Steps

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Steps to Developing a Successful Training Program

Selecting the “Training Program Participants”

Who will benefit the most from the Training Program? The following community groups and professionals who interact with women and families in underserved and under-resourced communities may be interested in this Training Program:

Community Breast Cancer Advocates
Health Educators
Environmental Health Advocates

The first group of Advocates Mentoring Advocates trainees were members of The Witness Project of Harlem (WPH), one of 26 active faith-based Witness Projects nationwide that provide breast and cervical cancer education to African-American women and their families in churches and community organizations. Participants are both breast cancer survivors and lay health advisers, women from the community who are trained as health advocates. The Witness Project model is evidence-based. The Witness Project of Harlem (WPH) was founded in 2001 supported by the Mount Sinai Division of Cancer Prevention and Control, Department of Oncological Sciences, a partnership that continues to the present.

Planning the Training Program: A Participatory Process

A. Selecting the development and training team
We recommend that the following advocates/peer mentors and professionals be involved in both developing and conducting the workshops:

Breast Cancer Advocates who are peer mentors with experience in community education and advocacy
Health Educators
At least one environmental scientist, epidemiologist and/or specialist in environmental health communication

An iterative and participatory planning process that includes breast cancer advocates, potential trainees and scientists can be very effective, drawing on the skills of both consumers and professionals. A team approach enriches and provides a sharper focus for the content in training workshops. Some of the scientific content that is important to present as a foundation for understanding environmental risks and what is known about potential links to breast cancer is best presented by professional team members with a background in environmental sciences. Health educators with expertise in health literacy are important consultants. The inclusion on the team of knowledgeable peer mentors provides the perspective of those who have a lengthy historical experience in bringing breast cancer and the environment education to diverse communities. The initial Advocates Mentoring Advocates Training Program was supported by two experienced breast cancer peer mentors from the Great Neck Breast Cancer Coalition and the Huntington Breast Cancer Action Coalition.

B. Focus Groups
Representatives of potential trainee groups should be involved in helping to shape or focus the training. Focus groups are an excellent method to assess the current knowledge of group members about breast cancer and the environment. Sample focus group questions that were used to understand the knowledge base of Witness Project of Harlem members, the original trainees, are included in this toolkit.

C. Establishing Learning Objectives
The focus group provided a basis from which to articulate learning objectives and to prioritize the choice of curriculum topics, with emphasis placed on issues pertinent to communities of color. As an example, at the end of a workshop series, participants might be expected to:

Identify environmental risk factors for breast cancer;
Identify chemicals of concern to avoid that are linked to breast cancer risk;
Choose safer products and practices to reduce exposure to chemicals of concern that are linked to breast cancer;
Design and conduct their own workshop presentation on breast cancer and the environment that was tailored to the cultural styles, language, education and health literacy of the women and communities they sought to reach;
Communicate information to people who influence policy on environmental conditions and on policies that are linked to breast cancer risk.

Designing and Delivering the Training Workshops

Training workshops and their learning objectives should be tailored to the individual trainees based upon what is learned from focus groups. To address the needs and interests of the WPH trainees, our team of seasoned advocates, scientists and health educators each took the lead in designing workshops in their own area of expertise.

For example, environmental health scientists developed the workshops on the Basics of Breast Cancer and the Environment. The educated peer mentors created two workshops, one on Toxic Environmental Exposures in Consumer Products as well as a workshop on How to Influence Policy on Environmental Conditions. The health educators on the team developed a workshop on Communicating to Diverse Audiences.

The workshop content was delivered in five (5) visually attractive power point presentations and taught by both faculty and peer mentors. Workshops were 1 ½ hours each and held over a four month period to accommodate the schedules of trainees, the majority of whom had day jobs. Twelve volunteers started and completed the training. The workshop length and schedule could be more or less frequent depending on the needs of the trainees. The WPH volunteers that participated in the training received gift cards for use at a local store.

The content of the six training workshops is outlined below. Links to the first five training presentations are included in this toolkit. A sixth workshop was devoted to developing and presenting a community presentation.

Note that the content of individual training programs need not be identical to these; rather it should be targeted to individual audiences based on needs identified through the process described in Steps 2b and 2c.

Workshop I: The Basics of Breast Cancer and the Environment

Workshop II: Avoiding Risk from Personal Care Products

Workshop III: Toxic Environmental Exposures in Consumer Products

Workshop IV: Steps to Success in Policy Reform

Workshop V: How to Communicate About Breast Cancer and the Environment to Diverse Lay Audiences

Workshop VI: Developing a Presentation for the Community

Workshop I: The Basics of Breast Cancer and the Environment

Known and suspected environmental risk factors
How evidence of risk is determined and weighed
Endocrine disrupting chemicals (EDCs) and carcinogens in wide use
Windows of susceptibility and low dose exposures
Importance of the Precautionary Principle – better safe than sorry

Workshop II: Avoiding Risk from Personal Care Products

How do we know what chemical ingredients are in personal care products? Learning how to read labels and truth in advertising
Personal care products with ingredients that may increase the breast cancer risk in general and specifically for African-Americans
How to find and choose safer, affordable personal products
The importance of the Precautionary Principles

Workshop III: Toxic Environmental Exposures in Consumer Products

Pesticides and methods to limit household exposures; safer pest control
Plastics – how to present exposure and make safer choices
Household cleaning products with chemicals of concern – most brand names, air fresheners, toilet bowl sanitizers, mothballs, canned foods lined with BPA, candles
Label reading and making safer and affordable choices
PFOA (perfluorooctanoic acid) used in non-stick cookware; safer choices

Workshop IV: Steps to Success in Policy Reform

Individuals and organizations that influence environmental conditions and policies in your life
Steps necessary to take action on an issue of concern to the community
Techniques for meeting and talking with decision makers such as a landlord or legislator
Examples of how evidence based science and the Precautionary Principle have been used to influence changes in policies and regulations

Workshop V: How to Communicate About Breast Cancer and the Environment to Diverse Lay Audiences

Recognition of different adult learning styles
Recognition of different communication styles that community members may use in group education programs
Recognition of the breast cancer advocate’s roles as a communicator and educator

Workshop VI: Developing a Presentation for the Community

Prioritize content ideas from the five previous workshops
Develop an outline for a community presentation on breast cancer and the environment

Handouts provided at each of the first five workshops are provided at the links within this toolkit. They included a glossary of terms (including phonetic pronunciations); Look Before you Leap Healthy Reference Cards; information on toxic chemicals prevalent in communities of color and personal care products marketed to black women; healthier alternatives to personal care products such as nail polish, shampoo, cosmetics, to plastics, to pesticides and to household products; and agencies that investigate or regulate environmental toxins.

Evaluation of the Training Program

A survey to evaluate the initial Advocates Mentoring Advocates training workshops was completed by WPH volunteers after each workshop to learn:

Whether the content of the workshop was understandable to the volunteer trainees. Too complex? Too simple? What changes should be made?
Whether the content of the workshop was understandable and appropriate to take out to the community. Too complex? Too simple? What changes should be made?
What information in the presentation is the most important for the community to know?
Which slides and handouts should be chosen to include in a community presentation?

The workshop evaluation survey used in our program is included in this toolkit. At the completion of the program we asked trainees to evaluate their entire experience by completing an overall program evaluation form. From these evaluations we learned that the trainees were very satisfied or satisfied with the workshops but identified scientific terms and concepts that could be simplified into laymen’s terms to be more acceptable to the community.

Designing the Community Presentation (Workshop VI)

WPH volunteers, through a process of elimination and consensus, selected 45 slides from the first four training workshops as the content to include in a one hour community presentation. Based on our previous experience with community presentations, the workshop was timed for 45-50 minutes with 10-15 minutes for questions and answers. This process took several sessions beyond Workshop VI. Those slides that captured some of their “AH HA! Moments” and that they believed would deliver the most important messages and have the most impact among African-American women were selected. Topics included:

Myths about environmental risks for breast cancer;
How chemical exposures have the potential to disrupt the endocrine or hormone system;
Windows of susceptibility when women may be the most vulnerable to exposure to EDCs (during pregnancy, puberty and menarche, and menopause) and why these are periods of greater risk;
The Precautionary Principle
Affordable alternatives to lower or prevent chemical exposures in personal care and household products
Federal regulations don’t require manufacturers to provide complete lists of ingredients or prove their products are safe before they sell them.
How can we advocate for laws and regulations that might protect the public?

A link to the community presentation is included in this toolkit. Organizations that wish to use this template may want to select other slides from the Training Program or modify the community presentation to fit the specific targeted audience. There is also a link to handouts that were selected by WPH volunteers from those they received during the training workshops. Again, the number and content of the handouts is dependent on the targeted audience and an assessment of the education level of the audience.

Delivering the Community Presentation

A. Rehearsals
Prior to taking the Breast Cancer and the Environment presentation to the community, it is important to plan rehearsals with and for the new trainees. In the initial Advocates Mentoring Advocates training program, three rehearsals were held during which volunteers made presentations to each other. Project staff participated and helped to insert talking points in slides to provide the presenter with prompts rather than just reading a slide. (The talking points are included in the Community Presentation Power Point included in the toolkit in the Notes section of each slide)

B. Identification of community audiences.
Program staff and WPH volunteers reached out to community organizations in African-American and Afro-Caribbean communities to bring the workshop to their membership. Ten presentations were scheduled beginning in July 2014 and ending in February 2015. Demographics of the community participants are included at the link in this toolkit.

C. Delivering the community presentation.
Presentations were the most effective when given by two advocates together. An evaluation component could be integrated into the presentation. In the initial Advocates Mentoring Advocates program, questions were asked and data captured via an Audience Response System (ARS). The ARS is an effective tool to administer a survey for low literacy individuals. The questions are read aloud (and shown in the power point) before (pre-test) and after (post-test) the presentation. Participants select their responses on a small hand-held answer keypad. While basic demographic information is collected, confidentiality of responses is maintained as the ARS does not ask for any other identifying information from the participant. If an Audience Response System is not available, the evaluation of knowledge gained can be administered by paper and pencil surveys. The Institutional Review Board that oversees protection of human subjects at Mount Sinai determined that this project was exempt from federal human subjects research regulations; academic institutions who wish to include an evaluation component should check with their own Institutional Review Board to determine exemption status. The pre- and post- test evaluation questions and our study statistics are included in this toolkit. In addition to receiving a packet of handouts, audience members were given a round trip MetroCard to be used on New York City buses and/or subways to thank them for their time.

Timeline

The initial Advocates Mentoring Advocates Training Program and community presentations were developed and took place over a 14 month period (Figure 1).

Fig. 1. Timeline of the development of the Advocates Mentoring Advocates Training Program on Breast Cancer and the Environment.

Additional Toolkit Materials