Role of informed decision-making and survivor educators in prostate cancer community outreach

Background: African-American (AA) men continue to be disproportionately affected by prostate cancer (CaP) in terms of prevalence, mortality, access to care, and knowledge. AA communities have responded by promoting early screening. However, the absence of evidence demonstrating that screening reduces mortality means that patients considering screening must make a difficult decision. We adopted a community-based participatory approach to design and pilot-test a community outreach strategy promoting informed decision-making about CaP screening among AA men in St. Louis, MO. We formalized the role of CaP survivors as educators in the outreach process and compared their narrative power with lay health educators.

Methods: In-depth interviews with six local subject matter experts informed the content and design of the educational outreach strategy. The strategy was pre-tested with two groups of AA men for feedback. The revised strategy was pilot-tested through a quasi-experiment among two groups of African-American men – one receiving messages from lay health educators, and the other from survivor educators.

Results: We observed a general upward trend in CaP knowledge, beliefs and decision self-efficacy. The presentation was perceived as more culturally appropriate in the survivor group. Study participants found the survivor educators to be more appealing, with greater identification and liking.

Conclusions: Community-based outreach that incorporates survivors as health educators is a potentially effective strategy to shape knowledge, beliefs and decision self-efficacy related to prostate cancer screening. Further research is required to assess and formulate strategies to address informed decision-making about CaP screening in community settings.