Breast Cancer Survivorship Program: Testing for Cross-cultural Relevance

Lynna K. Chung, MPH; Bernadine Cimprich, PhD, RN, FAAN; Nancy K. Janz, PhD; Sharon M. Mills-Wisneski, DNSc, RN


Cancer Nurs. 2009;32(3):236-245. 

In This Article

Abstract and Introduction


Taking CHARGE, a theory-based self-management program, was developed to assist women with survivorship concerns that arise after breast cancer treatment. Few such programs have been evaluated for cultural relevance with diverse groups. This study determined the utility and cultural relevance of the program for African American (AA) breast cancer survivors. Two focus groups were held with AA women (n = 13), aged 41 to 72 years, who had completed primary treatment. Focus group participants assessed the program content, format, materials, and the self-regulation process. Content analysis of audiotapes was conducted using an open, focused coding process to identify emergent themes regarding program relevance and topics requiring enhancement and/or further emphasis. Although findings indicated that the program's content was relevant to participants' experiences, AA women identified need for cultural enhancements in spirituality, self-preservation, and positive valuations of body image. Content areas requiring more emphasis included persistent fatigue, competing demands, disclosure, anticipatory guidance, and age-specific concerns about body image/sexuality. Suggested improvements to program materials included portable observation logs, additional resources, more photographs of younger AA women, vivid colors, and images depicting strength. These findings provide the basis for program enhancements to increase the utility and cultural relevance of Taking CHARGE for AA survivors and underscore the importance of evaluating interventions for racially/ethnically diverse groups.


With advances in treatment, now, more than 2 million women with a past diagnosis of breast cancer are alive in the United States, representing one of the largest groups of cancer survivors.[1] Despite long-standing evidence that after breast cancer treatment, women need continuing support to deal with the emotional, physical, and psychosocial concerns that arise,[2,3,4] few programs have been developed to meet these needs. This gap in healthcare services was first highlighted in the Institute of Medicine's report on cancer survivorship, which emphasized that the "transition from active treatment to social reintegration is crucial and should receive special attention in survivor's care."[5] Thus, the period after active treatment of breast cancer represents a particularly important "teaching moment" to help women regain or adopt health promoting behaviors.[6]

The Taking CHARGE program, which uses an innovative and unique self-management approach, was specifically designed to help women make a successful transition to survivorship after completion of breast cancer treatment. Although there is recognition of the need for culturally appropriate cancer survivorship interventions, few existing programs have been evaluated to determine if they are culturally relevant to the needs of minority women. The need for culturally appropriate healthcare approaches was emphasized by the Institute of Medicine's report in 2002 on health disparities for racial and ethnic minorities.[7] Thus, the purpose of this study was to assess the utility and relevance of the Taking CHARGE program in a selected minority group, namely, African American breast cancer survivors.


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