Posted 9/11/2008

Seed grant from Arnold School’s Office of Research funded study, additional research planned

Daniela Friedman

Arnold School researcher Dr. Daniela B. Friedman is the 2008 winner of the James G. Zimmer New Investigator Research Award from the Gerontological Health Section of the American Public Health Association.

Friedman, an assistant professor in the Arnold School’s Department of Health Promotion, Education and Behavior, will receive the award and present her research at the APHA’s annual meeting in October in San Diego.

A seed grant from the Arnold School’s Office of Research funded Friedman’s formative research on African-American men’s knowledge about prostate cancer and innovative strategies for delivery of prostate cancer messages to African-Americans.

Prostate cancer is the most commonly diagnosed cancer among men. African-American men in South Carolina experience the highest mortality from prostate cancer in the United States.

Additional research team members were co-investigator Dr. Sara Corwin and doctoral graduate students Gregory Dominick and India Rose, all from HPEB.

The Zimmer Award recognizes “new investigators” - researchers who are within three years of completing a doctoral degree. Criteria for selection from a national pool of applicants include the importance of the research topic, the rigor of design, quality of writing, and potential benefit to the field of aging and public health.

The award-winning project, “What do Older African-American Men Really Think about Prostate Cancer? A Comprehensive Analysis Using a Health Literacy Framework,” involved 25 Black men from the Columbia area.

When asked about the health literacy framework, Friedman explained, “Some research on health literacy focuses on basic functional health literacy or the ability to read and understand health care information. But being health literate does not only require skills needed to read an American Cancer Society brochure you may pick up at a health fair. It also involves being able to search for, access, and apply the information from that brochure to influence healthy behaviors and improve health outcomes.”

This study used Don Nutbeam's broader definition of health literacy. According to Nutbeam, there are three forms of health literacy: (1) functional health literacy (being able to read and understand information), (2) interactive health literacy (having skills to search for health information and care), and (3) critical health literacy (having the capacity to use health information and be empowered to engage in healthy behaviors).

Study findings showed that participants had low to adequate functional health literacy according to two written literacy instruments (Shortened Test of Functional Health Literacy in Adults and a multiple-choice Cloze test). Results from in-depth interviews and focus groups showed that the men had even poorer interactive and critical health literacy skills. They had never actively sought out prostate cancer resources and they had misconceptions about prostate cancer risk.

Themes related to limited critical health literacy revealed important recommendations for the effective promotion and delivery of cancer prevention messages in African-American communities. Several men said they wanted to learn, in the near future, how to educate or “spread the word” about prostate cancer to family members and close friends as long as the messages were clear and easy to understand. They volunteered to be the messengers. While they requested information that was culturally specific and that targeted older Black men, having timely, accurate, and straightforward information was more of a priority for them.

Many participants also voiced that an effective communication strategy would be to tell women about prostate cancer. They said, “Tell our wives. Tell our partners. Tell the women at church. We will learn about it from the women.”

The men expressed multiple barriers to learning more about cancer: embarrassment, fear of being perceived as weak, and limited family communication about the disease. Friedman said, “The seed grant afforded us the opportunity to develop a preliminary framework so we can begin to address current barriers to successful prostate cancer communication with African-American men. We cannot ignore these barriers if our goal is for cancer messages to reach and impact high risk populations. That is indeed our goal.”

The study’s graduate students have already presented the study through academic presentations at USC in recent months.

Dominick gave an oral presentation at the S.C. Public Health Association meeting in May and Rose presented a poster as part of the James E. Clyburn Health Disparities Lecture Series in April. Her poster received second prize in the Health Sciences and Policy category at USC Graduate Student Day.

As for the future of the study, Friedman said, “We need to keep the momentum going and continue our cancer communication efforts with this community. We have been dedicated to dissemination of our findings. Next we will apply for external funding to expand on this informative pilot work.” She said the research team is considering a cancer communication and literacy intervention which involves both African-American men and women.

Friedman completed a bachelor’s degree in biology and psychology at McMaster University and a masters of Science and doctorate in Health Studies and Gerontology at the University of Waterloo in Canada.

Her research on the scope and difficulty level of cancer prevention messages in seniors’ print media and on older adults’ comprehension of cancer information in the media earned her the APHA Gerontological Health Retirement Research Foundation Graduate Student Research Award in 2002.

The APHA is the largest organization of public health professionals in the world, representing more than 50,000 members from more than 50 occupations of public health.

The Gerontological Health Section of the APHA includes more than 600 members. The mission of the Section is to stimulate public health actions to improve the health, functioning, and quality of life of older persons and to call attention to their health care needs. Friedman was recently elected to a Councilor position within the Gerontological Health Section.