Project Summary Breast cancer (BC) is the most common cancer among women worldwide and has profound implications for the well-being of women and their families. In sub-Saharan Africa, BC incidence is rising, late presentation is common, younger women are disproportionately affected, and survival rates are low. One of the Government of Ghana’s top strategies to combat BC is early detection through routine screening, yet screening rates are low. Our multidisciplinary team has designed two interventions to surmount three key sociocultural and economic barriers and increase the utilization of BC screening, including (1) time and transportation costs, (2) cultural beliefs and stigma, and (3) male dominance in decision-making and lack of social support for women. The BUNDLING intervention offers women BC and diabetes education followed by BC and type II diabetes screenings during the same visit to the local clinic. Provision of simultaneous (bundled) screenings is hypothesized to increase BC screening through several mechanisms, including reducing time/transportation costs and diluting the stigma of seeking BC screening on its own. The MEGH (Male Engagement in Gender and Health) Program offers BC education to women and their male partners, invites partners to 7 weekly discussion group sessions (5 men-only and 2 women and men), and subsequently offers women BC screening at the local clinic. The MEGH Program is hypothesized to increase BC screening through several mechanisms, including changing men’s gender attitudes, increasing women’s control over decision-making, and increasing men’s social support. Our long-term goal is to test the effectiveness of these interventions in a future clustered RCT. The overall goal of the proposed R21 project is to finalize the design and implementation aspects for the future RCT in a feasibility study. The specific aims are: (1) Refine study materials (education materials, MEGH Program curriculum, data collection instruments) for cultural relevance and implementation. We consult with an expert advisory committee and a local committee in an iterative process. (2) Determine the feasibility of the two interventions using sequential mixed methods. We assess the interventions in three clinic zones (2 interventions + a control) with women age 20+ (and male partners in the MEGH group). We conduct baseline and endline surveys, followed by qualitative in-depth interviews. (2A) Establish feasibility based on recruitment, retention, and acceptability. (2B) Assess initial evidence of efficacy and intervention fidelity, and clarify these findings through participants’ insights from follow-on in-depth interviews. We assess the strengths and weaknesses of the interventions, challenges to intervention fidelity, and implementation approaches. (2C) Examine initial evidence of the effect of interventions on the mechanisms, and clarify these findings through participants’ insights. (2D) Finalize the protocol for the future clustered RCT using study findings. These new interventions tackle key barriers to improving a critical health behavior—BC screening—for women. The study will generate a prototype for addressing the high incidence of BC in low-income settings.

Project Narrative The proposed study will assess the feasibility of two novel interventions to tackle important sociocultural and economic barriers to the utilization of routine breast cancer screening by women. In doing so, this study will inform efforts to improve a critical health behavior for women and generate a prototype for addressing the high incidence of breast cancer in low-income settings.