Program Overview
Nuevo Amanecer (A New Dawn) is a 10-week community-based cognitive-behavioral stress management program for Spanish-speaking Latinas with breast cancer. It aims to improve health-related quality of life and reduce distress by increasing self-efficacy for coping and use of stress-management skills. Women receive cancer information, emotional support, training in stress management and cognitive reframing skills, and tools to locate relevant information and resources in Spanish. The program is delivered by trained peer breast cancer survivors (compañeras) in urban and rural community settings.
The program was developed by blending scientific evidence and community “best practices,” through a process of working closely with Latinas with breast cancer and community organizations that provided them with supportive services. Its development and testing reflects our extensive translational research to implement programs in community settings to reach vulnerable populations.
Program Content
Content/Topics:
Over the 10 sessions, the following topics are covered, some in more than one session:
Managing the impact of cancer
Common reactions to cancer diagnosis and treatment, signs of depression, how to track symptoms
Breast cancer and survivorship
Information about breast cancer, treatments, survivorship care plans, their individualized survivorship care plan
Finding cancer information
Communicating with health care professionals, asking for an interpreter, participating in medical care, calling the National Cancer Institute Information Service
Getting support
Effect of cancer diagnosis on family/friends, talking about cancer with others, communication skills, identifying sources of support, asking for help when needed
Managing thoughts and mood
How thoughts affect mood, changing unhelpful thoughts to helpful thoughts, using coping statements and positive thoughts to feel good
Stress management techniques
Identifying causes of stress, ways to reduce stress including deep breathing, progressive muscle relaxation and guided imagery) • Setting goals (how to set and track realistic goals, setting goals to care for oneself
Healthy lifestyle
How to overcome barriers to a healthy lifestyle such as walking, nutrition, maintaining healthy weight, sleeping
Program Description
Participant Program Manual:
Each participant receives a program manual at the first session containing written materials and activities organized by the 10 sessions. The manual is designed to be appropriate for women with a range of literacy (e.g., contains images, uses simple language). Participants bring the manual to each session to be reviewed with the compañera, and it can be used at home as a resource.
Delivery and Setting:
Trained Spanish-speaking Latina breast cancer survivors from the community (compañeras or companions) deliver the intervention and provide social support. Most participants met with their compañera in their homes; a few met at the community organization the compañera was associated with or at some other venue (e.g., library). The program can be delivered one-on-one or in a group.
Format:
Each session (60-90 minutes duration) begins with a deep breathing exercise, a session overview, and a review of the prior week. Referring to the Participant Program Manual, the compañera explains the content for that week. Each session included 2-3 activities to reinforce a new stress management skill. The compañera and participant discuss content, activity sheets, and skills practice. Compañeras are encouraged to individualize the program depending on the participants’ cancer stage and treatment, family dynamic, or other personal context. At each session, participants are given an activity to do at home, such as practice deep breathing.
Skills Training:
Skills training is provided in relaxation techniques (guided imagery, progressive muscle relaxation), cognitive reframing (changing unhelpful thoughts to helpful thoughts), goal setting, and communication. During each session, one skill is taught and modeled by the compañera, participants practice it, and the compañera provides positive reinforcement. Deep breathing is practiced at all sessions. Participants then practice the skills at home using DVDs or YouTube videos that demonstrate the skills.
Videos:
English and Spanish videos provide demonstrations of relaxation techniques and cognitive reframing. All videos are available on a tablet for use by the compañera during the session, e.g., to demonstrate the skill. The same videos are available to participants as a DVD and through free YouTube links to guide participants at home. Videos are also available that provide information on breast cancer and its treatments.