BACKGROUND African American women with hereditary breast cancer risk are less likely to undergo genetic counseling and testing compared with non‐Hispanic White women. Inequities in the use of precision cancer care are likely to exacerbate racial disparities in cancer outcomes. A culturally sensitive multimedia narrative intervention was developed to motivate African American women at risk for hereditary breast cancer to engage in genetic counseling. METHODS Development of the intervention was grounded in the Integrative Model of Behavioral Prediction using a phenomenological, deductive approach and employed multiple qualitative methods for data collection, including 1‐on‐1 interviews and story circles with members of the target audience to identify salient themes and lived experiences. Focus group testing was then conducted with members of the group of focus, primary care providers, and community stakeholders. RESULTS Six themes that mapped to the theoretical model were identified. Lived experiences were abstracted from story circle data to create a narrative storyline. Educational content and motivational messaging derived from the 6 themes were embedded into the script. Focus group testing with stakeholder groups was used to refine the intervention. Testing of the final multimedia narrative with focus groups indicated that the intervention was culturally sensitive and authentic, and the messaging was effective. CONCLUSIONS Multiple qualitative data collection methods and a robust theoretical framework of health behavior were key elements for this study to develop a culturally sensitive, narrative intervention that reflects lived experiences and motivates underserved African American women with hereditary breast cancer risk to engage in genetic counseling. This strategy can be applied to mitigate racial inequities in the use of other genomic approaches for personalizing cancer care.

The authors present a conceptual framework for expanding the use of relational theory with African-American women. Relational theory (RT) informs practice with women but is inadequate in addressing all aspects of culture and identity. RT presumes that all women desire or are able to make therapeutic connections, yet race, gender, and cultural experiences influence their ability to do so. Successful practice with minority women must address racism and its impact. Critical race theory (CRT) that incorporates a solution-focused (SF) approach is well-suited to address the limits of RT. This overview of a CRT/SF approach describes treatment for diverse women that extends RT and enhances effective social work practice to provide culturally sensitive treatment to women.

Critical Service Learning Toolkit offers a strengths-based, interdisciplinary approach to promoting social competence while enhancing emotional and academic skill development. Designed as a user-friendly guide to carrying out successful CSL projects, this Toolkit provides practitioners with step-by-step assistance in planning, implementing, and evaluating Critical Service Learning (CSL) projects in elementary and high schools. CSL trains youth to become active and conscientious citizens through engagement and leadership experiences that meet real needs in the community. This approach is unique in that it places the youth/student at the center of the process. Prioritizing social and emotional learning (SEL) and school engagement, CSL changes the role of the school-based, counseling professional into that of a facilitator who encourages skill-building, reflection, and civic engagement. Cultivating self-awareness, social-consciousness, and critical-thinking skills, brainstorming and community web mapping activities serve as the cornerstone of CSL and allow youth to become comfortable articulating concerns about their communities. By extending learning beyond the classroom and into the community, CSL enhances what is taught throughout the school curriculum, at all levels, and fosters a sense of civic responsibility and social agency.

Background Despite the benefits of genetic counseling and testing, uptake of cancer genetic services is generally low and Black/African American (Black) women are substantially less likely to receive genetic services than non-Hispanic White women. Our team developed a culturally sensitive, narrative decision aid video to promote uptake of genetic counseling among Black women at risk for a hereditary breast cancer syndrome that can be incorporated in conjunction with population-based cancer risk assessment in a clinical setting. We report here a pilot study to demonstrate changes in intention to access genetic counseling and intervention satisfaction. Methods Black women who were personally unaffected by breast cancer and were recommended for genetic counseling based on family history screening in a mammography center were recruited at the time of the mammogram. A prospective, pre-post survey study design, guided by theoretical constructs, was used to evaluate baseline and immediate post-intervention psychosocial factors, including intention to participate in genetic counseling and intervention satisfaction. Results Pilot recruitment goals were met (n = 30). Pre-intervention, 50% of participants indicated that they were extremely likely to make a genetic counseling appointment, compared with 70% post-intervention (p = 0.05). After watching the intervention, 50% of participants indicated that the video changed their mind regarding genetic counseling. Conclusions This study demonstrated cultural satisfaction with a decision aid intervention designed to motivate Black women with hereditary breast cancer risk to attend a genetic counseling appointment. Our study showed that intention may be a specific and key construct to target in interventions designed to support decision-making about genetic services. Study results informed the design of a subsequent large scale, randomized implementation study. Trial registration Trial registration: Clinicaltrials.govNCT04082117. Registered September 9, 2019. Retrospectively registered.

Critical service learning (CSL), social and emotional learning (SEL), and positive youth development (PYD) represent key elements for promot¬ing healthy attitudes and behaviors among youth. This chapter explains each component and provides a theoretical overview. As mentioned in Chapter 1, CSL represents a therapeutic strategy that encompasses a philosophy of youth empowerment. CSL emphasizes youth becoming empowered to view themselves in relation to others, as partners, to bring about change in their environment. Mitchell (2008) defined CSL as an approach that challenges youth to become self-aware of how their own situations influence their relationships within their community. When these relationships are based on the concerns of the community, they can facilitate CSL through the examination of issues of power, privilege, and oppression— and disparaging assumptions of class, gender, and race— and then take action to address unjust and inequitable social and economic systems (Cipolle, 2010). Youth engage in critical thinking about the problems they face within their own communities and are encouraged to take action. The critical approach to service learning promotes social justice and challenges the status quo. The approach to CSL involves three key elements: “working to redistribute power amongst all participants in the service learning relationship, developing authentic relationships in the classroom and in the community and working from a social change perspective” (Mitchell, 2008, p. 50). The goal of CSL is to examine power relations, challenge oppressive institutions, and cultivate in youth the power to take action. In our model, the CSL approach presents “student voice” as a necessary component to create a sense of empowerment and authentic engagement. The community web-mapping tool discussed in Chapter 3 serves as the vehicle for students to address social justice issues as they compare and contrast their vision of perfect and imperfect communities (Figure 2.1). Social and emotional learning is a framework that provides opportunities for young people to acquire the skills necessary for maintaining personal well-being and positive relationships across their life span (Elbertson, Brackett, & Weissberg, 2009). The five competency clusters for students are the following: 1. Self- awareness: the ability to accurately recognize one’s emotions and thoughts and how they influence behavior.