Prostate Cancer and Psychosocial Concerns in African American Men: Literature Synthesis and Recommendations

Pierce, Robert, Chadiha, Letha A., Vargas, Amy, Mosley, Muriel, Health and Social Work

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African American men have the highest prostate cancer rates in the world, and more die from the disease than men from other racial or ethnic groups (Parker, Johnston Davis, Wingo, Ries, & Heath, 1998). Data from the National Cancer Institute's Surveillance, Epidemiology and End Results Project show that African American prostate cancer patients have higher age-adjusted incidence and mortality rates than white, Hispanic, and Asian and Pacific Islander patients with the disease (Wingo, Ries, Rosenberg, Miller, & Edwards, 1998). Moreover, between 1990 and 1995 the age-adjusted (to the 1970 U.S. standard 100,000 population) incidence of prostate cancer among these groups was 220.3 for African Americans 153.5 for white men, 106.7 for Hispanics, and 91.3 for Asian and Pacific Islanders. Mortality rates from prostate cancer for the same five-year period per 100,000 population were 66.0 for African Americans, 24.1 for white men, 16.6 for Hispanics, and 11.1 for Asian and Pacific Islanders (Wingo et al., 1998). Despite improvements in diagnosis and treatment, these data indicate that African Americans have yet to realize noticeable gains in prostate cancer survival (Clayton & Byrd, 1993).

The observed racial disparity and the psychosocial concerns of African American prostate cancer patients are addressed in literature on cancer screening, prevention, risk factors, knowledge, beliefs, barriers, and facilitators to cancer screening (Abbott, Taylor, & Barber, 1998; Chodak, 1996; Demark-Wahnefried et al., 1995; Myers, Wolf, Balshem, Ross, & Chodak, 1994; Myers et al., 1996; Ndubuisi, Kofie, Andoh, & Schwartz, 1995; Weinrich, 1998). Given their greater susceptibility and the disproportionate burden that prostate cancer places on African American men and their families, why is so little heard from social workers about the psychosocial concerns of these men and their families? Like all men with prostate cancer, African Americans also agonize over the physical and emotional effects of the disease. Other psychosocial concerns African Americans must contend with include background characteristics (for example, race, location, socio-economic status, family history, and medical history), attitudes and beliefs about cancer (for example, risk, severity, screening and testing, and treatment), social support from family and church, family caregiving issues, religious coping, motivations for engaging in preventive health behavior, acquisition of and exposure to educational and informational programs, and help-seeking behaviors (Myers, 1999; Myers et al., 1994, 1996; Plowden, 1999; Sharp, 1993).

Although prostate cancer is a serious threat to them, African American men are highly underrepresented in clinical trials. Robinson, Ashley, and Haynes (1996), in a focus group study of African American men, found them less willing to participate in clinical trials when they were of lower socioeconomic background and distrusted the medical establishment. On the other hand, if they knew a professional, such as a doctor or researcher, who was deemed competent and compassionate and referred men to participate, then the men were more willing to participate in clinical trials. Social workers in health care settings are in an ideal position to communicate the facts about prostate cancer and psychosocial concerns and pursue a more active role in designing and implementing effective interventions for African American men.

The purpose of this article is to increase understanding of prostate cancer and the accompanying psychosocial concerns of African American men. We reviewed and synthesized literature on prostate cancer and psychosocial concerns in African American men. We present an overview of the Health Belief Model and prostate cancer literature supporting the model.

HEALTH BELIEF MODEL

The Health Belief Model (HBM; Rosenstock, 1960) provides a useful theoretical framework for understanding and predicting the health-related behaviors of African Americans with prostate cancer (Myers, 1999; Plowden, 1999). An underlying assumption of the HBM is that understanding an individual's motivation to engage or not engage in certain health-related behaviors will help determine the individual's pattern of preventive health practices (Rosenstock; Strecher & Rosenstock, 1997). Five dimensions of the HBM can help explain what motivates African Americans with prostate cancer to engage or not engage in health-related behaviors (Plowden): (1) perceived susceptibility (that is, the person's beliefs and attitudes about contracting the illness); (2) perceived severity (that is, the person's assessment of the seriousness of having the illness or not having treatment for the illness); (3) perceived benefits (that is, the person's assessment of the positive outcomes of seeking treatment for the illness); (4) perceived barriers (that is, factors that impede a person's motivation to engage in health-related practices); and (5) prompts to take action (that is, internal and external triggers that stimulate an individual to change his or her behavior for more positive outcomes.

A number of researchers consider the HBM the most influential and empirically based theory of motivation for understanding health-related behaviors (Damrosch, 1991; Myers, 1999; Plowden, 1999). However, some claim the original model is limited for addressing such psychosocial concerns as attitudes and beliefs about illness, economic and cultural factors, and the role of the social network of family and peers in illness or disease (Damrosch). Addressing these issues is important in achieving a fuller understanding of African American men's health-related behaviors. Even with limitations the HBM is a useful framework for understanding motivations, global attitudes, and beliefs underlying a person's health-related behaviors. Studies that address psychosocial concerns, such as the attitudes, beliefs, social support, coping, and psychological distress for African American prostate cancer patients, help to overcome the weakness of the original HBM (Germino et al., 1998; Myers et al., 1994, 1996; Tingen, Weinrich, Heydt, Boyd, & Weinrich, 1998; Underwood, 1991).

LITERATURE RELATING TO HBM MODEL

The discussion in this article builds and expands on work by Plowden (1999) on the HBM, integrating psychosocial literature on African American can prostate cancer patients with theoretical and empirical literature on the HBM. This integration of literature can yield greater insights into prostate cancer and accompanying psychosocial concerns in African American men.

Perceived Susceptibility

Perceived susceptibility is the individual's attitudes and beliefs about the risk of acquiring an illness or disease (Rosenstock, 1960). With regard to psychosocial concerns in African …

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Publication information: Article title: Prostate Cancer and Psychosocial Concerns in African American Men: Literature Synthesis and Recommendations. Contributors: Pierce, Robert - Author, Chadiha, Letha A. - Author, Vargas, Amy - Author, Mosley, Muriel - Author. Journal title: Health and Social Work. Volume: 28. Issue: 4 Publication date: November 2003. Page number: 302+. © 1999 National Association of Social Workers. COPYRIGHT 2003 Gale Group.

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