Training Community Health Workers to promote breast cancer screening in Brazil

Abstract

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.

Participation in Cervical Screening by Self-collection, Pap, or a Choice of Either in Brazil

“…The capacity building equipped them with behavior change strategies as evidenced by the significant pre-and post-training changes in perceived skills to promote behavior change and motivate women to be screened (21). This supports our work and others' that CHWs can be actively involved in behavior change if provided with appropriate training and supervision (29)(30)(31)(32)(33)(34).…”

Community health workers at the dawn of a new era: 5. Roles and tasks

“…In addition, as healthcare trends change and new events occur, countries are turning to CHW programmes. CHWs are increasingly recognized as potential providers of services tied to noncommunicable diseases (NCDs) [ 3 ] such as hypertension [ 4 ], diabetes [ 5 ], cancer screening [ 6 – 8 ], and mental health [ 9 ]; as well as services tied to environmental health [ 10 ], digital health [ 11 ], and humanitarian events [ 12 , 13 ]. This interest has also increased in the face of the coronavirus disease 2019 (COVID-19) pandemic [ 14 ].…”

<p>Prevention of cervical and breast cancer mortality in low- and middle-income countries: a window of opportunity</p>

“…Patient navigation programs can help to shorten the time from initial presentation to final diagnosis and entry to treatment 37. Community health workers are also an important resource that can provide insight into the needs of women and potential misunderstandings of health-related issues 38. Workshops including community stakeholders can contribute to tailoring interventions and implementing solutions to reduce the barriers to service uptake.…”