Open community meetings were held in four districts of the Apsáalooke reservation in May 2002.  The purpose of the meetings was to:

1. introduce the Messengers for Health program,
2. report on results of a cervical health community survey done with 100 women,
3. recruit women to be Messengers, and
4. evaluate existing cervical health educational materials.

This web page will focus on the fourth goal.

 Purpose of educational material evaluation

The purpose of the educational material evaluation was to understand what women liked and didn’t like in existing printed cervical health educational materials. We took this information and developed a Crow-specific cervical health pamphlet. We wanted to develop a pamphlet that Crow women would pick up, read, and understand.

How we did this evaluation

Existing cervical health education materials developed for Native American women were acquired from  other Native American cervical health programs and from the Mayo Clinic Native C.I.R.C.L.E (Cancer Information Resource Center and Learning Exchange) . The Native C.I.R.C.L.E. is a resource center providing cancer-related materials to healthcare professionals and lay people involved in the education, care and treatment of American Indians and Alaska Natives.  During the community meetings, staff members sat with groups of 4-8 women.  A set of educational materials was given to each small group.  Women were asked to look over the materials and comment on what they liked and disliked about them.  Staff members took detailed notes during the meeting regarding what was shared by the group members.  After the meetings were completed, staff members filled in any gaps in their field notes. Notes were also taken on non-verbal communication.  Probing was used to elicit detailed information on what women liked and disliked about:

               Type of information

               Specific sayings/wording

               Font

               Graphics/pictures (e.g. type, amount)

               Amount of text

               Size (e.g. letter size, legal size, bi-fold, tri-fold)

               Use of Native language

               Color

What we learned 

           The results consist of the feedback received during the community meetings regarding the educational materials. Comments across the four community sites were similar. Following are some of the comments that were repeatedly conveyed by women in the meetings:

               Women liked the sayings “The Path for Health” and “Women are the Backbone of the Family” but the saying should be changed to make them specific to Crow women.

               The response to anatomy pictures was positive. It was thought that older women or those not able to read will be able to see pictures.

               Women liked the photo of a young woman in an Elk Tooth dress because she was a Native woman who was dressed in traditional Crow style (see pamphlet-The Pap Test and Abnormal Test Results).

               Women wanted to see a photograph of several generations of women on the front. The women should be dressed traditionally.

               Women preferred photographs on the front of the brochure compared to drawings.

               Women did not like drawings showing medical procedures (i.e., Pap test procedure).

               Medical terms need to be written showing the correct pronunciation of the word.

               Women perceived the information on the pamphlets as important for all women, especially the information concerning what to do if results of a Pap test were abnormal.

               Women liked that good health was stressed. It was a positive view of health.

               Women liked page borders but wanted a Crow style design.

               The language preference for the brochure was English with a few Crow words interspersed.  The women agreed that most people speak the Crow language but often cannot read it.

               Women did not like pamphlets that were full of writing. They liked pamphlets that had some white space. They did not want to be overloaded with information.

               Women did not want the words “cancer” or “abnormal” or “Pap/Pap test/Pap smear”  or “cervix/cervical” on the front of a brochure.

               The pamphlet from Alaska and the unfolded handouts were not picked up by many women.

               Women were also interested in information on breast cancer.

               Women preferred age appropriate materials.

               Women felt it was important and were proud to be involved in decisions on educational materials that   were going to be used in their community.

Conclusions

The results of the educational material evaluation  lead to several conclusions.  First, this method and results support the necessity of utilizing a community-based participatory model in order to gain community support and enthusiasm for promoting cervical health.  Women had strong and similar opinions on educational materials that would be read and respected versus those that would likely be ignored.  Second, through community meetings and the evaluation of materials women made decisions that would affect their community rather than having decisions made for them.  This method of community participation has been found effective for interventions conducted with Native American communities in that it empowers people in these communities to make decisions relevant to their needs.  Third, the involvement of Crow women in project decisions will enable the Messengers for Health program to be more effective in reaching women about the risk factors and prevention of cervical cancer.