The first phase of research for the Witness Project included intervention (n=206) and control (n=204) groups of women from the Arkansas Delta region. Women in the intervention and control groups were interviewed at pre-intervention and 6-month follow-up to assess beliefs, attitudes, knowledge, and practices related to breast and cervical cancer screening. Women who participated in the Witness programs demonstrated significant increases (p<0.001) in mammography and BSE.

Baseline measures demonstrate that the intervention is reaching low-income, less educated minority women who have previously been difficult to contact through traditional health education methods. Accepted and supported by African-American church groups and communities, it is effective in drawing low income, less educated, rural African American women to participate.

Significant behavior changes which are influenced by participation in a Witness Program have been documented. Of every 100 women who normally do not get mammograms, an average of 23.6 sought and received a mammogram in the 6-month period following the intervention. Of every 100 women who did not do BSE, 69.4 now do BSE regularly, and 60.7 did BSE in the past month. Of every 100 women who had not received clinical breast exams, 18.8 received one in the follow-up period. (Erwin Do, Spatz TS, Stotts RC, Hollenberg JA, Deloney LA: Increasing mammography and BSE in African American women using The Witness Project Model, Journal of Cancer Education, December 1996:11(4)210-215.)

It is suggested that the intervention changes behavior because the messages are crafted to meet rather than to change the women's belief. Instead of trying to dispel a belief or a myth, or overcome beliefs which center around the power of God's will versus the power or biomedicine, the WRMs present their stories within a framework which honors culture and local health beliefs. Their very presence as cancer survivors is evidence supporting God's will. Cancer education programs should incorporate and honor concepts (like religion) within interventions.

Significant results were found from the long-term effects study of the Witness Project from part of the second phase of the research. A 2 to 3 year re-survey was administered to original women living in two counties (Phillips and Monroe) in the Lower Mississippi River Delta region of Eastern Arkansas who participated in the Witness Project first intervention.

The results indicated that 67% (n=97) of the women reached through the first intervention had a mammogram after the program, and of those 65 women who had their mammogram, 100% were willing to go in for their next scheduled mammogram. 90% (n=76) of the women were satisfied with the services that they received when they had their mammogram, and 93% (n=76) of the women were satisfied with the way they were treated by the technologist when they had their mammogram.

Also, the results indicated that 99% (n=126) of the women were helped by the Witness program; 90% (n=124) of the women were taught something new about breast self-examinations; and 83% (n=126) of the women were taught something new about mammography. 75% (n=123) of the women learned something new about cervical cancer and seventy-five percent(n=123) of the women learned something new about Pap tests.

These data indicate that by providing intensive, community-based, culturally-competent educational programs, the Witness Project can positively influence screening behaviors in rural, underserved African American women on a long-term basis.

A second phase of research, funded by the Arkansas Department of Health through the Centers for Disease Control & Prevention (CDC), is investigating short-term and long-term behavior changes related to following the transtheoretical model of change in a group of 430 women in 2 intervention (n=215) and 2 control (n=205) counties. This research in ongoing.

1995-98	The Witness Project "AMEN" Revival	Susan G. Komen Breast Cancer Foundation, Arkansas Chapter
1995-98	Witness Instructional Training Program: A Breast Cancer Education Program for African American Women	National Cancer Institute R25-CA66800-01A1 Training Grant
1995-97	Witness Instructional Training Program: A Breast Cancer Education Program for African American Women	Supplemental grant through the Centers for Disease Control, Cancer Prevention and Control Program; Arkansas Breast and Cervical Cancer Control Program, Arkansas Department of Health
1995-96	Witness Instructional Training Program: A Breast Cancer Education Program for African American Women	Susan G. Komen Breast Cancer Foundation
1994-95	Witness Instructional Training Program: A Breast Cancer Education Program for African American Women	Susan G. Komen Breast Cancer Foundation
1994-95	Outreach Education Training for African American Women, video development	Avon Breast Health Access Fund
1993-94	A Breast and Cervical Cancer Education Program: Witnessing in the Delta	Susan G. Komen Breast Cancer Foundation, Education Grant
1992-93	A Breast and Cervical Cancer Education Program: Witnessing in the Delta	Susan G. Komen Breast Cancer Foundation, Education Grant
1992	A Program to Promote Utilization of Breast Cancer Detection Resources by Minority Women	Fifty For the Future Incentive Grant, University of Arkansas at Little Rock
1991	A Program to Promote Utilization of Breast Cancer Detection Resources by Rural Elderly and Minority Women	Arkansas Department of Human Services, Title XX
1989	Breast Cancer Screening of Rural Black Women	University of Arkansas at Little Rock Cooperative Research Grant
1989	Investigation of Factors which Influence the Use of Screening Mammography	American Cancer Society Institutional Grant