About Dr. Weinrich

Benefits/Limitations of Screening

Hereditary Prostate Cancer Project

Your Life – You Decide©

The brochure, Your Life- You Decide, is based on the Social Learning Theory (Bandura, 1977). According to the Social Learning Theory, people learn by observing persons they admire and respect.  This has been documented with CaP in Weinrich’s study in which testimonies from peer educators significantly increased participation in CaP screening. (Weinrich, Weinrich, Boyd, Mettlin, 1998).

Both supporting and opposing opinions for CaP screening from doctors and peers is presented.  Both physicians and peers discuss the risks and benefits of CaP screening.  Four of the leading physicians in CaP research participated: (Powell, Banerjee, Sakr, Grignon, Wood, Novallo, & Pontes,1999; Godley, 1999; Morgan, Jacobsen, McCarthy, et al. 1996; Moul, 1999; Chodak, 1993). 

Weinrich has documented the effectiveness of peer education with CaP screening. (Weinrich, Weinrich, Boyd, Mettlin, 1998). To increase the identification with the peer in accordance with the Social Learning Theory, directions encourage each man to read the pro and con opinions of men who are “like themselves.”  Opinions represent both African-American and Caucasian men.  Pictures of both the physicians and the men accompany the opinions in concordance with the Social Learning Theory.  The pro and con opinions are side by side on the same page in order to give equal weight to both opinions.

S. Weinrich, a prostate cancer educator with 20 plus years of experience with African American and medically under-served men designed the brochure.  Content is based on risk perception literature (Arkin, 1999) and include content identified as critical for CaP screening. (Chan and Sulmasy 1998; Coley, Barry, Fleming, Fahs, & Mulley1997; Guidry, Fagan, & Walker, 1998; Myers, Chodak, Wolf, Burgh, McGrory, Marcus, Diehl, & Williams, 1999; Wolf, Nasser, Wolf & Schorling 1996). The risks factors for CaP, an explanation of  the DRE and PSA, and the potential risks and benefits of having a CaP examination are included.  Also included are a warning that false-positive and false-negative results can and do sometimes occur, the information that it is not proven whether or not PSA testing reduces CaP mortality, and the fact that possible side effects of CaP treatment can include incontinence and erectile dysfunction.

Design principles to increase understanding in men with low literacy include pictorial representation. (Lipkus & Hollands, 1999; Weinrich, Boyd, Powe, 1997). Techniques include formatting with bullets to highlight key points, written message with a theme of “Things for You to Think About,” and visual presentation with color pictures. (Guidry, Fagan, & Walker, 1998; Weinrich, 1999). The text is written at a reduced readability level with a SMOG grade level of 7 and a Fleish grade level of 2.7.  Personal pronouns are used to increase understanding and identification (Boyd, Whitman, Graham, Gliet, 1997).  Active learning is reinforced with questions and answers that increase involvement.  Numerous revisions were made in the brochure based on feedback from 9 expert consultants and four pilot testings with low-income and underserved men.  The brochure includes the color red to increase alertness and is professionally printed.

Pictures of several men were taken at two locations in the city of Louisville, Kentucky in Spring 2001.  The men were asked if they were willing to have their picture taken for a nationally distributed brochure about Prostate Cancer Screening.  The men then signed a consent form. 

The decision on which four men to use in the brochure was made based on feedback from men in the target community.  Advice on the pictures was solicited from men in the community.  These men were chosen in attempt to mirror the target audience of the brochure.  Approximately 10 men were asked to vote on which four men they would like to see in a brochure about health.  The average age of the voting men was 48 years.  Forty percent of these men were black; sixty percent were white.  The four pictures receiving the most votes were included in the brochure.

References

• Arkin, E. B. (1999).Cancer risk communication-what we know. J Natl Cancer Inst Monographs, 25, 182-185.

• Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ:  Prentice Hall.

• Boyd, M., Whitman, N., Graham, B., Gliet, C. 1997. Teaching in Nursing Practice. Norwalk, CT: Appleton-Century-Crofts.

• Chan, E. C. Y., & Sulmasy, D. P. (1998).  What should men know about prostate-specific antigen screening before giving informed consent?  The American Journal of Medicine, 105, 266-274.
• Chodak, G. W.  Questioning the value of screening for prostate cancer in asymptomatic men.  Urology 1993; 42:116-8.
• Coley, C.M. Barry, M.J., Mulley, A.G. (1997).  Screening for prostate cancer.  Clinical guidelines: III. Ann Intern Med 126:480-484.
• Godley, P. A. (1999). Prostate cancer screening: promise and peril--a review. Cancer Detection and  Prevention, 23, 316-324.

• Guidry, J. J., Fagan, P., & Walker, V. (1998).  Cultural sensitivity and readability of breast and prostate printed cancer education materials targeting African Americans.  J Natl Med Assoc, 90(3), 165-169.

• Lipkus, I. M. & Hollands, J. G. (1999). The visual communication of risk. J Natl Cancer Inst Monographs, 25, 149-163.
• Morgan, T., Jacobsen, S., McCarthy, W., et al. (1996). Age-specific reference ranges for prostate-specific antigen in black men. N Engl J Med, 355, 304-310.
• Moul, J. W. (1999).  The Watkins Bruner et al article reviewed.  Oncology, 13(3), 337-351.
• Myers, R. E., Chodak, G. W., Wolf, T. A., Burgh, D. Y., McGrory, G. T., Marcus, S. M., Diehl, J. A., & Williams, M. (1999). Adherence by African American men to prostate cancer education and early detection. Cancer, 86(1), 88-104.

• Powell, I. J., Banerjee, M., Sakr, W., Grignon, D., Wood, D. P. Jr., Novallo, M., & Pontes, E. (1999).  Should African-American men be tested for prostate carcinoma at an earlier age than white men?  Cancer, 85(2), 472-477. 

• Weinrich, S. (1999). The high risk of low literacy. Reflections, Fourth Quarter, 22-24.
• Weinrich, S.P., Boyd, M., Powe, B.  (1997). Tool adaptation for socioeconomically disadvantaged populations. In M. Stromborg & S. Olsen (Eds.) Instruments for Clinical Nursing Research Oncology Nursing Society, pgs. 20-29.

• Weinrich, S. P., Weinrich, M.C., Boyd, M. D., Mettlin, C.(1998). Increasing Prostate Cancer    

• Screening in African American Men with Peer Educator and Client Navigator Educational  Interventions. Journal of Cancer Education, 13, 213-219.
• Wolf, A. M. D., Nasser, J. F., Wolf, A. M., & Schorling, J. B. (1996).  The impact of informed consent on patient interest in prostate-specific antigen screening.  Arch Intern Med., 156, 1333-1336. 

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Dr. Sally Weinrich,

May 04, 2007

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