Appendix A: Impact of the Cultural Broker Program

The following programs illustrate the diverse settings and linguistic approaches in which cultural brokers positively impacted the communityÕs health.

Empowering Girls to Take Control of Their Bodies Through Breast Cancer Detection Skills

The health concern: Washington, DC, has the second highest breast cancer death rate for women in the United States, particularly African American women. Many of those deaths are due to late diagnosis, and could have possibly been avoided through early detection and an understanding of risk factors. Rosemary Williams, M.Ed., CTR, cancer program manager at the Howard University Cancer Center, notes that the cancer center is seeing an increase in the number of African American women in their 20s and 30s with lumps.

The strategy: In 2001, the Howard University Cancer Center, with funding from the Cancer Research and Prevention Foundation, entered into a partnership with five area high schools to create a long-term initiative to reduce the death rate. Howard health officials realized that talking with women while they were still young would be a critical time to create an awareness and understanding about their bodies and for them to learn breast cancer detection skills.

The action: Working with five DC high schools to create an open class period, the cancer center launched ÒProject Early Awareness: a Breast Health Education Program for High School Girls,Ó which takes breast health education to 11thand 12th-grade girls, most of whom are African American. Program coordinator Kimberly Marks, a 27-year-old African American breast cancer survivor, shares her story with the girls. A nurse or health educator from the Howard University Medical Center then teaches breast self-examination (BSE) using a video and plastic model. Students also are encouraged to talk with the school nurse or guidance counselor about any concerns they have. The girls receive a Breast Health Awareness bag, which contains information about the Howard University Cancer Center, a BSE shower card and plastic breast model, and a brochure on BSE. They are asked to share the information with their mothers, grandmothers, and other female relatives. A gift incentive has been found to lead many of these women to follow up on a checkup of suspicious lumps in their breast.

Why it works: The success of the program was due to the use of cultural brokers as a liaison at both the administrative and community levels. At the administrative level, Williams worked diligently with principals from the high schools to schedule the educational session around the girlsÕ class schedules. At the community level, KimberlyÕs participation as a real-life example of the impact of breast cancer was an immediate draw. Like the girls she spoke to, she was a young African American woman from the community. ÒThe girls know Kimberly is not that much older than them, and that makes breast cancer prevention very real,Ó Williams notes. ÒWhen Kimberly starts to tell her story of breast cancer, that really gets their attention.Ó