Co-Producing the Design Brief for an Intervention to Increase Breast Cancer Awareness Among Black Women in Ante-Natal Settings: A Qualitative Study With Breast Cancer Survivors, Community Members, and Midwives in the UK

Abstract

Background

Women of Black African/Caribbean heritage in the UK are more likely to develop breast cancer at an early age (before being eligible for breast screening from 50 years of age), be diagnosed with advanced breast cancer, and have lower survival than White British women. Culturally acceptable interventions are needed to encourage timely symptomatic presentation.

Objective

Using the Behaviour Change Wheel (BCW) stages of intervention development, we developed the design brief for an intervention to be delivered in ante-natal settings to Black women not yet eligible for breast cancer screening.

Design/Methods

Four co-production sessions with 14 women: 4 with a history of breast cancer, 5, without, and 5 healthcare professionals (4 midwives and 1 public health apprentice). One Patient and Public Involvement (PPI) representative of Black African & White heritage helped facilitate the sessions. The data were analysed deductively using Template Analysis and the themes were mapped onto the BCW stages and steps of intervention development.

Results and Discussion

The participants agreed that the key behaviour to address is timely help-seeking for breast changes indicative of breast cancer. It was agreed the intervention should have three main functions: education, that is, increase Black women's knowledge of breast cancer symptoms (psychological capability), training, that is, teach breast self-checks (physical capability), and persuasion, that is, convince that a breast cancer diagnosis is not a death sentence and increase intentions to seek timely help (reflective motivation).

Conclusion

Delivering breast cancer education in ante-natal settings was seen as acceptable and feasible by the co-production participants. Further feasibility and acceptability testing is needed.

Patient or Public Contribution

A female breast cancer survivor of mixed Black African and White heritage was involved as PPI representative during the project. She advised on the draft funding application, the ethics documents, and the planning of each co-production session. She helped recruit participants, facilitated the co-production sessions, provided feedback on the interpretation of the findings, and reviewed and edited the manuscript draft.