Practical Guidelines for African Americans : 6.0 Developing Culturally Sensitive Materials

6.0 Developing Culturally Sensitive Printed Cancer Education Materials
for African Americans

Information about the audience must be organized into an appropriate format so that the cancer prevention message can get to the audience. Four main content and assessment areas guide the organization of information about the audience in developing printed cancer education materials for African Americans. These content and assessment areas include written message, visual message, format, and language.

Message/Content

In general, message refers to the underlying theme or idea in the printed cancer education material. The written message relates to the content of information based on the way the printed cancer education material is worded. It comprises several particular concepts:

legibility/clarity - Is the information understandable/readable?
accuracy - Is the information correct? Does the information represent the audience? Does the information overstate/understate the problem?
effectiveness - Is the material informative? Is the information useful? Is the amount of information provided adequate?
interest - Is the information presented in an interesting way? Is the information itself interesting?
offense - Is the information offensive to the audience? Is the information negatively presented?
promotion of particular behavior - Does the information cause the audience to seek [avoid] health care? Does the information remove [invoke] fear and or apathy in the audience?
documentation - Are sources cited correctly?

Printed cancer education materials should be designed to deliver the correct message using simple words and terms that are familiar to the audience. If technical jargon or unfamiliar words are used, they should be defined in the printed cancer education material.

Printed cancer education materials should be written at a fourth or fifth grade level to reach a greater segment of the audience. Specific readability tests such as the SMOG test can be used to determine the reading comprehension level of the printed cancer education material. The use of wordy sentences and offensive and stereotypical language in printed cancer education materials should be avoided. Instead, slogans and dialects congruent with those of the audience should be used to deliver the message.

Below are statements related to the written message that you should consider when designing printed cancer education materials for African Americans. You should seek a positive response to the statements that ranges from strongly agree to strongly disagree. For example, you Strongly Agree, Agree, Disagree, Strongly Disagree that:

the medical terms are understandable to African Americans,
the words, phrases, and expressions are free from stereotypical meaning, and
the message(s) addresses stereotypes and myth.

Avoid using slang or out-dated terminology in the written message that might be offensive to African Americans. As well, avoid portraying African Americans as victims of cancer. Terms to avoid include:

"Boy" when you mean "Man"

"Negro" when you mean "African-American"

"Targeting" when you mean "Intended for"

Visuals/Graphics/Presentation

Similar to the written message, the visual message refers to the underlying theme or idea delivered through graphic components in the printed cancer education material. Here, graphic refers to any visual representation (other than text) used to convey an idea or present information (e.g., pictures, charts, and diagrams). The visual message comprises several concepts related to the written message:

legibility/clarity - Is the graphic understandable/readable?
accuracy - Is the graphic correct? Does the graphic represent the audience? Does the graphic overstate/understate the problem?
effectiveness - Is the material informative? Is the graphic useful? Is the amount of information provided in the graphic adequate?
interest - Is the graphic presented in an interesting way?
offense - Is the graphic offensive to the audience? Is the information in the graphic negatively presented?
promotion of particular behavior - Does the information cause the audience to seek [avoid] health care? Does the information remove [invoke] fear and or apathy in the audience?
documentation - Are sources cited correctly?
backgrounds - Are the backgrounds effective in getting the message across?

Visuals can be used in printed cancer education materials, but it is important to understand how these visuals impact the learning and communication process of the audience. Visuals should be used to reinforce the message and enhance the learning process.

Several types of visuals can be used. These include photographs, illustrations, fotonovelas, cartoons, graphs, and line drawings. Use visual types, colors, people, objects, and settings that are familiar to the culture. If pictures are used, make sure they realistically portray the audience. Portrayals should reflect a diversity in hair texture, color, and length and in clothes, skin color, anatomy, facial expressions and familiar activities, images, and symbols. Pictures, shades of color, types of activities, and so on should accurately represent the audience. For example, demonstrations, such as of breast self-exams, should include persons that are representative of the audience and not generic, featureless persons. Format visuals so that they are easily understandable to the audience.

Below are statements related to the visual message that you should consider when designing printed cancer education materials for African Americans. You should seek a positive response to the statements that ranges from strongly agree to strongly disagree. For example, you Strongly Agree, Agree, Disagree, or Strongly Disagree that:

The graphics illustrate contemporary activities of African Americans.
The graphics are clear.
The hair colors are representative of African Americans.
The hair textures are representative of African Americans.
Customs portrayed are representative of African Americans.

Some of the stereotypes and biases that must be eliminated in printed cancer education materials for African Americans are:

Pictures of African Americans and watermelons;
African-American women displayed in subservient roles;
Distortion and omission of critical incidents in the lives of African Americans;
An unrealistic portrayal of life styles, such as the "ghettorization" and non-ghettorization images of the "Good Times" and "The Jeffersons" television sitcoms; and
Images that do not portray accurate representations of skin tones, hair texture, and physical features.

Language

Language encompasses the words, phrases, and modes of written and oral communication the audience uses. Language used in printed cancer education materials should be carefully selected so that it is congruent to the cultural language preferred by the audience. This congruence increases the degree to which the audience is able to read, comprehend, and accept the intended message. Language, a non-static entity, should be evaluated constantly so that it is appropriate for the culture. Steps to take when developing the text in printed cancer education materials include the following:

Understand how the culture expresses symptoms and uses words, phrases, and medical terminology. Words, phrases, and medical terminology may carry different meanings in different cultures. Choose words and phrases familiar to the audience and easily identifiable to the audience.

Example: "The blood disease" is used by some African Americans to refer to cancer.
Use specific nouns/pronouns to identify the audience.

Examples:
1. "You can get information about breast self-exams by calling..."
2. "African-American men die from prostate cancer more than any other group."
Use appropriate positive or negative language. Choose phrases that will elicit the desired behavioral response.

Examples: "It is important to have regular check-ups to increase your chances of detecting cancer in the early stages of the disease."

Printed cancer education materials are most effective at promoting positive behavior change when the audience is able to easily understand the information delivered in them. In terms of language, it is important to determine how African Americans communicate their health concerns related to cancer.

Many printed cancer education materials for African Americans were reviewed during the Cancer Prevention Materials for African Americans project. Below are a couple examples of culturally sensitive printed cancer education materials developed by the Texas Southern University Minority Cancer Education Center.

The printed cancer education materials were used with the consent
of the developers at the Texas Southern University Minority Cancer Education Center.