title: From Community Laywomen to Breast Health Workers: A Pilot Training Model to Implement Clinical Breast Exam Screening in Malawi.
abstract: BACKGROUND
  Breast cancer burden is high in low-income countries. Inadequate early detection contributes to late diagnosis and increased mortality. We describe the training program for Malawi's first clinical breast exam (CBE) screening effort.
  
  
  METHODS
  Laywomen were recruited as Breast Health Workers (BHWs) with the help of local staff and breast cancer advocates. The four-week training consisted of lectures, online modules, role-playing, case discussions, CBE using simulators and patients, and practice presentations. Ministry of Health trainers taught health communication, promotion, and education skills. Breast cancer survivors shared their experiences. Clinicians taught breast cancer epidemiology, prevention, detection, and clinical care. Clinicians and research staff taught research ethics, informed consent, data collection, and professionalism. Breast cancer knowledge was measured using pre- and post-training surveys. Concordance between BHW and clinician CBE was assessed. Breast cancer talks by BHW were evaluated on a 5-point scale in 22 areas by 3 judges.
  
  
  RESULTS
  We interviewed 12 women, and 4 were selected as BHWs including 1 breast cancer survivor. Training was dynamic with modification based on trainee response and progress. A higher-than-anticipated level of comprehension and interest led to inclusion of additional topics like breast reconstruction. Pre-training knowledge increased from 49% to 91% correct (p<0.0001). Clinician and BHW CBE had 88% concordance (kappa 0.43). The mean rating of BHW educational talks was 4.4 (standard deviation 0.7).
  
  
  CONCLUSIONS
  Malawian laywomen successfully completed training and demonstrated competency to conduct CBE and deliver breast cancer educational talks. Knowledge increased after training, and concordance was high between BHW and clinician CBE.
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States of America.
authors.forename: Lily
authors.initials: L
authors.lastname: Gutnik
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States of America.
authors.forename: Agnes
authors.initials: A
authors.lastname: Moses
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Christopher
authors.initials: C
authors.lastname: Stanley
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: Tapiwa
authors.initials: T
authors.lastname: Tembo
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States of America.|Department of Surgery, University of North Carolina, Chapel Hill, United States of America.
authors.forename: Clara
authors.initials: C
authors.lastname: Lee
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States of America.|Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, United States of America.|University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Satish
authors.initials: S
authors.lastname: Gopal
mesh_terms: D000328:Adult; D001943:Breast Neoplasms; D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008295:Malawi; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017741:Survivors; D055815:Young Adult