Evaluation of the Helping You Take
Care of Yourself Curriculum 2009-
2010
Final Report
September 23, 2011
Mindy Lipson Melanie Besculides Ebo Dawson-Andoh Nicholas Redel
Contract Number: PRF06 (02) (formerly ST2H191)
Mathematica Reference Number: 06339
Submitted to: Heather Nelson Director of Community Health Services Women’s Health Network & Men’s Health Partnership Care Coordination Program Massachusetts Department of Public Health 250 Washington Street, 4th Floor Boston, MA 02108 Submitted by: Mathematica Policy Research P.O. Box 2393 Princeton, NJ 08543-2393 Telephone: (609) 799-3535 Facsimile: (609) 799-0005 Project Director:
Evaluation of the Helping You Take
Care of Yourself Curriculum 2009-
2010
September 23, 2011
Mindy Lipson Melanie Besculides Ebo Dawson-Andoh Nicholas Redel
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
iii
CONTENTS
I INTRODUCTION ............................................................................................. 1 II METHODS ...................................................................................................... 7
A. Quantitative Methods .............................................................................. 8
1. Data Collection ................................................................................... 8 2. Data Entry, Cleaning, and Coding ....................................................... 8 3. Data Analysis ..................................................................................... 9
B. Qualitative Methods ............................................................................... 10
1. Data Collection ................................................................................. 10 2. Data Analysis ................................................................................... 13
III RESULTS ...................................................................................................... 15
A. Project Implementation ......................................................................... 15
1. Recruitment of CBOs ........................................................................ 15 2. Training CBO Educators .................................................................... 15 3. Relationship with CMAHEC ............................................................... 23
B. Project Reach ......................................................................................... 23
1. Recruiting Workshop Participants ..................................................... 24 2. Conducting Workshops .................................................................... 25 3. Description of Workshop Participants ............................................... 26 4. Preventative Health Behaviors ........................................................... 29
C. Project Effectiveness (Knowledge Improvement Among Workshop
Participants) .......................................................................................... 50
1. Knowledge of Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health ................................................................................. 50
2. Satisfaction with the Education ......................................................... 56 D. Project Maintenance (Evaluation of Longer-Term Effect of Program) ...... 57
1. Information Learned and Shared ....................................................... 57 2. Informed Decision Making with Providers ......................................... 58 3. Knowledge Posttest .......................................................................... 63
E. Limitations ............................................................................................ 63
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CONTENTS (continued)
IV RECOMMENDATIONS AND CONCLUSION ...................................................... 65
A. Implementation (CBO Recruitment and Training) ................................... 65
B. Reach (Number of People Educated) ...................................................... 66 C. Effectiveness (Knowledge Improvement) ................................................ 66
D. Maintenance (Longer-term Effect of the Program) .................................. 67
E. Conclusion ............................................................................................ 68
REFERENCES ................................................................................................. 69 APPENDIX A: DATA COLLECTION FORMS APPENDIX B: INTERVIEW AND FOCUS GROUPS PROTOCOLS APPENDIX C: SOLICITATION FOR APPLICATIONS APPENDIX D: DEMOGRAPHIC CHARACTERISTICS OF WORKSHOP
PARTICIPANTS, BY REGION OF TRAINING APPENDIX E: DEMOGRAPHIC CHARACTERISTICS OF WORKSHOP
PARTICIPANTS BY HEALTH UNIT APPENDIX F: PRE- AND POSTTEST KNOWLEDGE BY QUESTION AND BY
GENDER, AGE, RACE/ETHNICITY, AND EDUCATION
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
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TABLES
1 Massachusetts Health Quality Partners (MHQP) 2007-2008 Adult Preventive Care Recommendations .................................................................................. 2
2 Helping You Take Care of Yourself Topics by Health Unit ................................ 3
3 Sample of Changes Made to Demographic Form ............................................. 5
4 Data Collection Methods ................................................................................ 7
5 Number of Education Units Given by Health Topic .......................................... 8
6 Description of Community-Based Organizations that Participated in the Qualitative Evaluation ................................................................................... 11
7 Characteristics of CHWs ............................................................................... 16
8 Breast, Cervical, Cardiovascular, Colorectal, and Prostate Knowledge on the Pretests and Posttests, by Demographic Characteristics of CHWs ................. 19
9 Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health Knowledge, by Pretest and Posttest Questions Among CHWs ........................................... 21
10 Capacity Reached by Health Unit .................................................................. 24
11 Characteristics of Workshop Participants ...................................................... 28
12 Receipt of Mammograms Among Female Workshop Participants Over Age 40, by Demographic Characteristics .............................................. 31
13 Receipt of Pap Smears Among Female Workshop Participants, by Demographic Characteristics ................................................................... 34
14 Receipt of Blood Cholesterol Check Among Workshop Participants, by Demographic Characteristics ................................................................... 37
15 Receipt of Blood Stool Test Among Workshop Participants Over Age 50, by Demographic Characteristicsa .................................................................. 41
16 Receipt of Sigmoidoscopy/Colonoscopy Among Workshop Participants Over Age 50, by Demographic Characteristics .............................................. 42
17 Receipt of Digital Rectal Exams (DRE) Among Male Workshop Participants Over Age 40, by Demographic Characteristics .............................................. 46
18 Receipt of Prostate-Specific Antigen (PSA) Tests Among Male Workshop Participants Over Age 40, by Demographic Characteristics ........................... 47
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TABLES (continued)
19 Discussion About Prostate Cancer Early Detection or Screening with Health Care Provider Among Male Workshop Participants Over Age 40, by Demographic Characteristics ........................................................................ 48
20 Breast, Cervical, Cardiovascular, Colorectal, and Prostate Knowledge on the Pretests and Posttests by Demographic Characteristics of Workshop Participants .................................................................................................. 51
21 Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health Knowledge, by Pretest and Posttest Questions Among Workshop Participants ................. 54
22 Summary of Responses to Evaluation Questions Among Workshop Participants .................................................................................................. 56
23 Prostate Health Screening Behaviors After Attending Workshop by Screening Behaviors Before Attending Workshop .......................................................... 59
24 Person Who Made Decision for Workshop Participant to Receive Prostate Cancer Screening ......................................................................................... 61
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FIGURES
1 Flow Chart of Project Implementation and Evaluation ..................................... 6
2 Breast Health Screening Behaviors Among Women Over Age 40 in the United States, Massachusetts, and Participating CBOs .................................. 32
3 Cervical Health Screening Behaviors Among Women in the United States, Massachusetts, and Participating CBOs ......................................................... 35
4 Cardiovascular Health Screening Behaviors Among Men in the United States, Massachusetts, and Participating CBOs ......................................................... 38
5 Cardiovascular Health Screening Behaviors Among Women in the United States, Massachusetts, and Participating CBOs .................................. 39
6 Colorectal Health Screening Behaviors Among Individuals Over Age 50 in the United States, Massachusetts, and Participating CBOs ....................... 43
7 Prostate Health Screening Behaviors Among Men Over Age 40 in the United States, Massachusetts, and Participating CBOs ................................. 49
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
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I. INTRODUCTION
Disease prevention and early detection are cornerstones of public health. When disease occurs, early detection and treatment can decrease morbidity and mortality. State and national organizations and task forces have developed guidelines for early screening for many conditions, including cardiovascular disease and breast, cervical, colorectal, and prostate cancers. For instance, the Centers for Disease Control and Prevention (CDC) recommend routine monitoring of cardiovascular disease risk factors such as high blood pressure and cholesterol (Centers for Disease Control and Prevention 2009). The Massachusetts Health Quality Partners (MHQP) echo this recommendation stating that blood pressure should be checked at all medical encounters and cholesterol assessed every five years. They also recommend routine measurement of body mass index to screen for overweight and eating disorders (Massachusetts Health Quality Partners Adult Preventative Care Recommendations, 2008). Routine screening for many cancers is also suggested; the U.S. Preventive Services Task Force recommends population-based screening for colon and rectum cancer, female breast cancer, and uterine/cervical cancer (Henley et al. 2010). Currently, population-based screening for prostate cancer is not recommended because the benefits of routine screening have not yet been proven to outweigh the potential harms (U.S. Preventive Services Task Force 2008). Rather, it is recommended that men make an informed decision with their health care providers about testing (U.S. Preventive Task Force 2008; American Cancer Society 2010; Centers for Disease Control and Prevention 2010). Table 1 displays MHQP's preventive care recommendations for adults. As shown in the table, the age at which screening should commence, the types of tests used, and the frequency of testing are affected by factors such as family history of disease and previous screening results.
To educate the public about the importance of prevention and screening, the Massachusetts
Department of Public Health (MDPH) developed the Helping You Take Care of Yourself curriculum in 2006. In particular, the curriculum was targeted towards Massachusetts’ underserved populations in an effort to raise their rates of preventative health screening. Initially, the curriculum had two units—breast health and cervical health. A cardiovascular health unit was added in 2007, and colorectal and prostate health units were added in 2009. The curriculum was designed as a “train-the-trainer” model, whereby community-based organizations (CBOs) were trained to carry out educational workshops with members of their community. Each unit of the curriculum consists of PowerPoint presentations, notes, and anatomical models. The curriculum has been translated into Spanish and Portuguese. The topics covered in each unit are listed in Table 2.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
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Table 1. Massachusetts Health Quality Partners (MHQP) 2007-2008 Adult Preventive Care Recommendations
Cancer Recommendations
Cancer Type Recommended Screening Breast Ages 18-39: Starting at age 20, clinical breast exam and self-exam
Ages 40-49: Clinical breast exam and self-exam instruction. Annual mammography at discretion of clinician/patient.
Ages 50-64: Clinical breast exam and self-exam instruction. Annual mammography.
Ages 65+: Clinical breast exam and self-exam instruction. Annual mammography through age 69; > age 70 at clinician/patient discretion.
Cervical (Pap Test and Pelvic Exam)
Ages 18-64: Initiate Pap test and pelvic exam at 3 years after first sexual intercourse or by age 21. Every 1-3 years depending on risk factors.
Ages 65+: Every 1-3 years at clinician discretion.
Colorectal Ages 18-49: Not routine except for patients at high risk. Ages 50+: Colonoscopy at age 50 and then every 10 years, or annual fecal
occult blood test (FOBT) plus sigmoidoscopy every 5 years, or sigmoidoscopy every 5 years, or double-contrast barium enema every 5 years or annual FOBT. Screening after age 80 at clinician/patient discretion.
Ages 50+: Digital Rectal Exam (DRE). Offer PSA screening at clinician/patient discretion.
Prostate Ages 18-39: Prostate cancer screening not routine. Ages 40-49: Digital Rectal Exam (DRE) for patients at high risk for prostate
cancer. PSA screening in high-risk patients at clinician/ patient discretion.
Other Recommendations
Disease Recommended Screening
Cardiovascular Adults of all ages:
Body mass index (BMI): Screen for overweight and eating disorders. Consult the CDC’s growth and BMI charts (www.cdc.gov/nccdphp/dnpa/bmi/index.htm). Ask about body image and dieting patterns.
Hypertension: At every acute/nonacute medical encounter and at least once every 2 years.
Cholesterol: Screen if not previously tested. Screen every 5 years with fasting lipoprotein profile (total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride).
Source: Massachusetts Health Quality Partners Adult Preventive Care Recommendations, 2008.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
3
Tab
le 2
. H
elp
ing
You T
ake
Car
e of
Yours
elf
Top
ics
by H
ealt
h U
nit
Brea
st H
ealth
Ce
rvic
al H
ealth
Ca
rdio
vasc
ular
Hea
lth
Colo
rect
al H
ealth
Pr
osta
te H
ealth
Br
east
ana
tom
y
W
hat i
s br
east
can
cer?
Be
nign
bre
ast
cond
ition
s
Ri
sk fa
ctor
s fo
r bre
ast
canc
er
Si
gns
of b
reas
t pr
oble
ms
Br
east
can
cer
dete
ctio
n m
etho
ds
Fe
mal
e re
prod
uctiv
e an
atom
y
Wha
t is
cerv
ical
ca
ncer
?
Wha
t is
HPV
?
Risk
fact
ors
for
HPV
and
cer
vica
l ca
ncer
Pap
test
HPV
test
W
hat i
s ca
rdio
vasc
ular
di
seas
e?
H
eart
att
ack
war
ning
sig
ns
St
roke
war
ning
si
gns
H
eart
dis
ease
an
d st
roke
risk
fa
ctor
s
Eatin
g an
d liv
ing
“hea
rt h
ealth
y”
Kn
owin
g yo
ur
num
bers
(c
hole
ster
ol,
trig
lyce
rides
, bl
ood
pres
sure
, gl
ucos
e, h
eigh
t, w
eigh
t)
Co
lon
anat
omy
and
func
tion
W
hat i
s co
lore
ctal
ca
ncer
?
Risk
fact
ors
for
colo
rect
al c
ance
r
Sign
s of
co
lore
ctal
pr
oble
ms
Po
lyps
Colo
rect
al c
ance
r sc
reen
ing
M
ale
repr
oduc
tive
anat
omy
Pr
osta
te g
land
Wha
t is
pros
tate
can
cer?
Risk
fact
ors
for p
rost
ate
canc
er
Si
gns
and
sym
ptom
s of
pr
osta
te p
robl
ems
En
larg
ed p
rost
ate
Pr
osta
te c
ance
r scr
eeni
ng
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
4
At the project’s inception, MDPH regional Outreach Specialists educated community members using the curriculum. In 2007, in an effort to expand the project’s reach, MDPH contracted with Mathematica Policy Research to administer funds to CBOs to carry out education using the curriculum. To date, there have been three phases of education: Phase 1—February 2007 through June 2007; Phase 2—August 2007 through November 2008; and Phase 3—August 2009 through May 2010. In Phases 1 and 2, CBOs were selected to participate in the project by MDPH regional Outreach Specialists based on their expertise and ties with target members of their communities. In Phase 3, CBOs applied to participate in the project through a competitive Solicitation for Applications process. Also in Phase 3, MDPH contracted with the Central Massachusetts Area Health Education Center (CMAHEC) to train CBOs to use the curriculum. This change was made in response to staffing reassignments within MDPH. Mathematica has evaluated Phases 1 and 2 of the project (Trebino et al. 2008; Besculides et al. 2010) and the rest of this report focuses on Phase 3.
In Phase 3, Mathematica contracted with 26 CBOs, 25 of which carried out education.1 Some
CBOs had participated in previous phases of the project and some were newly funded. Before holding workshops with community members, community health workers (CHWs) from each CBO attended a three-hour orientation training and topic-specific trainings led by CMAHEC. Topic-specific trainings were day-long sessions that covered one or two topics. CMAHEC provided ongoing technical assistance to programs on the curriculum as requested and provided data collection forms.
For each CBO, Mathematica developed a memorandum of understanding (MOU) that
described the project and outlined expectations for participation. The MOUs specified the number of people the CBO agreed to educate for each health unit and, in some cases, also specified a target population (such as black men). CBOs could only carry out education in units that were specified in their MOUs. The MOUs further stated that organizations would be paid $30 per unit (breast, cervical, cardiovascular, colorectal, or prostate health) for each person educated for whom complete data were submitted. Specifically, CBOs were contracted to collect data using four standardized forms: (1) a pretest of knowledge, (2) an identical posttest of knowledge, (3) a demographic form, and (4) an evaluation.
Data collection forms were modified slightly from versions used in previous phases of the
project to incorporate suggestions made by CHWs and participants during the previous project evaluations. For example, multilevel questions on education, health insurance, length of time since last mammogram, and length of time since last Pap smear were combined into single questions. Table 3 demonstrates one of the changes made to the demographic form that is representative of other modifications.
1 One CBO signed an MOU but did not hold any workshops because it shifted its attention to responding to the
needs of people affected by the 2010 earthquake in Haiti.
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Table 3. Sample of Changes Made to Demographic Form
Questions in Previous Phase Updated Question
Have you ever had a mammogram? Yes No
If yes, when was your most recent mammogram?
Less than 1 year ago 1 – 3 years ago 4 – 5 years ago More than 5 years ago
A mammogram is an x-ray of each breast to look for breast cancer. When was your most recent mammogram?
Within the past year (anytime less than 12 months ago)
Within the past 2 years (1 year but less than 2 years ago)
Within the past 3 years (2 years but less than 3 years ago)
Within the past 5 years (3 years but less than 5 years ago)
5 or more years ago I have never had a mammogram
In addition, the updated demographic form included a question on gender and questions on
colorectal and prostate health to reflect the addition of these units. The pre- and posttests for the cardiovascular health units were also changed to replace a problematic question. Last, additional response options were added to some questions that were identified as confusing in the previous phase of the project. For example, for a question related to country of birth, the updated demographic form added “One of the US Territories (Puerto Rico, Guam, American Samoa, US Virgin Islands, Mariana Islands, Solomon Islands)” to clarify which countries should be classified as the U.S. territories. Data collection forms are included in Appendix A.
Mathematica analyzed the data to describe the population served, assess health screening behaviors, determine baseline knowledge, assess whether the educational workshops improved knowledge, and assess satisfaction with the education. We also analyzed data from CBO CHWs that were collected during the CMAHEC training sessions to understand their demographic characteristics and assess their knowledge of the educational units before and after receiving training. To supplement the analysis of data collected during educational workshops, Mathematica conducted a qualitative evaluation of the prostate health unit. We focused on the prostate health unit for two reasons. First, our previous evaluation covered the breast, cervical, and cardiovascular health units (Besculides et al. 2010). Second, MDPH’s Comprehensive Cancer Prevention and Control Program, which provides partial funding for this project, receives CDC funding to reduce prostate cancer disparities among African American men in Massachusetts. One of the program’s objectives is to increase the number of black, non-Hispanic men who have discussed prostate cancer early detection with their health care providers. The qualitative evaluation helped assess whether men have had these discussions and the barriers to seeking care.
This report summarizes the findings from Mathematica’s evaluation. The report organizes our findings along four dimensions: (1) project implementation, (2) reach, (3) effectiveness, and (4) maintenance. This organization is loosely based on the RE-AIM framework, which assesses Reach, Effectiveness/Efficacy, Adoption, Implementation, and Maintenance of public health interventions to determine program impact (Glasgow et al. 1999). Figure 1 summarizes the flow of project implementation and evaluation. An overarching goal of this report is to identify ways to improve the project for future phases.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
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Figure 1. Flow Chart of Project Implementation and Evaluation
Project Effectiveness
Project Reach
Project Implementation
Maintenance
CBOs selected by CMAHEC/MDPH
MOUs executed between Mathematica and CBOs
CHWs trained by CMAHEC
Data forms for CHWs sent to Mathematica and entered
(demographic, pretest, posttest, evaluation forms)
Qualitative information on prostate health unit collected and analyzed from selected CBOs CMAHEC staff person interviewed CHWs interviewed
Data analyzed on knowledge gained and evaluation of all educational sessions (pretest, posttest, and
evaluation forms)
Focus groups with prostate health workshop participants conducted and data analyzed to assess
behavior change and maintenance of knowledge
Community members recruited and educated by CBOs
Data forms for those educated sent to Mathematica and entered (demographic, pretest, posttest, evaluation forms)
Data analyzed on population served (demographic form)
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II. METHODS
To evaluate the effectiveness of the Helping You Take Care of Yourself curriculum and identify areas for program improvement, Mathematica collected and analyzed quantitative data from all participating CBOs and qualitative data from a subset of CBOs that held prostate health workshops. The quantitative component of the evaluation involved the analysis of (1) data forms completed by CBO CHWs during the workshops they attended with CMAHEC, and (2) data forms completed by workshop participants. The qualitative component of the evaluation involved the analysis of information gathered through interviews with CBO CHWs, focus groups with men educated by CBOs, and an interview with CMAHEC. Table 4 provides an overview of the data collection methods used in both the quantitative and qualitative components of the evaluation. In the Quantitative Methods section below, we describe the data collection and data analysis methods in greater detail. Table 4. Data Collection Methods
Data Collection Method Description of Respondents Timing of Data Collection
Quantitative Evaluation
Forms completed by CBO CHWs Demographic form Pretest Posttest
76 CHWs trained to educate members of their community in at least one of the following educational units:
Breast health Cervical health Cardiovascular health Colorectal health Prostate health
June 2009-January 2010
Forms completed by workshop participants
Demographic form Pretest Posttest Evaluation form
2,806 workshop participants educated in at least one of the following educational units:
Breast health Cervical health Cardiovascular health Colorectal health Prostate health
August 2009-May 2010
Qualitative Evaluation
Interviews with CBO CHWs 11 CHWs from 10 CBOs who educated men in the prostate health unit
August 2010-September 2010
Focus groups with men educated by CBOs in the prostate health unit
25 men from four CBOs September 2010-October 2010
Interview with CMAHEC 1 person November 2010
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
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A. Quantitative Methods
1. Data Collection
Twenty-five CBOs held 376 workshops with members of their community covering one or two units of education per workshop. CBOs submitted data for 2,806 unique workshop participants, who received 4,617 education units. Table 5 illustrates the number of education units given by health topic.
Table 5. Number of Education Units Given by Health Topic
Health topic Number of CBOs Conducting
Workshops (N = 25) Number of Education Units
(N = 4,617)
Breast health 16 851 Cervical health 15 654 Cardiovascular health 16 1,382 Colorectal health 13 821 Prostate health 21 909
Source: Analysis of data collected from workshop participants.
As noted above, CBOs were contracted to submit a demographic, pretest, posttest, and evaluation form for each workshop participant. Demographic forms were printed with unique identification numbers and CHWs or participants wrote the corresponding identification number on pre- and posttest forms. Evaluation forms were anonymous. After collating a set of forms for a participant, CBOs submitted completed forms to Mathematica. When a set of forms was not complete (that is, was missing a demographic, pretest, posttest, or evaluation form), Mathematica contacted CHWs and supervisors at CBOs to attempt to obtain the missing form(s).
2. Data Entry, Cleaning, and Coding
CBOs mailed data collection forms to Mathematica in batches that included a cover sheet for each workshop. Mathematica staff entered the data into an Access database that had been developed by MDPH at the beginning of the project and had been modified by Mathematica when educational units were added or forms were updated. After data entry was complete, Mathematica staff conducted a 10 percent validation check to ensure that data had been entered accurately.
When the data were determined to be complete and validated, Mathematica converted the
Access data into SAS data sets. Demographic, pretest, and posttest data, and information on workshop date, location, and CHW were merged for all participants, creating one record for each date that a participant was educated using the curriculum. Evaluation forms remained separate from the other forms. Each record was assigned a unique identifier composed of a combination of the identification number printed on the demographic form and the session identification number that was assigned to the workshop.
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To prepare the data for further analysis, Mathematica staff identified participants with multiple records in the data set to flag individuals who had attended a workshop in the same unit multiple times.2 In these cases, we retained the data from the first training and eliminated data from subsequent trainings. After the completion of this process, each workshop participant had one set of data for each educational unit in which he or she attended a workshop. An individual may have had multiple records with different unique identifiers if he or she had attended multiple workshops covering different units on multiple dates, but these cases were flagged so that the demographic data would only be counted once in analysis.
Next, the data set was cleaned using methods developed in earlier phases of this project (see
Besculides et al. 2010 and Trebino et al. 2008 for details). However, because of changes to the structure of the project and data collection forms, we made the following modifications for this phase of analysis:
Coding of gender. The inclusion of men in the project necessitated that the data be
cleaned by gender. If breast or cervical health unit data forms were completed by men or prostate health unit data forms were completed by women, they were eliminated. In cases where the gender field had not been filled, Mathematica assessed the following fields to attempt to code the participant’s gender:
- First name associated with a record
- Presence of responses to gender-specific questions on the demographics form, such as questions relating to mammograms, Pap smears, digital rectal exams (DREs), or prostate-specific antigen (PSA) tests
- Presence of education data for the breast, cervical, and prostate health units
Using a combination of these fields, a gender determination was made for the vast majority of participants who did not self-report their gender. However, there were ultimately nine records where gender could not be recoded.
Coding of race and ethnicity. Participants who self-identified as non-Hispanic but then wrote “Hispanic” in the race field were recoded as being Hispanic. Their race was then coded as other.
3. Data Analysis
The data analysis process included the following three steps: (1) analyzing the demographic forms to describe the population served by the program, (2) assessing changes in knowledge before and after the educational workshops, and (3) examining satisfaction with the education (see Trebino et al. [2008] for further details on the analytic methods).
2 Name, date of birth, and city of residence were the main fields used to determine if two records belonged to the
same individual. If date of birth was missing in one of the two records that had other matching identifying information, the records were not considered to be the same person (there were 18 instances of this). In addition, 245 records that lacked a first and/or last name could not be included in the de-duplication process. As a result, the number of unique people educated may be a slight overestimate.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
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To assess the population served by the program, we ran frequencies on responses to questions related to breast, cervical, cardiovascular, colorectal, and prostate screening tests. Then, we ran cross-tabs of the health behavior questions with select demographic variables (gender when applicable, age, race/ethnicity, health insurance status, and education) to determine whether behaviors varied by demographic group. Chi-squared tests were used to assess the significance of differences within each demographic group. In addition, to serve as a benchmark comparison, we ran frequencies on the receipt of mammograms, Pap smears, blood cholesterol tests, blood stool tests, DREs, and PSA tests using data from the Behavioral Risk Factor Surveillance System (BRFSS). We calculated 95 percent confidence intervals to determine whether workshop participants received these tests in proportions significantly different from the nationwide and overall Massachusetts population.
To assess knowledge of breast, cervical, cardiovascular, colorectal, and prostate health before and after the educational workshops, responses on the pre- and posttests were examined. The pre- and posttests contained five questions each. Each test was scored on a five-point scale for which a score of 0 indicates that the participant responded incorrectly to all test questions and a score of 5 indicates that the participant responded correctly to all test questions. To determine whether knowledge changed as a result of attending the educational workshop, we calculated mean pre- and posttest scores for all participants. Additionally, we calculated the percentage of participants who increased their scores between the pre- and posttests. Paired t-tests were used to assess the significance of the change among those who completed both the pre- and posttests.
B. Qualitative Methods
1. Data Collection
To assess the implementation and effectiveness of the newly developed prostate health unit of the Helping You Take Care of Yourself curriculum, Mathematica conducted a qualitative evaluation of this unit. The qualitative evaluation included interviews with 11 CHWs who educated men using the prostate curriculum, four focus groups composed of men who had attended the prostate workshops, and an interview with CMAHEC (see Table 6 for a list of CBOs that participated in this component of the evaluation). The qualitative evaluation was designed to collect data about the following topic areas:
Background information about the CHWs leading the workshops
Quality of the training and support provided by CMAHEC
Quality of the curriculum and materials used to train the CBO CHWs and educate workshop participants
Ease of data collection and submission
Outcomes of the workshop, including maintenance of knowledge, discussions with health care providers, and receipt of prostate screening
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Table 6. Description of Community-Based Organizations That Participated in the Qualitative Evaluation
CBO # Educated Across All
Unitsa
Prostate Unit People Interviewed As Part of Qualitative Evaluation
CBO Held Focus Group
# Educated
# in Target Population
% in Target Populationb
Akwaaba Health Initiative 159 84 83 98.8 1 CHW Apostolic Holiness House of Prayer 11 11 11 100.0 1 CHW Brockton Neighborhood Health Center 302 89 56 62.9 1 CHW √Cambridge Health Alliance 523 116 31 26.7 1 CHW Greater Springfield Pro-Am Basketball League 34 34 34 100.0 1 CHW √Health Imperatives 35 35 32 91.4 1 CHW Lee B. Revels Scholarship and Mentoring Foundation 40 40 39 97.5 1 CHW √Massachusetts Community Health Services 58 58 56 96.6 1 CHW √St. John’s Congregational Church 13 13 13 100.0 1 CHW
Whittier Street Health Center 117 65 50 76.9 2 CHWs
Source: Analysis of data collected from workshop participants. aSome CBOs participated in only the prostate unit of this project; other CBOs educated people in multiple units. bMen were classified as being part of the target population for the prostate unit if they self-identified as black, African American, African, Cape Verdean, Haitian Creole, or some type of multiracial or multiethnic group that includes one of the previously named groups.
To collect information about these topics, Mathematica developed semi-structured protocols for the different groups of respondents: CBO CHWs, focus group participants, and CMAHEC. The protocols can be found in Appendix B. Twelve CBOs were selected to participate in the qualitative evaluation based on the target population they reached. Specifically, we sought to recruit CBOs that educated men who self-identified as black, African American, African, Cape Verdean, Haitian Creole, or a type of multiracial or multiethnic group that includes one of the previously named groups. We primarily selected CBOs that educated more than 30 men, in hopes that they would be able to recruit enough men for a focus group. We also selected a few CBOs in Springfield, Massachusetts, whose CHWs had close ties with black men in the community and in most cases were part of the community themselves.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
12
Interviews with CHWs at CBOs
For each CBO, Mathematica used the quantitative data to identify the CHW who had conducted the majority of workshops composed of men in the target population. At one CBO, two CHWs educated an approximately equal number of men in the target population; we interviewed both CHWs at this CBO. CMAHEC provided entrée to CBOs by sending an email explaining the purpose and importance of the evaluation and asking for their participation. Mathematica followed up by email and later by phone if necessary to schedule the interviews. CHWs from all CBOs that we reached agreed to a telephone interview; however, we were unable to reach one CHW despite multiple contact attempts. Ultimately, 11 CHWs from 10 CBOs were interviewed. Interviews lasted approximately one hour.
The interviewers asked CBO CHWs about their backgrounds and how they got involved in the
project, the training led by CMAHEC, the curriculum, the experiences they had recruiting and educating men, and the data collection and submission process. The male CHWs from the Springfield CBOs were also asked about their experiences with and barriers to having a discussion with a health care provider about prostate screening. This information helped us better understand and refine the topics for discussion in focus groups. At the end of interviews with CHWs, we asked CHWs from eight CBOs whether they were willing and able to organize a focus group of men who had attended prostate workshops run by their CBO.3 All of these CHWs indicated that they were willing to consider organizing a focus group.
Focus Groups
After completing the interviews with CHWs, Mathematica staff followed up with the eight CBOs to try to schedule focus groups with men who had attended the prostate workshops. Although all eight CBOs indicated that they were willing to consider organizing a focus group, only four CBOs actually did so. Obstacles to organizing focus groups included scheduling them and recruiting men who had many competing demands. CBOs were asked to recruit 10 to 12 men for the focus groups and to choose a location that would be convenient for the men. In order to facilitate recruitment, Mathematica offered all CBOs a list of men they had educated who belonged to MDPH’s target demographic group for the prostate health unit. Three CBOs used this list to recruit focus group participants; the fourth CBO had tracked workshop participants and recruited men without the assistance of Mathematica. After each focus group, we sent the CHW or CBO (depending on the preference of the organization) an honorarium payment of $250 for their efforts in recruiting participants and organizing the logistics for the focus group.
Focus groups were held at times that were convenient for the participants. All focus groups
lasted about an hour and a half. Mathematica provided focus group participants with a $25 gift card to Walmart and a snack or meal. Across the four CBOs, 25 men participated in the focus groups, which ranged in size from three to nine men, with an average of six participants.
3 CBOs were recruited for focus groups based on the number of men they had educated in MDPH’s target
population for the prostate health unit.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
13
A male Mathematica staff member who identifies culturally with the participants facilitated all of the focus groups in English. The facilitator used a semi-structured protocol to guide the discussion. The protocol covered topics such as recruitment for the workshop, quality of the workshop, experiences with and barriers to having a discussion with a health care provider about prostate screening, and comfort with the data collection forms. In addition, men who attended the focus groups were asked to complete a quantitative data collection form, composed of two sections. The first section included the questions asked on the pre- and posttests during the workshops to assess maintenance of knowledge from the workshops. The second section asked participants about their behavior related to prostate health screening, including receipt of care both before and after attending the prostate health workshops. Using name and workshop location, we were able to link data from 19 of the focus group participants with pre- and posttest data from prostate health workshop participants. We believe that men who could not be linked did not put their names on the original demographic forms.
Interview with CMAHEC
After the culmination of interviews with CHWs and workshop participants, Mathematica staff interviewed the CMAHEC staff person responsible for training CBOs and providing them with technical assistance. This interview lasted approximately one hour. The interview was conducted by phone using a semi-structured protocol and covered topics such as recruitment of CBOs, training CBO educators, contact with CBOs including technical assistance provided by CMAHEC, and feedback on project curriculum and materials from CHWs. In addition to participating in the telephone interview, CMAHEC provided Mathematica with informal feedback on the implementation of the project throughout its course. 2. Data Analysis
After completing the interviews with CHWs and focus groups with workshop participants, Mathematica staff members who participated in the qualitative data collection efforts reviewed notes from the interviews and focus groups. They organized responses into a data abstraction tool that mapped related questions across the three protocols into thematic areas. Then all participating staff members met to discuss key themes identified during all modes of qualitative data collection. This information was synthesized into a comprehensive set of notes that facilitated further analysis and integration with quantitative data.
The quantitative data collected during the focus groups were entered into an Excel file and
converted to a SAS data set. Then, using name and training location, this data set was merged with the education data collected at the workshops. Mean scores for the pretest, posttest, and focus group posttest were calculated and compared. In addition, mean changes of score between the focus group and pre- and posttests were calculated. Last, we analyzed responses to questions assessing preventative prostate health behaviors before and after workshop attendance.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
15
III. RESULTS
The combination of quantitative data collected from workshop participants and qualitative information from interviews and focus groups facilitated a well-rounded evaluation of the project. Below, we present the main evaluation findings and limitations in the following areas: project implementation, project reach, project effectiveness, maintenance (longer-term effect of the program), and limitations of the analysis. A. Project Implementation
Based on the qualitative data, project implementation was fairly smooth. Together, MDPH and CMAHEC were able to successfully recruit CBOs. In addition, through training and technical assistance, CMAHEC built strong relationships with CBO supervisors and CHWs. The following sections describe key findings related to the recruitment of CBOs, the process of training CBO educators, and the relationship between CMAHEC and CBOs.
1. Recruitment of CBOs
As part of an effort to professionalize this phase of the project, CBOs were recruited through a Solicitation for Applications. In April 2009, the solicitation was distributed to CBOs that were part of MDPH’s professional network across the state (see Appendix C for the text of the solicitation). A committee composed of MPDH staff, CMAHEC staff, and community stakeholders reviewed the proposals and selected CBOs for funding. CBO applications were assessed for fit with project goals and demonstrated capacity to conduct health education. The majority of CBOs that applied to participate in the project were funded. After the initial set of CBOs was awarded funding, there was still money available to educate more men in the prostate unit. A second solicitation was therefore issued to recruit additional CBOs to participate in only the prostate health unit; three CBOs were funded through this solicitation. Despite this addition of CBOs, the desired prostate health capacity was not attained and five additional CBOs were funded to ensure that there was equitable distribution of prostate health funds across the state.
2. Training CBO Educators
After CBOs were notified that they had received funding through this project, their CHWs were required to attend training sessions led by CMAHEC. All CHWs had to attend an orientation session, which reviewed the scope of the project, provided guidance on facilitating workshops, and instructed CHWs on the requirements for data submission. In addition, CHWs attended separate health-unit-specific trainings. The breast and cervical health units were taught together, as were the cardiovascular and colorectal health units. The prostate health unit was taught alone. CBOs were not permitted to begin offering workshops until educators had been trained. According to CMAHEC sign-in sheets, 90 CBO staff members were trained to conduct workshops in at least one of the health topics. Mathematica received demographic, pre- and posttest data for 76 (84 percent) of these CHWs. As shown in Table 7, among these CHWs, almost 70 percent were trained in the prostate health unit, more than half were trained in the cardiovascular (57 percent), colorectal (53 percent), or cervical (52 percent) health units, and just under half (49 percent) were trained in the breast health unit. The vast majority (80 percent) of CHWs were trained in more than one unit.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
16
Table 7. Characteristics of CHWs
N = 76 %
Units of Education
Units of Traininga Breast health 37 48.7Cervical health 39 51.3Cardiovascular health 43 56.6Colorectal health 40 52.6Prostate health 53 69.7
Number of Units of Training
1 15 19.72 19 25.03 23 30.34 5 6.65 14 18.4
Demographic Characteristics
Gender Male 24 31.6Female 52 68.4Unknown 0 0.0
Age
Under 40 31 40.840-64 42 55.365 and over 2 2.6Unknown 1 1.3
Race/Ethnicityb
White 7 9.2Black 28 36.8Asian 5 6.6Hispanic 29 38.2Other 6 7.9Unknown 1 1.3
Language of Demographic Form
English 76 100.0Spanish 0 0.0Portuguese 0 0.0
Country of Birth
Born in United States 24 31.6Born in U.S. territories 9 11.8Born in other country 40 52.6
Less than 1 year in United States 0 0.0 1-5 years in United States 4 10.0 More than 5 years in United States 29 72.5 Unknown length of time in United States 7 17.5
Unknown 3 4.0 Health Insurance
Yes 75 98.7Through an employer 56 74.7 Through purchase 1 1.3 Medicare 1 1.3 Medicaid, MassHealth, and so on 13 17.3 Free Care or Safety Net 0 0.0 Other 4 5.3
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Table 7 (continued)
17
N = 76 % No 0 0.0Unknown 1 1.3
Education Less than high school 0 0.0High school or equivalent 7 9.2Training program 6 7.9College 61 80.3Other 1 1.3Unknown 1 1.3
Source: Analysis of data collected from CHWs. aCHWs could be trained in more than one unit.
bRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.
Demographic Characteristics of CHWs
All trainings led by CMAHEC were given in English. As shown in Table 7, the majority of CHWs were female (68 percent) and between ages 40 and 64 (55 percent). The most common racial and ethnic groups among CHWs were Hispanic and black (38 percent and 37 percent, respectively). More than half of the CHWs were born outside of the United States (53 percent), with almost three-quarters of this group (73 percent) having lived in the United States for more than five years. CHWs were highly educated; approximately 80 percent had attended at least some college, and all of the CHWs responding reported that they had attained at least a high school education. All but one CHW reporting having health insurance (99 percent); the remaining CHW did not respond to the insurance question (1 percent). Of those with health insurance, three-quarters received it from their employer. CHWs’ Knowledge of Health Units
Table 8 presents CHWs’ knowledge of breast, cervical, cardiovascular, colorectal, and prostate health before and after completing the training session with CMAHEC. Baseline knowledge was high; for all units, the average pretest score was above 4.20 on a five-point scale. Changes in knowledge based on the results of paired t-tests among CHWs completing both the pre- and posttest for each unit are as follows:
Breast health. Baseline knowledge of breast health was higher than any other unit; the
CHWs’ average score was 4.8 on a five-point scale. After the training, the average score among CHWs was 5.0 (rounded), which was not a statistically significant improvement (p < 0.05). Seventeen percent of CHWs increased their score from pretest to posttest.
Cervical health. There was a significant increase in cervical health scores between the pretest and posttest (p < 0.05). Before training, CBO educators attending the cervical health unit training scored an average of 4.3 on a five-point scale, which was the lowest baseline score of any unit. After being trained, their average score increased to 5.0 (rounded). Half of CHWs improved their scores in this unit.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
18
Cardiovascular health. Among CHWs, pretest scores for the cardiovascular health unit were second highest (after the breast health unit). Before training, CBO educators averaged a score of 4.7 on a five-point scale. Their average score increased to 4.9 after completing training, which was a statistically significant improvement (p < 0.05). More than one-quarter of CHWs improved their score in this unit after receiving training.
Colorectal health. CHWs attending colorectal health training scored an average of 4.5 on a five-point scale on the pretest. After the training, their score improved to an average of 4.9, which was a significant increase (p < 0.05). In this unit, 43 percent of CHWs improved their score between pre- and posttest.
Prostate health. At pretest, CHWs scored an average of 4.3 out of a five-point scale for the prostate health unit. After training, their average score increased to 4.6. Although this increase was significant (p < 0.05), it was the lowest posttest score of any unit. Twenty-nine percent of CHWs increased their prostate health score between pre- and posttest.
Table 9 displays the percentage of CHWs correctly answering each of the pre- and posttest questions. For most questions, the percentage of CHWs responding correctly increased between pre- and posttest; however, for a few questions the percentage either remained the same or decreased slightly (between 2 and 3 percent in all cases). At posttest, 23 out of the 25 total questions across all units were answered correctly by over 90 percent of CHWs. The two questions that were answered incorrectly most frequently were both part of the prostate health unit. Over 20 percent of CHWs provided an incorrect answer to the question, “Starting at the age of 65, men should start talking to their doctor about testing for prostate cancer,” (false). In addition, approximately 14 percent of CHWs responded incorrectly to the question, “Difficulty or pain during urination are signs of prostate problems” (true). In the future, the prostate training for CBO educators may want to focus more on these topics to ensure that they are conveyed clearly to workshop participants.
19
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
Tab
le 8
. Bre
ast
, Cerv
ical,
Card
iovasc
ula
r, C
olo
rect
al,
and
Pro
state
Know
led
ge o
n t
he P
rete
sts
and
Post
test
s, b
y D
em
og
rap
hic
Chara
cteri
stic
s of
CH
Ws
Br
east
Can
cer
Cerv
ical
Can
cer
Card
iova
scul
ar H
ealth
Pret
est
Post
test
%
with
In
crea
sed
Scor
e
Pret
est
Post
test
%
with
In
crea
sed
Scor
e
Pret
est
Post
test
%
with
In
crea
sed
Scor
e
N
Aver
age
Scor
e N
Av
erag
e Sc
ore
N
Aver
age
Scor
e N
Av
erag
e Sc
ore
N
Aver
age
Scor
e N
Av
erag
e Sc
ore
Tota
l C
om
ple
ting B
oth
Pre
- a
nd
Post
test
s 36
4.
81
36
4.97
16
.7
38
4.29
38
4.
97**
50
.0
43
4.67
43
4.
91**
27
.9
Tota
l C
om
ple
ting E
ith
er
Test
36
4.
81
37
4.89
n.
a.
39
4.23
38
4.
97
n.a.
43
4.
67
43
4.91
n.
a.
Gend
er
M
ale
3 5.
00
3 5.
00
0.0
4 3.
75
4 5.
00
75.0
10
4.
60
10
5.00
40
.0
Fem
ale
33
4.79
34
4.
88
18.2
35
4.
29
34
4.97
47
.1
33
4.70
33
4.
88
24.2
Un
know
n 0
n.a.
0
n.a.
n.
a.
0 n.
a.
0 n.
a.
n.a
0 n.
a.
0 n.
a.
n.a.
A
ge
Un
der
40
17
4.82
17
5.
00
17.7
17
4.
18
17
4.94
70
.6
21
4.57
21
4.
86
33.3
40
-64
18
4.78
19
4.
79
16.7
21
4.
24
20
5.00
35
.0
20
4.75
20
4.
95
25.0
65
and
ove
r 1
5.00
1
5.00
0.
0 1
5.00
1
5.00
0.
0 2
5.00
2
5.00
0.
00
Unkn
own
0 n.
a.
0 n.
a.
n.a.
0
n.a.
0
n.a.
n.
a 0
n.a.
0
n.a.
n.
a.
Race
/ Eth
nic
ity
a
W
hite
3
4.33
3
5.00
66
.7
3 4.
33
3 5.
00
66.7
5
5.00
5
5.00
0.
00
Blac
k 11
5.
00
11
5.00
0.
0 10
4.
40
10
4.90
40
.0
10
4.40
10
4.
80
50.0
As
ian
3 4.
67
3 4.
67
33.3
3
3.33
3
5.00
10
0.0
3 4.
67
3 5.
00
33.3
H
ispa
nic
14
4.71
15
4.
80
21.4
17
4.
24
16
5.00
50
.0
23
4.74
23
4.
91
21.7
O
ther
5
5.00
5
5.00
0.
0 6
4.33
6
5.00
33
.3
2 4.
50
2 5.
00
50.0
Un
know
n 0
n.a.
0
n.a.
n.
a.
0 n.
a.
0 n.
a.
n.a
0 n.
a.
0 n.
a.
n.a.
Ed
uca
tion
Le
ss th
an h
igh
scho
ol
0 n.
a.
0 n.
a.
n.a.
0
n.a.
0
n.a.
n.
a.
0 n.
a.
0 n.
a.
n.a.
H
igh
scho
ol/e
quiv
alen
t 4
4.75
4
5.00
25
.0
3 4.
00
3 5.
00
66.7
5
4.60
5
4.80
40
.0
Trai
ning
pro
gram
4
4.50
4
5.00
50
.0
4 4.
00
4 5.
00
50.0
4
4.75
4
4.75
25
.0
Colle
ge
28
4.86
29
4.
86
10.7
32
4.
28
31
4.97
48
.4
34
4.68
34
4.
94
26.5
O
ther
0
n.a.
0
n.a.
n.
a 0
n.a.
0
n.a.
n.
a 0
n.a.
0
n.a.
n.
a Un
know
n 0
n.a.
0
n.a.
n.
a 0
n.a.
0
n.a.
n.
a 0
n.a.
0
n.a.
n.
a
Tab
le 8
(con
tin
ued
)
20
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
Co
lore
ctal
Can
cer
Pros
tate
Can
cer
Pr
etes
t Po
stte
st
% w
ith
Incr
ease
d Sc
ore
Pret
est
Post
test
%
with
Incr
ease
d Sc
ore
N
Av
erag
e Sc
ore
N
Aver
age
Scor
e N
Av
erag
e Sc
ore
N
Aver
age
Scor
e T
ota
l C
om
ple
ting
Both
Pre
-
and
Post
test
s 40
4.
45
40
4.90
**
42.5
51
4.
31
51
4.57
* 29
.4
T
ota
l C
om
ple
ting E
ith
er
Test
40
4.
45
40
4.90
n.
a.
52
4.27
52
4.
58
n.a.
Gend
er
Mal
e 9
4.56
9
4.78
33
.3
21
4.33
21
4.
62
35.0
Fe
mal
e 31
4.
42
31
4.94
45
.2
31
4.23
31
4.
55
25.8
Un
know
n 0
n.a.
0
n.a.
n.
a 0
n.a.
0
n.a.
n.
a
Ag
e
Unde
r 40
19
4.
32
19
5.00
63
.2
21
4.14
20
4.
50
35.0
40
-64
19
4.53
19
4.
79
26.3
30
4.
37
30
4.63
26
.7
65 a
nd o
ver
2 5.
00
2 5.
00
0.0
1 4.
00
1 4.
00
0.0
Unkn
own
0 n.
a.
0 n.
a.
n.a
0 n.
a.
1 5.
00
0.0
R
ace
/Eth
nic
ity
a
Whi
te
5 4.
80
5 5.
00
20.0
4
4.50
4
4.50
25
.0
Blac
k 6
4.33
6
4.67
50
.0
19
4.21
18
4.
72
38.9
As
ian
3 4.
33
3 5.
00
66.7
3
3.67
3
4.33
66
.7
His
pani
c 23
4.
43
23
4.96
43
.5
22
4.41
22
4.
59
18.2
O
ther
3
4.33
3
4.67
33
.3
4 4.
00
4 4.
00
25.0
Un
know
n 0
n.a.
0
n.a.
n.
a 0
n.a.
1
5.00
0.
0
Ed
uca
tion
Less
than
hig
h sc
hool
0
n.a.
0
n.a.
n.
a 0
n.a.
0
n.a.
n.
a H
igh
scho
ol o
r eq
uiva
lent
4
4.25
4
4.75
50
.0
4 4.
00
4 4.
50
50.0
Tr
aini
ng p
rogr
am
4 4.
50
4 5.
00
50.0
5
4.40
5
4.40
0.
0 Co
llege
32
4.
47
32
4.91
40
.6
42
4.31
41
4.
61
29.3
O
ther
0
n.a.
0
n.a.
n.
a 1
3.00
1
4.00
10
0.0
Unkn
own
0 n.
a.
0 n.
a.
n.a
0 n.
a.
1 5.
00
0.0
So
urce
: An
alys
is o
f dat
a co
llect
ed fr
om C
HW
s.
Not
e: T
he fi
rst r
ow o
f the
tabl
e sh
ows
stat
istic
s fo
r CH
Ws
who
com
plet
ed b
oth
the
pret
est a
nd th
e po
stte
st o
f a u
nit.
A pa
ired
t-te
st w
as c
ondu
cted
for
thes
e CH
Ws
in e
ach
unit
of t
he c
urric
ulum
to
dete
rmin
e w
heth
er t
he in
crea
se in
ave
rage
sco
res
was
sta
tistic
ally
sig
nific
ant.
Beca
use
the
sam
ple
size
s w
ere
smal
l, pa
ired
t-te
sts
wer
e no
t co
nduc
ted
for
indi
vidu
al d
emog
raph
ic g
roup
s.
a Rac
e an
d H
ispa
nic
ethn
icity
wer
e co
mbi
ned
for
this
ana
lysi
s be
caus
e 12
per
cent
of
His
pani
c w
orks
hop
part
icip
ants
did
not
ide
ntify
the
ir ra
ce,
and
55 p
erce
nt o
f H
ispa
nic
wor
ksho
p pa
rtic
ipan
ts m
arke
d th
e ot
her
race
cat
egor
y on
the
ir de
mog
raph
ic f
orm
. O
f th
e pa
rtic
ipan
ts t
hat
mar
ked
othe
r ra
ce,
man
y w
rote
“H
ispa
nic”
into
the
fre
e re
spon
se
field
.
*Po
stte
st s
core
is s
igni
fican
tly d
iffer
ent f
rom
pre
test
sco
re a
t the
.05
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21
Table 9. Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health Knowledge, by Pretest and Posttest Questions Among CHWs
Pretest Posttest
% Change
N = # Answering Correctly
% Answering Correctly
N = # Answering Correctly
% Answering Correctly
Question (Correct Response)
Breast Health Unit (N = 36)
1. If you have a lump in your breast, you absolutely have breast cancer (false) 36 100.0 36 100.0 0.0
2. Starting at the age of 40, you should get a mammogram once a year (true) 35 97.2 35 97.2 0.0
3. Mammograms cause breast cancer (false) 36 100.0 36 100.0 0.0
4. As women get older, their risk of breast cancer increases (true) 34 94.4 36 100.0 5.9
5. You should have a clinical breast exam done by a health care provider every 5 years (false) 32 88.9 36 100.0 12.5
Cervical Health Unit (N = 38)
1. If you get an abnormal Pap test, it means you have cervical cancer (false) 38 100.0 38 100.0 0.0
2. Women should get their first Pap test at age 21 or three years after they become sexually active (true) 25 65.8 38 100.0 52.0
3. Cervical cancer is preventable through routine screening (true) 36 94.7 38 100.0 5.6
4. Getting a positive HPV test means you have cervical cancer (false) 35 92.1 37 97.4 5.7
5. Most women have been exposed to the Human Papilloma Virus (HPV) (true) 29 76.3 38 100.0 31.0
Cardiovascular Health Unit (N = 43)
1. Men and women have the exact same heart attack warning signs (false) 29 67.4 40 93.0 37.9
2. Quitting smoking can help reduce the risk for cardiovascular disease (true) 43 100.0 43 100.0 0.0
3. LDL (bad) cholesterol can clog your blood vessels and cause damage to your heart and brain (true) 43 100.0 43 100.0 0.0
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Pretest Posttest
% Change
N = # Answering Correctly
% Answering Correctly
N = # Answering Correctly
% Answering Correctly
4. If someone shows one of the symptoms of a stroke, the most important thing to do is call 911 right away (true) 43 100.0 43 100.0 0.0
5. High blood pressure forces your heart to work harder than normal and raises your risk for heart attack and stroke (true) 43 100.0 42 97.7 -2.3
Colorectal Health Unit (N = 40)
1. Eating foods high in fat is a risk factor for colorectal cancer (true) 35 87.5 40 100.0 14.3
2. All people should begin getting screened for colorectal cancer at the age of 30 years (false) 31 77.5 40 100.0 29.0
3. Colorectal cancer can develop without signs over a long period of time without being noticed (true) 39 97.5 39 97.5 0.0
4. Screening is the only way for someone to know if they have colorectal cancer (true) 35 87.5 40 100.0 14.3
5. A polyp found on colonoscopy will always be cancer (false) 38 95.0 37 92.5 -2.6
Prostate Health Unit (N = 51)
1. Men are more likely to get prostate cancer when they are younger (false) 49 96.1 48 94.1 -2.0
2. Starting at the age of 65, men should start talking to their doctor about testing for prostate cancer (false) 35 68.6 40 78.4 14.3
3. Men of African descent are at high risk for getting prostate cancer (true) 48 94.1 51 100.0 6.3
4. Difficulty or pain during urination are signs of prostate problems (true) 44 86.3 44 86.3 0.0
5. PSA test results are typically higher in men with prostate cancer (true) 44 86.3 50 98.0 13.6
Source: Analysis of data collected from CHWs.
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Satisfaction with Training Sessions
CHWs interviewed as part of the qualitative evaluation were generally satisfied with the training given by CMAHEC. Overall, CHWs felt comfortable leading workshops after receiving training. However, they offered a few suggestions for improving the quality of the training sessions. First, CHWs expressed a desire for the training to cover additional depth. CHWs would have liked to be able to answer some of the more difficult questions on their own instead of referring workshop participants to health care providers. Second, a few CHWs suggested that it would have been helpful to have separate training sessions for people with different amounts of prior health education experience. In particular, CHWs who had less experience in health education wished that the training sessions had included more opportunities for conducting dry runs of giving presentations. Third, a few CHWs recommended that, given the long field period, it would have been helpful if CMAHEC had offered a refresher training session in the middle of the project.
3. Relationship with CMAHEC
CHWs were very enthusiastic when asked about their relationship with CMAHEC. Aside from conducting the training sessions for educators, CMAHEC was available throughout the course of the project for technical assistance regarding the curriculum and administrative matters.4 Primarily, CBOs contacted CMAHEC to obtain more data collection forms, to send session sign-in sheets, and to notify them of upcoming workshops. To a lesser extent, CBOs asked CMAHEC staff for advice on recruitment and to report problems with the translation of the forms. Most CBOs were in contact with CMAHEC at some point during the course of the project.
B. Project Reach
During the project, a total of 2,806 unique individuals were educated by CBOs across the six regions of Massachusetts. The project was effective in reaching individuals who had not before been educated using the curriculum. Comparison of the quantitative data from earlier phases of this project indicate that very few individuals educated during this phase of the project had been educated as part of this project previously, suggesting that CBOs that had previously participated in the project had not saturated their communities.5
Although almost 3,000 people were reached by the education, the majority of CBOs were not
able to attain their approved participant capacity for the project. Mathematica was contracted to administer funds to CBOs for conducting 7,423 units of education. At the end of the project, CBOs had given only 4,617 education units, of which 4,416 were eligible for reimbursement,6 meaning that, in total, they achieved only 60 percent of the contracted project capacity. As a whole, CBOs had more success reaching capacity when they were educating women than when educating men. Table 10 shows the number of educational units conducted and eligible for reimbursement, the
4 Mathematica provided CBOs with technical assistance related to data collection and data submission.
5 Specifically, of female workshop participants in this phase, four had been educated in three units during an earlier phase, eight had been educated in two units previously, and nine had been educated in one unit earlier.
6 An educational unit was only eligible for reimbursement when a CBO submitted a complete set of forms.
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number of units CBOs were contracted to complete, and the percentage of capacity met, by health topic and gender.
Table 10. Capacity Reached, by Health Unita
Educational Unit Number of Units
Conducted Number of Units
Contracted Percentage of
Capacity Reached
Total 4,416 7,423 59.5
Breast health (women) 818 1,198 68.3
Cervical health (women) 665 1,188 56.0
Cardiovascular health (women) 818 1,122 72.9
Cardiovascular health (men) 508 969 52.4
Colorectal health (women) 472 797 59.2
Colorectal health (men) 329 588 56.0
Prostate health (men) 806 1,561 51.6 Source: Analysis of data collected from workshop participants. aData that were not eligible for reimbursement are not included in this table.
CHWs suggested a variety of reasons for this shortfall. First, the CBOs did not always have sufficient infrastructure to recruit the approved number of participants. In at least one instance, CBO supervisors set the target number of workshop participants without consulting CHWs about the feasibility of this target. Within CBOs, only a limited number of CBOs were trained to lead workshops, and many CHWs were also participating in other grants. As a result, they had a limited amount of time to devote to recruitment for this project. Second, some CBOs that worked primarily with the Haitian community had their work disrupted when an earthquake struck Haiti in January 2010. These CBOs diverted their attention from this project and focused much of their organizations’ efforts on aiding Haiti. Third, with regard to recruitment for the prostate curriculum, CBOs noted that men, as opposed to women, are particularly difficult to recruit for health education, especially given the sensitive nature of prostate health. One CHW noted that in order to reach his target number of participants for a workshop, he had to recruit twice as many men. Overall, it was most difficult for CBOs to reach people in their communities who were not affiliated with any community groups.
Quantitative and qualitative analysis of data collected during this project suggest that: (1) CHWs
felt that the Helping You Take Care of Yourself curriculum and materials were effective education tools, (2) the curriculum reached a diverse population, and (3) the population educated by CBOs generally received preventative health screenings less often than the greater Massachusetts population (fewer differences were found between participants and the national population). Key findings related to participants’ recruitment, education, demographic characteristics, and preventative health behaviors are described below.
1. Recruiting Workshop Participants
CBOs employed a variety of strategies to recruit workshop participants. Often, CBOs combined recruiting participants from existing contacts and conducting outreach activities in their communities. Common strategies included the following:
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Group Meetings. Many CBOs incorporated workshops into meetings of existing community groups, such as church groups, clubs, or sports teams.
Individual Contacts. Some CBOs used existing telephone or email lists of community members with whom they had previous contact to recruit workshop participants.
Public Outreach. Some CBOs reported that they conducted outreach through print or radio media, including techniques such as flyers, radio advertisements, and public service announcements. These CBOs mentioned churches, liquor stores, and community soccer games as successful locations for recruitment.
To increase the likelihood of targeted community members’ attending workshops, CBOs often employed several techniques. For workshops that were not offered as part of meetings of existing groups, CBOs noted that reminders often helped increase workshop attendance. For example, CBOs sometimes contacted potential workshop participants by phone or email to remind them of upcoming workshops. One CBO that recruited with flyers had interested community members write their name and phone number at the bottom of the workshop advertisement so that they could remind them about the workshop. Some CBOs also mentioned that incentives were helpful in increasing workshop attendance. Examples of incentives provided by CBOs include food, babysitting, and small gifts, such as t-shirts and key chains. However, many CBOs suggested that a monetary stipend would better increase workshop attendance. CHWs who educated men in the prostate health unit noted that it was often effective to contact the wives of targeted workshop participants as part of recruitment. Wives were often able to convince their husbands that attending a prostate health workshop was worthwhile.
2. Conducting Workshops
CHWs used the Helping You Take Care of Yourself curriculum and materials developed by MDPH to educate health workshop participants. Workshop location, size, and length often varied by CBO.
Workshop Characteristics
CBOs held workshops in a variety of venues, including at their organization’s location, churches, community centers, halfway houses, housing developments, restaurants, and people’s homes. Across all CBOs, the number of participants per workshop ranged from one to 53. CHWs reported that the ideal workshop size was 10 to 20 participants. This size was small enough to answer all participants’ questions, but large enough to facilitate a meaningful conversation.
Prostate health CHWs reported that workshops ranged in length from 15 minutes to two hours.
Length of workshops often varied by the number of participants and whether an ad hoc translation of the presentation and data collection forms was needed. For the prostate health unit, CHWs conducted workshops in English, Portuguese, and Spanish, and performed ad hoc translations of the workshop and corresponding materials into Cape Verdean Creole, Haitian Creole, French, and several African languages.
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Curriculum and Workshop Materials
At the training sessions led by CMAHEC, CHWs received the workshop curriculum and PowerPoint presentations developed by MDPH, which included some graphics. CHWs who conducted workshops in the prostate health unit reported that, overall, the curriculum was written clearly, presented an appropriate amount of information at the right level of difficulty, and addressed an important topic. Many prostate CHWs mentioned that, although they were comfortable leading workshops after the training with CMAHEC, they also conducted additional research about the topic before leading workshops in order to increase their knowledge and prepare for potential questions. Although CHWs and focus groups participants were positive about the prostate curriculum, they did offer some suggestions for improvement. First, some CHWs suggested that the curriculum could better motivate participants if it were tailored to specific racial or ethnic groups. Since there are large racial and ethnic disparities in prostate cancer incidence and mortality (National Cancer Institute 2008), this information could help make participants’ risk for cancer more salient. Second, CHWs thought it would be helpful if the curriculum included more concrete recommendations relating to screening. Focus group participants would have liked the curriculum to include information about obtaining insurance since preventative health screening is often tied to insurance status.
CHWs were generally satisfied with the workshop materials. The CHWs and focus group
participants noted that the diagram of the prostate gland was particularly useful in helping men understand the anatomical facts about prostate cancer and why screening tests like the DRE are needed. Accordingly, they believed that workshop participants would benefit from additional visual aids, such as videos and graphics. The CHWs occasionally modified the workshop materials in ways that they thought would motivate the people in their communities. At least one CHW supplemented the PowerPoint presentation with additional information about the incidence and burden of prostate cancer, risk factors, and racial and ethnic disparities. Another CHW noted that having a prostate cancer survivor speak to the workshop participants was an effective complement to the workshops. CHWs also mentioned that they would have liked to have had access to materials that they could give to participants as they were leaving the workshop to reinforce the key messages.
3. Description of Workshop Participants
Table 11 presents the demographic characteristics of people who were educated using the Helping You Take Care of Yourself curriculum. Appendices D and E provide additional breakdowns of demographic characteristics of workshop participants by region (Appendix D) and health unit (Appendix E). Overall, 2,806 people participated in at least one workshop, of whom 1,251 (45 percent) were male, 1,546 (55 percent) were female, and nine were of unknown gender. Participants attended 4,617 units and almost half (48 percent) attended multiple education units. The workshop participants represented a diverse population with the following characteristics:
Age. The project targeted people ages 40 to 64; however, approximately 18 percent of workshop participants were below age 40 and 11 percent were above age 65. Overall, the age of workshop participants ranged from 16 to 99, of which the mean age was 49.5.
Race, Ethnicity, and Language. With regard to race and ethnicity, Hispanics composed the largest percentage of workshop participants (43 percent), followed by blacks (27 percent), whites (15 percent), other racial/ethnic groups (8 percent), and Asians (5 percent). Two percent of the project population did not report their race or
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ethnicity. For the prostate health unit, which MDPH targeted to a specific group of men, 53 percent of men educated were black and 66 percent identified as part of the project’s target population (data not shown). More than half of workshop participants (51 percent) completed data collection forms that were printed in English, while 31 percent completed forms in Spanish and 17 percent completed forms in Portuguese. It is important to note that, although forms may have been completed in English, education may have been held in a different language for which there were no forms.7 CHWs typically read the forms aloud as participants completed them and offered one-on-one help as needed.
Country of Birth. Workshop participants also varied by their country of birth. Almost half of workshop participants (47 percent) indicated that they were born outside of the United States mainland and territories, of whom approximately half (49 percent) had been in the United States for more than five years. There was a substantial amount of missing data related to country of birth (12 percent) and length of time in the United States among foreign-born workshop participants (37 percent). CHWs interviewed as part of the qualitative evaluation attributed this gap in data to the fact that many workshop participants were not legal residents of the United States, and these participants were uncomfortable providing information that they perceived to be related to their immigration status.
Health Insurance. The vast majority of workshop participants (86 percent) had some sort of health insurance, including insurance provided by an employer, individual purchase, Medicare, Medicaid, and Safety Net. Of participants with insurance, approximately half received their coverage through Medicaid, indicating that the project reached a high percentage of people of a low socioeconomic status. Nine percent of workshop participants reported that they did not have health insurance, and 5 percent did not indicate their insurance status.
Educational Attainment. There was also considerable variation among workshop participants with regard to educational attainment. More than one-third of workshop participants did not complete high school, while 26 percent of workshop participants were high school graduates, and 29 percent had attended at least some college. The remainder of participants had completed another type of education or did not report their educational attainment.
Region. Workshops were held in all six regions of Massachusetts—Boston, Central, Metrowest, Northeast, Southeast, and West. The number of workshop participants by region ranged from 288 in the Northeast region to 576 in the Central region. Further breakdown of the demographic characteristics of workshop participants by region is displayed in Appendix D.
7 We know from the prostate evaluation, for example, that ad hoc translations were made for many languages but
forms were completed in English.
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Table 11. Characteristics of Workshop Participants
Total
N = 2,806 %
Units Of Education
Units of Education Totala 4,617 100.0 Breast cancer 851 27.0 Cervical cancer 654 20.8 Cardiovascular disease 1,382 43.9 Colorectal cancer 821 26.1 Prostate cancer 909 28.9
Number of Units of Education Receivedb
1 1,456 51.9 2 1,038 37.0 3 171 6.1 4 143 5.1
Demographic Characteristics
Gender Male 1,251 44.6 Female 1,546 55.1 Unknown 9 0.3
Age
Under 40 497 17.7 40-64 1,951 69.5 65 and over 318 11.3 Unknown 40 1.4
Race/Ethnicityc
White 410 14.6 Black 770 27.4 Asian 146 5.2 Hispanic 1,208 43.1 Other 214 7.6 Unknown 58 2.1
Form Language
English 1,439 51.3 Spanish 879 31.3 Portuguese 488 17.4
Country of Birth
Born in United States 774 27.6 Born in U.S. territories 389 13.9 Foreign 1311 46.7
<1 Year in United States 36 2.8 1-5 Years in United States 152 11.6 >5 Years in United States 643 49.1 Unknown length of time spent in United States 480 36.6
Unknown 332 11.8 Health Insurance
Yes 2,424 86.4 Through an employer 646 26.7 Through purchase 104 4.3
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research Table 11 (continued)
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Total
N = 2,806 % Medicare 169 7.0 Medicaid, MassHealth, etc. 1,203 49.6 Free Care or Safety Net 233 9.6 Other 69 2.9
No 246 8.8 Unknown 136 4.8
Education
Less than high school 994 35.4 High school or equivalent 741 26.4 Training program 141 5.0 College 817 29.1 Other 39 1.4 Unknown 74 2.6
Source: Analysis of data collected from workshop participants. a This total refers to the number of educational units received by participants, not the number of unique project
participants. b Because male workshop participants were approved to receive education in only three units (cardiovascular,
colorectal, and prostate health) and female workshop participants were approved to receive education in only four units (breast, cervical, cardiovascular, and colorectal health), it was possible for a workshop participant to receive a maximum of only four units of education. CHWs could be trained in any of the five units regardless of their gender.
c Race and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.
4. Preventative Health Behaviors
Early and regular screening can lead to a decrease in mortality from certain cancers. To assess the rate of screening among workshop participants, all participants were asked about their previous screening behaviors related to breast, cervical, cardiovascular, colorectal, and prostate health. Screening behaviors varied by demographic characteristics. To facilitate comparison of health behaviors between the workshop participants and the overall Massachusetts and national populations, the questions and response categories matched those in CDC’s BRFSS.8 For each disease, we analyzed screening behaviors by two key measures: (1) percentage of workshop participants who received screening within the past year and (2) percentage of workshop participants who were never screened. The time frame of one year was chosen to help determine the proportion of workshop participants who receive preventative care annually. In addition, since screening recommendations vary by age, health history, and other risk factors for many of the health topics covered by this project, it is impossible to analyze workshop participants’ data in complete accordance with MHQP guidelines, so instead we chose to assess the percentage of each population that was never screened.
8 As noted above, on the demographics form multilevel questions were condensed into a single question based on
feedback from earlier rounds of this project. In this analysis, data from workshop participants were manipulated to match the format of the BRFSS data.
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Breast Health
Table 12 displays the receipt of mammograms among female workshop participants, by demographic characteristic. The chi-squared tests indicate that there were significant differences among participants in the receipt of mammograms by age group, racial and ethnic categories, and health insurance status, but not by educational attainment. Findings include the following:
Age. Women ages 40 to 64 were significantly more likely than those over age 64 to
have received a mammogram in the past year (62 percent versus 48 percent).
Race and Ethnicity. In comparison to the other racial/ethnic categories, it appears that Hispanics were most likely to have received a mammogram in the past year (70 percent) and least likely to have never received a mammogram (5 percent).
Insurance Status. Workshop participants without health insurance appeared to be almost half as likely to have received a mammogram in the past year (34 percent versus 62 percent) and approximately five times as likely to have never received a mammogram (25 percent versus 5 percent) as participants with health insurance.
Figure 2 shows breast health screening behavior among workshop participants and comparable women in Massachusetts and nationally who participated in BRFSS.
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Table 12. Receipt of Mammograms Among Female Workshop Participants Over Age 40, by Demographic Characteristics
Most Recent Mammogram (%)
N
<1 Year Ago
1-2 Years Ago
2-3 Years Ago
3-5 Years Ago
≥5 Years Ago Never Unknown
Total 1,252 59.5 17.2 6.4 2.5 3.3 5.8 5.4 Age**
40-64 1,046 61.9 16.7 6.4 2.4 2.2 6.4 4.065 and over 206 47.6 19.4 6.3 2.9 8.7 2.9 12.1
Race/Ethnicitya**
White 231 49.8 20.8 9.5 5.6 8.2 4.8 1.3Black 185 51.4 14.6 8.6 1.1 4.3 9.2 10.8Asian 92 58.7 22.8 5.4 0.0 2.2 9.8 1.1Hispanic 632 69.6 13.3 4.9 2.1 1.3 4.7 4.1Other 99 36.4 33.3 6.1 3.0 4.0 6.1 11.1Unknown 13 38.5 15.4 0.0 0.0 0.0 0.0 46.2
Health Insurance**
Yes 1,163 61.5 17.5 6.3 2.3 3.4 5.3 3.7No 47 34.0 17.0 12.8 8.5 0.0 25.5 2.1Unknown 42 33.3 7.1 2.4 0.0 2.4 0.0 54.8
Education
Less than high school 539 54.7 18.9 8.7 1.9 3.5 6.3 5.9
High school or equivalent 300 62.7 16.7 6.3 3.0 3.0 4.7 3.7
Training program 49 63.3 16.3 6.1 2.0 2.0 6.1 4.1
College 326 65.3 16.3 3.1 2.8 3.4 6.4 2.8Other 19 52.6 10.5 5.3 10.5 5.3 5.3 10.5Unknown 19 42.1 0.0 0.0 0.0 0.0 0.0 57.9
Source: Analysis of data collected from workshop participants. a Race and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants
did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.
*Differences in the receipt of mammograms across categories are statistically significant at the .05 level.
**Differences in the receipt of mammograms across categories are statistically significant at the .01 level.
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Cervical Health
Table 13 presents information related to the receipt of Pap smears among female workshop participants. There were significant differences among participants in the receipt of Pap smears by age group, race and ethnicity, and insurance status, but not by educational attainment. Findings include the following:
Age. Data collected by CBOs suggest that women ages 65 and older were almost half as
likely as women under 65 to have received a Pap smear within the past year (31 percent versus 58 percent). Women under age 40 were most likely to have never received a Pap smear (12 percent).
Race and Ethnicity. Hispanic women were most likely to have received a Pap smear in the past year (64 percent) and Asian women were most likely to report never having a Pap smear (13 percent).
Insurance Status. Women without health insurance were less likely to have received Pap smears in the past year (37 percent versus 56 percent) and more likely to have never received a Pap smear (18 percent versus 4 percent) than were those with insurance.
Figure 3 shows cervical health screening behavior among workshop participants and comparable women in Massachusetts and nationally who participated in BRFSS.
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.
Table 13. Receipt of Pap Smears Among Female Workshop Participants, by Demographic Characteristics
Most Recent Pap Smear (%)
N
<1 Year Ago
1-2 Years Ago
2-3 Years Ago
3-5 Years Ago
≥5 Years Ago Never Unknown
Total 1,546 53.6 19.1 6.4 3.6 5.8 4.8 6.7 Age**
Under 40 278 62.6 13.7 3.6 1.8 1.1 12.2 5.040-64 1,046 56.3 20.7 7.6 3.5 4.9 2.6 4.465 and over 206 30.6 18.9 4.9 6.8 17.0 6.3 15.5Unknown 16 18.8 12.5 0.0 0.0 0.0 0.0 68.8
Race/Ethnicitya**
White 263 43.7 21.3 9.9 6.8 12.9 1.9 3.4Black 223 43.5 22.0 6.3 3.1 8.1 7.6 9.4Asian 104 46.2 24.0 9.6 2.9 3.8 12.5 1.0Hispanic 826 63.6 16.6 4.5 3.0 3.3 4.0 5.1Other 107 36.4 25.2 11.2 2.8 5.6 5.6 13.1Unknown 23 21.7 8.7 0.0 0.0 0.0 0.0 69.6
Health Insurance**
Yes 1,416 55.9 19.7 6.6 3.4 5.9 4.2 4.3No 67 37.3 19.4 6.0 10.4 7.5 17.9 1.5Unknown 63 19.0 6.3 3.2 1.6 1.6 3.2 65.1
Education
Less than high school 623 48.6 20.1 7.1 4.5 7.4 5.9 6.4
High school or equivalent 377 52.3 21.5 6.1 3.2 5.3 5.6 6.1
Training program 71 60.6 16.9 9.9 2.8 4.2 2.8 2.8
College 420 63.8 17.1 5.7 3.1 4.0 2.9 3.3Other 23 47.8 17.4 4.3 4.3 8.7 8.7 8.7Unknown 32 21.9 6.3 0.0 0.0 3.1 0.0 68.8
Source: Analysis of data collected from workshop participants. aRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.
*Differences in the receipt of Pap smears across categories are statistically significant at the .05 level. **Differences in the receipt of Pap smears across categories are statistically significant at the .01 level.
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Cardiovascular Health
Table 14 displays the receipt of blood cholesterol screening among workshop participants by demographic characteristic. Chi-squared tests indicate that there were significant differences in the receipt of blood cholesterol screening by gender, age group, racial and ethnic categories, insurance status, and educational attainment. Findings include the following:
Gender. Female workshop participants were significantly more likely than male
participants to report having had their blood cholesterol checked in the past year (59 percent versus 46 percent). Accordingly, male participants were more likely than females (22 percent versus 10 percent) to have never received blood cholesterol screening.
Age. Likelihood of receiving a blood cholesterol check in the past year increased by age categories. Workshop participants who were 65 and over were most likely to be screened in the past year (62 percent), while participants under age 40 were least likely (43 percent).
Race and Ethnicity. In comparison to the other racial and ethnic categories, it appears that Hispanics were most likely to have had their blood cholesterol checked in the past year (58 percent). Black workshop participants were most likely to report never having been screened (21 percent).
Insurance Status. Workshop participants with health insurance were more than three times as likely as participants without health insurance to have had their blood cholesterol checked in the past year (59 percent versus 17 percent), while those without health insurance were more than four times as likely to have never had a blood cholesterol screening compared to participants with health insurance (53 percent versus 12 percent).
Educational Attainment. Workshop participants who had completed at least some college were most likely to have undergone blood cholesterol screening in the past year (61 percent).
Figures 4 and 5 show cardiovascular health screening behavior among male and female workshop participants, respectively, and comparable BRFSS participants in Massachusetts and nationally.
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Table 14. Receipt of Blood Cholesterol Check Among Workshop Participants, by Demographic Characteristics
Most Recent Blood Cholesterol Check (%)
N <1 Year
Ago 1-2 Years
Ago 2-5 Years
Ago >5 Years
Ago Never Unknown Total 2,806 53 15.5 5.7 4.7 15.5 5.6 Gender**
Male 1,251 46.1 14.3 5.9 6.2 22.1 5.3Female 1,546 58.9 16.5 5.6 3.4 10.2 5.4Unknown 9 11.1 0 0 0 0 88.9
Age**
Under 40 497 43.1 14.3 4.6 5.2 28.2 4.640-64 1,951 54.9 15.6 6.3 4.9 14.2 465 and over 318 62.3 17.9 4.1 2.8 5 7.9Unknown 40 10 2.5 5 0 2.5 80
Race/Ethnicitya**
White 410 54.4 21.5 7.1 3.9 9.8 3.4Black 770 48.7 14.7 5.3 6.4 20.6 4.3Asian 146 58.2 17.8 8.2 0.7 12.3 2.7Hispanic 1,208 58.4 13.4 5.4 4.5 14.2 4.1Other 214 43.5 20.1 6.5 3.3 19.6 7Unknown 58 12.1 3.4 0 6.9 5.2 72.4
Health Insurance**
Yes 2,424 58.8 16.8 5.7 4.3 11.9 2.6No 246 17.1 9.3 8.5 10.2 52.8 2Missing 136 14.7 3.7 2.2 0.7 11.8 66.9
Education**
Less than high school 994 51.1 18.1 5.4 3.6 17.5 4.2High school or equivalent 741 51.4 13.1 6.6 6.5 17.5 4.9Training program 141 53.9 11.3 11.3 9.9 10.6 2.8College 817 60.5 16.2 4.7 3.4 12.1 3.2Other 39 41 17.9 2.6 7.7 25.6 5.1Unknown 74 17.6 2.7 4.1 2.7 8.1 64.9
Source: Analysis of data collected from workshop participants. aRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.
*Differences in the receipt of blood cholesterol checks across categories are statistically significant at the .05 level. **Differences in the receipt of blood cholesterol checks across categories are statistically significant at the .01 level.
38
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Colorectal Health
Tables 15 and 16 display participants’ health behaviors related to screening for colorectal cancer. Chi-squared tests indicate that there were significant differences in the receipt of blood stool tests by age group, racial and ethnic categories, and insurance status (Table 15). There was no significant difference in the likelihood of undergoing a blood stool test by gender or educational attainment. In addition, receipt of sigmoidoscopies or colonoscopies differed significantly by age and health insurance; however, no significant differences were found in the rate of sigmoidoscopies and colonoscopies by gender, race and ethnicity, and educational attainment. Findings include the following:
Age. Workshop participants between ages 50 and 64 were more likely than participants
age 65 and over to have never received a blood stool test (41 percent versus 31 percent) or sigmoidoscopy or colonoscopy (37 percent versus 31 percent).
Race and Ethnicity. White workshop participants were the most likely to report never having taken a blood stool test (43 percent). No racial/ethnic differences were found for sigmoidoscopy or colonoscopy.
Insurance Status. Workshop participants with health insurance were more than twice as likely to report having taken a blood stool test within the past year as participants without health insurance (29 percent versus 13 percent) and almost half as likely to have never received a blood stool test (38 percent versus 66 percent). While the percentages of participants with and without health insurance who had undergone a sigmoidoscopy or colonoscopy within the past year were similar (24 percent versus 22 percent), the percentages of participants with and without health insurance who had never received one of these tests differed widely (34 percent versus 65 percent).
Figure 6 shows colorectal health screening behavior among workshop participants and comparable BRFSS participants in Massachusetts and nationally.
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Table 15. Receipt of Blood Stool Test Among Workshop Participants Over Age 50, by Demographic Characteristicsa
Most Recent Blood Stool Check (%)
N
<1 Year Ago
1-2 Years Ago
2-3 Years Ago
3-5 Years Ago
>5 Years Ago Never Unknown
Total 1,152 27.8 12.3 5.4 4.8 5.6 38.4 5.7 Gender
Male 493 28.2 13.0 3.9 5.1 6.3 38.9 4.7Female 658 27.5 11.9 6.5 4.6 5.2 38.0 6.4Unknown 1 0.0 0.0 0.0 0.0 0.0 0.0 100.0
Age*
50-64 834 28.3 11.3 5.3 4.1 5.6 41.1 4.365 and over 318 26.4 15.1 5.7 6.6 5.7 31.1 9.4
Race/Ethnicityb**
White 205 22.9 11.7 3.9 6.8 6.8 42.9 4.9Black 328 23.5 15.2 6.4 5.5 9.1 36.0 4.3Asian 97 29.9 14.4 5.2 6.2 6.2 36.1 2.1Hispanic 425 31.1 10.4 5.4 4.0 3.5 40.0 5.6Other 81 35.8 11.1 6.2 0.0 0.0 37 9.9Unknown 16 37.5 6.3 0.0 0.0 0.0 6.3 50.0
Health Insurance**
Yes 1,037 29.2 13.1 5.9 4.7 6.0 37.8 3.3No 68 13.2 8.8 1.5 4.4 2.9 66.2 2.9Unknown 47 17.0 0.0 0.0 6.4 2.1 10.6 63.8
Education
Less than high school 464 32.3 11.9 5.6 3.9 2.8 38.4 5.2High school or equivalent 282 23.0 11.7 5.0 6.0 8.2 40.4 5.7Training program 44 22.7 11.4 6.8 4.5 11.4 38.6 4.5College 317 26.5 13.9 6.0 5.4 7.3 37.5 3.5Other 19 15.8 21.1 0.0 0.0 5.3 47.4 10.5Unknown 26 30.8 3.8 0.0 3.8 0.0 19.2 42.3
Source: Analysis of data collected from workshop participants. aThe demographic form asked participants to classify their age as under 40, between 40 and 64, or over 64. Actual ages were calculated using date of birth and workshop date. Any participants who identified as being between 40 and 64 but did not provide a date of birth were excluded from this table, because we could not determine whether they were age 50 or older. bRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.
*Differences in the receipt of blood stool tests across categories are statistically significant at the .05 level. **Differences in the receipt of blood stool tests across categories are statistically significant at the .01 level.
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Table 16. Receipt of Sigmoidoscopy/Colonoscopy Among Workshop Participants Over Age 50, by Demographic Characteristics
Most Recent Sigmoidoscopy/Colonoscopy (%)
N
<1 Year Ago
1-2 Years Ago
2-3 Years Ago
3-5 Years Ago
5-10 Years Ago
>10 Years Ago Never Unknown
Total 1,152 23.1 16.1 8 7.3 3.5 1.3 35.4 5.4 Gender
Male 493 25.6 15.6 8.5 6.7 2.8 1.0 35.5 4.3Female 658 21.3 16.4 7.6 7.8 4.0 1.5 35.3 6.2Unknown 1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0
Age*
50-64 834 24.6 15.3 7.6 7.3 3.2 0.7 37.1 4.265 and over 318 19.2 17.9 9.1 7.2 4.1 2.8 31.1 8.5
Race/Ethnicityb
White 205 18.0 16.1 7.3 9.3 5.4 0.0 40.0 3.9Black 328 21.3 17.1 8.2 7.6 4.9 2.4 33.5 4.9Asian 97 17.5 21.6 8.2 5.2 2.1 1.0 44.3 0.0Hispanic 425 28.9 14.4 8.7 7.3 2.1 0.9 32.9 4.7Other 81 21.0 13.6 4.9 3.7 2.5 2.5 39.5 12.3Unknown 16 12.5 18.8 6.3 6.3 0.0 0.0 6.3 50.0
Health Insurance**
Yes 1,037 24.0 17.1 8.4 8.1 3.8 1.5 34.1 3.1No 68 22.1 7.4 4.4 0.0 0.0 0.0 64.7 1.5Unknown 47 4.3 6.4 4.3 0.0 2.1 0.0 21.3 61.7
Education
Less than high school 464 23.5 17.7 7.3 5.4 1.9 1.3 38.6 4.3High school or equivalent 282 20.9 13.8 9.6 8.9 5.0 1.8 34.4 5.7Training program 44 18.2 6.8 6.8 13.6 0.0 2.3 43.2 9.1College 317 26.5 17.7 8.2 8.2 5.0 0.9 30.6 2.8Other 19 10.5 21.1 0.0 5.3 0.0 0.0 57.9 5.3Unknown 26 15.4 3.8 7.7 3.8 3.8 0.0 19.2 46.2
Source: Analysis of data collected from workshop participants. a The demographic form asked participants to classify their age as under 40, between 40 and 64, or over 64.
Actual ages were calculated using date of birth and workshop date. Any participants who identified as being between 40 and 64 but did not provide a date of birth were excluded from this table, because we could not determine whether they were age 50 or older.
b Race and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.
*Differences in the receipt of sigmoidoscopies/colonoscopies across categories are statistically significant at the .05 level.
** Differences in the receipt of sigmoidoscopies/colonoscopies across categories are statistically significant at the .01 level.
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Prostate Health
To assess screening behavior related to prostate cancer, male workshop participants were asked about their receipt of digital rectal exams (DREs) and prostate-specific antigen (PSA) tests. Table 17 displays the receipt of DREs and Table 18 shows the receipt of PSA tests among men over 40.9 In addition, in response to recent changes in prostate screening recommendations, male workshop participants were asked whether they had discussed prostate cancer early detection or screening with a health care provider. These data are reported in Table 19. Chi-squared tests indicate that there were significant differences in the occurrence of a discussion about prostate cancer early detection or screening with providers and the receipt of both prostate cancer screening tests by age group, racial and ethnic categories, insurance status, and educational attainment. Findings include the following:
Age. Male workshop participants age 65 and over were more likely than those ages 40 to
64 to have discussed prostate cancer early detection or screening (62 percent versus 47 percent). In addition, those over 65 were more likely to have received a DRE (38 percent versus 25 percent) and/or PSA test (36 percent versus 25 percent) in the past year and less likely to have never received these screenings (21 percent versus 39 percent and 27 percent versus 48 percent for DRE and PSA test, respectively).
Race and Ethnicity. White men were the most likely to report having discussed prostate cancer early detection or screening with a provider (58 percent). Additionally, they were most likely to report having received a DRE and/or PSA test in the past year (43 percent and 38 percent for DRE and PSA test, respectively) and least likely to have never received one of these tests (27 percent and 40 percent for DRE and PSA test, respectively). Asian men were least likely to report discussing prostate cancer early detection or screening with a provider (17 percent) and to report never having either test (64 percent and 69 percent for DRE and PSA test, respectively). The prostate health screening behaviors of black men were in between those of white and Asian men; 54 percent of black men reported discussing prostate cancer early detection or screening with a provider. However, only 24 percent of black men had received a DRE in the past year, and 25 percent had received a PSA in that timeframe. In addition, 36 percent of black men reported that they never received a DRE, and 44 percent had never received a PSA test.
Insurance Status. Workshop participants with health insurance were almost three times as likely as participants without insurance to report discussing prostate cancer early detection or screening with a health care provider (63 percent versus 23 percent) and were twice as likely to report being screened in the past year 33 percent versus 11 percent for DRE, and 33 percent versus 14 percent for PSA test).
9 In accordance with MHQP recommendations, in this section, data related to prostate cancer screening were only
analyzed for men over age 40.
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Educational Attainment. As the education level of participants increased, they were more likely to report having discussed prostate cancer early detection or screening with a provider.
Figure 7 shows prostate health screening behavior among workshop participants and comparable BRFSS participants in Massachusetts and nationally.
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Table 17. Receipt of Digital Rectal Exams (DREs) Among Male Workshop Participants Over Age 40, by Demographic Characteristics
Percentage with Most Recent DRE
N
<1 Year Ago
1-2 Years Ago
2-3 Years Ago
3-5 Years Ago
≥5 Years Ago Never Unknown
Total 1,016 26.7 10.6 5.0 4.2 4.6 37.3 11.5 Age*
40-64 904 25.3 10.7 5.1 4.2 4.6 39.3 10.765 and over 112 37.5 9.8 4.5 4.5 4.5 21.4 17.9
Race/Ethnicitya**
White 124 42.7 12.9 4.8 2.4 3.2 26.6 7.3Black 454 23.6 12.1 6.4 5.3 4.6 36.1 11.9Asian 36 25.0 5.6 5.6 0.0 0.0 63.9 0.0Hispanic 302 28.8 9.9 4.3 3.6 6.3 32.8 14.2Other 89 16.9 5.6 1.1 5.6 2.2 62.9 5.6Unknown 11 0.0 0.0 0.0 0.0 9.1 36.4 54.5
Health Insurance**
Yes 847 33.2 13.1 5.3 2.5 6.6 29.5 9.8No 126 11.1 4.8 3.2 5.6 3.2 64.3 7.9Unknown 43 7.0 0.0 2.3 0.0 0.0 25.6 65.1
Education*
Less than high school
319 22.9 7.2 4.4 3.8 4.4 44.2 13.2
High school or equivalent
292 24.3 13.4 5.8 4.1 3.4 41.4 7.5
Training program 61 29.5 9.8 4.9 6.6 6.6 32.8 9.8
College 313 33.5 12.5 4.8 4.8 5.4 26.5 12.5Other 12 25.0 8.3 8.3 0.0 0.0 50.0 8.3Unknown 19 5.3 0.0 5.3 0.0 10.5 42.1 36.8
Discussed Prostate Screening with Provider**
Yes 491 46.0 16.1 6.5 6.1 5.9 17.1 2.2No 309 10.7 6.5 4.9 4.2 4.2 67.0 2.6Don't know/ not sure 105 5.7 6.7 2.9 0.0 3.8 75.2 5.7
Unknown 111 5.4 1.8 0.9 0.0 0.9 8.1 82.9 Source: Analysis of data collected from workshop participants. aRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.
*Differences in the receipt of DREs across categories are statistically significant at the .05 level. **Differences in the receipt of DREs across categories are statistically significant at the .01 level.
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Table 18. Receipt of Prostate-Specific Antigen (PSA) Tests Among Male Workshop Participants Over Age 40, by Demographic Characteristics
Most Recent PSA (%)
N
<1 Year Ago
1-2 Years Ago
2-3 Years Ago
3-5 Years Ago
≥5 Years Ago Never Unknown
Total 1,016 26.0 8.6 3.7 1.8 2.5 45.2 12.3 Age**
40-64 904 24.8 8.5 3.7 1.8 2.3 47.5 11.565 and over 112 35.7 8.9 4.5 1.8 3.6 26.8 18.8
Race/Ethnicitya**
White 124 37.9 7.3 1.6 4.0 0.8 39.5 8.9Black 454 24.7 10.6 4.8 1.5 2.0 44.3 12.1Asian 36 19.4 5.6 2.8 0.0 0.0 69.4 2.8Hispanic 302 28.1 7.6 3.6 1.0 4.3 40.7 14.6Other 89 14.6 5.6 2.2 3.4 1.1 65.2 7.9Unknown 11 0.0 0.0 0.0 0.0 9.1 27.3 63.6
Health Insurance**
Yes 847 32.8 11.1 3.7 1.2 2.9 38.1 10.2No 126 13.5 4.8 3.2 0.8 3.2 66.7 7.9Unknown 43 7.0 0.0 2.3 0.0 0.0 27.9 62.8
Education**
Less than high school
319 22.9 6.9 2.2 2.8 2.5 49.5 13.2
High school or equivalent
292 21.6 9.2 4.8 1.4 1.4 51.7 9.9
Training program 61 31.1 8.2 3.3 0.0 8.2 41.0 8.2
College 313 34.2 10.2 4.2 1.6 1.9 35.5 12.5Other 12 0.0 8.3 8.3 0.0 8.3 50.0 25.0Unknown 19 10.5 0.0 5.3 0.0 5.3 42.1 36.8
Discussed Prostate Screening with Provider**
Yes 491 46.6 13.8 6.1 3.1 3.5 23.4 3.5No 309 9.1 4.5 1.9 1.0 2.3 78.3 2.9Don't know/ not sure 105 1.9 3.8 1.9 0.0 1.0 84.8 6.7
Unknown 111 4.5 0.9 0.0 0.0 0.0 11.7 82.9 Source: Analysis of data collected from workshop participants. aRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.
*Differences in the receipt of PSA tests across categories are statistically significant at the .05 level. **Differences in the receipt of PSA tests across categories are statistically significant at the .01 level.
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Table 19. Discussion About Prostate Cancer Early Detection or Screening with Health Care Provider Among Male Workshop Participants Over Age 40, by Demographic Characteristics
Discussed Prostate Cancer Early Detection or Screening with Provider (%)
N Yes No Don't Know/
Not Sure Unknown Total 1,016 48.3 30.4 10.3 10.9 Age**
40-64 904 46.7 31.6 11.3 10.465 and over 112 61.6 20.5 2.7 15.2
Race/Ethnicitya**
White 124 58.1 20.2 8.1 13.7Black 454 54.0 25.8 10.1 10.1Asian 36 16.7 50.0 30.6 2.8Hispanic 302 46.4 34.8 7.0 11.9Other 89 29.2 47.2 16.9 6.7Unknown 11 18.2 18.2 18.2 45.5
Health Insurance**
Yes 847 63.1 24.2 4.1 8.6No 126 23.0 42.1 27.0 7.9Missing 43 14.0 25.6 4.7 55.8
Education**
Less than high school
319 35.1 40.8 13.5 10.7
High school or equivalent 292 47.6 33.6 10.6 8.2
Training program 61 59.0 14.8 11.5 14.8
College 313 62.0 20.4 5.1 12.5 Other 12 33.3 33.3 25.0 8.3Unknown 19 31.6 21.1 26.3 21.1
Source: Analysis of data collected from workshop participants. aRace and Hispanic ethnicity were combined for this analysis because 12 percent of Hispanic workshop participants did not identify their race, and 55 percent of Hispanic workshop participants marked the other race category on their demographic form. Of the participants that marked other race, many wrote “Hispanic” into the free response field.
*Differences in the rate of discussion about prostate cancer early detection or screening across categories are statistically significant at the .05 level. **Differences in the rate of discussion about prostate cancer early detection or screening across categories are statistically significant at the .01 level.
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C. Project Effectiveness (Knowledge Improvement Among Workshop Participants)
Analysis of quantitative data suggests that all units of the curriculum were effective in increasing knowledge among workshop participants and workshop participants were satisfied with the education they received. Below, we present key findings related to project effectiveness in the following topic areas: (1) demonstrated knowledge of breast, cervical, cardiovascular, colorectal, and prostate health; and (2) satisfaction with the workshops.
1. Knowledge of Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health
Pre- and posttest data suggest that knowledge increased after a workshop for all units of the curriculum (breast, cervical, cardiovascular, colorectal, and prostate health) (Table 20). For all units, average increases in scores were significant at the p < 0.01 level based on paired t-tests, suggesting the curriculum is effective at increasing knowledge. Findings include the following:
Breast Health. For those attending breast health workshops, average scores increased
significantly between the pretest and posttest, rising from 3.9 to 4.6 on a five-point scale, with 48 percent of breast health workshop participants increasing their scores.
Cervical Health. Average scores increased from 3.6 to 4.6 among cervical health workshop participants, with 60 percent of participants experiencing increases in scores between the pretest and posttest.
Cardiovascular Health. For cardiovascular health workshop participants, average scores increased from 4.1 to 4.7, with 56 percent of participants showing increases.
Colorectal Health. Average scores increased from 3.3 to 4.5 between the pretest and posttest among colorectal workshop participants, with 65 percent of participants exhibiting increases.
Prostate Health. Average scores increased from 3.6 to 4.3 among prostate health workshop participants, with 48 percent of participants increasing their knowledge.
Increases in scores were seen universally across gender, age, race/ethnicity, and education groups for all units of the curriculum. As expected, pre- and posttest scores were lower for workshop participants than they were for the CHWs who led the workshops in all units of the curriculum.
Notably, average pretest scores were highest for the cardiovascular health unit. This may reflect
that the cardiovascular health questions were easier than those for other units, that baseline knowledge of cardiovascular health is higher (perhaps due to state and national public health efforts), or both.
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Tab
le 2
0.
Bre
ast
, C
erv
ical,
Card
iovasc
ula
r,
Colo
rect
al,
and
Pro
state
K
now
led
ge
on
the
Pre
test
s and
Post
test
s,
by
Dem
og
rap
hic
C
hara
cteri
stic
s of
Work
shop
Part
icip
ants
Br
east
Can
cer
Cerv
ical
Can
cer
Card
iova
scul
ar H
ealth
Pr
etes
t Po
stte
st
% w
ith
Incr
ease
d Sc
ore
Pret
est
Post
test
%
with
In
crea
sed
Scor
e
Pret
est
Post
test
%
with
In
crea
sed
Scor
e
N
Aver
age
Scor
e N
Av
erag
e Sc
ore
N
Aver
age
Scor
e N
Av
erag
e Sc
ore
N
Aver
age
Scor
e N
Av
erag
e Sc
ore
Tota
l C
om
ple
ting
Both
Pre
-
and
Post
test
s 83
2 3.
90
832
4.60
**
47.8
63
0 3.
57
630
4.61
**
60.2
1,
319
4.14
1,
319
4.73
**
55.6
T
ota
l C
om
ple
ting
Eit
her
Test
84
0 3.
89
843
4.59
n.
a.
643
3.58
64
1 4.
61
n.a.
1,
340
4.14
1,
361
4.66
n.
a.
Gend
er
M
ale
0 n.
a.
0 n.
a.
n.a.
0
n.a.
0
n.a.
n.
a.
511
4.12
52
3 4.
59
54.3
Fe
mal
e 84
0 3.
89
843
4.59
47
.8
643
3.58
64
1 4.
61
60.2
82
3 4.
16
830
4.71
56
.2
Unkn
own
0 n.
a.
0 n.
a.
n.a.
0
n.a.
0
n.a.
n.
a.
6 3.
67
8 4.
88
83.3
A
ge
Un
der
40
136
4.15
13
8 4.
71
46.3
94
4.
03
91
4.70
43
.3
255
4.16
25
6 4.
68
49.2
40
-64
577
3.86
57
7 4.
55
47.9
45
0 3.
59
450
4.66
62
.5
900
4.13
91
7 4.
64
57.1
65
and
ove
r 11
8 3.
69
118
4.58
50
.0
92
3.11
92
4.
23
63.7
16
9 4.
20
170
4.74
57
.8
Unkn
own
9 4.
33
10
4.80
37
.5
7 3.
43
8 4.
88
83.3
16
4.
19
18
4.78
46
.7
Race
/ Eth
nic
ity
a
W
hite
11
8 3.
63
118
4.60
54
.2
85
3.31
82
4.
84
77.5
25
8 4.
34
271
4.68
48
.1
Blac
k 13
6 3.
82
138
4.30
42
.6
112
3.88
11
2 4.
43
39.6
22
6 4.
14
226
4.65
51
.1
Asia
n 71
4.
25
71
4.86
49
.3
63
3.33
63
4.
38
61.9
82
4.
11
81
4.85
63
.8
His
pani
c 44
6 3.
98
449
4.63
45
.9
314
3.66
31
4 4.
72
61.2
67
9 4.
06
686
4.62
57
.7
Oth
er
54
3.35
52
4.
58
64.7
55
3.
25
55
4.36
72
.2
75
4.24
74
4.
85
64.4
Un
know
n 15
4.
13
15
4.53
33
.3
14
3.57
15
4.
20
46.2
20
4.
10
23
4.65
68
.4
Ed
uca
tion
Le
ss th
an
high
sc
hool
37
5 3.
74
376
4.55
51
.1
303
3.32
30
1 4.
49
65.4
50
3 4.
03
505
4.71
64
.8
Hig
h sc
hool
/ eq
uiva
lent
20
0 3.
95
202
4.60
47
.0
140
3.72
13
8 4.
62
57.4
36
7 4.
11
378
4.62
52
.7
Trai
ning
pr
ogra
m
33
3.73
33
4.
61
60.6
33
3.
91
33
4.79
54
.5
63
4.33
62
4.
48
42.6
Co
llege
19
8 4.
15
197
4.70
41
.3
147
3.94
14
7 4.
81
53.5
36
3 4.
31
370
4.67
47
.8
Oth
er
14
3.71
14
4.
57
57.1
5
4.00
5
4.80
60
.0
16
3.88
15
4.
73
60.0
Un
know
n 20
3.
90
21
4.14
29
.4
15
3.33
17
4.
41
57.1
28
4.
21
31
4.71
55
.6
Tab
le 2
0 (c
onti
nue
d)
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
52
Co
lore
ctal
Can
cer
Pros
tate
Can
cer
Pr
etes
t Po
stte
st
% w
ith
Incr
ease
d Sc
ore
Pret
est
Post
test
%
with
In
crea
sed
Scor
e
N
Aver
age
Scor
e N
Av
erag
e Sc
ore
N
Aver
age
Scor
e N
Av
erag
e Sc
ore
Tota
l C
om
ple
ting B
oth
Pre
- a
nd
Post
test
s 78
2 3.
33
782
4.46
**
64.8
86
3 3.
59
863
4.33
**
48.4
Tota
l C
om
ple
ting
Eit
her
Test
79
1 3.
32
812
4.43
n.
a.
889
3.60
88
3 4.
32
n.a.
Gend
er
Mal
e 33
9 3.
25
347
4.29
59
.7
889
3.60
88
3 4.
32
48.4
Fe
mal
e 44
8 3.
37
460
4.53
68
.6
0 n.
a.
0 n.
a.
n.a.
Un
know
n 4
3.25
5
4.40
75
.0
0 n.
a.
0 n.
a.
n.a.
Ag
e
Unde
r 40
14
0 3.
68
140
4.52
54
.3
141
3.65
13
6 4.
46
54.5
40
-64
585
3.25
60
2 4.
42
65.8
66
8 3.
58
666
4.32
48
.2
65 a
nd o
ver
57
3.14
60
4.
30
77.2
68
3.
63
69
4.10
42
.4
Unkn
own
9 3.
33
10
4.70
87
.5
12
3.92
12
4.
17
22.2
Race
/Eth
nic
ity
a
Whi
te
139
3.40
14
3 4.
56
68.8
75
3.
73
79
4.58
50
.7
Blac
k 90
3.
21
94
4.07
56
.8
460
3.70
45
5 4.
28
43.0
As
ian
71
3.39
73
4.
86
80.3
19
3.
89
19
4.89
66
.7
His
pani
c 39
8 3.
38
407
4.44
60
.7
233
3.47
22
9 4.
20
50.0
O
ther
82
2.
99
83
4.17
69
.1
83
3.19
82
4.
60
67.5
Un
know
n 11
3.
00
12
4.42
10
0.0
19
3.58
19
4.
05
53.3
Ed
uca
tion
Less
than
hig
h sc
hool
32
8 3.
08
331
4.48
74
.5
243
3.08
24
3 4.
21
62.2
H
igh
scho
ol o
r eq
uiva
lent
21
2 3.
32
221
4.38
63
.3
269
3.58
26
9 4.
33
48.7
Tr
aini
ng p
rogr
am
36
3.50
42
4.
12
55.6
52
3.
62
52
4.25
43
.1
Colle
ge
190
3.71
19
2 4.
49
52.4
28
6 4.
06
280
4.46
37
.2
Oth
er
9 3.
44
9 4.
33
55.6
14
3.
57
14
4.14
42
.9
Unkn
own
16
3.19
17
4.
18
60.0
25
3.
52
25
3.96
52
.4
Sour
ce:
Anal
ysis
of d
ata
colle
cted
from
wor
ksho
p pa
rtic
ipan
ts.
Not
e:
The
first
row
of
the
tabl
e sh
ows
stat
istic
s fo
r w
orks
hop
part
icip
ants
who
com
plet
ed b
oth
the
pret
est
and
the
post
test
of
a un
it. A
pai
red
t-te
st w
as
cond
ucte
d fo
r th
ese
part
icip
ants
in e
ach
unit
of t
he c
urric
ulum
to
dete
rmin
e w
heth
er t
he in
crea
se in
ave
rage
sco
res
was
sta
tistic
ally
sig
nific
ant.
Beca
use
the
sam
ple
size
s w
ere
smal
l, pa
ired
t-te
sts
wer
e no
t con
duct
ed fo
r in
divi
dual
dem
ogra
phic
gro
ups.
a R
ace
and
His
pani
c et
hnic
ity w
ere
com
bine
d fo
r th
is a
naly
sis
beca
use
12 p
erce
nt o
f H
ispa
nic
wor
ksho
p pa
rtic
ipan
ts d
id n
ot id
entif
y th
eir
race
, an
d 55
per
cent
of
His
pani
c w
orks
hop
part
icip
ants
mar
ked
the
othe
r ra
ce c
ateg
ory
on t
heir
dem
ogra
phic
for
m. O
f th
e pa
rtic
ipan
ts t
hat
mar
ked
othe
r ra
ce, m
any
wro
te “
His
pani
c” in
to
the
free
res
pons
e fie
ld.
*Pos
ttes
t sco
re is
sig
nific
antly
diff
eren
t fro
m p
rete
st s
core
at t
he .0
5 le
vel,
two-
taile
d te
st.
**Po
stte
st s
core
is s
igni
fican
tly d
iffer
ent f
rom
pre
test
sco
re a
t the
.01
leve
l, tw
o-ta
iled
test
.
n.a.
= n
ot a
pplic
able
.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
53
Table 21 shows the percentage of workshops participants who correctly answered each of the pre- and posttest questions. In general, questions that asked about recommended ages for screening were more challenging than other questions. Below, we describe the questions that participants were most likely to answer incorrectly, by health unit:
Breast Health. For the breast health unit, the pre- and posttest question most often
answered incorrectly was, “You should have a clinical breast exam done by a healthcare provider every 5 years” (false, see Table 1 for screening recommendations). As shown in Table 21, 42 percent of participants answered this question incorrectly at pretest. Although the percentage who answered the question correctly increased by 39 percent between pre- and posttest, 20 percent of workshop participants still answered the question incorrectly at posttest. Notably, this was also the breast health question that CBO CHWs found most challenging.
Cervical Health. The cervical health pretest question most commonly answered incorrectly initially was, “Getting a positive HPV test means you have cervical cancer” (false). In the pretest, 42 percent of people answered this question incorrectly. Knowledge improved greatly for this question; only 9 percent of participants answered incorrectly on the posttest, a 56 percent increase in knowledge.
Cardiovascular Health. “Men and women have the exact same heart attack warning signs” (false) was the pretest question most often answered incorrectly for the cardiovascular health unit. It also had the fewest correct responses among all the questions across all the units. Overall, 63 percent of people answered this question incorrectly at pretest. This question was also the cardiovascular health question that CHWs had the most trouble with on the pretest. Knowledge on this question improved 130 percent among workshop participants between pre- and posttest; however, 15 percent still answered incorrectly on the posttest.
Colorectal Health. The colorectal health unit question that was most likely to be answered incorrectly by workshop participants on the pretest was, “All people should begin getting screened for colorectal cancer at the age of 30 years old” (false, see Table 1 for screening recommendations). Altogether, 60 percent of people answered this question incorrectly. Another challenging question was “A polyp found on a colonoscopy will always be cancer” (false); 45 percent of people answered this question incorrectly at pretest. Knowledge improved greatly between pre- and posttest for both of these questions; however, 17 percent still answered each of these incorrectly at posttest.
Prostate Health. For the prostate health unit, the pre- and posttest question answered incorrectly most often was, “Starting at the age of 65, men should start talking to their doctor about prostate cancer” (false, see Table 1 for recommendations). As shown in Table 21, 48 and 29 percent answered this question incorrectly on the pre- and posttests, respectively.
A more detailed breakdown of pre- and posttest knowledge by question and demographic characteristics can be found in Appendix F.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
54
Table 21. Breast, Cervical, Cardiovascular, Colorectal, and Prostate Health Knowledge, by Pretest and Posttest Questions Among Workshop Participants
Pretest Posttest
% Change
N = # Answering Correctly
% Answering Correctly
N = # Answering Correctly
% Answering Correctly
Question (Correct Response)
Breast Health Unit (N = 832)
1. If you have a lump in your breast, you absolutely have breast cancer (false) 676 81.3 801 96.3 18.5
2. Starting at the age of 40, you should get a mammogram once a year (true) 779 93.6 815 98.0 4.6
3. Mammograms cause breast cancer (false) 684 82.2 786 94.5 14.9
4. As women get older, their risk of breast cancer increases (true) 623 74.9 756 90.9 21.3
5. You should have a clinical breast exam done by a health care provider every 5 years (false) 479 57.6 666 80.0 39.0
Cervical Health Unit (N = 630)
1. If you get an abnormal Pap test, it means you have cervical cancer (false) 483 76.7 602 95.6 24.6
2. Women should get their first Pap test at age 21 or 3 years after they become sexually active (true) 468 74.3 576 91.4 23.1
3. Cervical cancer is preventable through routine screening (true) 532 84.4 603 95.7 13.3
4. Getting a positive HPV test means you have cervical cancer (false) 367 58.3 571 90.6 55.6
5. Most women have been exposed to the Human Papilloma Virus (HPV) (true) 398 63.2 552 87.6 38.7
Cardiovascular Health Unit (N = 1,319)
1. Men and women have the exact same heart attack warning signs (false) 487 36.9 1,120 84.9 130.0
2. Quitting smoking can help reduce the risk for cardiovascular disease (true) 1,249 94.7 1,289 97.7 3.2
3. LDL (bad) cholesterol can clog your blood vessels and cause damage to your heart and brain (true) 1,232 93.4 1,295 98.2 5.1
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research Table 21 (continued)
55
Pretest Posttest
% Change
N = # Answering Correctly
% Answering Correctly
N = # Answering Correctly
% Answering Correctly
4. If someone shows one of the symptoms of a stroke the most important thing to do is call 911 right away (true) 1,272 96.4 1,252 94.9 -1.6
5. High blood pressure forces your heart to work harder than normal and raises your risk for heart attack and stroke (true) 1,224 92.8 1,287 97.6 5.1
Colorectal Health Unit (N = 782)
1. Eating foods high in fat is a risk factor for colorectal cancer (true) 600 76.7 747 95.5 24.5
2. All people should begin getting screened for colorectal cancer at the age of 30 years old (false) 311 39.8 650 83.1 109.0
3. Colorectal cancer can develop without signs over a long period of time without being noticed (true) 634 81.1 747 95.5 17.8
4. Screening is the only way for someone to know if they have colorectal cancer (true) 628 80.3 692 88.5 10.2
5. A polyp found on colonoscopy will always be cancer (false) 428 54.7 650 83.1 51.9
Prostate Health Unit (N = 863)
1. Men are more likely to get prostate cancer when they are younger (false) 680 78.8 769 89.1 13.1
2. Starting at the age of 65, men should start talking to their doctor about testing for prostate cancer (false) 446 51.7 611 70.8 37.0
3. Men of African descent are at high risk for getting prostate cancer (true) 679 78.7 826 95.7 21.6
4. Difficulty or pain during urination are signs of prostate problems (true) 653 75.7 738 85.5 13.0
5. PSA test results are typically higher in men with prostate cancer (true) 644 74.6 792 91.8 23.0
Source: Analysis of data collected from workshop participants.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
56
2. Satisfaction with the Education
Table 22 shows the quantitative results of the participants’ evaluation of the workshops. The vast majority (97 percent) of workshop participants said they would recommend the workshop to family or friends. Moreover, 96 percent rated the workshop as either “good” or “excellent” and 96 percent rated their workshop group leader as “good” or “excellent.” Satisfaction by workshop unit was not assessed because many people received education in multiple units in one day and filled out a single evaluation form.
Table 22. Summary of Responses to Evaluation Questions Among Workshop Participants
Question Frequency
(N = 3,281)a Percentage
Would you suggest that your family or friends come to this health session?
Yes 3,175 96.8No 61 1.9Unknown 45 1.4
Overall, how would you rate this health session?Excellent 2,039 62.2Good 1,117 34.0Average 65 2.0Fair 23 0.7Poor 2 0.1Unknown 35 1.1
Overall, how would you rate the group leader?Excellent 2,162 65.9Good 990 30.2Average 66 2.0Fair 18 0.6Poor 1 0.0Unknown 44 1.3
Source: Analysis of data collected from workshop participants. aThe evaluation forms were anonymous and not linked to individual participants. As a result, evaluation forms could not be de-duplicated, and the denominator for this table represents all evaluation forms received.
Below are a few quotes from workshop participants’ evaluation forms that illustrate their satisfaction with the workshops:
“Yes I loved it and I learned a lot. I would like to return, and bring friends.”
“The meeting was great. I understood everything clearly. I am so glad that I came. I don't have any suggestion, but I wish more people will come because it is very important to learn and educate ourselves about cancer myths, appointments etc.”
“Thank you for the program because it helps us to understand the dangerous diseases in order to protect our health. I learned a lot. Thank you very much! “
“My suggestion is that you should never stop from giving these courses. They are super important - I was very happy for efforts made to educate the women in the community.”
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
57
The findings from our qualitative assessment of the prostate health unit confirm that the education was effective and participants left the workshops satisfied. The CHWs and focus group participants we spoke with reported that the workshops were clear and that men were excited to receive the information. One focus group participant noted, “My dad never went to the doctor, so I like the idea of taking the message out to the public instead of waiting for people to go to their doctors.” Some men reported being happy to get the information for free. Men also reported that they liked seeing how much they learned from the pre- to the posttest.
D. Project Maintenance (Evaluation of Longer-Term Effect of Program)
The goal of health education is to increase awareness and improve knowledge, ideally over the long term. In an effort to assess the longer-term effects of this program, focus group participants were asked (1) to summarize what they learned from the prostate health workshops and state whether they shared what they learned with others; (2) to report if they spoke with a health care provider about prostate health after the workshop and describe why or why not; and (3) to complete the knowledge posttest again.
1. Information Learned and Shared
Men who participated in the focus group retained a substantial amount of information about early prostate cancer screening and early detection. In particular, these participants reported learning about:
Prevalence of prostate cancer
Factors that affect risk for prostate cancer such as race, genes, environment, and age
Symptoms of prostate problems and prostate cancer
Treatability of prostate cancer when caught early
Ways of being more proactive about screening
In speaking about being proactive about screening, one focus group participant remarked, “Usually men think because they feel healthy, they don't need to go to the doctor or get screened. But this session made me realize that this [prostate cancer] is serious.” Overall, focus group participants demonstrated an understanding of the burden of prostate cancer, especially among black men, and the importance of seeking care even if they feel healthy. They noted that changing behavior is difficult given the stigma associated with being screened and discussed the importance of bringing men together to talk about the issue, dispel myths, and share screening experiences.
Focus group participants reported sharing the information they learned with family and friends.
In some cases, the sharing of information helped start family conversations about health history. Many focus group participants noted that their friends and family wanted to attend the workshops; however, others reported friends and family brushed off the information. Men noted that people are scared of prostate cancer but that is also very hard to convince people about the importance of taking preventive health actions.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
58
2. Informed Decision Making with Providers
A major goal of the prostate health unit is to make men feel comfortable having informed discussions with health care providers about prostate health and prostate cancer screening. There was a general consensus among the men we spoke with that attending the prostate health workshops helped them feel more comfortable in having these conversations. One focus group participant remarked “…you’re more open to ask questions because you have more of an idea of what it is and you’re not intimidated. A lot of people don’t want to hear the worst of a situation but being prepared and knowing the information, which is what the workshop did, you’re better off talking to your doctor knowing what to ask rather than being blind about it. You’re more comfortable with the doctor about what it is or what it can be.”
As shown in Table 23, of the 19 focus group participants whom we were able to link to data
from prostate health workshops, 11 had discussed prostate cancer with a provider prior to attending a prostate health workshop. Many of these men cited their awareness of their risk for prostate cancer as a reason for discussing the issue with a provider. For example, one participant wrote, “I am over 40 and African American. [This is a] high risk group.” Multiple respondents cited risk factors of age, race, or family history as reasons for discussions. The eight men who had not talked to a health care provider about prostate cancer screening before the workshop named a variety of reasons for not talking with a provider, including not having insurance, not thinking they were at risk for prostate cancer, not thinking that prostate cancer was that bad, not thinking that getting screened for prostate cancer was worthwhile, and not feeling comfortable talking about this subject with a provider (data not shown).
The workshop may have prompted men to have informed discussions with providers. As
shown in Table 23, three of the eight focus group participants (38 percent) who had not talked to a provider before the workshop did so after the workshop. In addition, three of the seven participants (43 percent) who had not been screened for prostate cancer before the workshop were screened after; a fourth was waiting for his next doctor’s appointment to be screened. Of the three participants who were only screened after the workshop, all made the decision to get screened on their own (data not shown). In contrast, six of 11 participants (55 percent) who had been screened prior to the workshop reported being involved in the decision making process; 27 percent made the decision themselves and 27 percent made the decision together with a provider (Table 24). Eight men were screened both before and after the workshop. Of these eight, 63 percent reported being involved in the decision to be screened before the workshop (38 percent made the decision themselves and 25 percent made the decision together with a provider) and 88 percent reported being involved after the workshop (50 percent made the decision themselves and 38 percent made the decision with a provider). These results suggest that the workshop may help men become involved in the decision-making process for prostate cancer screening.
59
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
Tab
le 2
3. P
rost
ate
Healt
h S
creenin
g B
ehavio
rs A
fter
Att
end
ing W
ork
shop
by S
creen
ing
Behavio
rs B
efo
re A
tten
din
g W
ork
shop
Aft
er
Work
shop
Tota
l (n
= 1
9)
Befo
re W
orks
hop
Had
not
talk
ed w
ith
heal
thca
re p
rovi
der
and
had
not
bee
n sc
reen
ed (n
= 6
)a
Had
talk
ed to
he
alth
care
pro
vide
r,
but h
ad n
ot b
een
scre
ened
(n =
2)
Had
not
talk
ed to
he
alth
care
pro
vide
r,
but h
ad b
een
scre
ened
(n =
2)
Had
talk
ed to
he
alth
care
pro
vide
r an
d ha
d be
en
scre
ened
(n =
9)
n %
n %
n %
n %
n %
Had
con
vers
atio
n w
ith h
ealth
car
e pr
ovid
er a
bout
pro
stat
e ca
ncer
or
scre
enin
g fo
r pr
osta
te c
ance
r
Yes
9 47
.4
3 50
.0
1 50
.0
0 0.
0 5
55.6
N
o 7
36.8
2
33.3
0
0.0
2 10
0.0
3 33
.3
Blan
k 3
15.8
1
16.7
1
50.0
0
0.0
1 11
.1
O
f par
ticip
ants
who
did
not
talk
to a
pr
ovid
er a
bout
pro
stat
e ca
ncer
or
scre
enin
g fo
r pr
osta
te c
ance
r, re
ason
s fo
r not
talk
ing
to a
pro
vide
rb (n
= 7
)
D
idn’
t hav
e a
prov
ider
or
regu
lar
plac
e to
get
car
e 1
14.3
1
50.0
-- -
---
0 0.
0 0
0.0
Did
n’t h
ave
insu
ranc
e or
cou
ldn’
t af
ford
to s
ee a
pro
vide
r 0
0.0
0 0.
0 -- -
---
0 0.
0 0
0.0
Did
n’t t
hink
they
wer
e at
risk
for
pros
tate
can
cer
2 28
.6
1 50
.0
-- - --
- 0
0.0
1 33
.3
Did
n’t t
hink
get
ting
pros
tate
can
cer
was
that
bad
1
14.3
0
0.0
-- - --
- 1
50.0
0
0.0
Did
n’t t
hink
get
ting
scre
ened
for
pros
tate
can
cer w
as w
orth
whi
le
0 0.
0 0
0.0
-- - --
- 0
0.0
0 0.
0 D
idn’
t fee
l com
fort
able
talk
ing
abou
t thi
s w
ith a
pro
vide
r 1
14.3
0
0.0
-- - --
- 1
50.0
0
0.0
Oth
er
2 28
.6
0 0.
0 -- -
---
0 0.
0 2
66.7
Blan
k 0
0.0
0 0.
0 -- -
---
0 0.
0 0
0.0
W
as s
cree
ned
for
pros
tate
can
cer
Yes
11
57.9
2
33.3
1
50.
0 1
50.0
7
77.8
N
o
7 36
.8
3 5
0.0
1 5
0.0
1 50
.0
2 22
.2
Blan
k 1
5.3
1 16
.7
0 0.
0 0
0.0
0 0.
0
Tab
le 2
3 (
conti
nued
)
60
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
Aft
er
Work
shop
Tota
l (n
= 1
9)
Befo
re W
orks
hop
Had
not
talk
ed w
ith
heal
thca
re p
rovi
der
and
had
not
bee
n sc
reen
ed (n
= 6
)a
Had
talk
ed to
he
alth
care
pro
vide
r,
but h
ad n
ot b
een
scre
ened
(n =
2)
Had
not
talk
ed to
he
alth
care
pro
vide
r,
but h
ad b
een
scre
ened
(n =
2)
Had
talk
ed to
he
alth
care
pro
vide
r an
d ha
d be
en
scre
ened
(n =
9)
n %
n %
n %
n %
n %
Of p
artic
ipan
ts w
ho w
ere
not s
cree
ned
for
pros
tate
can
cer,
reas
ons
for n
ot
gett
ing
scre
ened
b (n
= 7
)
D
idn’
t hav
e a
prov
ider
or
regu
lar
plac
e to
get
car
e 0
0.0
0 0.
0 0
0.0
0 0.
0 0
0.0
Did
n’t h
ave
insu
ranc
e or
cou
ldn’
t af
ford
to s
ee a
pro
vide
r 0
0.0
0 0.
0 0
0.0
0 0.
0 0
0.0
Did
n’t t
hink
they
wer
e at
risk
2
28.6
1
33.3
1
100.
0 0
0.0
0 0.
0 D
idn’
t thi
nk p
rost
ate
canc
er w
as
that
bad
0
0.0
0 0.
0 0
0.0
0 0.
0 0
0.0
Did
n’t t
hink
get
ting
scre
ened
was
w
orth
whi
le
0 0.
0 0
0.0
0 0.
0 0
0.0
0 0.
0 D
idn’
t fee
l com
fort
able
get
ting
scre
ened
1
14.3
0
0.
0 0
0.0
1 10
0.0
0 0.
0 D
idn’
t wan
t to
find
out s
cree
ning
re
sults
0
0.0
0 0.
0 0
0.0
0 0.
0 0
0.0
Oth
er
2
28.6
1
33.3
0
0.0
0 0.
0 1
50.0
Bl
ank
2 28
.6
1 33
.3
0 0.
0 0
0.0
1 50
.0
Sour
ce:
Anal
ysis
of d
ata
colle
cted
from
focu
s gr
oup
part
icip
ants
. a O
ne p
artic
ipan
t in
dica
ted
that
bef
ore
the
wor
ksho
p, h
e ha
d no
t ta
lked
with
a h
ealth
car
e pr
ovid
er a
bout
pro
stat
e ca
ncer
or
scre
enin
g fo
r pr
osta
te
canc
er a
nd d
id n
ot a
nsw
er w
heth
er h
e ha
d be
en s
cree
ned
for
pros
tate
can
cer.
He
is in
clud
ed in
this
tabl
e as
hav
ing
not b
een
scre
ened
. b P
artic
ipan
ts c
ould
mar
k al
l res
pons
es th
at a
pplie
d. A
s a
resu
lt, p
erce
ntag
es m
ay n
ot a
dd u
p to
100
per
cent
.
61
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
Tab
le 2
4. P
ers
on W
ho M
ad
e D
eci
sion
for
Work
shop P
art
icip
ant
to R
ece
ive P
rost
ate
Cance
r Sc
reenin
g
Pa
rtic
ipan
ts S
cree
ned
Befo
re o
r Aft
er W
orks
hop
Part
icip
ants
Scr
eene
d Be
fore
and
Aft
er W
orks
hop
Be
fore
Att
endi
ng P
rost
ate
Hea
lth W
orks
hop
(n =
11)
Afte
r At
tend
ing
Pros
tate
Hea
lth
Wor
ksho
p (n
= 1
1)
Befo
re A
tten
ding
Pro
stat
e H
ealth
Wor
ksho
p (n
= 8
)
Afte
r At
tend
ing
Pros
tate
Hea
lth
Wor
ksho
p (n
= 8
)
n
% n
% n
% n
% Pa
rtic
ipan
t 3
27.3
763
.63
37.5
450
.0H
ealth
car
e pr
ovid
er
3 27
.31
9.1
2 25
.01
12.5
Part
icip
ant
and
heal
th
care
pr
ovid
er to
geth
er
3 27
.3
3 27
.3
2 25
.0
3 37
.5
Oth
er
1 9.
10
0.0
0 0.
00
0.0
Blan
k 1
9.1
00.
01
12.5
00.
0 So
urce
: An
alys
is o
f dat
a co
llect
ed fr
om fo
cus
grou
p pa
rtic
ipan
ts.
Not
e:
Thre
e fo
cus
grou
p pa
rtic
ipan
ts w
ere
scre
ened
onl
y be
fore
att
endi
ng a
pro
stat
e he
alth
wor
ksho
p, a
nd a
n ad
ditio
nal
thre
e fo
cus
grou
p pa
rtic
ipan
ts w
ere
scre
ened
onl
y af
ter
atte
ndin
g a
pros
tate
hea
lth w
orks
hop.
Eig
ht fo
cus
grou
p pa
rtic
ipan
ts w
ere
scre
ened
bot
h be
fore
and
af
ter a
tten
ding
a p
rost
ate
heal
th w
orks
hop.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
62
Given the sensitive nature of the topic, focus group participants were asked to describe barriers to talking with providers about prostate health for themselves or their peers. They mentioned:
Lack of trust in the medical system. Distrust of the medical system was mentioned
repeatedly among focus group participants. One man noted “We have had bad experiences, culturally, with the medical profession and that experience carries across generations.” The Tuskegee trials were mentioned as one reason for this distrust.
Misinformation. Focus group participants discussed many myths they had heard about prostate cancer and screening tests (particularly the DRE) and remarked that misinformation is a barrier for many men in seeking care. One man remarked:
“There is a lot of misinformation about the digital exam. Why are they doing it? Will it turn you into whatever, a homosexual? This [misinformation] drives negative behavior.”
Another recalled: “Before I had my first screening, I asked the doctor some frank questions, which probably seemed silly to the doctor but I was serious because I had received so much misinformation over the years. I asked, ‘Is there any chance you could damage something inside me?’”
Fear of tests or results. Men noted that there is substantial fear about the screening tests, somewhat related to misinformation. They also stated that men are afraid of the results. In speaking about fear of being tested, one focus group participant mentioned, “Yeah, because they’re too ‘macho’ you know? But when they die, there’s no more machismo. It’s too late.”
Feeling healthy. Focus group participants said that feeling healthy prevents men from seeking care because of the attitude that, if a man feels healthy, he must be healthy and does not need to see a doctor. One man remarked “You're young and strong and you think nothing's going to happen to you.”
Cost of care. A few focus group participants expressed that uncertainty about the cost of tests and treatment was a barrier. One man also noted fear of not being able to obtain insurance in the future if he received a positive screening result.
Comfort with the provider. Men reported that their level of comfort with a health care provider affects their willingness to seek care. They mentioned three factors that affect comfort level: (1) the provider’s background and familiarity, (2) mutual respect between patient and provider, and (3) the provider’s gender, as follows:
- Provider background and familiarity. Men discussed the racial, ethnic, and cultural differences between themselves and the health care providers in their neighborhoods as a barrier to care. One man stated: “I think that it would be nice to have someone from a similar perspective, maybe we might be comfortable with someone who looks like [us].” Another remarked, “When the majority of the health providers aren’t from the community, some men aren’t as receptive to it—it’s not the message, it’s the messenger.” The importance of the messenger was
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also mentioned by CHWs we spoke with. One CHW noted: “Men would rather see a provider they know or have a connection with than go into a clinic, which is a…public forum for their private health issues. For men that do have access [to healthcare], the messenger is really an important motivator in convincing them of the importance of prostate health.”
- Respect. Focus group participants noted that a provider who respects them can make them comfortable with an uncomfortable health topic. Men wanted to have ownership over their health, and being respected by their provider helped them achieve this feeling.
- Gender. Focus group participants noted that the gender of a provider could make them more or less comfortable in being screened; some men said they would feel more comfortable being screened by a male provider and others preferred a female provider. From our data, we could not discern whether preference for a male or female provider varied by race, ethnicity, or any other factors.
3. Knowledge Posttest
At the start of each focus group, men were asked to complete the knowledge posttest and we linked these results with the pre- and posttest results completed during the workshop. The average score at the focus group was 4.21 on a five-point scale. This value is slightly higher than the average pretest score of 4.16 for these participants but lower than their average score on the posttest completed immediately after the workshop (4.41); thus, some knowledge was maintained 5 to 12 months after the workshops, although the improvement is not significant (p < 0.05) (data not shown).
E. Limitations
One limitation of the quantitative analysis is related to the evaluation forms. Many workshop participants were educated in multiple units of the curriculum. In some cases, people were educated in two units of the curriculum in a single day. These individuals may have filled out a single evaluation form covering both units of the curriculum or separate evaluation forms for each unit. Other people were educated in different units of the curriculum on different days and completed separate evaluation forms for each unit. Because evaluation forms were not linked to the other forms (in an effort to promote honest evaluations of the workshops), all evaluation forms were included in the analysis.
A second limitation of the analysis is related to the qualitative evaluation. The qualitative
analysis was based on information gathered from 10 CBOs and 25 men who attended prostate health workshops and were able to participate in focus groups. The focus group participants had higher pre- and posttest scores on average than the entire group of men who attended prostate health workshops, suggesting men in the focus groups are not representative of all men who attended prostate health workshops. It is therefore unclear whether the information gathered can be generalized to other men attending prostate health workshops, and what information is generalizable to all participants educated. However, many of the recommendations to improve the workshops that were identified through the qualitative evaluation were not specific to prostate health and may be applicable to the other units.
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A third limitation is the high percentage of missing data among workshop participants. Questions about country of birth and prostate health screening had particularly high rates of missing data; all questions related to these two topics had greater than 10 percent missing data. Missing data related to country of birth and length of time in the United States limited our ability to fully identify the reach of the project. With regard to prostate health screening, missing data lessened the comparability of our data to BRFSS data and limited our ability to obtain a complete overview of workshop participants’ likelihood of receiving prostate health screening.
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IV. RECOMMENDATIONS AND CONCLUSION
This evaluation identified several successes of the project as well as some areas for improvement that can inform future project phases. Below we summarize some of these successes and areas for improvement along the dimensions of implementation, reach, effectiveness, and maintenance.
A. Implementation (CBO Recruitment and Training)
Twenty-five CBOs were successfully recruited and trained to carry out workshops in the five units of the curriculum. The CHWs who conducted the workshops had a high level of baseline knowledge, which was improved further through the training process. Although CHWs were overwhelmingly satisfied with the training, the following strategies might improve the training:
Modify training based on background. CBO CHWs came to the training with
different levels of experience conducting health education; however, the training did not account for background. Adapting the training to consider previous experience is recommended. One way to accomplish this would be to hold separate trainings for people based on health education experience (that is, one training for experienced health educators and one for CHWs with less health education experience). Although the content of the curriculum could be consistent between the two trainings, the training for less experienced CHWs could provide more details on how to facilitate a workshop and offer more opportunities for role playing. An alternative strategy to separate trainings would be to pair experienced health educators with less experienced CHWs during a joint training and have teams practice role playing, with the experienced health educators mentoring the less experienced CHWs. A third strategy would be to provide a supplemental training via conference call after the initial training to less experienced CHWs or those who self-identify as wanting more training.
Re-organize presentation notes to complement the slides. The current curriculum includes slides and notes as separate documents. It was suggested that because of this, CHWs may skip the notes and only use the slides to lead their workshops. It would be beneficial to integrate the notes and slides to increase the likelihood of the CHWs using the notes when they conduct workshops.
Focus data collection training on problematic questions. Name, country of birth, length of time in the United States, and date of birth are the questions most often left blank on the data collection forms. Emphasizing the importance of these fields and explaining how they are used in analysis and program improvement efforts could help CHWs feel comfortable answering workshop participants’ questions regarding these data fields and might improve data completeness.
Offer refresher training. For some CBOs, substantial time passed between training and workshops. Refresher courses (in person or via conference call) could be used to remind CHWs of the key health education messages for each unit, answer questions that have arisen during workshops, and discuss recurrent data issues.
Provide more information on outreach strategies. Although CBOs were funded in part because they had ties to their communities, some encountered problems recruiting workshop participants. Including sample outreach strategies in the binder that CHWs
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receive and discussing these strategies during the initial training could lessen this problem. Successful outreach strategies could also be shared among CHWs during refresher trainings.
B. Reach (Number of People Educated)
CBOs educated 2,806 unique people across the five units of the curriculum. Despite this effort, the majority of CBOs were not able to attain their approved capacity. The following strategies may help improve program reach:
Develop realistic targets. To increase the likelihood of CBOs reaching their capacity,
working with CBOs CHWs responsible for recruiting workshop participants instead of CBO supervisors to identify realistic targets should be considered.
Expand age eligibility criteria. CBOs often had close ties with community members who were outside the age range they were permitted to recruit. Expanding the age eligibility criteria, for example to 30, could expand program reach. Allowing CBOs to recruit younger populations might also improve program effectiveness, as younger people may be more easily able to change their preventative health behaviors.
Recruit men through their spouses. Several CHWs we spoke with mentioned recruiting men for the prostate health workshops by going through their spouses. One remarked “Perhaps the best way to promote prostate health is to involve women and to promote it more in the media (much in the same way that breast cancer awareness has saturated the culture).”
Provide incentives to participants. Many CBOs found that providing incentives such as food or babysitting helped improve attendance.
Consider renaming sessions on taboo topics. CBOs may have trouble recruiting participants for workshops due to the sensitive nature and cultural taboos of certain health topics. Many CBOs reported this to be an issue for the prostate unit. At least one CBO recruited participants to a “men’s health workshop” instead of using the name “prostate health.” This tactic could be applied more broadly.
C. Effectiveness (Knowledge Improvement)
All units of the curriculum were effective in improving knowledge and increases occurred universally across gender, race/ethnicity, and education groups. Workshop participants and CBO CHWs recommended the following strategies, which might make the education even more successful:
Make workshops more engaging. Workshops could better engage participants by including videos, story sharing, games, and quizzes. This change might improve knowledge retention.
Tailor the curriculum to target populations. Tailoring the curriculum to workshop participants might make the health topic more salient and motivate participants to take action. This could entail providing cancer incidence, death statistics, and screening rates by racial/ethnic group.
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Have cancer survivors attend workshops. When feasible, having cancer survivors attend workshops and tell their stories could make the education more relevant and help motivate participants, especially if participants can relate to the survivors (culturally, for example).
Have medical professionals attend workshops. CHWs were told to refer workshop participants to their providers when they could not answer questions, but this response frustrated some workshop participants who were eager for answers. In particular, questions related to clinical recommendations and treatment were especially problematic. Having a health care provider present would alleviate this problem, although it may be infeasible. Alternatively, giving CBOs lists of frequently asked questions and answers by health unit and providing training on these questions to CBO CHWs might be effective. Referrals to clinicians may still be needed in some cases, and CBOs should consider developing lists of local health care providers for referral.
Place a stronger emphasis on screening recommendations and next steps. In general, questions that asked about recommended ages for screening were among the most challenging for participants. This is not surprising, given recent changes in recommendations for prostate screening and controversy around the breast cancer screening guidelines. Spending more time on screening recommendations and developing a wallet card with screening recommendations should be considered for future workshops. Providing participants with clear next steps was also suggested, particularly for the prostate unit.
Provide materials for participants to take home. Workshop participants are given a large amount of information in a short time. Having materials to refer to at home might help them absorb and retain the information longer. These materials could include a summary of the key points of the presentation as well as talking points to facilitate discussions with providers.
D. Maintenance (Longer-Term Effect of the Program)
Focus group participants were able to describe key themes from the prostate workshops such as the importance of having an informed discussion with a provider about prostate health, suggesting some knowledge was maintained over time. We know, however, from repeat posttests, that some knowledge was lost. We also know that at the focus groups, men had many unanswered questions, some of which had been covered in the workshops. Questions that arose repeatedly were:
Reasons why prostate cancer disproportionately affects black men
Steps men can take to prevent prostate cancer (such as, what role can exercise play in prevention)
Recommended timing of screening for prostate cancer
Cost of screening tests
More details about the screening tests (which tests are needed and what they entail) and interpretation of test results
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Treatment for the disease and the treatment’s side effects (particularly sexual side effects if the prostate is removed)
Adding these topics to the prostate health curriculum or placing more emphasis on them should be considered in future iterations of the project. E. Conclusion
This quantitative and qualitative evaluation revealed that CBOs successfully expanded the reach of the curriculum and educated a diverse population in Massachusetts. The curriculum was effective in improving breast, cervical, cardiovascular, colorectal, and prostate health knowledge, at least in the short term. Although the curriculum was well implemented and effective, the evaluation identified many areas for improvement. Specific recommendations were made to improve the education’s implementation, reach, effectiveness, and maintenance. Many of the recommendations are currently being put into action, such as working with CBOs to develop realistic targets for recruitment and finding videos to supplement the curriculum. Other recommendations can feasibly be adopted before the next phase of the project commences in the coming months.
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REFERENCES
American Cancer Society (ACS). “American Cancer Society Guidelines for the Early Detection of Cancer.” ACS, 2010. [http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer]. Accessed December 1, 2010.
American Urological Association (AUA). “Prostate Specific Antigen Best Practice Statement 2009 Update.” AUA, 2009. [http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf]. Accessed December 8, 2010.
Besculides, M., L. Trebino, S. Jones, and J. Kim. “Assessment of the Train the Trainer Project Using the Helping You Take Care of Yourself Curriculum.” Princeton, NJ: Mathematica Policy Research, 2010.
Centers for Disease Control and Prevention (CDC). “Heart Disease Prevention: What You Can Do.” CDC, 2009. [http://www.cdc.gov/HeartDisease/what_you_can_do.htm]. Accessed January 25, 2011.
Centers for Disease Control and Prevention (CDC). “Prostate Cancer, Informed Decision Making: How to Make a Personal Health Care Choice.” CDC, 2010. [http://www.cdc.gov/cancer/prostate/informed_decision_making.htm]. Accessed December 1, 2010.
Glasgow, R.E., T.M. Vogt, and S.M. Boles. “Evaluating the Public Health Impact of Health Promotion Interventions: The RE-AIM Framework.” American Journal of Public Health, vol. 89, no. 9, 1999, 1322-1327.
Henley, S.J., J.B. King, R.R. German, L.C. Richardson, and M. Plescia. “Surveillance of Screening-Detected Cancers (Colon and Rectum, Breast, and Cervix)—United States, 2004–2006. Morbidity and Mortality Weekly, vol. 59(SS09), November 26, 2010, pp. 1-25. [http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5909a1.htm?s_cid=ss5909a1_e]. Accessed December 1, 2010.
Massachusetts Health Quality Partners (MHQP). “2007/8 Adult Preventative Care Recommendations.” MHQP, 2008. [http://www.mhqp.org/guidelines/preventivePDF/MHQP_Adult_DeskGuides07-08.pdf]. Accessed March 17, 2011.
National Cancer Institute (NCI). “Cancer Health Disparities.” NCI, 2008. [http://www.cancer.gov/cancertopics/factsheet/disparities/cancer-health-disparities#9]. Accessed January 25, 2011.
Trebino, L., K. Hourihan, and M. Besculides. “Assessment of the Initial Phase of the Train the Trainer Project Using the Helping You Take Care of Yourself Curriculum.” Princeton, NJ: Mathematica Policy Research, 2008.
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U.S. Preventive Services Task Force. “Screening for Prostate Cancer Recommendations Statement August 2008.” U.S. Preventive Services Task Force, 2008. [http://www.uspreventiveservicestaskforce.org/uspstf08/prostate/prostaters.htm]. Accessed December 1, 2010.
APPENDIX A
DATA COLLECTION FORMS
Date:__________ Location:____________
Light green
8/09
Helping You Take Care of Yourself – Health Education Session
Demographics Form
1. Name: ___________________________ 2. Sex:
Female
3. What is your date of birth? ____month ____day ____year
4. How old are you? under 40
40-64
65 and over
5. What city or town do you live in? __________________________
6. Were you born in….
One of the 50 states or the District of Columbia
One of the US territories (Puerto Rico, Guam, American Samoa, US Virgin Islands, Mariana
Islands, Solomon Islands)
Some other country →How old were you when you first moved to the United States?
___ Age ___Don’t know
7. Are you Latino/Hispanic?
No
Yes →Which one of these groups best describes you?
Brazilian
Cuban
Dominican
Mexican, Chicano, Mexican American
Puerto Rican
Some other Hispanic or Latino origin (please specify): ___________________
8. What is your race? (you may check more than one) Are you….. Alaska Native or American Indian
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Other (please specify): ___________________
9. What is the highest grade or level of school you have finished?
I didn’t go to school
8th Grade or less
Some high school but did not graduate
High School graduate or GED
Training Program
College
Other: (please specify): __________________
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
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Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
Date:__________ Location:____________
Light green
8/09
10. What type of health care coverage (insurance) do you use to pay for most of your medical care? Is
it coverage through:
Your employer or someone else’s employer
A plan that you or someone else buys
Medicare
Medicaid, MassHealth, CommonHealth or MassHealth HMOs offered through Neighborhood
Health Plan, Fallon Community Health Plan, Boston Medical Center HealthNet or Network
Health or Commonwealth Care
Free Care or Safety Net
Other (please specify): ___________________
I don’t have any health coverage (insurance)
Health Questions (for women and men):
11. Blood cholesterol is a fatty substance found in the blood. About how long has it been since you
last had your blood cholesterol checked?
Within the past year (anytime less than 12 months ago)
Within the past 2 years (1 year but less than 2 years ago)
Within the past 5 years (2 years but less than 5 years ago)
5 or more years ago
I have never had my blood cholesterol checked
12. A blood stool test is a test that may use a special kit at home to determine whether the stool
contains blood. When was your most recent blood stool test using a home kit?
Within the past year (anytime less than 12 months ago)
Within the past 2 years (1 year but less than 2 years ago)
Within the past 3 years (2 years but less than 3 years ago)
Within the past 5 years (3 years but less than 5 years ago)
5 or more years ago
I have never had a blood stool test using a home kit
13. Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the
colon for signs of cancer or other health problems. When was your most recent sigmoidoscopy or
colonoscopy?
Within the past year (anytime less than 12 months ago)
Within the past 2 years (1 year but less than 2 years ago)
Within the past 3 years (2 years but less than 3 years ago)
Within the past 5 years (3 years but less than 5 years ago)
Within the past 10 years (5 years but less than 10 years ago)
10 or more years ago
I have never had a sigmoidoscopy or colonoscopy
A.4
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
Date:__________ Location:____________
Light green
8/09
WOMEN ONLY Health Questions
14. A mammogram is an x-ray of each breast to look for breast cancer. When was your most recent
mammogram?
Within the past year (anytime less than 12 months ago)
Within the past 2 years (1 year but less than 2 years ago)
Within the past 3 years (2 years but less than 3 years ago)
Within the past 5 years (3 years but less than 5 years ago)
5 or more years ago
I have never had a mammogram
15. A Pap test (smear) is a test for cancer of the cervix. When was your most recent Pap test?
Within the past year (anytime less than 12 months ago)
Within the past 2 years (1 year but less than 2 years ago)
Within the past 3 years (2 years but less than 3 years ago)
Within the past 5 years (3years but less than 5 years ago)
5 or more years ago
I have never had a Pap test
MEN ONLY Health Questions
16. Have you ever discussed prostate cancer early detection or screening with your healthcare
provider?
Yes
No
Don’t know / Not sure
17. A digital rectal exam is an exam in which a doctor, nurse or other health professional places a
gloved finger into the rectum to feel the size, shape, and hardness of the prostate gland. When
was your most recent digital rectal exam (DRE)?
Within the past year (anytime less than 12 months ago)
Within the past 2 years (1 year but less than 2 years ago)
Within the past 3 years (2 years but less than 3 years ago)
Within the past 5 years (3 years but less than 5 years ago)
5 or more years ago
I have never had a DRE
18. A Prostate-Specific Antigen test, also called a PSA test, is a blood test used to check men for
prostate cancer. When was your most recent prostate specific antigen (PSA) test?
Within the past year (anytime less than 12 months ago)
Within the past 2 years (1 year but less than 2 years ago)
Within the past 3 years (2 years but less than 3 years ago)
Within the past 5 years (3 years but less than 5 years ago)
5 or more years ago
I have never had a PSA test
A.5
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
ID number:______________ Date: _________________
Location: _________________
Pink paper
5/09
Helping You Take Care of Yourself – Health Education Session
Pre-test
Breast Health and Breast Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree
with the statement.
1. If a woman discovers a lump in her breast, she absolutely has breast cancer………….YES NO
2. Starting at the age of 40, women should get a mammogram once a year……………..YES NO
3. Mammograms cause breast cancer……………………………….………………….…YES NO
4. As women get older, their risk of breast cancer increases…………………….…….…YES NO
5. Women need to have a clinical breast exam done by a healthcare provider
every five years…………………………………………………………………………YES NO
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.6
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
ID number:______________ Date: _________________
Location: _________________
Lavender paper
12/09
Post-test
Breast Health and Breast Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree
with the statement.
1. If a woman discovers a lump in her breast, she absolutely has breast cancer………….YES NO
2. Starting at the age of 40, women should get a mammogram once a year……………..YES NO
3. Mammograms cause breast cancer……………………………….………………….…YES NO
4. As women get older, their risk of breast cancer increases…………………….…….…YES NO
5. Women need to have a clinical breast exam done by a healthcare provider
every five years…………………………………………………………………………YES NO
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.7
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
ID number:______________ Date: _________________
Location: _________________
Pink paper
5/09
Helping You Take Care of Yourself – Health Education Session
Pre-test
Cervical Health and Cervical Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree
with the statement.
1. If a woman has an abnormal Pap test, it means she has cervical cancer………..……..YES NO
2. Women should get their first Pap tests at age 21 or three years after they
become sexually active…………………………………………………………………YES NO
3. Cervical cancer is preventable through routine screening.…………………………….YES NO
4. When a woman gets a positive HPV test, it means she has cervical
cancer…..………….………………………………………………………………..….YES NO
5. Most women have been exposed to the Human Papilloma Virus (HPV) ……………..YES NO
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.8
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
ID number:______________ Date: _________________
Location: _________________
Lavender paper
12/09
Helping You Take Care of Yourself – Health Education Session
Post-test
Cervical Health and Cervical Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree
with the statement.
1. If a woman has an abnormal Pap test, it means she has cervical cancer………..……..YES NO
2. Women should get their first Pap tests at age 21 or three years after they
become sexually active…………………………………………………………………YES NO
3. Cervical cancer is preventable through routine screening.…………………………….YES NO
4. When a woman gets a positive HPV test, it means she has cervical
cancer…..………….………………………………………………………………..….YES NO
5. Most women have been exposed to the Human Papilloma Virus (HPV) ……………..YES NO
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.9
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
ID number:______________ Date: _________________
Location: _________________
Pink paper
5/09
Helping You Take Care of Yourself – Health Education Session
Pre-test
Cardiovascular Health and Disease Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree
with the statement.
1. Men and women have the exact same heart attack warning signs.…...……………...YES NO
2. Quitting smoking can help reduce the risk for cardiovascular disease……………….YES NO
3. LDL (bad) cholesterol can clog the blood vessels and cause damage to
the heart and brain…….……………………………………………………………...YES NO
4. If someone shows one of the symptoms of a stroke the most important
thing to do is call 911 right away..…………………………………...………………YES NO
5. High blood pressure forces the heart to work harder than normal and
raises the risk for heart attack and stroke……………………………………………..YES NO
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.10
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
ID number:______________ Date: _________________
Location: _________________
Lavender paper
5/09
Helping You Take Care of Yourself – Health Education Session
Post-test
Cardiovascular Health and Disease Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree
with the statement.
1. Men and women have the exact same heart attack warning signs.…...……………...YES NO
2. Quitting smoking can help reduce the risk for cardiovascular disease……………….YES NO
3. LDL (bad) cholesterol can clog the blood vessels and cause damage to
the heart and brain…….……………………………………………………………...YES NO
4. If someone shows one of the symptoms of a stroke the most important
thing to do is call 911 right away..…………………………………...………………YES NO
5. High blood pressure forces the heart to work harder than normal and
raises the risk for heart attack and stroke……………………………………………..YES NO
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.11
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
ID number:______________ Date: _________________
Location: _________________
Pink paper
8/09
Helping You Take Care of Yourself – Health Education Session
Pre-test
Colorectal Health and Colorectal Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree
with the statement.
1. Eating foods high in fat is a risk factor for colorectal cancer………………………….YES NO
2. All people should begin getting screened for colorectal cancer at the age
of 30 years old……………………………………………………………...………….YES NO
3. Colorectal cancer can develop without signs over a long period of time
without being noticed………………………………………………………………….YES NO
4. Screening is the only way for someone to know if they have colorectal cancer………YES NO
5. A polyp found on colonoscopy will always be cancer…………………………………YES NO
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.12
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
ID number:______________ Date: _________________
Location: _________________
Lavender paper
8/09
Helping You Take Care of Yourself – Health Education Session
Post-test
Colorectal Health and Colorectal Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree
with the statement.
1. Eating foods high in fat is a risk factor for colorectal cancer………………………….YES NO
2. All people should begin getting screened for colorectal cancer at the age
of 30 years old……………………………………………………………...………….YES NO
3. Colorectal cancer can develop without signs over a long period of time
without being noticed………………………………………………………………….YES NO
4. Screening is the only way for someone to know if they have colorectal cancer………YES NO
5. A polyp found on colonoscopy will always be cancer…………………………………YES NO
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.13
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
ID number:______________ Date: _________________
Location: _________________
Pink paper
6/09
Helping You Take Care of Yourself – Health Education Session
Pre-test
Prostate Health and Prostate Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree
with the statement.
1. Men are more likely to get prostate cancer when they are younger………..………….YES NO
2. Starting at the age of 65, men should start talking to their doctor about
testing for prostate cancer………………………………………………………………YES NO
3. Men of African descent are at high risk for getting prostate cancer……………………YES NO
4. Difficulty or pain during urination are signs of prostate problems……………………YES NO
5. PSA test results are typically higher in men with prostate cancer ……………………YES NO
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.14
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
ID number:______________ Date: _________________
Location: _________________
Lavender paper
6/09
Helping You Take Care of Yourself – Health Education Session
Post-test
Prostate Health and Prostate Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree
with the statement.
1. Men are more likely to get prostate cancer when they are younger………..………….YES NO
2. Starting at the age of 65, men should start talking to their doctor about
testing for prostate cancer………………………………………………………………YES NO
3. Men of African descent are at high risk for getting prostate cancer……………………YES NO
4. Difficulty or pain during urination are signs of prostate problems……………………YES NO
5. PSA test results are typically higher in men with prostate cancer ……………………YES NO
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.15
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
Date:_____________
Location:_____________
Light blue paper
5/09
Helping You Take Care of Yourself – Health Education Session
Participant Evaluation
Please take a minute to let us know how you liked this health education session.
1. Would you suggest that your family or friends come to this health session?
Yes No
2. Overall, how would you rate this health session?
Poor Fair Average Good Excellent
1 2 3 4 5
3. Overall, how would you rate the group leader?
Poor Fair Average Good Excellent
1 2 3 4 5
4. Do you have any ideas about how to make the sessions
better?_______________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Thank you for filling out this form! Please pass it in before you leave.
For Internal Use ONLY
Organization Name
_________________________
Trainer Name
_________________________
A.16
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
APPENDIX B
INTERVIEW AND FOCUS GROUP PROTOCOLS
B.3
Interview Guide for Community Organization Trainers (Project 6339)
Name of Trainer: Organization: Phone Number: Date of Discussion: Interviewer: Hi, my name is [NAME] and I am with Mathematica Policy Research, Inc. We are working with the Massachusetts Department of Public Health (MDPH) to evaluate the Train the Trainer project, including the Helping You Take Care of Yourself prostate curriculum, data collection forms, and the how the program was incorporated into your organization. As part of the evaluation, we are talking to the staff at CMAHEC, trainers at community organizations who used the prostate curriculum, and men who were educated in the prostate unit. I am hoping to talk with you about your experiences with the project. Your input will help us improve the program. Our conversation should take about an hour. Do you still have time to talk now? [if not, reschedule a time] As we talk today, please keep in mind that you don’t have to answer any questions that
make you uncomfortable. Everything you say will be kept confidential and we will not use your name in our reports.
Before I begin asking questions about the Train the Trainer project, I would first like to get some background information about you.
1. How/When did you first become involved with [ORGANIZATION NAME]?
2. What kind of work did you do prior to working at [ORGANIZATION NAME]?
3. Did you have previous training on prostate cancer? If so, can you please tell me about that training/background?
4. How did you become involved in the Train the Trainer project? Now I would like to ask you a little bit about your experience with the CMAHEC prostate training and your thoughts on the curricula.
5. When you were being trained by Dr. Phil Wood and Alex DePalo, what did you
think about the amount of information presented to you during the prostate training you received? (too much, too little, just about right).
B.4
6. Were the training materials that Dr. Wood used clear and easy to understand
a. [if they were trained in more than one unit] How would you compare the quality of the prostate training and materials to the other units you were trained in?
7. Following the prostate training, did you feel prepared to educate men on
prostate cancer? [we are trying to get at comfort level when they first started] a. If yes, what was most helpful in preparing you? b. If not, what would you have liked to learn to help you feel better
prepared? 8. Do you have any suggestions for improving the training process? 9. How much time elapsed between the time that you were trained on prostate
cancer and the time when you offered the first prostate workshop to men in the community?
10. Did you feel comfortable calling Alex at CMAHEC if you had questions about the
project or needed support? a. Did you contact Alex for anything? Please explain. b. [If they contacted her] did she help you work through the issue you were
having?
The next questions I would like to ask you are about recruiting and educating men. Recruiting
11. How did you or your organization go about recruiting men for the prostate workshops you held?
a. [if not answered] Were you involved in recruiting?
i. If yes, what role did you play in the recruitment? b. What challenges did you face in recruiting men?
i. [for organizations that conducted workshops in multiple units] Was the prostate unit more challenging to recruit for than other units?
c. Was there anything that facilitated recruitment? d. Were men reminded about the prostate workshops? If so, how? e. Did most people that you recruited for the prostate workshops actually
attend them? If not, why? What did you do to address non-attendance?
12. Were you able to educate all of men who wished to participate? If not, why not? (probe: were language barriers an issue)
B.5
Educating
13. About how many prostate workshops did you hold? f. About how many men were educated per workshop? Did you think this
number of participants was manageable? If not, what should it be?
14. What languages did you conduct workshops in?
15. Briefly describe a typical workshop that you held.
16. What aspects of the workshop do you feel went particularly well? Why?
17. What aspects of the workshop do you think were challenging? Why?
18. How did men respond to the prostate workshops? (Probes: Did they seem interested/Were they excited about what they were learning?)
19. Where did you hold the workshops?
g. Were the workshops received differently at various locations? If so, please explain.
20. What would you do to improve the workshop?
Now I would like to ask you a few questions about the workshop curricula and the data collection forms.
21. During the workshops you held, did you encounter any problems with the educational materials? (probe: which materials?)
a. What were the most common problems? b. Were the problems/questions different among different demographic groups
(age, education level, language, income, etc).
22. Do you have any ideas for how to improve the education materials? If so, please explain.
23. During each workshop men were supposed to complete 4 forms: a demographic
form, a pre-test of knowledge, a post-test of knowledge, and an evaluation form. Were there any questions that made people uncomfortable? How did you handle this?
B.6
The final set of questions I would like to ask is about submitting data in order to get paid for educating men.
24. Please describe the process you followed for submitting the forms you collected from men to Mathematica (demographic, pre-test, post-test, evaluation forms)?
a. How did you collect and organize the forms after the workshops? b. How did you prepare to submit the forms to Mathematica? Who
submitted the forms? c. Was there any aspect of this process that was challenging? If so, please
explain. d. What would you do differently to improve data collection and submission
to make it easier for you?
25. Would you participate in the project again? h. If no, why not?
26. Is there anything else you want to share about the program, working with Alex,
the training materials, or the workshop itself? Ask about focus groups: recruit 10-12 African American men aged 40+ to participate in a focus group (goal is to have 8-10 show up). Will receive $250 for work recruiting. Men will receive $25 gift card and a meal.
Those are all of the questions I have for you today. Is there anything that I didn’t ask that I should have asked? Do you have any questions for me? As I sort through what you have told me I may think of one or two follow-up questions or points of clarification. If this happens, would you mind if I call you again? Thanks so much for your time.
Focus Group Guide for Community Men attending a Prostate Health Education Session of the Helping You Take Care of Yourself Curricula/Train the Trainer Project
Preparation
As men enter the room
introduce yourself
ask their name and invite them to have refreshments
ask them to complete the post-test and questionnaire before the session begins
Introduction
As I mentioned, my name is ________ and I have ______with me.
We are from Mathematica Policy Research, an independent research company in Princeton, NJ
We were hired by the Massachusetts Department of Public Health to gather information about the prostate health workshop that was offered [name of org].
We are talking with lots of different people involved in the program, including the people who conducted the trainings and men like you who were educated to understand what worked well, and what may need to be changed to improve future workshops. So, in that way, you will help design future workshops.
Everything you say during today’s session will be kept confidential. That means that we will never use your name in our reports or discuss our conversation today with the organizations who trained you. It is important for you to be open and honest. There are no right or wrong answers. We have scheduled about 1 hour for this discussion.
I am giving you a gift certificate [for the local supermarket, or similar store] to show our appreciation for the time you are spending with us today. [pass these around and have them complete sign in sheet/receipt-first names are ok].
Does anyone have any questions?
B.7
My colleague ___________ is going to do his best to take notes as we talk. But as you can imagine, at times it will be difficult to keep up with everything that is said. Therefore, we would like to tape the discussion to make sure we do not miss anything anyone says. This way,_____________ [name of note taker] will be able to listen to the recording and make sure that everything he wrote was accurate. It would be helpful if you could try to speak one at a time, loudly, and clearly. I want to reassure you that no one outside of the Mathematica research team will have access to these tapes and they will be stored in a locked file.
We have a number of topics we want to discuss. At times, I may need to move the conversation along to be sure we cover everything.
Again, there are no right or wrong answers. People may disagree and that’s OK. Please feel free to speak your mind. We want to hear both positive and negative comments, whatever you want to share.
We know that some of these topics can be difficult to discuss, so if you feel more comfortable sharing something in a written form, or discussing this with us after the session, we can do that as well.
**********START TAPE************* ********************************* First, I would like to go around the room and have everyone introduce themselves, just first names. Recruitment 1. How did you find out about the workshop on prostate health?
2. What made you decide to go to the workshop?
3. Was this the first time you attended a workshop on prostate health?
4. Had you received information on prostate health from another person such as a relative, a friend or a healthcare provider?
Content of the Workshop and Quality of Presenter 5. Please tell me about some of the things you learned in the prostate health workshop
you attended through [name organization]?
6. What did you like the most about the workshop?
7. What did you like the least about the workshop?
8. Was there anything you would have liked to learn about that was not included in the workshop? Please explain.
B.8
9. Was the information clear and easy to understand?
10. Was the presenter knowledgeable about prostate health?
11. Did you share the information you learned during the prostate workshop with any of your friends and family? Please explain.
12. Would you tell a friend to go to the workshop? Why/why not?
Outcomes of the Workshop Next I’d like to talk about experiences you have had in going to a healthcare provider to
discuss prostate health or screening for prostate cancer and then to talk about reasons why you may not go.
First:
13. Would anyone like to share an experience they had in going to see a healthcare provider to discuss prostate health, for example, symptoms of an enlarged prostate, or to discuss screening for cancer?
(note: people may say they talked to a doctor, nurse, health educator, patient navigator, case manager or some other professional about prostate health, please keep track of who they talked to)
14. What made you go talk to a healthcare provider?
a. Did you go talk to a healthcare provider before the workshop?
b. How did the workshop influence your decision to go talk to a healthcare provider? Please explain.
15. Did you feel prepared (like you had enough information) to talk with the healthcare provider about prostate health or about getting screened for prostate cancer? Can you explain what made you feel prepared?
16. Is there anything that would have made your visit with the healthcare provider better?
Now let’s talk about not going to a healthcare provider.
17. Would anyone like to share the reasons they have not gone to a healthcare provider to discuss prostate health or screening for prostate cancer? (probe: no perceived risk for getting prostate cancer, don’t believe prostate cancer is that bad, no perceived value of screening, no provider, no insurance, not comfortable with screening tests)
(note: a myth around screening is that if a man screens a man the act is homosexual)
B.9
18. Let’s imagine that you have five minutes to talk to a healthcare provider about prostate health or screening for prostate cancer.
a) What would you ask or want to know? (probe: e.g., whether/when/where to get screened, am I at risk for prostate cancer, how effective is prostate cancer screening for saving lives, the pros and cons of prostate cancer screening, what happens after I am screened and I find out that I have prostate cancer)
b) What would make you feel comfortable talking with a healthcare provider about prostate health or screening for prostate cancer? (probe: reassurance from the healthcare provider about the effectiveness of prostate cancer screening, more knowledge about symptoms to look for)
c) What in particular would make you uncomfortable during a visit?
[If time permits] Forms You were asked to fill out several forms during the workshop. One form asked about your
age, education, and race/ethnicity. Another was a short quiz (like the one you filled out when you walked in today) that you took before and after the workshop. And then you filled out an evaluation form. (show the forms)
19. Did any questions on the forms make you feel uncomfortable? (probe: which questions) If yes, did you tell the presenter? What did they say?
20. How would you make the forms better in the future?
Other. We are almost done. I just have just a few questions left.
21. What other types of health education would be helpful to you?
22. Is there anything else that we haven’t talked about that you want to share?
23. Do you have any questions for me?
(note: please remind men that you are open to talking after the session if anyone wants to talk. If they have health questions, refer them to the CBO. Thank participants.)
B.10
Interview Guide for Springfield Men Community Organization Trainers (Project 6339)
Name of Trainer: Organization: Phone Number: Date of Discussion: Interviewer: Hi, my name is [NAME] and I am with Mathematica Policy Research, Inc. We are working with the Massachusetts Department of Public Health (MDPH) to evaluate the Train the Trainer project, including the Helping You Take Care of Yourself prostate curriculum, data collection forms, and the how the program was incorporated into your organization. As part of the evaluation, we are talking to the staff at CMAHEC, trainers at community organizations who used the prostate curriculum, and men who were educated in the prostate unit. I am hoping to talk with you about your experiences with the project. Your input will help us improve the program. Our conversation should take about an hour. Do you still have time to talk now? [if not, reschedule a time] As we talk today, please keep in mind that you don’t have to answer any questions that
make you uncomfortable. Everything you say will be kept confidential and we will not use your name in our reports.
Before we begin, do you have any questions? The first questions I have are about how you became involved in the Train the Trainer Project. Recruitment
1. How did you find out about the training for the workshops on prostate health?
2. Why did you decide to participate in the training? (probe: part of work requirements, out of interest)
3. Was this the first time you attended a training workshop on prostate health?
4. What experiences, if any, have you had providing health education before you attended the training?
Content and Format of the Trainings 5. Was any of the information presented during the prostate health training given by
Dr. Phil Wood confusing? (probe: was the information clear and easy to understand)
B.11
6. Prostate health is a sensitive topic. Was there anything that made you feel uncomfortable about the training?
7. What did you like the most about the workshop?
8. What did you like the least about the workshop?
9. Did you share the information you learned during the prostate workshop with any of your friends and family? Please explain.
10. Did you feel comfortable leading a workshop on prostate health after attending the training with Dr. Phil Wood? Please explain.
a. If no, what would have helped you to feel better prepared? (probe: were there materials that you would have liked but didn’t have; was there anything you would have liked to learn about that was not included in the workshop)
Participant Experiences Next, I want to talk about the prostate workshops you held for men.
11. How did you recruit men to come to the prostate health workshops you held?
a. Did you have trouble recruiting participants? Please explain.
12. How did the men in your prostate health workshops respond to the information you presented? (probe: what were some of the participants’ reactions, were they comfortable with the topics, were they glad to have the information)?
13. Did the men participate in discussions?
14. Did men talk about what they might do with the information they got during your workshop? What types of things did they say they’d do? (probe: talk to a provider about prostate health, get screened, tell family/friends)
Outcomes of the Workshop I’d like to switch topics now to talk about experiences you have had in going to a healthcare
provider to discuss prostate health or screening for prostate cancer. Then I’d like to talk about reasons why you or other men may not go.
First:
15. Have you ever talked with a healthcare provider about prostate health, for example, symptoms of an enlarged prostate, or to discuss prostate cancer screening?
a. If yes, please tell me about that experience?
b. If no, go to question 22.
B.12
[note: people may say they talked to a doctor, nurse, health educator, patient navigator, case manager or some other professional about prostate health, please keep track of who they talked to]
16. What made you go talk to a healthcare provider?
a. Did you go talk to a healthcare provider before the training?
b. How did the training influence your decision to go talk to a healthcare provider? Please explain.
17. Did you feel prepared (like you had enough information) to talk with the healthcare provider about prostate health or about getting screened for prostate cancer? Can you explain what made you feel prepared?
18. Is there anything that would have made your visit with the healthcare provider better?
Now let’s talk about not going to a healthcare provider.
If he has not talked with a provider:
19. Can you share the reasons you have not gone to a healthcare provider to discuss prostate cancer or screening for prostate cancer? (probe: no perceived risk for getting prostate cancer, don’t believe prostate cancer is that bad, no perceived value of screening, no provider, no insurance, not comfortable with screening tests)
Let’s imagine that you have five minutes to talk to a healthcare provider about prostate health or screening for prostate cancer.
20. What would you ask or want to know? (probe: e.g., whether/when/where to get screened, am I at risk for prostate cancer, how effective is prostate cancer screening for saving lives, the pros and cons of prostate cancer screening, what happens after I am screened and I find out that I have prostate cancer)
21. What would make you feel comfortable talking with a healthcare provider about prostate health or screening for prostate cancer? (probe: reassurance from the healthcare provider about the effectiveness of screening, more knowledge about symptoms to look for)
If he has talked with a provider:
22. Can you share the reasons why you believe that men in your community may not visit a healthcare provider to discuss prostate cancer or screening for prostate cancer? (probe: no perceived risk for getting prostate cancer, don’t believe prostate cancer is that bad, no perceived value of screening, no provider, no insurance, not comfortable with screening tests)
B.13
Let’s imagine that a man in your community had five minutes to talk to a healthcare provider about prostate health or screening for prostate cancer.
23. What do you think he would ask or want to know? (probe: e.g., whether/when/where to get screened, am I at risk for prostate cancer, how effective is prostate cancer screening for saving lives, the pros and cons of prostate cancer screening, what happens after I am screened and I find out that I have prostate cancer)
24. What might make him feel comfortable talking with a healthcare provider about prostate health or screening for prostate cancer? (probe: reassurance from the healthcare provider about the effectiveness of screening, more knowledge about symptoms to look for)
For all men:
25. What in particular would make you uncomfortable during a visit?
Other. We are almost done.
26. Is there anything else that we haven’t talked about that you want to share?
27. Are there any questions I should have asked but didn’t?
28. Do you have any questions for me?
As I sort through what you have told me I may think of one or two follow-up questions or points of clarification. If this happens, would you mind if I call you again?
Thanks so much for your time.
B.14
Name:_______________________
Helping You Take Care of Yourself – Health Education Session Post-test
Prostate Health and Prostate Cancer Screening Unit For the statements below, please check the box YES if you agree with the statement or NO if you disagree with the statement.
1. Men are more likely to get prostate cancer when they are younger………..……………………………..YES NO
2. Starting at the age of 65, men should start talking to their doctor about testing
for prostate cancer……………………………………………………………..…………………………………………………..YES NO
3. Men of African descent are at high risk for getting prostate cancer……………….……………………….YES NO
4. Difficulty or pain during urination are signs of prostate problems…………………………………………..YES NO
5. PSA test results are typically higher in men with prostate cancer …………………………………………..YES NO
B.15
Additional Questions
6. Before you attended the prostate health workshop through [name of organization] had you ever talked
to a healthcare provider about prostate cancer or screening for prostate cancer?
Yes
If yes, please explain why you decided to talk with a healthcare provider:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
No
If no, please check all the reasons why you did not talk with a healthcare provider:
I didn’t have a provider or regular place to get care I didn’t have insurance or couldn’t afford to see a provider I didn’t think I was at risk for prostate cancer I didn’t think getting prostate cancer was that bad I didn’t think getting screened for prostate cancer was worthwhile I didn’t feel comfortable talking about this with a provider Other (please explain):_____________________________________________________
7. Before you attended the prostate health workshop through [name of organization] were you ever screened for prostate cancer?
Yes
If yes, how did you make the decision to get screened for prostate cancer?
I made the decision myself My health care provider made the decision for me My health care provider and I made the decision together Other people made the decision for me (specify who: __________________ )
No
If no, what were your reasons for not getting screened before the workshop (check all that apply)?
B.16
I didn’t have a provider or regular place to get care I didn’t have insurance or couldn’t afford to see a provider I didn’t know where to go to get screened I didn’t think it was important to get screened I didn’t feel comfortable getting screened I didn’t want to find out the screening results Other (please explain):_____________________________________________________
8. After you attended the prostate health workshop through [name of organization] did you talk to a healthcare provider about prostate cancer or screening for prostate cancer?
Yes
If yes, please explain why you decided to talk with a healthcare provider:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
No
If no, please check all the reasons why you decided not to talk with a healthcare provider:
I didn’t have a provider or regular place to get care I didn’t have insurance or couldn’t afford to see a provider I didn’t think I was at risk for prostate cancer I didn’t think getting prostate cancer was that bad I didn’t think getting screened for prostate cancer was worthwhile I didn’t feel comfortable talking about this with a provider Other (please explain):_____________________________________________________
9. After you attended the prostate health workshop through [name of organization] were you screened for prostate cancer?
Yes
If yes, how did you make the decision to get screened for prostate cancer?
I made the decision myself My health care provider made the decision for me My health care provider and I made the decision together Other people made the decision for me (specify who: __________________ )
No
If no, what were your reasons for not getting screened after the workshop (check all that apply)?
B.17
I didn’t have a provider or regular place to get care I didn’t have insurance or couldn’t afford to see a provider I didn’t think I was at risk for prostate cancer I didn’t think getting prostate cancer was that bad I didn’t think getting screened for prostate cancer was worthwhile I didn’t feel comfortable getting screened I didn’t want to find out the screening results Other (please explain):_____________________________________________________
Thank you for your time!
B.18
Interview Guide for CMAHEC (Project 6339)
CBO Recruitment
1. How did you recruit or bring CBOs on board?
a. What were the successes/challenges to the approach?
b. What would you do differently in the future?
2. When CBOs applied to be part of the project did they state who would be
carrying out the education?
a. If yes, how did you consider previous health education experience in
selecting CBOs?
3. How important do you think previous health education experience is in
successfully carrying out the workshops?
4. What problems arose in working with CBOs (e.g., getting them to reach
targets, not speaking to right person at the org)
Training
5. In speaking with CBO trainers it seems people entered the training with
varying levels of knowledge. How did the training handle these different
knowledge bases (if at all)?
a. Did you observe differences in knowledge by CBO type (e.g., church
vs. health center)?
b. Would you do any differently to address differences in knowledge
during trainings in the future (probe: different trainings)?
6. What were trainers taught about how to collect the information on the forms.
For example, were they taught to walk through the questions, to put the
questions up on the screen and read them, or to hand out the forms and
then answer questions as they arose?
7. How did the training address the content of the forms (in particular, the demographics form)? For example, were the questions reviewed one by one?
8. What feedback did people give about the training?
9. How would you improve the training process?
10. What feedback did people give about the materials/curricula?
11. How would you improve the materials/curricula?
B.19
Contact with CBOs
12. After the trainings, what types of things did CBOs contact you about? (probe:
get more forms, problems with form translation, recruitment advice)
13. Did this vary by any factors such as previous relationships with the CBO or
trainer or with the trainer's previous health education experience?
14. Did you attend any of the workshops held by CBOs? Please describe
15. Do you have anything else to add about the recruiting process, training
process, the materials, or the program in general?
B.20
APPENDIX C
SOLICITATION FOR APPLICATIONS
C.3
Solicitation for Applications for The Community Train the Trainer Project FY09 - FY10
on behalf of the Massachusetts Department of Public Health
1. Contact Information:
Application Contact Person: Joanne L. Calista Title: The Community Train the Trainer Project
Address: Central Massachusetts Area Health Education Center, Inc.
35 Harvard Street, Suite 300 Worcester, MA 01609
Telephone: 508-756-6676 Ext. 10
Email: [email protected]
The Massachusetts Department of Public Health’s (MDPH) Women’s Health Network (WHN), Men’s Health Partnership (MHP) and the Massachusetts Comprehensive Cancer Prevention and Control Program (MCCPCP) are seeking community based organizations to provide health education sessions to community members utilizing the Helping You Take Care of Yourself Curriculum that focuses on breast, cervical, prostate, cardiovascular, and colorectal health. Over the course of FY10 (July 2009 through June 2010), approximately $240,000 will be paid to community based organizations across Massachusetts to provide community health education to women and men aged 40 to 64 from priority populations through trained Community Health Workers (CHWs). 2. Project Background The Women’s Health Network, in collaboration with the Men’s Health Partnership and the Massachusetts Comprehensive Cancer Control and Prevention Program developed the Helping You Take Care of Yourself Curriculum to address the need for accurate, appropriate and current information about women’s and men’s health issues in diverse communities across the Commonwealth. This curriculum consists of units about Breast Health, Cervical Health, Prostate Health, Cardiovascular Health and Colorectal Health. Recognizing the diversity of languages, cultures, literacy and education levels throughout Massachusetts, the curriculum is available in several languages including English, Portuguese and Spanish and provides several options for presenting the health units (e.g., PowerPoint presentations, flipcharts, models, etc.). Developed as a “train the trainer” model, the Helping You Take Care of Yourself Curriculum was designed to train Community Health Workers, employed by community based organizations, on women’s
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
C.4
and men’s health topics, with the intention that the CHWs would, in turn, educate their communities about these issues. 3. FY09 - FY10 Project Through this application process, community based organizations (CBOs) will be selected to train community members, (of the priority populations identified on pages 11 and 12 of this application), in the areas of breast, cervical, prostate, cardiovascular, and colorectal health. The MDPH has contracted with the Central Massachusetts Area Health Education Center, Inc. to train the CHWs employed by qualifying CBOs, to educate community members in one or more of these identified health topics. Please refer to the MDPH definition of a Community Health Worker in Appendix A of this application. 4. Program Requirements Community based organizations selected through this application process will agree to the following:
• Sign a Memorandum of Understanding (MOU) with Mathematica Policy Research, Inc. Mathematica Policy Research, Inc. has been contracted by MDPH to establish the Memoranda of Understanding with each of the qualifying CBOs to collect project data, to process payment to the CBOs, and to maintain and analyze the data collected by this project. The MOU will include denotation of the following:
o Terms of agreement, including: The start and end date of the MOU.
o Scope of Work and Payment, including: The number of community members in the selected
population(s) the CBO has agreed to educate; The health topic(s) that will be covered for each population; The maximum amount of funding from Mathematica Policy
Research, Inc.; The time frame in which the trainings will be conducted; Requirements for scheduling training and tracking participants; Requirements for receiving payment.
o Points of contact.
• Send Community Health Worker(s), who are employees of the CBO, to a two-four day curriculum training (the length of the training depends upon the number of health topics for which the CBO proposes to educate.) and any follow-up or refresher trainings as determined necessary, by MDPH, during the course of this
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
C.5
project. The trainings will be conducted by the Central Massachusetts Area Health Education Center, Inc. at locations throughout the Commonwealth.
• Hold educational sessions for groups of community members about breast, cervical, prostate, cardiovascular, and/or colorectal health, conducted by the Community Health Worker(s) trained through this initiative, for the designated groups of women and/or men in their community for which they have been approved through this application process and is described in their Memorandum of Understanding with Mathematica Policy Research, Inc. Community members cannot be educated in more than two topics in a given day.
• Provide a completed packet of data forms to Mathematica Policy Research, Inc.
for each community member trained. The packet of data forms include the following:
o Demographic sheet; o Pre-test; o Post-test; o Evaluation.
5. Reimbursement: Community based organizations selected through this application will be provided payment of $30 for a completed packet of the 4 forms listed above for each educated community member as delineated in the Memorandum of Understanding with Mathematica Policy Research, Inc. If a community member is educated in more than one unit, the CBO will be paid $30 for each unit of education for which they submit completed packets of forms. For instance, if a community member is educated in breast and cervical health units and has two completed sets of forms, the CBO will be paid $60. Community participants cannot be educated in more than two units in a given day.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
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6. Project Application and Instructions for Submission of Responses:
Application: • Complete the required application coversheet Sections A and B found on pages
6 and 7 of this solicitation. • Write a project narrative answering questions 1 – 10 outlined on pages 8 and 9.
Using single spaced standard 12 point font, please do not exceed 9 pages (including the coversheet pages).
Submission:
• Submit an original application with 6 copies. • Faxed applications are NOT acceptable. • Applications may be submitted anytime during the application period. • Applications submitted after the deadline will not be reviewed.
Responses must be submitted to:
Central Massachusetts Area Health Education Center, Inc. 35 Harvard Street, Suite 300 Worcester, MA 01609 Attn: Joanne L. Calista
Deadline for Responses Deadline Date: May 4, 2009 Deadline Time: 12:00 pm (noon)
Proposals must be received at the address above by the deadline date and time. Evaluation:
Proposals will be evaluated based on the applicant’s project narrative and the need of the population they plan to educate.
Preference will be given to applications containing the following elements: • Demonstrated experience working with CHWs; • Demonstrated experience providing health education to community members; • Demonstrated experience working with the specific priority populations the
applicant proposes to work; • Demonstrated organizational capacity to complete all project activities, including
data collection requirements.
In an effort to ensure that an equitable representation of populations will be educated across all geographic regions of the Commonwealth, applicants may not be awarded the full capacity (number of community members to be educated) they request.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
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For selected applicants, the number, populations, and geographic regions identified in your proposal will be specified in your Award Notification and subsequent Memorandum of Understanding (MOU) established with Mathematica Policy Research, Inc.
For a timeline of the application process and project implementation, please see Appendix C on page 13.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
C.8
Solicitation for Applications for The Community Train the Trainer Project FY09 - FY10
on behalf of the Massachusetts Department of Public Health
Section A In the section below, please provide us with your organization’s contact information. Name and address of Organization: Tax ID Number (TIN): Name of organization’s authorized signatory: Phone number: Email address: Name of project contact person: Phone number: Email address: Section B In the tables found on page 6 of this solicitation, please list with which target population(s) you would be interested in working (Who and Where columns). Please refer to Appendix B for guidelines in identifying underserved populations. Additionally, estimate the number of women and/or men from each group your organization could realistically educate in a 10 month period. Please indicate on which health topics you plan to educate these communities. Who Who is the target population you will be educating? What is their gender, race/ethnicity, nationality, language, rural/ urban, etc? Where What cities/towns do they live in? Health Topics Breast Health / Cancer Cervical Health / Cancer Prostate Health / Cancer Colorectal Health / Cancer Cardiovascular Health / Disease
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
C.9
Community Women to be Educated
Community Men to be Educated
Who Where
Health Topic
# of Women
1.
2.
3.
4.
5.
Who Where Health Topic # of Men 1.
2.
3.
4.
5.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
C.10
Project Narrative: (Questions 1-10: Please do not exceed 7 pages single spaced 12 point font.):
1) Describe how the proposed program will link with the mission statement for your agency. Attach a copy of your agency’s current mission statement.
2) Describe your organization’s experience working with and/or conducting outreach or education to the priority population(s) you have proposed to educate.
3) If you have proposed to educate a population(s) that is not listed as an MDPH-designated priority population in Appendix B, please describe why this group is underserved and in need of community health education.
4) Describe your organization’s experience providing health related education or training.
5) Describe your organization’s experience employing and/or working with Community Health Workers.
6) Please identify the Community Health Worker(s), employed, or who are contracted by your organization, who would be conducting the activities of this initiative. Note: If you will be utilizing more than one CHW in this initiative, please complete the following information for EACH CHW:
Name: ____________________________ %FTE_____________ CHW experience working with the identified Priority Population(s):
CHW language capacity working with this Priority Population(s):
Prior Training Received: (Please list all relevant trainings in which this CHW participated):
Is this CHW a graduate of any of the following training programs?
• The Boston Public Health Commission’s Community Health Education Center (CHEC) Yes________ No_______ Year Completed ______
• The Lowell Community Health Center’s Community Health Education Center (CHEC) Yes________ No_______ Year Completed ______
• The Central Massachusetts Area Health Education Center’s Outreach Worker Training
Institute (OWTI) Yes________ No_______ Year Completed ______
• OWTI/ MDPH Care Coordination Patient Navigation Training? Yes________ No_________ Year Completed ______
• Other CHW training program? Name of program:_______________________ Yes________ No_________ Year Completed ______
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
C.11
• Other CHW training program? Name of program:_______________________
Yes________ No_________ Year Completed ______
If this CHW is not an employee of your organization, please indicate in what capacity and length of time that your organization has worked with this CHW:
7) Describe your organization’s experience working with the Women’s Health Network,
Men’s Health Partnership and/or the Massachusetts Comprehensive Cancer Prevention and Control Program.
8) Describe how your organization will implement this project. Please include a
description of how you will recruit community members to attend the education sessions and in which language(s) you will hold the sessions, and a timeline for implementation.
9) Describe your plan to ensure the quality of the educational sessions.
10) What are the challenges that your organization anticipates in conducting this
educational initiative? How do you plan to overcome these challenges? Supporting Information (required): Please attach a copy of your organization’s Form 990 or most recent audited financial statement.
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
C.12
Appendix A. Community Health Worker (CHW) Definition A CHW is a public health outreach professional who applies his or her unique understanding of the experience, language and/or culture of the populations he or she serves in order to carry out at least one of the following roles:
• bridging/culturally mediating between individuals, communities and health and human services, including actively building individual and community capacity;
• providing culturally appropriate health education and information; • assuring that people get the services they need; • providing direct services, including informal counseling and social support; and • advocating for individual and community needs.1
1 Community Health Worker Task Force. (April 2002). Policy Statement on Community Health Workers. Massachusetts, Massachusetts Department of Public Health
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
C.13
Appendix B. Priority Populations MDPH has identified the following priority populations, by geographic regions, listed below. The priority populations are based upon statewide surveillance and reporting.2 Although we have identified the following populations, representing specific ethnic and racial groups, we recognize that your organization may work with additional underserved and in need populations not specifically identified below. These groups could potentially include additional racial/ethnic groups, persons living in isolated rural geographic areas, and/or persons who face specific occupational, behavioral, or socioeconomic factors related to breast, cervical, prostate, colorectal cancers and/or cardiovascular disease. The review committee welcomes applications from entities that work with any of these additional populations. Geographic Regions and Priority Populations Men and Women ages 40 – 64 Boston Region
• Asian • Black, non-Hispanic • Hispanic • Portuguese-speaking
Central Region
• Asian – Worcester • Black, non-Hispanic – Worcester • Hispanic – Worcester, Southbridge, Fitchburg and Milford • Portuguese-speaking – Worcester and Milford
Metrowest Region
• Asian – Quincy • Black, non-Hispanic – Cambridge • Hispanic – Cambridge, Framingham, Somerville and Waltham • Portuguese-speaking – Framingham, Cambridge and Somerville
Northeast Region • Asian – Lowell, Lynn, and Malden • Black, non-Hispanic – Lowell, Lynn and Medford • Hispanic – Lawrence, Methuen, Lynn, Salem and Peabody • Portuguese-speaking – Lowell, Lynn and Gloucester
2 Cancer Incidence and Mortality in Massachusetts, 2001-2005: Statewide Report and Cancer in Massachusetts by Race Ethnicity, 2004-2004
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
C.14
Southeast Region
• Asian – Attleboro, Fall River and New Bedford • Black, non-Hispanic – Brockton • Hispanic – Brockton, Attleboro, Fall River and New Bedford • Portuguese-speaking – Fall River, New Bedford, Cape Cod and the Islands
Western Region
• Asian – Springfield • Black, non-Hispanic – Springfield • Hispanic – Holyoke, Springfield, Northampton/Amherst, and Pittsfield • Rural – Ware/Palmer, Greater Greenfield, North Quabin, Great Barrington,
Pittsfield, North Adams, Williamsburgh, Worthington, Cummington and Chesterfield
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
C.15
Appendix C. Approximate Project Timeline (subject to change)
CHW- Community Health Worker CM AHEC – Central Massachusetts Area Health Education Center, Inc. CBO – Community Based Organization MDPH – Massachusetts Department of Public Health MOU – Memorandum of Understanding MPR – Mathematic Policy Research, Inc.
Activity Time Frame Responsible Parties Solicitation Released April 14, 2009 CM AHEC Solicitation Responses Due
May 4, 2009 CBOs
CBOs Selected May 18, 2009 MDPH/ CM AHEC MOU drafted, with numbers of trainees, priority populations, and geographic regions specified
May 18 – 29, 2009 MPR
MOUs Signed May 18-June 5, 2009 CBOs Trainings for Community Health Workers employed by the CBOs conducted
June 5 – June 30, 2009 (Training will be offered in two-three regions in MA.) Additional trainings will be held in FY 10.
CBOs and CM AHEC
CHWs Conduct Trainings as described in MOU
Upon completion of CM AHEC training, through May 2010.
CBOs
MDPH Train the Trainer Data Forms submitted to MPR for each participant trained
On a rolling basis (within 30 days of completion of education sessions) through April, 2010.
CBOs
CBOs receive payment for participants trained
Quarterly through May, 2010 (upon submission of completed data to Mathematica)
MPR
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
.
APPENDIX D
DEMOGRAPHIC CHARACTERISTICS OF WORKSHOP PARTICIPANTS, BY REGION OF TRAINING
Evaluation of the H
elping You Take Care of Y
ourself Curriculum 2009-2010
Mathematica Policy Research
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
D.3
Dem
og
rap
hic
Ch
ara
cteri
stic
s o
f W
ork
sho
p P
art
icip
an
ts, b
y R
eg
ion
of
Tra
inin
g
Bo
ston
(n =
450
) Ce
ntra
l
(n =
576
) M
etro
wes
t
(n
= 4
82)
Nor
thea
st
(n =
288
) So
uthe
ast
(n =
561
) W
est
(n
= 4
49)
Char
acte
ristic
s n
% n
% n
% n
% n
% n
% G
en
der
Mal
e 18
8 41
.8
340
59.0
19
5 40
.5
93
32.3
23
2 41
.4
203
45.2
Fe
mal
e 26
1 58
.0
236
41.0
28
2 58
.5
194
67.4
32
7 58
.3
246
54.8
Un
know
n 1
0.2
0 0.
0 5
1.0
1 0.
3 2
0.4
0 0.
0
Ag
e
Unde
r 40
13
1 29
.1
93
16.1
13
2 27
.4
25
8.7
74
13.2
42
9.
4 40
-64
289
64.2
45
9 79
.7
294
61.0
24
6 85
.4
355
63.3
30
8 68
.6
65 a
nd o
ver
27
6.0
19
3.3
46
9.5
8 2.
8 12
1 21
.6
97
21.6
Un
know
n 3
0.7
5 0.
9 10
2.
1 9
3.1
11
2.0
2 0.
4
Race
/Eth
nic
ity
Whi
te
27
6.0
52
9.0
65
13.5
18
6.
3 13
4 23
.9
114
25.4
Bl
ack
89
19.8
27
1 47
.0
116
24.1
0
0.0
162
28.9
13
2 29
.4
Asia
n 5
1.1
81
14.1
28
5.
8 0
0.0
2 0.
4 30
6.
7 H
ispa
nic
310
68.9
14
6 25
.3
225
46.7
26
1 90
.6
113
20.1
15
3 34
.1
Oth
er
14
3.1
16
2.8
36
7.5
0 0.
0 13
3 23
.7
15
3.3
Unkn
own
5 1.
1 10
1.
7 12
2.
5 9
3.1
17
3.0
5 1.
1
Fo
rm L
an
gu
ag
e
Engl
ish
144
32.0
47
5 82
.5
238
49.4
9
3.1
264
47.1
30
9 68
.8
Span
ish
306
68.0
98
17
.0
59
12.2
23
9 83
.0
37
6.6
140
31.2
Po
rtug
uese
0
0.0
3 0.
5 18
5 38
.4
40
13.9
26
0 46
.3
0 0.
0
Co
un
try o
f Bir
th
Born
in U
SA
99
22.0
18
4 31
.9
99
20.5
24
8.
3 11
5 20
.5
253
56.3
Bo
rn in
US
Terr
itorie
s 11
0 24
.4
60
10.4
24
5.
0 32
11
.1
44
7.8
119
26.5
Fo
reig
n 19
0 42
.2
270
46.9
2
87
59.5
1
97
68.
4 3
10
55.3
57
12
.7
< 1
yea
r in
US
8
4.2
8 3
.0
4 1.
4 10
5.
1 5
1.6
1
1.8
1-5
year
s in
US
38
20
.0
22
8.2
35
12.2
25
12
.7
26
8.4
6
10.5
>
5 y
ears
in
US
90
47.4
13
3 49
.3
144
50.2
13
5 68
.5
106
34.2
35
61
.4
Unkn
own
num
ber
of
year
s in
US
54
28.4
10
7 39
.6
104
36.2
27
13
.7
173
55.8
15
26
.3
Unkn
own
51
11.3
62
10.8
72
14
.9
35
12.
2 92
16
.4
20
4.5
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
D.4
Bo
ston
(n =
450
) Ce
ntra
l
(n =
576
) M
etro
wes
t
(n
= 4
82)
Nor
thea
st
(n =
288
) So
uthe
ast
(n =
561
) W
est
(n
= 4
49)
Char
acte
ristic
s n
% n
% n
% n
% n
% n
% H
ealt
h
Insu
ran
ce
Yes
415
92.2
45
5 79
.0
396
82.2
24
0 83
.3
495
88.2
42
3 94
.2
No
12
2.7
99
17.2
60
12
.4
33
11.5
35
6.
2 7
1.6
Unkn
own
23
5.1
22
3.8
26
5.4
15
5.2
31
5.5
19
4.2
Ed
uca
tio
n
Less
than
hig
h sc
hool
15
3 34
.0
181
31.4
14
4 29
.9
121
42.0
28
8 51
.3
107
23.8
H
igh
scho
ol o
r eq
uiva
lent
11
7 26
.0
175
30.4
14
5 30
.1
65
22.6
12
1 21
.6
118
26.3
Tr
aini
ng
prog
ram
17
3.
8 45
7.
8 17
3.
5 8
2.8
36
6.4
18
4.0
Colle
ge
147
32.7
14
8 25
.7
157
32.6
80
27
.8
90
16.0
19
5 43
.4
Oth
er
8 1.
8 12
2.
1 5
1.0
4 1.
4 5
0.9
5 1.
1 Un
know
n 8
1.8
15
2.6
14
2.9
10
3.5
21
3.7
6 1.
3 So
urce
: An
alys
is o
f dat
a co
llect
ed fr
om w
orks
hop
part
icip
ants
APPENDIX E
DEMOGRAPHIC CHARACTERISTICS OF WORKSHOP PARTICIPANTS, BY HEALTH UNIT
Evaluation of the H
elping You Take Care of Y
ourself Curriculum 2009-2010
Mathematica Policy Research
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
E.3
Dem
og
rap
hic
Ch
ara
cteri
stic
s o
f W
ork
sho
p P
art
icip
an
ts b
y H
ealt
h U
nit
Br
east
Hea
lth
Cerv
ical
Hea
lth
Card
iova
scul
ar H
ealth
Co
lore
ctal
Hea
lth
Pros
tate
Hea
lth
n %
n %
n %
n %
n %
T
ota
l 85
1 10
0.0
654
100.
0 13
82
100.
0 82
1 10
0.0
909
100.
0
Gen
der
Mal
e n.
a.
n.a.
n.
a.
n.a.
53
3 38
.6
351
42.8
90
9 10
0.0
Fem
ale
851
100.
0 65
4 10
0.0
841
60.9
46
5 56
.6
n.a.
n.
a.
Unkn
own
n.a.
n.
a.
n.a.
n.
a.
8 0.
6 5
0.6
n.a.
n.
a.
A
ge
Unde
r 40
13
8 16
.2
95
14.5
25
7 18
.6
142
17.3
14
3 15
.7
40-6
4 58
2 68
.4
457
69.9
93
3 67
.5
608
74.1
68
0 74
.8
65 a
nd o
ver
120
14.1
93
14
.2
173
12.5
60
7.
3 71
7.
8 Un
know
n 11
1.
3 9
1.4
19
1.4
11
1.3
15
1.7
R
ace
/Eth
nic
ity
Whi
te
118
13.9
87
13
.3
271
19.6
14
4 17
.5
79
8.7
Blac
k 13
8 16
.2
113
17.3
22
9 16
.6
96
11.7
46
8 51
.5
Asia
n 71
8.
3 63
9.
6 83
6.
0 73
8.
9 20
2.
2 H
ispa
nic
451
53.0
31
9 48
.8
699
50.6
41
1 50
.1
234
25.7
O
ther
55
6.
5 56
8.
6 76
5.
5 84
10
.2
85
9.4
Refu
sed/
Unkn
ow
n 18
2.
1 16
2.
4 24
1.
7 13
1.
6 23
2.
5
Fo
rm l
an
gu
ag
e
Engl
ish
381
44.8
30
0 45
.9
597
43.2
30
1 36
.7
631
69.4
Sp
anis
h 30
1 35
.4
192
29.4
45
6 33
.0
332
40.4
16
6 18
.3
Port
ugue
se
169
19.9
16
2 24
.8
329
23.8
18
8 22
.9
112
12.3
Co
un
try o
f Bir
th
Born
in U
SA
158
18.6
10
9 16
.7
291
21.1
16
3 19
.9
375
41.3
Bo
rn in
US
Terr
itorie
s 15
5 18
.2
93
14.2
20
0 14
.5
99
12.1
94
10
.3
Fore
ign
437
51.4
37
8 57
.8
754
54.6
4
88
59.4
3
12
34.
3 <
1 Y
ear
in U
S 10
2.
3 4
1.1
18
2.4
13
2.7
13
4.2
1-5
Year
s in
US
47
10
.8
39
10.3
83
11
.0
59
12.
1 43
13
.8
Mor
e th
an 5
ye
ars
in U
S 21
7 49
.7
182
48.
2 37
0 49
.1
240
49.2
16
4 52
.6
Unkn
own
leng
th o
f tim
e sp
ent i
n US
16
3 37
.3
153
40.5
2
83
37.5
17
6 36
.1
92
29.5
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
E.4
Br
east
Hea
lth
Cerv
ical
Hea
lth
Card
iova
scul
ar H
ealth
Co
lore
ctal
Hea
lth
Pros
tate
Hea
lth
n %
n %
n %
n %
n %
Unkn
own
101
11.9
7
4 11
.3
137
9.9
71
8
.7
128
14.1
Healt
h i
nsu
ran
ce
Yes
763
89.7
60
0 91
.7
1221
88
.4
732
89.2
71
1 78
.2
No
44
5.2
30
4.6
114
8.2
59
7.2
142
15.6
Un
know
n 44
5.
2 24
3.
7 47
3.
4 30
3.
7 56
6.
2
Ed
uca
tio
n
Less
than
hig
h sc
hool
37
9 44
.5
306
46.8
51
6 37
.3
334
40.7
24
8 27
.3
Hig
h sc
hool
or
equi
vale
nt
202
23.7
14
2 21
.7
379
27.4
22
3 27
.2
273
30.0
Tr
aini
ng
prog
ram
33
3.
9 33
5.
0 64
4.
6 42
5.
1 53
5.
8 Co
llege
19
9 23
.4
150
22.9
37
5 27
.1
195
23.8
29
2 32
.1
Oth
er
14
1.6
5 0.
8 16
1.
2 9
1.1
14
1.5
Unkn
own
24
2.8
18
2.8
32
2.3
18
2.2
29
3.2
Sour
ce:
Anal
ysis
of d
ata
colle
cted
from
wor
ksho
p pa
rtic
ipan
ts
n.a.
= n
ot a
pplic
able
APPENDIX F
PRE- AND POSTTEST KNOWLEDGE BY QUESTION AND BY GENDER, AGE, RACE/ETHNICITY, AND EDUCATION
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.3
Pre
test
an
d P
ost
test
Kn
ow
led
ge b
y G
en
der
Br
east
Can
cer
Cerv
ical
Can
cer
Card
iova
scul
ar H
ealth
Pr
etes
t (N
= 8
40)
Post
test
(N
= 8
43)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
641
) Po
stte
st
(N =
643
) %
with
In
crea
sed
Scor
e
Pret
est
(N =
1,3
40)
Post
test
(N
= 1
,361
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
% A
nsw
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
Questi
on 1
To
tal
68
1
81
.1
81
1
96
.2
18
.7
49
5
77
.0
61
3
95
.6
24
.2
49
7
37
.1
11
34
8
3.3
1
24
.6
Gen
der
M
ale
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
198
38.7
42
0 80
.3
107.
3 Fe
mal
e 68
1 81
.1
811
96.2
18
.7
495
77.0
61
3 95
.6
24.2
29
7 36
.1
707
85.2
13
6.0
Unkn
own
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
2 33
.3
7 87
.5
162.
5
Questi
on 2
To
tal
78
7
93
.7
82
5
97
.9
4.5
4
79
7
4.5
5
85
9
1.3
2
2.5
1
26
9
94
.7
13
06
9
6.0
1
.3
Gen
der
M
ale
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
483
94.5
49
1 93
.9
-0.7
Fe
mal
e 78
7 93
.7
825
97.9
4.
5 47
9 74
.5
585
91.3
22
.5
781
94.9
80
7 97
.2
2.5
Unkn
own
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
5 83
.3
8 10
0.0
20.0
Questi
on 3
To
tal
69
1
82
.3
79
5
94
.3
14
.6
54
5
84
.8
61
3
95
.6
12
.8
12
52
9
3.4
1
31
3
96
.5
3.3
Gen
der
M
ale
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
472
92.4
49
3 94
.3
2.1
Fem
ale
691
82.3
79
5 94
.3
14.6
54
5 84
.8
613
95.6
12
.8
776
94.3
81
2 97
.8
3.8
Unkn
own
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
4 66
.7
8 10
0.0
50.0
Questi
on 4
To
tal
62
8
74
.8
76
6
90
.9
21
.5
37
8
58
.8
58
1
90
.6
54
.2
12
91
9
6.3
1
29
1
94
.9
-1
.5
Gen
der
M
ale
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
488
95.5
50
6 96
.7
1.3
Fem
ale
628
74.8
76
6 90
.9
21.5
37
8 58
.8
581
90.6
54
.2
797
96.8
77
7 93
.6
-3.3
Un
know
n n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
6
100.
0 8
100.
0 0.
0
Questi
on 5
To
tal
48
0
57
.1
67
0
79
.5
39
.1
40
7
63
.3
56
2
87
.7
38
.5
12
42
9
2.7
1
30
4
95
.8
3.4
Gen
der
M
ale
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
463
90.6
48
8 93
.3
3.0
Fem
ale
480
57.1
67
0 79
.5
39.1
40
7 63
.3
562
87.7
38
.5
774
94.0
80
8 97
.3
3.5
Unkn
own
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
n.a.
n.
a.
5 83
.3
8 10
0.0
20.0
So
urce
: An
alys
is o
f dat
a co
llect
ed fr
om w
orks
hop
part
icip
ants
n.a.
= n
ot a
pplic
able
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.4
Pre
test
an
d P
ost
test
Kn
ow
led
ge b
y G
en
der
(co
nti
nu
ed
)
Co
lore
ctal
Can
cer
Pros
tate
Can
cer
Pr
etes
t (N
= 7
91)
Post
test
(N
= 8
12)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
889
) Po
stte
st
(N =
883
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
Quest
ion 1
T
ota
l 6
05
7
6.5
7
69
9
4.7
2
3.8
7
00
7
8.7
7
85
8
8.9
1
2.9
Gen
der
Mal
e 25
3 74
.6
328
94.5
26
.7
700
78.7
78
5 88
.9
12.9
Fe
mal
e 34
9 77
.9
436
94.8
21
.7
n.a.
n.
a.
n.a.
n.
a.
n.a.
Un
know
n 3
75.0
5
100.
0 33
.3
n.a.
n.
a.
n.a.
n.
a.
n.a.
Quest
ion 2
T
ota
l 3
14
3
9.7
6
69
8
2.4
1
07
.5
45
9
51
.6
62
4
70
.7
36
.9
Gen
der
Mal
e 13
9 41
.0
275
79.3
93
.3
459
51.6
62
4 70
.7
36.9
Fe
mal
e 17
4 38
.8
390
84.8
11
8.3
n.a.
n.
a.
n.a.
n.
a.
n.a.
Un
know
n 1
25.0
4
80.0
22
0.0
n.a.
n.
a.
n.a.
n.
a.
n.a.
Quest
ion 3
T
ota
l 6
41
8
1.0
7
77
9
5.7
1
8.1
7
00
7
8.7
8
43
9
5.5
2
1.2
Gen
der
Mal
e 26
5 78
.2
327
94.2
20
.6
700
78.7
84
3 95
.5
21.2
Fe
mal
e 37
2 83
.0
445
96.7
16
.5
n.a.
n.
a.
n.a.
n.
a.
n.a.
Un
know
n 4
100.
0 5
100.
0 0.
0 n.
a.
n.a.
n.
a.
n.a.
n.
a.
Quest
ion 4
T
ota
l 6
36
8
0.4
7
12
8
7.7
9
.1
67
5
75
.9
75
5
85
.5
12
.6
Gen
der
Mal
e 26
2 77
.3
298
85.9
11
.1
675
75.9
75
5 85
.5
12.6
Fe
mal
e 37
1 82
.8
410
89.1
7.
6 n.
a.
n.a.
n.
a.
n.a.
n.
a.
Unkn
own
3 75
.0
4 80
.0
6.7
n.a.
n.
a.
n.a.
n.
a.
n.a.
Quest
ion 5
T
ota
l 4
30
5
4.4
6
69
8
2.4
5
1.6
6
63
7
4.6
8
10
9
1.7
2
3.0
Gen
der
Mal
e 18
4 54
.3
260
74.9
38
.0
663
74.6
81
0 91
.7
23.0
Fe
mal
e 24
4 54
.5
405
88.0
61
.7
n.a.
n.
a.
n.a.
n.
a.
n.a.
Un
know
n 2
50.0
4
80.0
60
.0
n.a.
n.
a.
n.a.
n.
a.
n.a.
So
urce
: An
alys
is o
f dat
a co
llect
ed fr
om w
orks
hop
part
icip
ants
n.a.
= n
ot a
pplic
able
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.5
Pre
test
an
d P
ost
test
Kn
ow
led
ge b
y A
ge
Br
east
Can
cer
Cerv
ical
Can
cer
Card
iova
scul
ar H
ealth
Pr
etes
t (N
= 8
40)
Post
test
(N
= 8
43)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
641
) Po
stte
st
(N =
643
) %
with
In
crea
sed
Scor
e
Pret
est
(N =
1,3
40)
Post
test
(N
= 1
,361
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
Quest
ion 1
Tota
l 6
81
8
1.1
8
11
9
6.2
1
8.7
4
95
7
7.0
6
13
9
5.6
2
4.2
4
97
3
7.1
1
13
4
83
.3
12
4.6
Ag
e
Unde
r 40
125
91.9
13
6 98
.6
7.2
82
87.2
89
97
.8
12.1
95
37
.3
207
80.9
11
7.0
40-6
4 46
8 81
.1
554
96.0
18
.4
355
78.9
42
9 95
.3
20.8
33
2 36
.9
766
83.5
12
6.4
65 a
nd o
ver
80
67.8
11
1 94
.1
38.8
52
56
.5
87
94.6
67
.3
60
35.5
14
5 85
.3
140.
2 Un
know
n 8
88.9
10
10
0.0
12.5
6
85.7
8
100.
0 16
.7
10
62.5
16
88
.9
42.2
Quest
ion 2
Tota
l 7
87
9
3.7
8
25
9
7.9
4
.5
47
9
74
.5
58
5
91
.3
22
.5
12
69
9
4.7
1
30
6
96
.0
1.3
Ag
e
Unde
r 40
130
95.6
13
6 98
.6
3.1
71
75.5
82
90
.1
19.3
24
1 94
.5
249
97.3
2.
9 40
-64
541
93.8
56
4 97
.7
4.3
338
75.1
41
6 92
.4
23.1
85
3 94
.8
873
95.2
0.
4 65
and
ove
r 10
7 90
.7
115
97.5
7.
5 66
71
.7
79
85.9
19
.7
162
95.9
16
6 97
.6
1.9
Unkn
own
9 10
0.0
10
100.
0 0.
0 4
57.1
8
100.
0 75
.0
13
81.3
18
10
0.0
23.1
Quest
ion 3
Tota
l 6
91
8
2.3
7
95
9
4.3
1
4.6
5
45
8
4.8
6
13
9
5.6
1
2.8
1
25
2
93
.4
13
13
9
6.5
3
.3
Age
Un
der 4
0 12
5 91
.9
134
97.1
5.
6 86
91
.5
86
94.5
3.
3 23
9 93
.7
249
97.3
3.
8 40
-64
468
81.1
54
0 93
.6
15.4
37
7 83
.8
438
97.3
16
.2
838
93.1
88
1 96
.1
3.2
65 a
nd o
ver
90
76.3
11
1 94
.1
23.3
77
83
.7
81
88.0
5.
2 16
1 95
.3
165
97.1
1.
9 Un
know
n 8
88.9
10
10
0.0
12.5
5
71.4
8
100.
0 40
.0
14
87.5
18
10
0.0
14.3
Quest
ion 4
Tota
l 6
28
7
4.8
7
66
9
0.9
2
1.5
3
78
5
8.8
5
81
9
0.6
5
4.2
1
29
1
96
.3
12
91
9
4.9
-1
.5
Age
Un
der 4
0 10
3 75
.7
130
94.2
24
.4
70
74.5
85
93
.4
25.4
24
7 96
.9
245
95.7
-1
.2
40-6
4 42
4 73
.5
518
89.8
22
.2
263
58.4
41
0 91
.1
55.9
86
7 96
.3
866
94.4
-2
.0
65 a
nd o
ver
94
79.7
10
8 91
.5
14.9
39
42
.4
78
84.8
10
0.0
161
95.3
16
4 96
.5
1.3
Unkn
own
7 77
.8
10
100.
0 28
.6
6 85
.7
8 10
0.0
16.7
16
10
0.0
16
88.9
-1
1.1
Quest
ion 5
Tota
l 4
80
5
7.1
6
70
7
9.5
3
9.1
4
07
6
3.3
5
62
8
7.7
3
8.5
1
24
2
92
.7
13
04
9
5.8
3
.4
Age
Un
der 4
0 82
60
.3
114
82.6
37
.0
70
74.5
86
94
.5
26.9
23
9 93
.7
247
96.5
2.
9 40
-64
326
56.5
45
2 78
.3
38.7
28
2 62
.7
405
90.0
43
.6
824
91.6
87
3 95
.2
4.0
65 a
nd o
ver
65
55.1
96
81
.4
47.7
52
56
.5
64
69.6
23
.1
165
97.6
16
6 97
.6
0.0
Unkn
own
7 77
.8
8 80
.0
2.9
3 42
.9
7 87
.5
104.
2 14
87
.5
18
100.
0 14
.3
Sour
ce:
Anal
ysis
of d
ata
colle
cted
from
wor
ksho
p pa
rtic
ipan
ts
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.6
Pre
test
an
d P
ost
test
Kn
ow
led
ge b
y A
ge (
con
tin
ued
)
Co
lore
ctal
Can
cer
Pros
tate
Can
cer
Pr
etes
t (N
= 7
91)
Post
test
(N
= 8
12)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
889
) Po
stte
st
(N =
883
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
Quest
ion 1
T
ota
l 6
05
7
6.5
7
69
9
4.7
2
3.8
7
00
7
8.7
7
85
8
8.9
1
2.9
Ag
e
Un
der 4
0 12
2 87
.1
134
95.7
9.
8 11
5 81
.6
125
91.9
12
.7
40-6
4 42
9 73
.3
571
94.9
29
.3
527
78.9
59
4 89
.2
13.1
65
and
ove
r 48
84
.2
54
90.0
6.
9 49
72
.1
55
79.7
10
.6
Unkn
own
6 66
.7
10
100.
0 50
.0
9 75
.0
11
91.7
22
.2
Quest
ion 2
T
ota
l 3
14
3
9.7
6
69
8
2.4
1
07
.5
45
9
51
.6
62
4
70
.7
36
.9
Age
Unde
r 40
74
52.9
12
7 90
.7
71.6
77
54
.6
111
81.6
49
.5
40-6
4 21
9 37
.4
489
81.2
11
7.0
348
52.1
46
4 69
.7
33.7
65
and
ove
r 18
31
.6
44
73.3
13
2.2
31
45.6
44
63
.8
39.9
Un
know
n 3
33.3
9
90.0
17
0.0
3 25
.0
5 41
.7
66.7
Quest
ion 3
T
ota
l 6
41
8
1.0
7
77
9
5.7
1
8.1
7
00
7
8.7
8
43
9
5.5
2
1.2
Ag
e
Un
der 4
0 12
4 88
.6
131
93.6
5.
6 11
1 78
.7
130
95.6
21
.4
40-6
4 46
0 78
.6
579
96.2
22
.3
524
78.4
63
9 95
.9
22.3
65
and
ove
r 49
86
.0
57
95.0
10
.5
53
77.9
63
91
.3
17.1
Un
know
n 8
88.9
10
10
0.0
12.5
12
10
0.0
11
91.7
-8
.3
Quest
ion 4
T
ota
l 6
36
8
0.4
7
12
8
7.7
9
.1
67
5
75
.9
75
5
85
.5
12
.6
Age
Unde
r 40
109
77.9
12
8 91
.4
17.4
10
2 72
.3
112
82.4
13
.8
40-6
4 47
2 80
.7
523
86.9
7.
7 49
9 74
.7
570
85.6
14
.6
65 a
nd o
ver
47
82.5
53
88
.3
7.1
63
92.6
62
89
.9
-3.0
Un
know
n 8
88.9
8
80.0
-1
0.0
11
91.7
11
91
.7
0.0
Quest
ion 5
T
ota
l 4
30
5
4.4
6
69
8
2.4
5
1.6
6
63
7
4.6
8
10
9
1.7
2
3.0
Ag
e
Un
der 4
0 86
61
.4
113
80.7
31
.4
109
77.3
12
9 94
.9
22.7
40
-64
322
55.0
49
6 82
.4
49.7
49
1 73
.5
610
91.6
24
.6
65 a
nd o
ver
17
29.8
50
83
.3
179.
4 51
75
.0
59
85.5
14
.0
Unkn
own
5 55
.6
10
100.
0 80
.0
12
100.
0 12
10
0.0
0.0
Sour
ce:
Anal
ysis
of d
ata
colle
cted
from
wor
ksho
p pa
rtic
ipan
ts
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.7
Pre
test
an
d P
ost
test
Kn
ow
led
ge b
y R
ace
an
d E
thn
icit
y
Br
east
Can
cer
Cerv
ical
Can
cer
Card
iova
scul
ar H
ealth
Pr
etes
t (N
= 8
40)
Post
test
(N
= 8
43)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
641
) Po
stte
st
(N =
643
) %
with
In
crea
sed
Scor
e
Pret
est
(N =
1,3
40)
Post
test
(N
= 1
,361
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
Quest
ion 1
T
ota
l 6
81
8
1.1
8
11
9
6.2
1
8.7
4
95
7
7.0
6
13
9
5.6
2
4.2
4
97
3
7.1
1
13
4
83
.3
12
4.6
Ra
ce/
Ethn
icity
Whi
te
100
84.7
11
4 96
.6
14.0
65
76
.5
81
98.8
29
.2
117
45.3
23
0 84
.9
87.2
Bl
ack
113
83.1
13
0 94
.2
13.4
95
84
.8
105
93.8
10
.5
94
41.6
18
4 81
.4
95.7
As
ian
50
70.4
69
97
.2
38.0
42
66
.7
60
95.2
42
.9
24
29.3
75
92
.6
216.
4 H
ispa
nic
369
82.7
43
6 97
.1
17.4
23
9 76
.1
298
94.9
24
.7
225
33.1
55
8 81
.3
145.
5 O
ther
38
70
.4
49
94.2
33
.9
45
81.8
55
10
0.0
22.2
29
38
.7
67
90.5
13
4.2
Refu
sed/
Un
know
n 11
73
.3
13
86.7
18
.2
9 64
.3
14
93.3
45
.2
8 40
.0
20
87.0
11
7.4
Quest
ion 2
T
ota
l 7
87
9
3.7
8
25
9
7.9
4
.5
47
9
74
.5
58
5
91
.3
22
.5
12
69
9
4.7
1
30
6
96
.0
1.3
Ra
ce/
Ethn
icity
Whi
te
105
89.0
11
5 97
.5
9.5
62
72.9
76
92
.7
27.1
25
1 97
.3
258
95.2
-2
.1
Blac
k 12
3 90
.4
133
96.4
6.
6 82
73
.2
93
83.0
13
.4
207
91.6
21
3 94
.2
2.9
Asia
n 71
10
0.0
70
98.6
-1
.4
45
71.4
49
77
.8
8.9
79
96.3
79
97
.5
1.2
His
pani
c 42
2 94
.6
440
98.0
3.
6 22
9 72
.9
299
95.2
30
.6
645
95.0
66
3 96
.6
1.7
Oth
er
51
94.4
52
10
0.0
5.9
48
87.3
53
96
.4
10.4
69
92
.0
72
97.3
5.
8 Re
fuse
d/
Unkn
own
15
100.
0 15
10
0.0
0.0
13
92.9
15
10
0.0
7.7
18
90.0
21
91
.3
1.4
Quest
ion 3
T
ota
l 6
91
8
2.3
7
95
9
4.3
1
4.6
5
45
8
4.8
6
13
9
5.6
1
2.8
1
25
2
93
.4
13
13
9
6.5
3
.3
Race
/ Et
hnic
ity
W
hite
90
76
.3
113
95.8
25
.6
67
78.8
80
97
.6
23.8
25
0 96
.9
259
95.6
-1
.4
Blac
k 10
7 78
.7
117
84.8
7.
8 99
88
.4
101
90.2
2.
0 20
4 90
.3
215
95.1
5.
4 As
ian
66
93.0
69
97
.2
4.5
60
95.2
59
93
.7
-1.7
80
97
.6
79
97.5
0.
0 H
ispa
nic
378
84.8
43
5 96
.9
14.3
26
7 85
.0
303
96.5
13
.5
625
92.0
66
4 96
.8
5.2
Oth
er
37
68.5
47
90
.4
31.9
40
72
.7
55
100.
0 37
.5
75
100.
0 74
10
0.0
0.0
Refu
sed/
Un
know
n 13
86
.7
14
93.3
7.
7 12
85
.7
15
100.
0 16
.7
18
90.0
22
95
.7
6.3
Quest
ion 4
T
ota
l 6
28
7
4.8
7
66
9
0.9
2
1.5
3
78
5
8.8
5
81
9
0.6
5
4.2
1
29
1
96
.3
12
91
9
4.9
-1
.5
Race
/ Et
hnic
ity
W
hite
86
72
.9
107
90.7
24
.4
44
51.8
82
10
0.0
93.2
25
3 98
.1
264
97.4
-0
.7
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.8
Br
east
Can
cer
Cerv
ical
Can
cer
Card
iova
scul
ar H
ealth
Pr
etes
t (N
= 8
40)
Post
test
(N
= 8
43)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
641
) Po
stte
st
(N =
643
) %
with
In
crea
sed
Scor
e
Pret
est
(N =
1,3
40)
Post
test
(N
= 1
,361
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
Blac
k 10
2 75
.0
116
84.1
12
.1
81
72.3
10
1 90
.2
24.7
21
7 96
.0
223
98.7
2.
8 As
ian
59
83.1
68
95
.8
15.3
36
57
.1
53
84.1
47
.2
78
95.1
80
98
.8
3.8
His
pani
c 33
4 74
.9
414
92.2
23
.1
188
59.9
28
9 92
.0
53.7
64
9 95
.6
628
91.5
-4
.2
Oth
er
33
61.1
46
88
.5
44.8
22
40
.0
44
80.0
10
0.0
74
98.7
74
10
0.0
1.4
Refu
sed/
Un
know
n 14
93
.3
15
100.
0 7.
1 7
50.0
12
80
.0
60.0
20
10
0.0
22
95.7
-4
.3
Quest
ion 5
T
ota
l 4
80
5
7.1
6
70
7
9.5
3
9.1
4
07
6
3.3
5
62
8
7.7
3
8.5
1
24
2
92
.7
13
04
9
5.8
3
.4
Race
/ Et
hnic
ity
W
hite
47
39
.8
94
79.7
10
0.0
43
50.6
78
95
.1
88.0
25
0 96
.9
258
95.2
-1
.8
Blac
k 74
54
.4
97
70.3
29
.2
77
68.8
96
85
.7
24.7
21
3 94
.2
215
95.1
0.
9 As
ian
56
78.9
69
97
.2
23.2
27
42
.9
55
87.3
10
3.7
76
92.7
80
98
.8
6.6
His
pani
c 27
2 61
.0
355
79.1
29
.6
227
72.3
29
3 93
.3
29.1
61
4 90
.4
657
95.8
5.
9 O
ther
22
40
.7
44
84.6
10
7.7
24
43.6
33
60
.0
37.5
71
94
.7
72
97.3
2.
8 Re
fuse
d/
Unkn
own
9 60
.0
11
73.3
22
.2
9 64
.3
7 46
.7
-27.
4 18
90
.0
22
95.7
6.
3 So
urce
: An
alys
is o
f dat
a co
llect
ed fr
om w
orks
hop
part
icip
ants
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.9
Pre
test
an
d P
ost
test
Kn
ow
led
ge b
y R
ace
an
d E
thn
icit
y (
con
tin
ued
)
Co
lore
ctal
Can
cer
Pros
tate
Can
cer
Pr
etes
t (N
= 7
91)
Post
test
(N
= 8
12)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
889
) Po
stte
st
(N =
883
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
Questi
on 1
To
tal
60
5
76
.5
76
9
94
.7
23
.8
70
0
78
.7
78
5
88
.9
12
.9
Race
/ Et
hnic
ity
Whi
te
120
86.3
13
6 95
.1
10.2
64
85
.3
76
96.2
12
.7
Blac
k 62
68
.9
81
86.2
25
.1
354
77.0
39
8 87
.5
13.7
As
ian
47
66.2
72
98
.6
49.0
15
78
.9
18
94.7
20
.0
His
pani
c 30
9 77
.6
386
94.8
22
.2
204
87.6
20
2 88
.2
0.7
Oth
er
61
74.4
82
98
.8
32.8
49
59
.0
76
92.7
57
.0
Refu
sed/
Un
know
n 6
54.5
12
10
0.0
83.3
14
73
.7
15
78.9
7.
1
Questi
on 2
To
tal
31
4
39
.7
66
9
82
.4
10
7.5
4
59
5
1.6
6
24
7
0.7
3
6.9
Ra
ce/
Ethn
icity
W
hite
42
30
.2
122
85.3
18
2.4
50
66.7
63
79
.7
19.6
Bl
ack
43
47.8
74
78
.7
64.8
26
9 58
.5
331
72.7
24
.4
Asia
n 31
43
.7
72
98.6
12
5.9
9 47
.4
18
94.7
10
0.0
His
pani
c 16
1 40
.5
328
80.6
99
.2
84
36.1
12
7 55
.5
53.8
O
ther
33
40
.2
62
74.7
85
.6
39
47.0
73
89
.0
89.5
Re
fuse
d/
Unkn
own
4 36
.4
11
91.7
15
2.1
8 42
.1
12
63.2
50
.0
Questi
on 3
To
tal
64
1
81
.0
77
7
95
.7
18
.1
70
0
78
.7
84
3
95
.5
21
.2
Race
/ Et
hnic
ity
Whi
te
119
85.6
14
1 98
.6
15.2
46
61
.3
74
93.7
52
.7
Blac
k 65
72
.2
86
91.5
26
.7
402
87.4
43
4 95
.4
9.1
Asia
n 62
87
.3
71
97.3
11
.4
19
100.
0 19
10
0.0
0.0
His
pani
c 33
2 83
.4
391
96.1
15
.2
160
68.7
21
8 95
.2
38.6
O
ther
53
64
.6
78
94.0
45
.4
58
69.9
81
98
.8
41.4
Re
fuse
d/
Unkn
own
10
90.9
10
83
.3
-8.3
15
78
.9
17
89.5
13
.3
Questi
on 4
To
tal
63
6
80
.4
71
2
87
.7
9.1
6
75
7
5.9
7
55
8
5.5
1
2.6
Ra
ce/
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.10
Co
lore
ctal
Can
cer
Pros
tate
Can
cer
Pr
etes
t (N
= 7
91)
Post
test
(N
= 8
12)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
889
) Po
stte
st
(N =
883
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
Et
hnic
ity
Whi
te
120
86.3
12
4 86
.7
0.4
59
78.7
73
92
.4
17.5
Bl
ack
62
68.9
76
80
.9
17.4
33
4 72
.6
367
80.7
11
.1
Asia
n 64
90
.1
71
97.3
7.
9 15
78
.9
19
100.
0 26
.7
His
pani
c 32
7 82
.2
361
88.7
8.
0 18
8 80
.7
209
91.3
13
.1
Oth
er
54
65.9
71
85
.5
29.9
64
77
.1
71
86.6
12
.3
Refu
sed/
Un
know
n 9
81.8
9
75.0
-8
.3
15
78.9
16
84
.2
6.7
Questi
on 5
To
tal
43
0
54
.4
66
9
82
.4
51
.6
66
3
74
.6
81
0
91
.7
23
.0
Race
/ Et
hnic
ity
Whi
te
72
51.8
12
9 90
.2
74.2
61
81
.3
76
96.2
18
.3
Blac
k 57
63
.3
66
70.2
10
.9
343
74.6
41
6 91
.4
22.6
As
ian
37
52.1
69
94
.5
81.4
16
84
.2
19
100.
0 18
.8
His
pani
c 21
6 54
.3
341
83.8
54
.4
172
73.8
20
6 90
.0
21.9
O
ther
44
53
.7
53
63.9
19
.0
55
66.3
76
92
.7
39.9
Re
fuse
d/
Unkn
own
4 36
.4
11
91.7
15
2.1
16
84.2
17
89
.5
6.3
Sour
ce:
Anal
ysis
of d
ata
colle
cted
from
wor
ksho
p pa
rtic
ipan
ts
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.11
Pre
test
an
d P
ost
test
Kn
ow
led
ge b
y E
du
cati
on
Level
Br
east
Can
cer
Cerv
ical
Can
cer
Card
iova
scul
ar H
ealth
Pr
etes
t (N
= 8
40)
Post
test
(N
= 8
43)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
641
) Po
stte
st
(N =
643
) %
with
In
crea
sed
Scor
e
Pret
est
(N =
1,3
40)
Post
test
(N
= 1
,361
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
Quest
ion 1
Tota
l 6
81
8
1.1
8
11
9
6.2
1
8.7
4
95
7
7.0
6
13
9
5.6
2
4.2
4
97
3
7.1
1
13
4
83
.3
12
4.6
Ed
ucat
ion
Le
ss th
an
high
sch
ool
267
71.2
35
6 94
.7
33.0
21
0 69
.3
289
96.0
38
.5
146
29.0
42
6 84
.4
190.
6 H
igh
scho
ol
or e
quiv
alen
t 17
3 86
.5
198
98.0
13
.3
112
80.0
12
9 93
.5
16.8
13
3 36
.2
302
79.9
12
0.5
Trai
ning
pr
ogra
m
30
90.9
33
10
0.0
10.0
31
93
.9
31
93.9
0.
0 30
47
.6
47
75.8
59
.2
Colle
ge
184
92.9
19
2 97
.5
4.9
128
87.1
14
3 97
.3
11.7
16
8 46
.3
317
85.7
85
.1
Oth
er
12
85.7
14
10
0.0
16.7
5
100.
0 5
100.
0 0.
0 6
37.5
15
10
0.0
166.
7 Un
know
n 15
75
.0
18
85.7
14
.3
9 60
.0
16
94.1
56
.9
14
50.0
27
87
.1
74.2
Quest
ion 2
Tota
l 7
87
9
3.7
8
25
9
7.9
4
.5
47
9
74
.5
58
5
91
.3
22
.5
12
69
9
4.7
1
30
6
96
.0
1.3
Ed
ucat
ion
Le
ss th
an
high
sch
ool
351
93.6
36
8 97
.9
4.6
217
71.6
26
8 89
.0
24.3
47
5 94
.4
493
97.6
3.
4 H
igh
scho
ol
or e
quiv
alen
t 18
9 94
.5
196
97.0
2.
7 10
8 77
.1
128
92.8
20
.2
346
94.3
36
1 95
.5
1.3
Trai
ning
pr
ogra
m
30
90.9
31
93
.9
3.3
26
78.8
31
93
.9
19.2
61
96
.8
57
91.9
-5
.1
Colle
ge
185
93.4
19
5 99
.0
5.9
111
75.5
13
6 92
.5
22.5
34
7 95
.6
351
94.9
-0
.8
Oth
er
13
92.9
14
10
0.0
7.7
5 10
0.0
5 10
0.0
0.0
14
87.5
14
93
.3
6.7
Unkn
own
19
95.0
21
10
0.0
5.3
12
80.0
17
10
0.0
25.0
26
92
.9
30
96.8
4.
2
Quest
ion 3
Tota
l 6
91
8
2.3
7
95
9
4.3
1
4.6
5
45
8
4.8
6
13
9
5.6
1
2.8
1
25
2
93
.4
13
13
9
6.5
3
.3
Educ
atio
n
Less
than
hi
gh s
choo
l 29
7 79
.2
359
95.5
20
.6
248
81.8
28
2 93
.7
14.5
46
7 92
.8
494
97.8
5.
4 H
igh
scho
ol
or e
quiv
alen
t 16
7 83
.5
191
94.6
13
.2
123
87.9
13
3 96
.4
9.7
337
91.8
36
4 96
.3
4.9
Trai
ning
pr
ogra
m
25
75.8
30
90
.9
20.0
28
84
.8
33
100.
0 17
.9
61
96.8
58
93
.5
-3.4
Co
llege
17
5 88
.4
186
94.4
6.
8 12
9 87
.8
143
97.3
10
.9
348
95.9
35
3 95
.4
-0.5
O
ther
12
85
.7
13
92.9
8.
3 5
100.
0 5
100.
0 0.
0 14
87
.5
14
93.3
6.
7 Un
know
n 15
75
.0
16
76.2
1.
6 12
80
.0
17
100.
0 25
.0
25
89.3
30
96
.8
8.4
Quest
ion 4
Tota
l 6
28
7
4.8
7
66
9
0.9
2
1.5
3
78
5
8.8
5
81
9
0.6
5
4.2
1
29
1
96
.3
12
91
9
4.9
-1
.5
Educ
atio
n
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.12
Br
east
Can
cer
Cerv
ical
Can
cer
Card
iova
scul
ar H
ealth
Pr
etes
t (N
= 8
40)
Post
test
(N
= 8
43)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
641
) Po
stte
st
(N =
643
) %
with
In
crea
sed
Scor
e
Pret
est
(N =
1,3
40)
Post
test
(N
= 1
,361
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
n =
#
Answ
erin
g Co
rrec
tly
%
Answ
erin
g Co
rrec
tly
Less
than
hi
gh s
choo
l 28
7 76
.5
340
90.4
18
.2
151
49.8
26
6 88
.4
77.3
48
2 95
.8
475
94.1
-1
.8
Hig
h sc
hool
or
equ
ival
ent
144
72.0
18
3 90
.6
25.8
85
60
.7
124
89.9
48
.0
352
95.9
35
8 94
.7
-1.3
Tr
aini
ng
prog
ram
22
66
.7
30
90.9
36
.4
23
69.7
32
97
.0
39.1
62
98
.4
60
96.8
-1
.7
Colle
ge
152
76.8
18
3 92
.9
21.0
11
1 75
.5
141
95.9
27
.0
353
97.2
35
4 95
.7
-1.6
O
ther
6
42.9
11
78
.6
83.3
2
40.0
4
80.0
10
0.0
14
87.5
14
93
.3
6.7
Unkn
own
17
85.0
19
90
.5
6.4
6 40
.0
14
82.4
10
5.9
28
100.
0 30
96
.8
-3.2
Quest
ion 5
Tota
l 4
80
5
7.1
6
70
7
9.5
3
9.1
4
07
6
3.3
5
62
8
7.7
3
8.5
1
24
2
92
.7
13
04
9
5.8
3
.4
Educ
atio
n
Less
than
hi
gh s
choo
l 20
2 53
.9
286
76.1
41
.2
179
59.1
24
7 82
.1
38.9
45
5 90
.5
493
97.6
7.
9 H
igh
scho
ol
or e
quiv
alen
t 11
6 58
.0
161
79.7
37
.4
93
66.4
12
4 89
.9
35.3
33
9 92
.4
360
95.2
3.
1 Tr
aini
ng
prog
ram
16
48
.5
28
84.8
75
.0
21
63.6
31
93
.9
47.6
59
93
.7
56
90.3
-3
.6
Colle
ge
125
63.1
17
0 86
.3
36.7
10
0 68
.0
144
98.0
44
.0
350
96.4
35
2 95
.1
-1.3
O
ther
9
64.3
12
85
.7
33.3
3
60.0
5
100.
0 66
.7
14
87.5
14
93
.3
6.7
Unkn
own
12
60.0
13
61
.9
3.2
11
73.3
11
64
.7
-11.
8 25
89
.3
29
93.5
4.
8 So
urce
: An
alys
is o
f dat
a co
llect
ed fr
om w
orks
hop
part
icip
ants
Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.13
Pre
test
an
d P
ost
test
Kn
ow
led
ge b
y E
du
cati
on
Level
(co
nti
nu
ed
)
Co
lore
ctal
Can
cer
Pros
tate
Can
cer
Pr
etes
t (N
= 7
91)
Post
test
(N
= 8
12)
% w
ith
Incr
ease
d Sc
ore
Pret
est
(N =
889
) Po
stte
st
(N =
883
) %
with
In
crea
sed
Scor
e
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
n =
#
Answ
erin
g Co
rrec
tly
% An
swer
ing
Corr
ectly
Questi
on 1
T
ota
l 6
05
7
6.5
7
69
9
4.7
2
3.8
7
00
7
8.7
7
85
8
8.9
1
2.9
Ed
ucat
ion
Less
than
hig
h sc
hool
25
5 77
.7
320
96.7
24
.4
168
69.1
21
4 88
.1
27.4
H
igh
scho
ol o
r eq
uiva
lent
14
7 69
.3
208
94.1
35
.7
216
80.3
23
3 86
.6
7.9
Trai
ning
pr
ogra
m
31
86.1
35
83
.3
-3.2
45
86
.5
47
90.4
4.
4 Co
llege
15
2 80
.0
183
95.3
19
.1
243
85.0
25
9 92
.5
8.9
Oth
er
8 88
.9
8 88
.9
0.0
12
85.7
12
85
.7
0.0
Unkn
own
12
75.0
15
88
.2
17.6
16
64
.0
20
80.0
25
.0
Questi
on 2
T
ota
l 3
14
3
9.7
6
69
8
2.4
1
07
.5
45
9
51
.6
62
4
70
.7
36
.9
Educ
atio
n
Le
ss th
an h
igh
scho
ol
103
31.4
26
7 80
.7
156.
9 85
35
.0
159
65.4
87
.1
Hig
h sc
hool
or
equi
vale
nt
94
44.3
18
2 82
.4
85.7
15
0 55
.8
204
75.8
36
.0
Trai
ning
pr
ogra
m
15
41.7
34
81
.0
94.3
23
44
.2
29
55.8
26
.1
Colle
ge
94
49.5
16
5 85
.9
73.7
18
3 64
.0
203
72.5
13
.3
Oth
er
4 44
.4
8 88
.9
100.
0 6
42.9
13
92
.9
116.
7 Un
know
n 4
25.0
13
76
.5
205.
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Evaluation of the Helping You Take Care of Yourself Curriculum 2009-2010 Mathematica Policy Research
F.14
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Sour
ce:
Anal
ysis
of d
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colle
cted
from
wor
ksho
p pa
rtic
ipan
ts
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