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Reaching the Underserved: Providing Cancer Support,
Education and Hope
in Low Income African American Communities
Kathleen Coyne, LCSW
Jennifer Dorsey, MSW
The Wellness Community of Philadelphia
Philadelphia, Pennsylvania, USA
January 2005
PURPOSE
Founded in 1993, The Wellness Community of Philadelphia (TWCP) is non-profit organization with a
mission to help people affected by cancer enhance their health and well being through participation in
a professional program of emotional support, education and hope.
Through participation in professionally led support groups, educational workshops and mind body
spirit classes using the “patient active” concept, people affected by cancer and their loved ones learn
vital skills that enable them to regain control over their lives, reduce isolation and restore hope,
regardless of the stage of their disease. All of TWCP’s programs are offered at no cost to people with
cancer and their families and friends.
RATIONALE
Since its opening in 1993, 12,775 individuals affected by cancer have participated in the unique
programs of support, education and hope offered at the Wellness Community of Philadelphia. Despite
its urban location, TWCP had long been challenged to increase its visibility and attendance by African
American people with cancer living in lower income neighborhoods in close proximity to its main
facility in Philadelphia’s Fairmount Park. In fiscal year 2001-2002, less than 10% of the population
served by TWCP was African American, yet; the 2000 population census reported that African
Americans living in Philadelphia County comprised 43.2% of the population. It has long been
documented that African Americans have experienced higher mortality rates from cancer. In general,
African Americans have a decreased likelihood of surviving 5 years after diagnosis than whites for all
cancer sites and at all stages of diagnosis. Much of these differences are believed to be due to poverty,
disparities in treatment, reduced access to medical care or late diagnosis.
In January 2002 TWCP created a three year strategic plan with a goal that TWCP would replicate its
model of group support and education in community based settings to people with social, cultural,
and/or economic barriers that may prevent them from participating at its main facility in Fairmount
Park.
In March 2002 funding for the project was awarded from the Pennsylvania Department of Health. In
May 2002 a licensed therapist was hired to design and implement the project that was named The
Wellness Community of Philadelphia’s Community Based Program.
In September 2002 the first Community Based Site was officially opened and by January 2003 four
additional sites were developed in low income urban neighborhoods within the City of Philadelphia
including community centers, nurse run health centers and hospitals.
METHODS
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The initial partnership for the TWCP Community Based Program was developed with the National
Nursing Centers Consortium. The National Nursing Consortium is an association of Nurse Managed
Health Centers that includes: Nursing Centers, Managed Centers, Managed Care, Community Nurses,
Wellness Centers, Community Health Centers, and Nurse Managed Community Health Centers in the
United States. These provide quality health care services to vulnerable populations and eliminate
health disparities in underserved communities. TWCP offered the first Community Based Program at
Temple Health Connection.
Temple Health Connection is a neighborhood based primary health care clinic providing primary care,
family planning, disease prevention and health promotion for an indigent, underserved population in
North Philadelphia—in partnership with the community. Temple Heath Connection uses advanced
practice nurses and outreach workers to deliver care in collaboration with neighborhood family
medicine physicians. In addition, undergraduate and graduate students from Temple University, as
well as other educational institutions, participate through their formal education programs, as
volunteers or as student workers. THC sits within Norris Homes and Apartments, a Philadelphia
Housing Authority development, and primarily serves this development along with Fairhill
Apartments and the surrounding community.
TWCP administrative and clinical staff met with the nursing staff at Temple Health Connections along
with the Tenet Council of both Norris Homes and Fairhill Apartments to present the mission of
TWCP. Community meetings were held and residents invited to both lunch and dinner gatherings to
discuss TWCP support services available to residents affected by cancer. Temple Health Connection’s
Outreach Worker was trained by TWCP staff and coordinated efforts to promote Community Based
cancer education workshops and support groups at Norris Homes and Fairhill Apartments. Initially, a
monthly TWCP cancer education workshop was offered at both locations.
Based on the success of the partnership with Temple Health Connections, TWCP created additional
partnerships with Temple University Hospital Cancer Center and Einstein Hospital Cancer Center.
Both of these health care systems primarily serve lower income African American and Hispanic
communities.
An additional partnership was created with the Eastwick PAC (Project Area Committee) Inc. This
community action group meets regularly to advocate for a safer environment. They meet at The Mercy
Wellness Center of Mercy Hospital in the southwestern section of the city, which is low income and
reports an extremely high cancer incidence.
By January 2003, all of these sites were provided monthly TWCP cancer education workshops and
TWC support groups as part of TWCP’s Community Based Program initiative.
In an effort to gain visibility and to increase referrals, The Community Based Program(CBP) was
promoted to the following groups, organizations and individuals:

Area Churches – Health fairs, pulpit presentations, information lunches, meetings with
individual pastors and other clergy were offered.
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Black Clergy Meeting at TWCP – The head of the Black Clergy of Philadelphia was
welcomed to TWCP and presented with an opportunity to host the group’s monthly
business meeting. TWCP staff, along with community based participants, was invited
to offer their testimony to the benefits of the program.
Community Health Fairs – A movable display with CBP volunteers was a continuous
presence at church run health fairs.
Health Care Providers – Weekly meetings with physicians, nurses and social workers,
serving indigent populations with cancer, were held with TWCP staff and volunteers.
Civic and Community Leaders – Political offices, businesses and community action
leaders were provided with information to distribute to their constituencies.
Media Promotion through T.V., Radio, and Newspaper – Local city newspapers, radio
stations and T.V. programs, serving African American audiences, received continual
press releases featuring CBP programs. Several newsprint articles about the program
were featured in local papers. Radio interviews with CBP volunteers were broadcast. A
prominent local network program entitled, Visions, featured a 15 minute segment on the
CBP and its impact in Philadelphia’s African American community.
In an effort to plan culturally relevant programs with diverse faculty, the following groups,
organizations and individuals were utilized:
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Health Educators for Cultural Diversity – This local group of health educators
delivered cancer education workshops and were utilized at all CBP locations.
Discovery Playshops – A therapeutic artist taught mind body spirit classes at several
locations.
Mshindi Pan African Cultural Arts – A local storytelling/drumming group led
workshops with a goal of building community in several locations.
Cancer Information Specialists and other area Health Providers, Nutrition Educators,
Lawyers, Art Therapists – A range of other faculty have been cultivated as a group with
an interest and an expertise in issues around cancer and the underserved community.
FOCUS GROUPS
In the summer and fall of 2003, five focus groups with a total of 45 African American
people affected by cancer were convened by the Philadelphia Health Management
Corporation to provide a verbal evaluation of the benefits and barriers to participation in
TWCP groups and cancer education workshops for the African American community.
The Philadelphia Health Management Corporation (PHMC) is a non-profit, public health
organization committed to improving the health of the community through outreach,
education, research, planning, technical assistance and direct services.
Potential participants for the five focus groups were recruited from three existing CBP
support group from the Eastwick PAC site, Fairhill Apartments and Temple University
Cancer Center along with participants from TWCP’s Fairmount Park location. People
affected by cancer but not participating in TWCP or CBP programs were also recruited
from the community. (See tables 1 & 2 for characteristics of focus group participants).
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Two experienced PHMC facilitators led the discussion and the format followed a written
guide. Topic areas included access to health care and general experience with health care;
beliefs about cancer; the emotional impact of cancer; coping strategies; attitudes toward
cancer and support groups; participation in support groups; and suggestions for overcoming
barriers to participation in support groups in the African American community. The
discussions lasted approximately one and one-half hours and were audiotaped. Participants
were compensated $25.00 for their time and provided with a meal.
SUMMARY FINDINGS FROM FOCUS GROUPS
 Health Care Experiences
Participants revealed that a general distrust of the medical community, the rising cost of
health care and a routinely complicated process of insurance reimbursement kept people
from routine medical care. Avoidance of diagnostic screenings and clinical treatment were
due to a variety of economic and psychological reasons, especially for men.
 Attitudes and Beliefs
Participants expressed a general belief, held by many in their community, that cancer was
not a disease that commonly affects their population. People maintained an automatic
association with death and also felt that medical treatments and surgery often worsen the
condition rather than improve it.
 Knowledge
A lack of discussion and disclosure of cancer in African American communities and a lack
of cancer information disseminated to African Americans was described. Although several
found that information was now more accessible, and knowledge about cancer was
increasing, and that a lack of knowledge increases fears of cancer.
 Myths
Participants felt that the belief that “treatment is harmful” was still widely held and fueled
in part by lack of knowledge. This was expressed more often among focus group
participants with less education. A delay in treatment was also reported to be due to the fear
and desire not to upset family dynamic and structure.
 Coping Mechanisms
Religious faith was the predominate coping mechanism shared by most of the participants.
Both religion and medicine were considered essential to healing. Support groups were
viewed as beneficial as was having a positive attitude, and having an opportunity to talk
about the cancer.
 Benefits of Participation Reported
A decrease in feelings of isolation and fear, an increase in hope and/or acceptance of death,
and relief from stress was reported. For the caregivers, an increased understanding of the
impact of cancer on the lives of their loved ones was reported to have been helpful.
 Specific Barriers to Participation Reported
Transportation was unavailable to the Fairmount Park location. A lack of knowledge about
TWCP, and difficulties with acknowledging cancer and discussing it with strangers was
reported. Differences between African American and TWCP culture, particularly
regarding religion, was thought to discourage African Americans from participating. Many
felt that the support groups should make more of an effort to address spiritual issues,
especially relevant to African American religious practices.
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RESULTS
The following strategies were implemented in 2004 to overcome the stated barriers:
Lack of knowledge about TWCP
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In 2004, with a goal of informing more people about TWCP programs, a brochure was
created that focused on the CBP. It is currently being distributed to area churches,
neighborhoods, hospitals, clinics and other advocacy programs to reach a greater
number of potential participants.
TWCP staff has presented several programs at the monthly meeting of Sisters in Touch,
a support group for African American women with breast cancer.
Difficulties with acknowledging cancer and discussing it with strangers
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African American volunteers who are also cancer survivors have been recruited by
TWCP to meet people at health fairs, share their stories and lend support at CBP
workshops and support groups for people affected by cancer.
TWCP staff provided a workshop at Empowering Ourselves, a symposium offered by
the Philadelphia Black Women’s Health Project at the Fox Chase Cancer Center. The
symposium focused on empowering women to take control of their health to prevent
breast cancer.
TWCP has partnered with Living Beyond Breast Cancer to provide a half-day cancer
education workshop for men and women with prostate and breast cancer at the
Abbottsford homes housing development.
Differences between African American and TWCP culture, particularly regarding religion,
may initially discourage African Americans from participating
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While TWCP’s goal is to add to ones’ array of coping tools beyond the traditions of
religious faith, it is now recognized that to deny groups in the CBP the opportunity to
pray is a barrier to participation and so prayer, generated by the participants, is
recognized and included in most CBP meetings as deemed appropriate by the clinical
facilitator.
Speakers at TWCP’s annual cancer survivor’s conference, “Celebration of Hope” in
June 2004 included a prominent member of the African American community who was
a cancer survivor and minister at the Vine Memorial Baptist Church in Philadelphia.
The Philadelphia Gospel Seminars Choir concluded the “Celebration of Hope”
conference in song.
TWCP maintains collaborations with several cancer advocacy groups that focus on the
particular needs of African Americans affected by cancer. They include: Women of
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Faith and Hope, Philadelphia Black Women’s Health Project, Bridging the Gap, Living
Beyond Breast Cancer. TWCP has collaborated with these groups to offer more
comprehensive programs in underserved communities.
The lack of public transportation is also a serious barrier for African Americans who lack
access to an automobile and wish to participate in activities at The Wellness Community of
Philadelphia’s main site in West Fairmount Park
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In order for CBP participants to attend TWCP’s annual survivors’ conference,
“Celebration of Hope”, TWCP rented a van to transport participants from several CBP
sites.
Van service has continued to be utilized to bring CBP participants to special programs
offered at TWCP’s main site in Fairmount Park.
Van service also transported CBP participants to the TWCP annual holiday party. Over
30 CBP participants attended.
A pilot program utilizing cab vouchers was initiated in January 2005 and is currently
being utilized by CBP participants who plan to attend weekly programs at TWCP’s
main site in the park.
CONCLUSIONS
In fiscal year 2003-2004, TWCP provided 47 workshops and support groups to 290 individuals
impacted by cancer through its CBP. During the same period there were 592 program visits to the
CBP. Overall TWCP welcomed 410 African Americans affected by cancer to its full complement of
groups and workshops during this same time period. The CBP has been integral to TWCP’s success in
reaching low income African American people affected by cancer with its model of community
support and education. From 2001 to 2004 the percentage of new African American participants
served by TWCP and its CBP has risen from under 10% to 44%. (See table 3).
Present enrollment of 12 Community Advisory Board members representing community, civic,
political, advocacy and area health care organizations meet quarterly to lend support, advice, and
outreach. Several of them have assisted in new community partnerships.
On-going partnerships exist with five community based agencies and hospitals including:
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Abbottsford Family Health Center – a nurse managed primary health care center
serving low income public housing residents
Fairhill Community Center – a public housing high-rise served by Temple Health
Connections - nurse run health center
Fox Chase Temple Cancer Center – a university based hospital and cancer center
Eastwick PAC – Mercy Wellness Center – community action group
Haddington Multi-Services Center – multipurpose senior center
The following sites are in development:
 Mercy Hospital – a community hospital providing cancer care – CBP beginning weekly
support group in February 2005
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Christian Street YMCA – community center – partnership to be established in spring
2005
(See table 4 for locations).
As a result of grant funding from the Pennsylvania Department of Health, TWCP has raised its
visibility and improved attendance of low income African Americans affected by cancer. Through
convened focus groups, targeted outreach, community partners and dedicated personnel, TWCP has
replicated its model of group support and education within five community based sites in low income
urban neighborhoods.
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