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Vol. 06 Issue 3, Fall 2001

BCERF Completes Field Testing of Five-Module Tool Kit
The Ribbon 

Juliette Ramírez, BCERF Health Educator

The premise behind the BCERF Tool Kit is that practical breast cancer risk reduction messages can and should be integrated into the real lives of people living throughout the state of New York. Therefore, content addresses situations at work, home, and in the community, and has a multi-generational component wherever appropriate. Another basic tenet is that Cornell Cooperative Extension (CCE) and other community educators are "field experts" in the area of educating their own communities. Whenever possible, we integrated the expertise of these educators into the writing, presentation and evaluation of the modules. The Tool Kit maximizes use of existing education networks and groups, such as EFNEP (Expanded Food and Nutrition Program), NYS IPM (Integrated Pest Management program) and community clubs. This made the field testing process more attractive, practical and efficient for busy educators, and demonstrated how the modules could be integrated into existing programming.

The development and field testing process was funded by the New York State Departments of Health and Environmental Conservation. We would like to take this opportunity to share our process and results with Ribbon readers, as we believe we have created and carried out an efficient and replicable evaluation of materials, that provided rich and useful feedback. We thank our field testers!

Overall Results: A First Look A total of 630 participants attended presentations at 57 sites spanning 23 counties (see map on next page). We collected 536 quantitative participant evaluations and 429 forms providing qualitative feedback from participants.

In-depth qualitative data from facilitators and participants was more important to this process evaluation than large participant numbers, so we set modest goals for numbers of participants. We received detailed feedback from facilitators for every presentation, and met our participant goal with three of the modules.

Just a few items characterizing overall results include:

We have a wealth of information from participants, who offered comments such as:

"I learned safety precautions and alternatives for household chemicals."

"[I think differently about] how I look [at] nutrition. I was reminded of the strong link between nutrition and exercise. [The facilitator] made me remember that diet and exercise need not be painful and can be a great motivator for girls."

"Great ideas for my family and my students."

Likewise for facilitators, who were very generous with their time in describing their thoughts about the materials:

"Healthy eating and exercise components went well. Need to be reinforced because they are much lacking in our rural community."

"[I] definitely would give out the BCERF handouts.... Actually I would do everything as the program states. I thought it was a great program."

"This group received well the [information] about the puzzle of breast cancer. I would like the puzzle blown up, perhaps in color, to make a great instructional tool."

"My Attitudes Inventory generated some excellent discussion.... [A] great tool to initiate a discussion and get the group comfortable."

Module by Module: What Did We Learn?

Talking About Pesticides at Home and in the Neighborhood and Talking About Pesticides With Your Customers are two parts of a module aimed at helping landscape professionals and their customers communicate more effectively about pesticide use in home landscaping. Either the public or the professional part of this module was tested in Tompkins, Dutchess, Wayne, Orleans, Orange, Ontario, Yates, Schenectady and Albany counties. Public audiences included many Master Gardeners, while farmers and local nursery association leaders were among participants in the professional presentation. Most presentations took place at the CCE office, and a popular one was held in a local restaurant. This module is based on a slide show.

More facilitators chose to offer the public program rather than the professional program. We realized that this is because certified pesticide applicator training is a very specific responsibility of certain extension educators, many of whom did not learn of this field test. Through other activities we know with certainty that the type of material in Talking About Pesticides is relevant and appropriate to recertification training, and we will need to produce and market the professional part of the module accordingly. Facilitators had a range of success with this module, from very strong and positive programs, to less successful ones, with most being fairly strong. We are working closely with the NYS IPM program in analyzing results in order to produce the module in a way that works best for educators. Educators are very clear about the need for this type of programming in communities. The communication issues, the legal issues, and label-reading were all areas considered critical. Many participants and facilitators want to see more elaboration on the connection between pesticides and breast cancer, or health in general, integrated into this module. (See Pieces of the Puzzle below, an adaptation of which will be included in any Tool Kit order.)

Talking Around the Table: Chemicals in the Home is aimed at helping low income families identify, use, and store chemicals safely in their homes and gardens. This module was presented in Suffolk, Rockland, Greene, Westchester and Tioga counties. Audiences for the field test included EFNEP groups in several counties, a parenting group in Rockland County and residents of a Suffolk county shelter for battered women.

Feedback from this module is characterized by the overwhelming concern that women - even in difficult life circumstances - have about chemicals in their immediate environments. In every session, questions arose about the range of possible chemical exposures, and what could be done to reduce risk. Facilitators liked the teaching tools we included, but hoped for larger, more colorful versions of the visual aides, as well as other types of "giveaways" to help teach and remind in the home. Facilitators also looked for more background learning material for themselves. Many participants and facilitators were interested in alternatives to strong cleaning chemicals, and many inquired about any link between chemicals in the home and childhood asthma.

Pieces of the Puzzle: Putting It All Together for Breast Health is aimed at helping rural women to adopt practical breast cancer risk reduction strategies. Pieces of the Puzzle was field tested in Chautauqua, Wyoming, Yates, Herkimer and St. Lawrence counties. Groups included Fire Hall Ladies' Auxiliaries in Chautauqua county and a choral club in Wyoming county, as well as grassroots health promoters, and two shifts at a Kraft's Foods plant in St. Lawrence county.

Pieces of the Puzzle provides the core information on breast cancer risk factors for the Tool Kit. Facilitators were successful in using this module with groups of rural women. Participants liked the craft projects that reinforced the teaching messages, including the 4Es for breast health (eating, exposure, exercise and exams). We have decided to feature this "core"curriculum in all Tool Kit orders; in other words, when any module is ordered, a copy of this core curriculum will be included. Educators can choose to use it for their own background, or to teach it as part of their program.

Making the Connection: Breast Cancer Risk Reduction in Health Settings includes tools for creative integration of breast cancer risk reduction messages in community health care and breast cancer screening settings, especially in rural areas. Making the Connection was tested in Delaware, Yates, St. Lawrence, Herkimer and Steuben. Groups included health clinic and hospital staff (nurses, nurse practitioners and physician's assistants, and physicians) in Yates, Delaware and Herkimer counties, nursing students in St. Lawrence, and the Steuben County Wellness coalition of health educators and promoters.

Participants were enthusiastic about applying the new content on risk reduction to their work. They shared their own ways of integrating educational messages into these settings, and developed or reinforced community health networks in their regions. Because of the important and often untapped relationship between providing screening services and education about risk reduction at the same time, BCERF hopes to greatly expand initiatives in this area.

Growing Healthy Girls was presented as a three-part series of workshops for adult women youth leaders working with preadolescent girls, aimed at strengthening leader skills at modeling healthful behaviors for breast cancer risk reduction. The program features a unique approach: asking participants to look at their own attitudes and how they affect the girls in their lives. Participants have the opportunity to practice activities they can use in influencing girls and addressing body image issues, as well as physical and nutrition activities. This module was tested in Wyoming, Nassau, Erie and Ulster counties. Most field test sessions were held at the CCE offices. Audiences varied widely, from 4H leaders to nutritionists to teachers to parents. One Nassau county group was held at a literacy project office.

Growing Healthy Girlstargets youth leaders as important facilitators of breast cancer risk reduction for two groups: themselves and the girls for whom they serve as role models. Participants were enthusiastic about the program's empowerment approach and requested more discussion time and physical activities. Many raised concerns about eating disorders and how to best work with girls on these sensitive issues. Facilitators recommended reformatting the curriculum for maximum flexibility so it could better meet varied program and audience needs. They also suggested providing a resource guide for themselves and participants, and expanding the audience to include parents. The field test confirmed BCERF's concern that many women are less than comfortable leading physical activities and addressing the social-emotional issues that relate to nutrition, but are eager for practical tools in these areas. It also suggests that the Tool Kit's flexible, varied-format approach is the right direction to go, and that the added dimensions of videos, tip sheets and resource tools will be put to good use.

How We Gathered the Information

We developed and utilized four evaluation instruments for each of the five modules. The four instruments, designed for efficiency, effectiveness and thoroughness, provided us a complete, multi-dimensional picture of each event, even without BCERF staff being there.

The Facilitator's Pre-Session Overview ensured that the field tester had thought through various aspects of the program before carrying it out.

The Facilitator's Post-Session Feedback was described to field testers as "the single most important source of information about how well the program works." It assessed a wide range of aspects of the session, including:

The Participant Evaluation quantitatively measured the degree to which participants found the module informative and valuable on a 5-point scale ("Strongly Disagree" to "Strongly Agree"). Eight of the nine quantitative questions had a common "root question" to allow for later comparison across modules. Optional qualitative questions explored motivation to attend and gathered demographics on rural lifestyle and ethnicity.

Participant Feedback questions, offered in either oral or written form, asked for specific input from participants on what worked, what didn't, and how to improve the program. In addition to these four instruments, a Materials Evaluation form was developed specifically for Pieces of the Puzzle and Making the Connection. It allowed facilitators to evaluate the supporting BCERF materials, such as "4Es" posters.

Where We Go From Here

Final editing, design and production are underway, with completion expected in early 2002, in time for a satellite conference tentatively scheduled for April. The goal of this satellite conference will be to increase the ability of community educators nationwide to bring up-to-date breast cancer risk reduction programming into their communities. We hope that participants will come away from the satellite conference with new, science-based knowledge, informed and eager to use all or part of the Tool Kit, and with new community connections as a result of coming together to view the conference.

This will be BCERF's first satellite conference since 1997, and it will reflect changes in the technology that have occurred since then. For example, a supporting web site will offer efficient registration, downloadable materials, and communication with presenters and other participants. Please watch for more information on BCERF Tool Kit availability and satellite conference scheduling.

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Last Update 10.05.01