Disseminating Results and Advancement of the Profession




Initial Analysis for Program Planning



Evidence Based Practice I: Assessment and Design

December 23, 2018

Initial Analysis for Program Planning

Breast cancer is a common type of cancer affecting women in the whole world, and in the United States, it is one of the most leading causes of cancer death (The American Cancer Society, 2012). Irrespective of the significant improvements made in breast cancer detection, diagnosis as well as prevention, the American Cancer Society (2012) indicated that black American women are still unequally affected by breast cancer. White women have a 90 percent five-year survival white African Americans have a five-year survival rate of 78 percent, which is lower than that of other races as well as ethnic groups in America (The American Cancer Society, 2012). Therefore, there is a need for a new plan of action and methods to advocate for the prevention of breast cancer, decrease its mortality, as well as enhance survival rate among Black American women. The purpose of this paper is to establish an initial analysis for program planning and needs assessment of the issue of the breast cancer in black American women in the United States of America

Problem Identification and Target Population

Compared with Caucasian female, black American women have increased mortality rates and are more likely to be diagnosed with the disease prior the age of 40 years. Breast cancer incidence and mortality rates trends demonstrate varying patterns among different races. Whereas African American females have a lesser lifetime risk of suffering from cancer of the breast, they have an increased mortality rate than white American women (Allicock, Graves, Gray & Troester, 2013). Greater breast cancer-related deaths are occurring among black American women with nearly 33 percent higher risk of loss of loss due to breast cancer than white American females. A recent report showed that black American females with cancer of the breast have a poorer prognosis when compared to white women that were diagnosed at the same age and stage (Yedjou et al., 2017).

Social Cognitive Theory for African Women with Breast Cancer

The social cognitive theory utilizes several concepts associated with behavioral change. First, there is self-efficacy concept which is a belief that people have the ultimate control over their health and can do whatever they want. Second, there is the expectation concept which focuses on the behavioral change outcome (Hodges & Videto, 2011). For instance, a patient must go for regular checkups to keep her health in check and at the required standard. Self-control is another important concept of the social cognitive theory. This provides patients the autonomy as well as total control over their behavior change. Most importantly, African American can, through observational learning, observe whatever white women are doing to increase their survival rates. Finally, it is possible to reinforce the theory using incentives like free checkups as well as rewards for every patient who regularly visits the hospital for checkups (Hodges & Videto, 2011).

Social cognitive theory is appropriate for assessing the problem of breast cancer among Black American women. This is because the theory focuses on the effect of individual experiences, other peoples' activities and actions as well as environmental aspects on the behavior and health status of the affected population. This is made under the consideration that breast cancer is treatable but can also be fatal if advanced. Also, the social cognitive theory offers support in a social context by installing self-efficacy expectations and utilizing observational, and other reinforcements to achieve the desired behavioral change and perception (Hodges & Videto, 2011).

Literature Review

The phenomenon of higher cancer of the breast mortality among black American females in the America involves various factors. Black American females are more prone to suffer from the cancer of breast at an early age, to get the diagnosis at a later disease stage as well as to die from breast cancer than other women of other racial groups (Karcher et al., 2014). For more than four decades, the United States has witnessed an expansion in the five-year relative survival rate for breast cancer for both white and black American females. In any case, there is as yet a significant racial distinction with new data revealing that the 5-year survival rate for black American and Caucasians women is standing at 79 percent and 92 percent, respectively (Coughlin, 2015).

The contrast in survival rate is because of the diagnosis at a later stage as well as poorer stage-specific survival rates amid black American females (Coughlin, 2015). It is believed that various factors, both biological and non-biological, contribute to the higher mortality rate among African American women. Some of the biological factors include more treatment-resistant tumors as well as more aggressive histology. The common non-biological factors are access to care and attitudes about seeking care (Daniel et al., 2018). Given that the non-biological factors are more mutable compared to biological factors, there is a need to develop proactive measures to address the increasing mortality rates among African American women (Daniel et al., 2018).

Efforts to prevent breast cancer-related deaths have focused on various risk factors like the promotion of physical activity, reduced alcohol consumption, taking of balanced diet as well as early detection through regular mammography (Albuquerque, Baltar & Marchioni, 2014). In as much as, recent data from a national survey in the United States show that black American females are as unlikely as white females to have had mammograms in the recent past, some patient locations and geographical localities still have some black-white disparities in mammogram rates as well as referrals for breast cancer evaluation and detection. These are caused by socioeconomic factors like family income as well as educational attainment (Coughlin, 2015).

Cancer of the breast screening rates are low amid low-income, uninsured as well as underinsured households which lead to higher mortality rates due to breast cancer among these populations (Coughlin, 2015). Another issue is of some Black American females having misconceptions about breast cancer etiology, about their risk factors of breast cancer as well as barriers to receiving timely screening and treatment (Yedjou et al., 2017). Black American women who are at risk are unlikely than their white counterparts to be aware of the present guidelines as well as recommendations related to preventive measures (Coughlin, 2015).

Needs Assessment

Needs Assessment Approach

Monsen et al.'s Problem-Analysis Framework will be used to identify the needs of black American females in reducing mortality rates due to breast cancer. According to Annan et al. (2013), Monsen et al.’s problem analysis framework of 2008 focuses on clear conceptualization and clarity of facts to provide focused interventions. The framework is divided into five major phases, with phase 1 requiring therapist and researchers to focus on the background information, role as well as expectations. In phase 2, there is a need to prepare the initial guiding hypothesis for the problem under study. Phase 3 is about identifying the problem dimensions, and phase 4 is about the preparation of an integrated conceptualization. In phase 5, a researcher or a therapist must prepare an intervention plan and implementation strategy. Finally, phase 6 is about monitoring as well as the evaluation of actions and outcomes.

Method of Data Collection

The data collection methods that will be used for the study include questionnaires and interviews. The questionnaires will be in print and electronic form depending on the convenience of the respondents. The importance of allowing for flexibility so to allow the respondents to choose the type channel through which they can respond to the questions is that the respondents may be busy in income-generating or any other activities and as such, may have limited time to answer the questionnaires (Derguy et al., 2015). Thus, electronic questionnaires will allow for convenience since busy respondents can answer the questions at their free time in their mobile phones, tablets, or PCs. The questionnaires will contain semi-structured-open-ended questions to allow for flexibility and respondents' free expression. Apart from the questionnaires, face-to-face and telephone interviews will also be conducted depending on the respondent's convenience. Respondents who will have enough time at their disposal: those who are confident will take face-to-face interviews whereas those who are busy, shy, or value their privacy will take telephone interviews.

Potential Challenges and Possible Solutions

The possible challenges that will be encountered during the data-gathering process are poor cooperation by the respondents. This is because the study deals with breast cancer, which is a sensitive subject among women. Besides, there may be fears of ethical and privacy issues by the respondents in which they may believe that their health information and identities can be exposed in the study, which can significantly reduce the turnout and cooperation of disclosure of accurate information by the respondents. Different distant data-collection options will be provided such as online questionnaires and telephone interviews to increase the likelihood of cooperation. Ethical and privacy issues will be solved by involving community stakeholders and assuring the respondents of maximum privacy since their real names will not be used.


Albuquerque, R. C., Baltar, V. T., & Marchioni, D. M. (2014). Breast cancer and dietary patterns: a systematic review. Nutrition reviews72(1), 1-17. https://doi.org/10.1111/nure.12083.

Allicock, M., Graves, N., Gray, K., & Troester, M. (2013). African American women's perspectives on breast cancer: Implications for communicating the risk of basal-like breast cancer. Journal of Health Care for the Poor and Underserved, 24(2), 753–767. Doi: 10.1353/hpu.2013.0082.

American Cancer Society. (2012).Cancer facts and figures for African Americans 2011–2012. Atlanta, GA: American Cancer Society. Retrieved from: https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-figures-for-african-americans.html

Annan, M., Chua, J., Cole, R., Kennedy, E., James, R., Markúsdóttir, I., ... & Shah, S. (2013). Further iterations on using the Problem-analysis Framework. Educational Psychology in Practice29(1), 79-95. DOI: 10.1080/02667363.2012.755951

Coughlin, S. S. (2015). Intervention approaches for addressing breast cancer disparities among African American women. Annals of Translational Medicine & Epidemiology, 1(1), 1-12. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283773/

Daniel, J. B., Gaddis, C. L., Legros, J. R., Bennett, M. D., & Turner, N. C. (2018). Breast Cancer Knowledge, Beliefs and Screening Practices among African American Women in a Rural Setting: A Pilot Study. International Journal of Health Sciences6(1), 29-38. DOI: 10.15640/ijhs.v6n1a3

Hodges, B. C., & Videto, D. M. (2011). Assessment and planning in health programs. (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.

Karcher, R., Fitzpatrick, D. C., Leonard, D. J., & Weber, S. (2014). A community-based collaborative approach to improve breast cancer screening in underserved African American women. Journal of Cancer Education, 29(3), 482–487. Doi: 10.1007/s13187-014-0608-z.

Yedjou, C. G., Tchounwou, P. B., Payton, M., Miele, L., Fonseca, D. D., Lowe, L., & Alo, R. A. (2017). Assessing the racial and ethnic disparities in breast cancer mortality in the United States. International Journal of Environmental Research and Public Health, 14(486), 1-14. Retrieved from: https://doi.org/10.3390/ijerph14050486