictional nature, her character from the fotonovela (story), El Susto de Marta (Marta's Scare), plays an essential role in communicating critical health messages to her community, thereby increasing awareness of early detection.

The Fotonovela Process

The fotonovela is a communication tool familiar in Spanish-speaking communities. In health education, the novela's richness lies in its ability to foster self and cultural identification among Spanish-speaking readers. The fotonovela's format is similar to that of a comic book, combining photographs (replacing illustrations) with small dialogue bubbles. This format avoids health literacy issues by allowing readers to grasp health messages more easily.

The Rural Women's Health Project (RWHP) addresses health education from Paulo Freire's concept that "... the people must learn to read their own reality and write their own history." Therefore, we incorporate the following into our materials:

* Realistic health options: Accurate reflections of the target community's reality that will improve the reader's interpretation of health messages.

* Role modeling behavior: Positive health behaviors are demonstrated using photographic images and text depicting steps to healthy behavior.

* "Each one, teach one": Best expressed through character relationships. Characters educate one another about healthier lifestyle choices, usually based on their own experiences; challenging others to make better decisions regarding the highlighted health issue.

Communal storytelling: A tool for community health

Creando Nuestra Salud (Creating Our Health), is both a breast health education program and a series of educational materials. Evolved from a needs assessment in which Spanish-speaking women in two rural Florida counties identified breast cancer as an important health concern, the RWHP collaborated with community organizations to develop the fotonovelas. Using communal storytelling, through meetings, interviews and open-ended questionnaires, true stories and perspectives were related and then combined to form a community narrative. The narrative embraces health and cultural information that might be neglected by other informative approaches. Community participants also review the materials to ensure their linguistic diversity and appropriateness. All of the Creando Nuestra Salud materials were conceived from this method of communal storytelling.

Available breast cancer resources, novela materials

Two fotonovelas, posters and a magazine were developed from the Creando project. The following materials can serve as the cornerstones of outreach activities and community trainings that address breast cancer education in the Hispanic farmworking community:

* El Susto de Marta (Marta's Scare) is about a woman who experiences a false alarm after she performs the BSE, and then teaches her relatives about early breast cancer detection.

* Lo Que Dicen Mis Amigas Sobre El Cancer Del Seno (What My Friends Say About Breast Cancer) encourages breast health through Spanish-speaking women who share facts and advice about breast cancer. It provides illustrated instructions for the BSE.

* Creando Nuestra Salud Magazine is an informational companion to the novela materials. It focuses on treatment options and the importance of early detection screenings.

* Novela-style posters complement Creando's focus on early detection.

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The Creando Nuestra Salud curriculum includes a series of dynamic teaching tools on early breast cancer detection, promotora packet guides, contact sheets for outreach and data management and protocols and resources for breast health. Capacity building support and promotora trainings are also available.

For more information about the RWHP, Creando Nuestra Salud or our breast cancer resources, check out our new Web site at www.rwhp.org.

References available upon request.

By Robin Lewy, Rural Women's Health Project