Background: Each year, breast cancer kills more than 500,000 women worldwide (World Health Organization [WHO], 2016). In resource-poor settings, most are diagnosed at an advanced stage, with survival rates ranging from 10% to 40% (WHO, 2016). This contrasts sharply with settings in which early detection and basic treatment are available and accessible, with survival rates for early-stage breast cancer above 80% (WHO, 2016). This research investigates a method for improving these outcomes in both settings by sharing the success of the first global breast cancer awareness campaign and educational materials to help patients identify symptoms earlier. We ask, “How can nurse navigators better educate disparate populations about breast health and cancer screening at home and abroad?”
Objectives: 1) Help a diverse global and local population understand the symptoms of breast cancer through the use of a familiar metaphor, 2) overcome literacy issues by teaching through visuals rather than text descriptions, and 3) use friendly imagery to engage audiences and avoid censorship issues associated with breasts.
Methods: A patient-centered “U.S.E.R. Design Thinking Framework” (Beaumont, 2011), which was a mixed method of action research, iterative prototyping, interviews, and co-creative methods to identify problems and develop solutions within the health system, was used to develop the materials for a multilingual audience. User testing and patient surveys identified communication accuracy as the visuals were tested prior to deployment.
Results: Survey (n = 255) revealed that 51% of patients didn’t know what a cancerous lump felt like. Communication barriers were connected to negative emotions such as fear of cancer, disinterest, taboos associated with displaying breasts, and low literacy. Knowing this, a visual metaphor was developed as a stand-in for the breast (a friendly lemon) to avoid fear, taboo, and communicate without an overdependence on text while more effectively engaging the public. The educational materials illustrated cancer symptoms, information about palpability, and breast anatomy in relation to breast self-exam and the diagnostic pathway. Patient testing (n = 36) with the materials showed the visuals increased accurate tactile knowledge for breast self-exam (86%) compared with a traditional illustration (15%), and reported patient confidence in recognizing signs of breast cancer was high (89%). Further testing (n = 67) revealed that people could accurately identify most of the visual symptoms without a text label, making it a valuable teaching tool for low-literacy audiences.
Conclusions: Results show that visual metaphors likely have a strong impact on informing the public about breast cancer symptoms more effectively than traditional text-based methods. A more accurate tactile knowledge and understanding of visual signs of breast cancer could lead to decreased mortality rates by improving early reporting of symptoms in the United States and worldwide. Nurse navigators could use these materials to educate patients and promote breast cancer awareness in their local communities to reach disparate populations more effectively without having to use multiple sets of materials to reach multiple audiences.
Note: This was presented as an electronic poster at ONS 2016.