What we thought we knew: African American males' perceptions of prostate cancer and screening methods.

Abstract: This study applied the Health Belief Model in determining African American male's knowledge, attitudes and perceptions of prostate cancer and early detection methods. The ultimate value of the information assessed from this population was used to design specific theorybased, culturally relevant interventions which may decrease mortality in this high-risk population. Two focus groups were conducted with African-American men whose ages ranged from 38 - 80 years. After consenting to audio-taping, participants completed a survey questionnaire and viewed a culturally appropriate video on prostate cancer. Results indicate that, on average, the men believed in the efficacy of prostate cancer early detection methods. Study participants felt physicians did not adequately screen or suggest that they be screened for prostate cancer. Men between 40 and 50 years of age expressed concern about possible changes in their sex life if diagnosed with prostate cancer. Despite having limited knowledge of prostate cancer they considered a digital rectal examination to be embarrassing and uncomfortable. However, they were not opposed to having the procedure done. Key Words: Health Belief Model, Perceptions of Prostate Cancer, Digital Rectal Examination The incidence of prostate cancer is 60% higher in African American men, and these men are twice as likely to die from their disease. Reasons for this disparity range from a lack of knowledge about the disease to an unwillingness to participate in prostate cancer screening. Reduction in cancer mortality has been associated with early diagnosis and treatment. Since prostate cancer has no known primary prevention, African American men must incorporate yearly prostate cancer screening activities into their health care practices. BACKGROUND According to the American Cancer Society (ACS), in 2001 an estimated 198,100 men will be diagnosed with prostate cancer, of that number, 25,300 will be African American. Approximately 31,500 men will die of prostate cancer, and of these 6,100 will be African American. They continue to have higher prostate cancer incidence and mortality rates than any other racial or ethnic group. Statistics indicate African American men in the United States have a 1 in 9 chance of developing prostate cancer - the highest incidence rate in the world. Cancer statistics reported by the American Cancer Society for 2001 validate further the gross disparities that exist in both incidence and survival rates of cancer among African Americans males (Greenlee,Hill-Harmon, Murray, & Thun, 2001). The number of African American men who will die of prostate cancer will continue to be high if history repeats itself. Researchers attributed the increase in findings of prostate cancer incidence between 1989 and 1992 to the use of Digital Rectal Examination (DRE) and Prostate Specific Antigen (PSA) for prostate cancer screening (Merrill, Potosky, & Feuer, 1996). In 1997 the American Cancer Society revised its' guidelines to include the aforementioned test (von Eschenbach, Ho, Murphy, Cunningham, & Lins, 1997). The combined use of DRE and PSA are promising (Mettlin, 1993; Abdalla ,& Vijayakumar, 1998). However, the procedures are of no use if the population with the highest incidence and mortality rates is not screened on a regular basis (McDonald, 1999; Tingen, Weinrich, Heydt, Boyd, & Weinrich, 1998; Geland, Parzuchowski, Cort, & Powell, 1995). The reduction in mortality has been associated with early diagnosis and treatment of prostate cancer. Since prostate cancer has no known primary prevention available, (Brawley, 1998; Cooney, 1998, Denis, 1995; McDonald, 1999; Demark-Wahnefried, Strigo, Catoe, Conaway, Brunettie, Rimer, & Robertson, 1995) African American men must incorporate yearly prostate cancer screening activities as recommended by the ACS into their health care practices. CONCEPTUAL MODEL AND, RELATED LITERATURE The Health Belief Model is one of the most widely used theoretical frameworks for explaining preventive health behavior. …