From community laywomen to breast health workers: A pilot training model to implement clinical breast exam screening in Malawi

Lily Gutnik, Agnes Moses, Christopher Stanley, Tapiwa Tembo, Clara Lee, Satish Gopal

Research output: Contribution to journalArticle

  • 3 Citations

Abstract

Background Breast cancer burden is high in low-income countries. Inadequate early detection contributes to late diagnosis and increased mortality.We describe the training program for Malawi's first clinical breast exam (CBE) screening effort. Methods Laywomen were recruited as Breast Health Workers (BHWs) with the help of local staff and breast cancer advocates. The four-week training consisted of lectures, online modules, role-playing, case discussions, CBE using simulators and patients, and practice presentations. Ministry of Health trainers taught health communication, promotion, and education skills. Breast cancer survivors shared their experiences. Clinicians taught breast cancer epidemiology, prevention, detection, and clinical care. Clinicians and research staff taught research ethics, informed consent, data collection, and professionalism. Breast cancer knowledge was measured using pre- And post-training surveys. Concordance between BHW and clinician CBE was assessed. Breast cancer talks by BHW were evaluated on a 5- point scale in 22 areas by 3 judges. Results We interviewed 12 women, and 4 were selected as BHWs including 1 breast cancer survivor. Training was dynamic with modification based on trainee response and progress. A higher-than-anticipated level of comprehension and interest led to inclusion of additional topics like breast reconstruction. Pre-training knowledge increased from 49% to 91% correct (p<0.0001). Clinician and BHW CBE had 88% concordance (kappa 0.43). The mean rating of BHW educational talks was 4.4 (standard deviation 0.7). Conclusions Malawian laywomen successfully completed training and demonstrated competency to conduct CBE and deliver breast cancer educational talks. Knowledge increased after training, and concordance was high between BHW and clinician CBE.

LanguageEnglish (US)
Article number0151389
JournalPloS one
Volume11
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Malawi
health care workers
breasts
Screening
Breast
Health
screening
breast neoplasms
Breast Neoplasms
Personnel rating
Survivors
Pilots
Epidemiology
Role Playing
Research Ethics
Health Communication
Mammaplasty
Delayed Diagnosis
Simulators
Education

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

From community laywomen to breast health workers : A pilot training model to implement clinical breast exam screening in Malawi. / Gutnik, Lily; Moses, Agnes; Stanley, Christopher; Tembo, Tapiwa; Lee, Clara; Gopal, Satish.

In: PloS one, Vol. 11, No. 3, 0151389, 01.03.2016.

Research output: Contribution to journalArticle

@article{35c1aebb3f204b4da2c8ed23ad6bd3bd,
title = "From community laywomen to breast health workers: A pilot training model to implement clinical breast exam screening in Malawi",
abstract = "Background Breast cancer burden is high in low-income countries. Inadequate early detection contributes to late diagnosis and increased mortality.We describe the training program for Malawi's first clinical breast exam (CBE) screening effort. Methods Laywomen were recruited as Breast Health Workers (BHWs) with the help of local staff and breast cancer advocates. The four-week training consisted of lectures, online modules, role-playing, case discussions, CBE using simulators and patients, and practice presentations. Ministry of Health trainers taught health communication, promotion, and education skills. Breast cancer survivors shared their experiences. Clinicians taught breast cancer epidemiology, prevention, detection, and clinical care. Clinicians and research staff taught research ethics, informed consent, data collection, and professionalism. Breast cancer knowledge was measured using pre- And post-training surveys. Concordance between BHW and clinician CBE was assessed. Breast cancer talks by BHW were evaluated on a 5- point scale in 22 areas by 3 judges. Results We interviewed 12 women, and 4 were selected as BHWs including 1 breast cancer survivor. Training was dynamic with modification based on trainee response and progress. A higher-than-anticipated level of comprehension and interest led to inclusion of additional topics like breast reconstruction. Pre-training knowledge increased from 49{\%} to 91{\%} correct (p<0.0001). Clinician and BHW CBE had 88{\%} concordance (kappa 0.43). The mean rating of BHW educational talks was 4.4 (standard deviation 0.7). Conclusions Malawian laywomen successfully completed training and demonstrated competency to conduct CBE and deliver breast cancer educational talks. Knowledge increased after training, and concordance was high between BHW and clinician CBE.",
author = "Lily Gutnik and Agnes Moses and Christopher Stanley and Tapiwa Tembo and Clara Lee and Satish Gopal",
year = "2016",
month = "3",
day = "1",
doi = "10.1371/journal.pone.0151389",
language = "English (US)",
volume = "11",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "3",

}

TY - JOUR

T1 - From community laywomen to breast health workers

T2 - PLoS One

AU - Gutnik,Lily

AU - Moses,Agnes

AU - Stanley,Christopher

AU - Tembo,Tapiwa

AU - Lee,Clara

AU - Gopal,Satish

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background Breast cancer burden is high in low-income countries. Inadequate early detection contributes to late diagnosis and increased mortality.We describe the training program for Malawi's first clinical breast exam (CBE) screening effort. Methods Laywomen were recruited as Breast Health Workers (BHWs) with the help of local staff and breast cancer advocates. The four-week training consisted of lectures, online modules, role-playing, case discussions, CBE using simulators and patients, and practice presentations. Ministry of Health trainers taught health communication, promotion, and education skills. Breast cancer survivors shared their experiences. Clinicians taught breast cancer epidemiology, prevention, detection, and clinical care. Clinicians and research staff taught research ethics, informed consent, data collection, and professionalism. Breast cancer knowledge was measured using pre- And post-training surveys. Concordance between BHW and clinician CBE was assessed. Breast cancer talks by BHW were evaluated on a 5- point scale in 22 areas by 3 judges. Results We interviewed 12 women, and 4 were selected as BHWs including 1 breast cancer survivor. Training was dynamic with modification based on trainee response and progress. A higher-than-anticipated level of comprehension and interest led to inclusion of additional topics like breast reconstruction. Pre-training knowledge increased from 49% to 91% correct (p<0.0001). Clinician and BHW CBE had 88% concordance (kappa 0.43). The mean rating of BHW educational talks was 4.4 (standard deviation 0.7). Conclusions Malawian laywomen successfully completed training and demonstrated competency to conduct CBE and deliver breast cancer educational talks. Knowledge increased after training, and concordance was high between BHW and clinician CBE.

AB - Background Breast cancer burden is high in low-income countries. Inadequate early detection contributes to late diagnosis and increased mortality.We describe the training program for Malawi's first clinical breast exam (CBE) screening effort. Methods Laywomen were recruited as Breast Health Workers (BHWs) with the help of local staff and breast cancer advocates. The four-week training consisted of lectures, online modules, role-playing, case discussions, CBE using simulators and patients, and practice presentations. Ministry of Health trainers taught health communication, promotion, and education skills. Breast cancer survivors shared their experiences. Clinicians taught breast cancer epidemiology, prevention, detection, and clinical care. Clinicians and research staff taught research ethics, informed consent, data collection, and professionalism. Breast cancer knowledge was measured using pre- And post-training surveys. Concordance between BHW and clinician CBE was assessed. Breast cancer talks by BHW were evaluated on a 5- point scale in 22 areas by 3 judges. Results We interviewed 12 women, and 4 were selected as BHWs including 1 breast cancer survivor. Training was dynamic with modification based on trainee response and progress. A higher-than-anticipated level of comprehension and interest led to inclusion of additional topics like breast reconstruction. Pre-training knowledge increased from 49% to 91% correct (p<0.0001). Clinician and BHW CBE had 88% concordance (kappa 0.43). The mean rating of BHW educational talks was 4.4 (standard deviation 0.7). Conclusions Malawian laywomen successfully completed training and demonstrated competency to conduct CBE and deliver breast cancer educational talks. Knowledge increased after training, and concordance was high between BHW and clinician CBE.

UR - http://www.scopus.com/inward/record.url?scp=84962323678&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84962323678&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0151389

DO - 10.1371/journal.pone.0151389

M3 - Article

VL - 11

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 3

M1 - 0151389

ER -