Using targeted education cards in a breast cancer intervention among Amish and Mennonite women

Amish settlements exist in over half of the states within the United States, and Ohio is home to the world’s largest and fourth largest Amish and Mennonite settlements. Language barriers and cultural beliefs impact health literacy and numeracy in these rural areas where health care access is limited.   This study focuses on breast cancer education delivery among Amish and Mennonite women who have previously received the community-led breast cancer program called Project Hoffnung (German for “hope”), which is a culturally competent intervention developed to increase knowledge and screening compliance. 

All participants were given a pretest survey one week before the breast cancer education program. While attending a program, previous participants were asked to randomly choose a breast cancer education card that entailed one of six breast cancer topics.  All participants received a posttest survey within the mail at three months that asked the same breast cancer questions as the pretest. Knowledge scores were then compared to measure the impact of the breast cancer education cards on knowledge.

A total of 390 Amish and Mennonite women participated in the culturally competent breast cancer intervention between 5/15/14 and 12/06/14.  The mean age was 52.4 years, and 130 completed the post-test (33.1%).   The education program did statistically increase breast cancer knowledge for both new and repeat participants (p<.001).  However, the impact of the breast cancer cards was inconsistent in increasing specific breast cancer knowledge facts.  A targeted follow-up educational message in writing is recommended to reinforce key knowledge facts after the intervention.