Robert Pierce, Letha A. Chadiha, Amy Vargas, and Muriel Mosley
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. Because the social work
literature has little information on
prostate cancer in African American
men, the authors have synthesized the
literature on prostate cancer and
psychosocial concerns in African
American men. They used the Health
Belief Model as a framework to help
explain, understand, and predict
African American men’s preventive
health-related behaviors. The authors
make recommendations for social work
practice and research.
Key words
African American men
Health Belief Model
prostate cancer
A frican 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
303 Prostate Cancer and Psychosocial Concerns in African American Men
Americans must contend with include background
characteristics (for example, race, location, socioeconomic
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
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 American prostate
304 Health & Social Work / Volume 28, Number 4 / November 2003
cancer patients, background and lifestyle factors
such as age, race and ethnicity, family history, and
diet are known risk factors (Plowden, 1999). Being
an African American man below 50 with a family
history of prostate cancer and eating food high
in fat content are other risk factors for prostate
cancer (American Cancer Society, 1998; Demark-
Wahnefried et al., 1995; Powell, Gelfand,
Parzuchowski, Heilbrun, & Franklin, 1995). Although
men over age 60 are more likely to be diagnosed
with prostate cancer than men under age
60, African Americans are more likely to be diagnosed
at a much younger age than men from other
racial and ethnic groups (Wingo et al., 1998). Even
controlling for socioeconomic status, African
American men are at greater risk of being diagnosed
at a much earlier age and with late or more
advanced stages of prostate cancer than non–African
American men (Parker et al., 1998). Abrams
and colleagues (1990) suggested that the age or developmental
stage of the person at diagnosis may
be the single most important psychosocial determinant
in how a person reacts to cancer. For example,
the emotional responses of a younger man
with a family and young children to prostate cancer
may be quite different from those of an elderly
man with a family and adult children.
Being an African American man
below 50 with a family history
of prostate cancer and eating
food high in fat content are other
risk factors for prostate cancer.
Early detection and prompt treatment are essential
to controlling prostate cancer (Robinson et
al., 1996). Literature on early cancer detection and
risk reduction suggests that increasing knowledge
and awareness about prostate cancer is essential to
reducing cancer risk in African American men
(Smith, DeHaven, Grundig, & Wilson, 1997). Smith
and colleagues studied 556 African American men
over age 40 and found that they had limited knowledge
about risk factors for prostate cancer. Only
42.2 percent knew that family history was a cancer
risk factor; only 30 percent knew that race was a
risk factor. If a family member had cancer and men
had a regular doctor, they were more knowledgeable
about prostate cancer risks. If men reported
low education and low incomes, they were less
knowledgeable about prostate cancer risks. Other
studies support findings about risk factors and
knowledge among African American men with
prostate cancer (Myers et al., 1996; Smith et al.,
1997). For example, even though African American
men perceived the risk of prostate cancer as
being high for other same-race men, they tended
to rate their personal risk as lower (Myers et al.,
1996).
Perceived Severity
Actions that an individual takes to engage in healthrelated
behaviors is influenced by the individual’s
perceived seriousness of acquiring an illness or
leaving it untreated (Damrosch, 1991; Plowden,
1999; Strecher & Rosenstock, 1997). More specifically,
perceived severity is the extent to which an
individual evaluates the consequences of having
an illness—such as dying or losing his or her ability
to function (Strecher & Rosenstock). Perceptions
about cancer severity in African American
men are found in early detection literature. In a
study of African American (n = 286) and white (n
= 1,218) men, Demark-Wahnefried and colleagues
(1995) found that African American men were significantly
less likely to have had a digital rectal examination
or a prostate-specific antigen test. In a
study by Smith and colleagues (1997), 58 percent
of African American men reported that they felt
no need to have a digital rectal examination unless
they experienced pain while urinating. Yet, approximately
75 percent of men reported it was important
for a man age 40 or older to have a digital
rectal examination to identify prostate cancer problems.
These findings suggest that African American
men may know the risk of prostate cancer for
younger men. However, they may not perceive a
personal threat of acquiring prostate cancer because
of a misunderstanding of its symptomology.
Although a large screening study found no significant
racial difference between African American
and white men in advanced prostate cancer at diagnosis
(Smith, Bullock, Catalona, & Herschman,
1996), other studies have shown that African
Americans are more likely to be diagnosed with
and treated for more advanced prostate cancer than
white men (Mebane, Gibbs, & Horm, 1990;
Optenberg et al., 1995; Powell, Schwartz, & Hussain,
1995; Targonski, Guinan, & Phillips, 1991). Moreover,
the disparity in presentation with advanced
prostate cancer exists for African Americans even
when socioeconomic status is controlled (Ndubuisi
305 Prostate Cancer and Psychosocial Concerns in African American Men
et al., 1995), and African American men are believed
to have equal access to veteran’s health services
(Optenberg et al., 1995).
The perceived threat of an illness, especially
accompanying fears of illness outcome, may spur
an individual to seek treatment. However, if a person
is not threatened by an illness, then the person
is unlikely to be motivated to seek and accept
treatment (Damrosch, 1991). African Americans
reported more fear of cancer than members of the
general population; they may acknowledge the severity
of cancer yet be pessimistic about its cure
(American Cancer Society, 1998). Literature regarding
African American men’s perception about
cancer cure conflicts with this more fatalistic perception.
For instance, studies with relatively large
samples reported that a preponderance of African
American men believed that prostate cancer could
be cured (Myers, 1999; Smith et al., 1997). Still,
the perceived uncontrollability of cancer is often
at the root of pessimism and fatalism for some
individuals with cancer and this, in turn, may affect
individuals’ psychosocial functioning in an
unfavorable way (Christ, 1989).
Perceived Benefits
Whether an individual is motivated to engage in
health-related actions is determined by an
individual’s perceptions of outcomes (Rosenstock,
1960). An African American man’s perceptions
about the saliency and efficacy of an early detection
examination help inform his perceptions
about benefits. Among 218 African American men
in a study by Myers and colleagues (1996), more
than one-half (59 percent) perceived an early detection
examination to be an effective health behavior
for preventing cancer. In this same study,
results of multivariate analyses indicated that perceived
efficacy of an early detection examination
and support from a physician significantly predicted
an African American man’s intention to
undergo early detection examination. Tingen and
colleagues (1998) found that a measure of perceived
benefits (that is, the personal beliefs about
the usefulness of prostate cancer screening and
early detection) was a significant predictor of a
man’s participation in prostate cancer screening
when controlling for race, education, marital status,
and receiving an educational intervention.
Although African American and white men reported
similarly on the perceived benefits measure,
African American men were significantly less likely
to participate in screening. These findings are instructive
in considering ways to increase African
American men’s participation in early detection
examination. Plowden (1999) noted that if a person
perceived no benefit from cancer screening or
treatment, then he was unlikely to participate in
such health-related behaviors. Damrosch (1991)
stated that it is essential for the person seeking care
to know that perceived positive outcomes are
“both feasible and efficacious” (p. 834). To the extent
that African American men perceive an early
detection examination and cancer treatment as
feasible and efficacious, these men may lower their
risk of presenting with a more advanced stage of
cancer. They are also likely to reduce their risk of
dying from cancer. Findings in a study by Tingen
and colleagues suggest a warning about perceived
benefits and participation in screening for African
American men: Men may perceive both benefits
and barriers to screening. These researchers
suggested that an examination of perceived benefits
and barriers in future studies involving African
American men could help clarify their perceptions
of benefits.
Perceived Barriers
According to the HBM, perceived barriers to seeking
care are factors that hinder a person from engaging
in health-seeking behaviors (Rosenstock,
1960). Barriers may operate from within or outside
the individuals (Plowden, 1999). One way in
which a barrier operates from within individuals
can be seen through the perceptions they hold
about illness and disease.
With regard to African American men and prostate
cancer, findings in a national cancer study of
U.S. men illuminate how their own perceptions
may be a barrier to early prostate cancer detection
(Gallup Organization Healthcare Group, 1995).
African American men were 8 percent (n = 95) of
1,193 men ranging in age from 45 to 75 years in this
national study. Fifty percent of all African American
men in this national study were least likely to
feel men should have annual rectal exams to determine
the prostate size; a corresponding percentage
of African American men viewed the cancer test as
embarrassing and painful. All men in the study
responded that the possibility of wearing diapers
and becoming impotent would affect their decision
to seek an early diagnosis of cancer, but these
issues were of greater concern to African American
and Hispanic men than to white men.
Other studies document similar concerns about
incontinence and impotence among African
306 Health & Social Work / Volume 28, Number 4 / November 2003
American men (Coley, Barry, & Mulley, 1997;
Myers et al., 1996). Cultural values may help explain
these concerns. Plowden (1999) asserted that
many men value their sexuality and independence
and that, for a large proportion, their masculinity
and sexuality are closely linked. Franklin (1992)
noted that being in control of a situation is a key
symbol of manliness in African American male
culture. An African American man’s more negative
perceptions about pain and embarrassment,
as well as possible incontinence and impotence in
prostate cancer treatment, may have been shaped
largely through the culture of masculinity and
oppression in U.S. society. These men may bear
witness indirectly and directly to the history of
oppression in U.S. society in which African American
men have been violated in terms of their sexual
organs. Regardless of the origins of these men’s
perceptions, their negative perceptions about an
annual rectal exam, pain and embarrassment associated
with the exam, wearing diapers, and impotence
may hinder their participation in cancer
screening. Lacking cancer screening, African
American men may be less likely to have their cancer
detected early and likely to increase their risk
of dying from cancer.
Religion may serve as both a barrier and a coping
resource in African Americans with prostate
cancer. Geertz (1973) defined religion as “a system
of symbols which acts to establish powerful, pervasive,
and long-lasting moods and motivations in
men [sic] by formulating conceptions of a general
order of existence and clothing these conceptions
with such an aura of factuality that the moods and
motivations seem uniquely realistic” (p. 90).
Underwood (1991) found that African American
men perceived their cancer as the will of God. Potts
(1996) found that African American cancer patients
often looked to “God as the source of healing and
recovery from cancer” (p. 9). Moreover, cancer
patients used prayer to cope with cancer (Potts).
Pierce (1999), in a case study of a man with prostate
cancer, learned that the man found strength to
cope with his cancer through support from family—
his mother “prayed on it” and reminded him
that God would see him through the illness.
Plowden (1999) and others (Strawbridge, Cohen,
Shema, & Kaplan, 1997) highlighted the salutary
effect of religion on health behavior in African
Americans. For example, a study found that frequent
church attendees had lower mortality rates
than infrequent church attendees (Strawbridge et
al.). African Americans were more likely than non–
African Americans to attend church frequently. A
sparse literature exists on religion and prostate
cancer, thus making it difficult to reach firm conclusion
about this topic for African American men.
Nonetheless, this literature stresses the importance
of religion in helping these men make sense of their
illness.
Research suggests that men’s socioeconomic
status may serve as a barrier to seeking care. African
American men with less than a high school
education ranked highest among men most likely
to postpone or avoid testing and screening because
of lack of insurance or health care plans (Gallup
Organization Healthcare Group, 1995). Early cancer
detection and intervention with these men to
deal with their cancer are hampered when they lack
access to medical care (Plowden, 1999).
Although studies are fairly consistent in reporting
a higher incidence and mortality rate resulting
from prostate cancer in African Americans,
studies are mixed about the role of socioeconomic
status in their survival (Optenberg et al.,
1995; Powell, Schwartz, et al., 1995; Robbins,
Whittemore, & Thom, 2000). Robbins and colleagues
noted that a lower survival rate in relatively
younger African American men (those under age
65) diagnosed with prostate cancer may have multiple
reasons, including detection of a more virulent
prostate tumor, an inaccurate measure of socioeconomic
status, unmeasured factors such as
social support, and residual confounding of socioeconomic
status and treatment. Noneconomic
barriers such as race and location may explain the
poorer survival of African Americans with prostate
cancer. According to Friedman (1994), African
Americans experience racial discrimination in
obtaining health care because of skin color. They
also reside in low-income urban areas that lack
adequate health care services.
Prompts to Action
Plowden (1999) noted that having a perceived susceptibility
to prostate cancer, knowing the severity
associated with it, and knowing the benefits of
early treatment are necessary, but not sufficient,
motivators for an individual to engage in preventive
health behavior. Equally important, “an individual
has to have the perceived ability to seek care”
(Plowden, p. 5). An underlying assumption of the
HBM in emphasizing readiness to take action is
that a person must be prompted to act. Both internal
prompts (for example, symptoms) and external
prompts (for example, knowledge and
307 Prostate Cancer and Psychosocial Concerns in African American Men
information about illness and disease) may motivate
a person to seek care (Plowden).
There is compelling evidence that significant
others, such as peers and professionals, can be effective
prompts to action for an African American
man’s participation in cancer screening. A study
by Tingen and colleagues (1998) showed that an
educational intervention including a peer educator
and social worker to help men navigate the
health system was a more effective motivator for
their screening participation than either educational
information or a peer educator’s personal
testimony.
Institutions such as churches,
barbershops, taverns, and fraternal
organizations may also
serve as a source of help to African
Americans with prostate
cancer.
Help seeking is a key variable in cancer management
and rehabilitation. All human societies
practice some form of help seeking and health
maintenance that govern decisions about illness
identification, treatment, and management
(Landrine & Klonoff, 1992; Sussman, 1996). Individuals
learn practices of help seeking and illness
management through their family, culture, and
society.
The literature has long emphasized the role of
the informal help system in cancer patients’ psychosocial
functioning. Wortman and Dunkel-
Schetter (1979) asserted that an informal support
system—the social network of family, friends, and
even other cancer patients—is essential to the cancer
patient’s illness management and rehabilitation.
Sussman (1996) noted that an illness may lead
not only to a medical crisis but also to a social and
psychological crisis among a network of people—
patient, family, friends, and community. Members
of the cancer patient’s informal network play a
critical role in helping the person clarify and manage
an illness through the use of existing cultural
beliefs, norms, and values.
Literature documents African Americans’ heavy
reliance on the informal network of family, friends,
and neighbors. Such a support system provides
African Americans who are experiencing crisis with
tangible and intangible sources of help (Neighbors,
1985; Neighbors & Taylor, 1985). Regarding African
American prostate cancer patients, Myers et
al. (1996) found that support received from family
was significantly associated with a man’s intention
to seek cancer screening and health advice from
professionals. Although we found no literature on
the social support that African Americans with
prostate cancer receive from friends, a work by
Franklin (1999) illuminates the structuring of
friendship relationships in African American men.
According to Franklin, friendship structures
among African American men may vary within
race and across class. For example, same-sex friendships
among working-class African American men
tend to be warm and intimate. The converse would
be true for same-sex friendships among upwardly
mobile African American men.
Institutions such as churches, barbershops, taverns,
and fraternal organizations may also serve as
a source of help to African Americans with prostate
cancer (Lee, 1999). Powell, Gelfand, and colleagues
(1995) found the church and ministers to
be a motivating factor in the recruitment and participation
of African American men in an early
detection prostate cancer educational program. For
instance, ministers of local churches played a critical
role in gaining the trust and participation of
men in a cancer educational program. Churches
may also function as a quasi-family to African
Americans with prostate cancer (Pierce, 1999). According
to Lum (2000), “for African Americans,
the church is intricately involved in personal, family,
and social needs” of community residents (p.
301).
The help a cancer patient receives from an informal
support system may facilitate illness clarification,
validation, and management (Goldberg
& Cullen, 1985; Wortman & Dunkel-Schetter,
1979), but seeking help from others during the illness
has costs as well as benefits. Neighbors (1997),
in a national study of African Americans, documented
that spouses, kin, and friends were a source
of stress and a source of support. Also, African
American prostate cancer patients may receive severe
criticism from a loved one or friend about
hesitating to comply with a recommended medical
intervention or course of therapy (for example,
chemotherapy). However, the benefits of seeking
help from others may outweigh the costs. Literature
indicates that African Americans with prostate
cancer value the support of family and professionals
in seeking early detection examination or
308 Health & Social Work / Volume 28, Number 4 / November 2003
participating in clinical trials (Myers et al., 1996;
Robinson et al., 1996).
Recommendations
Practice
An underlying assumption of the HBM is that
understanding an individual’s motivation to engage
or not engage in certain health-related behaviors
helps determine that individual’s pattern
of preventive health practices. Social workers can
help motivate African American men with prostate
cancer to engage in positive health-related
behaviors by understanding and appreciating the
factors that hinder or promote such behaviors
(Sharp, 1993). Social workers can motivate African
American men to participate in prostate cancer
screening by providing educational information
and making timely personal follow-up
telephone calls (Tingen et al., 1998).
From a social work perspective, maximizing
health care services to African American prostate
cancer patients requires that social workers acknowledge
the vital roles they play (for example,
teacher, enabler, mediator, broker, planner, and
advocate) in the lives of these men and their families.
Regardless of social workers’ roles, they should
consider the facts about African American prostate
cancer patients when “judging and deciding
what is good and what is bad” about their health
beliefs and behaviors (Julia, 1996, p. 4).
Perhaps the most important roles for social
workers are those of educator and active listener.
As active listeners, social workers suspend personal
views about how people should believe and behave
when ill. Rather, social workers become
enablers and encourage people to talk about their
health beliefs and behaviors—a process that benefits
both client and social worker. For many African
American men, their encounter with the social
worker may be the first opportunity to share
fears and concerns about prostate cancer. For social
workers, this sharing process becomes an opportunity
to understand an African American
man’s distrust and fear of medical systems, their
lack of knowledge about being vulnerable to prostate
cancer, and their defeatist attitudes about engaging
in treatment (Robinson et al., 1996; Smith
et al., 1997). Through active listening, social workers
learn that African American men are a diverse
group of people reflecting a variety of responses
to poor health (Berry Winbush, 1996). Thus, individualizing
interventions for these men is an essential
component of practice.
As educators and teachers, social workers must
strive to understand what motivates or does not
motivate African Americans with prostate cancer
to seek information, engage in preventive health
practices, and turn to others for help. African
American men are likely to be more receptive to
prostate cancer screening when they perceive it as
being important, efficacious, and easily integrated
into their daily lives (Myers et al., 1994). Thus, when
giving information, social workers need to ensure
that the explanations for prostate cancer screening
and treatment make sense to African American
men, given their greater susceptibility to the
disease. Social workers should not be surprised or
insulted if men seek help outside the mainstream
service system from family members, friends, and
ministers about what makes sense. Social workers
are cautioned that the informal support received
from others may motivate men to engage in positive
health-related behaviors (Goldberg & Cullen,
1985; Wortman & Dunkel-Schetter, 1979; Myers
et al., 1996) and that it can also be a source of stress
for men (Neighbors, 1997). Social workers should
understand that African American men respond
to illness in various ways. Some may rely on selfhelp
remedies, others on folk medicine, and others
may rely on mainstream services or no treatment
at all (Berry Winbush, 1996). However, an
important point for social workers to remember is
that “treatment action will vary according to class,
region, and degree of assimilation” (Bailey, 1991,
cited in Berry Winbush, p. 12).
Given the importance of religion and the church
to African Americans (Strawbridge et al., 1997),
including men with prostate cancer (Plowden,
1999; Powell, Gelfand, et al., 1995), social workers
may wish to alert African American men about a
pending medical intervention that may conflict
with their religious beliefs or health behaviors. A
man may want the prayerful support of his family
or minister before undergoing the prescribed
medical procedure. Social workers may need to
educate themselves and staff members about how
religion and the church fit into the experience of
African Americans with prostate cancer. Personal
religious beliefs about coping may serve as a barrier
to seeking health care; however, church leaders
may serve as external prompts motivating African
American men seeking health care. Ministers,
for example, play an important role in motivating
African American men to participate in cancer
screening and educat ion programs (Powell,
Gelfand, et al.). Using the church as an informal
309 Prostate Cancer and Psychosocial Concerns in African American Men
help system, social workers may have the potential
of enhancing the overall quality of treatment protocols,
building trust, and promoting participation
of men in preventive health-related behaviors
(Pierce, 1999; Potts, 1996; Powell, Gelfand, et al.).
Finally, social workers may be called on to function
in several roles (for example, educator, enabler,
or broker) simultaneously. If this happens,
they should prioritize their work and focus not only
on the roles that satisfy the medical regimen but
also on the roles that offer the greatest comfort
and well-being to men and their families. Social
workers might also consider that bombarding African
American men with information about prostate
cancer and its treatment may be confusing and
may not be the best way to help them take charge
of their illness. A systems approach, using all facets
of the individual’s context, may be more applicable
to working with African American men because
of the influence of family on a man’s
receptivity to seek prostate cancer screening and
health advice from professionals (Myers et al.,
1996). Family members and ministers, too, are often
allies—motivating men to engage in positive
health-related behaviors, to negotiate medical systems,
and take advantage of health resources.
Research
Drawing on ideas from a national blueprint for
actions to take in prostate cancer research, Eyre
and Feldman (1998) cited several steps to be taken
in basic and behavioral prostate cancer research
that apply to social work research. We adopted
many of their ideas for research recommendations
for social workers. Given conflicting reports about
cancer screening and prevention, research on prostate
cancer should continue to examine the benefits
of screening programs. African American men
contract prostate cancer and die from it at a
younger age than men in the general population
(Parker et al., 1998; Wingo et al., 1998); thus, researchers
should pay careful attention to the lower
survival rate of younger men with prostate cancer.
More descriptive and longitudinal studies of
health-related behaviors and their effect on the degree
of risk for younger men are needed, particularly
when male relatives have been diagnosed with
prostate cancer. Multivariate studies with larger
and more representative samples would increase
understanding about how younger men are at risk
as a result of their family history. Whereas research
shows that African American men report inaccurate
knowledge about prostate cancer even after
they have participated in a knowledge-building
program (Abbot et al., 1998), more imaginative
and rigorous intervention studies that emphasize
cancer prevention and knowledge awareness are
needed. African American men are underrepresented
in prostate cancer clinical trials (Robinson
et al., 1996); thus, researchers should develop partnerships
and collaborate with medical and lay leaders
in African American communities to increase
men’s participation in prostate cancer clinical trials.
Empirical research about family caregiver concerns
for African Americans with prostate cancer
is seriously lacking. More research is needed to
delineate the effect of men’s disability from the
disease on family members’ psychological, social,
and economical well-being (Sharp, 1993).
Because the majority of health research is conducted
and interpreted by members of the dominant
culture, social workers should facilitate greater
involvement of African American researchers, institutions,
and laypeople in prostate cancer research.
Such involvement should include management
and participation in research and advocacy
for research.
Conclusion
Cancer is a frightening experience regardless of who
is diagnosed or when the diagnosis is made. An
individual with a diagnosis of cancer may experience
a number of debilitating psychological and
social conditions, which may challenge the overall
functioning of the person with cancer and his family.
Prostate cancer need not be taken to mean a
man’s death sentence, however. Changing the perceptions
that African American men hold about
cancer can contribute to early cancer detection and
cancer risk-reduction health behavior. Programs
that aim to increase their knowledge and trust about
screening, illness prevention, treatment, and rehabilitation
can facilitate change in misperceptions
about cancer. Greater access to health care for African
American men is warranted because of continuing
economic and noneconomic barriers. Professionals
and community leaders can facilitate a
man’s actions to detect early cancer and lower cancer
risk, and ultimately increase cancer survival, by
offering men educational programs that emphasize
the importance, effectiveness, and ease of engaging
in early detection strategies.
References
Abbott, R. R., Taylor, D. K., & Barber, K. (1998). A
comparison of prostate knowledge in African
310 Health & Social Work / Volume 28, Number 4 / November 2003
American and Caucasian men: Changes from
prescreening baseline to intervention.