Training Volunteers to Deliver a Breast Health Programme
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Training Volunteers to Deliver
a Breast Health Programme
Merle Kisby, RN, BScN, Marilyn MacKenzie, RN, BScN, MEd., Diane Finkle, MA,
and Carolyn Hill, RN, Canadian Cancer Society, Ontario Division,
Breast Health Training Programme
HISTORICAL BACKGROUND
Since its establishment in 1938, the of women, women felt powerless to play
Canadian Cancer Society (CCS) has a part in cancer control. Women did not
placed strong emphasis on the importance request examinations from their doctors
of the early detection of cancer. Although and rarely practised self-examination.
breast cancer has always been an area of By 1989 it was clear that women in On-
concern, it has taken many years to de- tario felt the time had come to be more as-
velop a clear message and an organised sertive about breast cancer issues. The
programme of delivery. The struggle to es- public demand for information, effective
tablish this programme was affected by and accessible services, and research into
both internal and external forces such as: the cause of breast cancer began to esca-
late. More and more breast cancer sur-
• the reluctance of the medical commu-
vivors began to speak out about the need
nity to support breast self examination
for early detection, and the media pro-
(BSE)as a valuable health habit;
vided a public platform for the debate.
• the increasing expectations of edu-
The debate regarding BSE and mam-
cated health consumers;
mography in the medical community
• the increasing frustration on the part
continued. However, there was a growing
of women wishing to exercise control
body of research that supported a multi-
over their own bodies in the area of
faceted approach to early detection of
breast health; and
breast cancer. In 1991, the National Board
• the desire of CCS volunteers to re-
of Directors of the CCS approved guide-
spond, but unable to act because of the
lines on mammography, physical breast
confusion created by the lack of con-
examination, and a set of recommenda-
sistent research and information from
tions regarding breast self-examination
the medical community.
based on the report from the National
During the 1970s although breast can- Workshop on the Early Detection of
cer was the leading cause of cancer death Breast Cancer in 1988 (The Workshop
MerleKisby,RN, BScN, has been actively involved, for 10 years, with both volunteer and professional train-
ing programs. Training programs and train the trainer models have been developed with the Halton Region
Health Department, School Smoking Prevention Project, Council for a Tobacco Free Ontario, the Ontario To-
bacco Strategy, the Ontario Breast Screening Program and the Canadian Cancer Society, Ontario Division.
Mepe is currently principal of Kisby and Colleagues, Health Promotion Specialists. She co-developed the
Canadian Cancer Society,Ontario Division Breast Health Programme with Marilyn MacKenzie in consulta-
tion with the Societies Breast Health Working Group. MarilynMacKenzie,RN, BScN,MEd. is a long-term Ed-
ucation Volunteer with the Canadian Cancer Society. She is also a founding partner of Partners Plus, a con-
sulting firm that specializes in volunteer management issues. Marilyn developed the Canadian Cancer
Society Breast Health Programme with Merle Kisby in consultation with the Societies Breast Health Work-
ing Group. DianeFinkle,MA, is currently the Manager of Health Promotion for the Ontario Division of the
Canadian Cancer Society. Diane has been involved in volunteer sector management for over 10 years and
has worked for organizations such as the Easter Seal Society, the Red Cross Society and the Ontario Feder-
ation for Cerebral Palsy. Diane has a Master's degree in Canadian Studies and a Certificate in Voluntary Sec-
tor and Arts Management from York University in Toronto. CarolynHill, RN, has 20 years of volunteer in-
volvement with the CanaC.1c1n Cancer Society, Ontario Division, many of those with the Society's public
education programs. Carolyn chaired the working group that developed the Cancer Society's Ontario
Breast Health Programme whic~ was implemented in the spring of 1994.Carolyn trained as a Public Health
Nurse at the Hamilton Civic Hospital and the University of Western Ontario where she received a Diploma
in Public Health Nursing.
22 THE JOURNAL OF VOLUNTEER ADMINISTRATION
Summer 1995Group, 1989). At the same time, the On- GOALS OF THE BREASTHEALTH
tario Government launched a major new TRAINING PROGRAMME
initiative-the Ontario Breast Screening
1. To provide women with information
Program.
and support that will motivate them to
The Society recognised that a strong
adopt positive breast health behav-
health promotion programme on breast
iours.
health and the early detection of breast
2. To educate women that early detection
cancer was necessary.
of breast cancer can save lives.
3. To work collaboratively with the com-
THE DEVELOPMENT OF THE munity to promote positive breast
CANADIAN CANCER SOCIETYI health behaviours.
ONTARIO DIVISION BREAST 4. To encourage women to:
HEALTH PROGRAMME • adopt the Canadian Cancer Soci-
Breast health is defined as "taking per- ety-Ontario Division breast health
sonal responsibility for awareness and ac- guidelines;
tions throughout one's lifespan that can • act promptly and assertively if
lead to the early detection and treatment there are any breast changes;
of abnormalities that may develop in the • be more knowledgeable and less
breast." fearful about breast cancer;
The Education Committee of the Cana- • take responsibility for their own
dian Cancer Society (Ontario Division) es- breast health.
ta?lished a Breast Health Working Group
with a goal to develop strategies and re- To effectively deliver this new CCS pro-
sources to inform the public about the gram a "train-the-trainer" program was
early detection of breast cancer. developed, with supporting resource ma-
In preparation, the Breast Health Work- terials, to prepare volunteers in local com-
ing Group reviewed materials, surveyed munities. Two trainers were recruited
volunteers on their experience in deliver- from each of the nine CCS Regions to
ing breast health messages in their com- train local breast health volunteers to de-
munities, obtaining internal support for liver the breast health message.
the Breast Health Awareness message, The train-the-trainer program consists
began to work with the Division's Medical of four parts: targeted recruitment and se-
Affairs Committee to promote breast lection, training the trainers, evaluation,
health among the health professional com- implementation and follow-up.
munity, conducted a worldwide review of
existing programmes, and established TargetedRecruitmentand Selection
partnerships with external groups such as Recruitment was targeted to volunteers
the Ontario Breast Screening Program. who had teaching or training experience
In 1992,a Health Promotion Grant from and who had knowledge of the topic area,
the Ontario Ministry of Health was re- in this case breast health issues.
ceived to develop a well planned, high Two breast health trainers were recruited
quality, volunteer delivered Breast Health for each of the nine CCS Regions in the
Awareness Programme in Ontario which province; the calibre of candidates who ap-
recognised the complexity of the issue. plied for training was extremely high.
Two health promotion consultants were Prior to beginning recruitment, the de-
hired to develop a breast health training sired skills, knowledge, experience and
program for CCS volunteers. With the qualities of the trainers were identified.
Breast Health Working Group of the Edu- The criteria for recruiting volunteers were
cation Committee, they formulated the carefully selected to enhance the ability of
goals of the program. the trainers to relate to a diverse audience
targeted for breast health messages.
THE JOURNAL OF VOLUNTEER ADMINISTRATION 23
Summer 1995The criteria included: education, nurs- and reference checks were done on all po-
ing background, experience with volun- tential candidates.
teers, training experience, community Once the successful candidates were
skills, breast cancer personal experience identified, a written contract was signed.
(they must have worked through their The contract clearly outlines the role of
feelings and be comfortable with the CCS the trainer and the role of the Canadian
Guidelines), breast health experience (e.g., Cancer Society.The contract anticipated a
Ontario Breast Screening Program, cur- two-year commitment.
rent involvement in breast health pro- FACTORS FOR SUCCESS:
grammes, etc.), communication skills, or- Recruitment/selection:targeted recruit-
ganizational skills, second language, ment; clearly identified trainer qualifica-
second culture, personality/ approacha- tions; candidate interviews; reference
bility, female, grooming, and age 40+. checks; and written definition of roles.
A screening process based on the crite-
ria was set up. A point system was used Trainingthe Trainers
to assess the qualifications in the selection The trainers recruited from each of the
of the successful candidates. The criteria CCS Regions were trained to prepare
were weighted based on "essential quali- local breast health volunteers in each of
ties," "desirable qualities," and "nice but the regions to deliver the breast health
not necessary qualities." programme.
Recruitment was carried out through The consultants hired to develop the
the local CCS unit offices. Information Breast Health Training Programme deliv-
about the training session, a job descrip- ered the first training session.
tion and a clear outline of the recruitment
process was given to the staff and senior A. Setting
education volunteers in the local offices. The training workshop was held in a
Identifying the benefits of carefully select- quiet, scenic location with a minimum of
ing recruits and providing the local office distractions. It was held for three days,
with the desired qualifications of prospec- starting in the evening of the first day and
tive trainers were crucial steps in gaining ending midday on the third day. The
support. large block of time allowed participants to
Once the candidates were recruited, in- become familiar with the programme
terviews were conducted with individu- content, the principles of adult education,
als whose written applications most close- and to practise training and presentation
ly reflected the identified criteria. skills in a supportive team environment.
The interview provided an opportunity The staff partners for the Breast Health
to assess the individuals' interpersonal Programme and the health promotion
skills, willingness to follow CCS guide- consultants from each of the regions at-
lines and to get further information about tended a portion of the workshop. This
the recruit's qualifications. It also allowed meeting provided an opportunity for staff
the candidate to ask questions and clarify and volunteers to discuss their comple-
expectation of the trainer's role. The re- mentary roles, their expectations, commu-
quirements of the position were clearly nication channels, and initial planning for
laid out to the candidates including time, their respective areas.
commitment and work expectations. The schedule was full and demanding;
The interviews were conducted from however, the feelings of exhilaration, en-
the provincial office by telephone. In ergy, and accomplishment, and the bond-
some cases it was difficult to get a clear ing amongst the participants outweighed
picture of the candidate. To assist with the the exhaustion experienced by the partici-
screening process the health promotion pants by the end of the three days.
staff at the regional level were consulted The first night set the stage for a work-
24 THE JOURNAL OF VOLUNTEER ADMINISTRATION
Summer1995shop based on the principles of openness, elling, group work, utilisation of all the
honesty and respect. A warm-up or ice- learning approaches, e.g., auditory, visual,
breaker exercise started the evening and hands-on.
expectations for the three days were out- Topics discussed included: how adults
lined. The needs of the participants were learn, the experiential learning cycle,
identified and addressed by making ad- planning effective workshops, tasks of a
justments in the agendas wherever possi- trainer, adapting for special audiences, se-
ble and through the use of the "parking lecting training techniques, controlling in-
lot." The "parking lot'' is a blackboard or dividual behaviours, and working with
flip chart where questions and concerns groups.
that cannot be addressed immediately are (c). Practical Demonstration by
tabled for future consideration. Participants and Trainers
FACTORS FOR SUCCESS: The ability to deliver messages clearly
Training:three-day training session; a and effectively is essential to a good
comfortable, quiet residential setting; in- trainer. An integral part of the training
volvement of both the provincial and re- was to provide an opportunity for indi-
gional staff support; team approach with viduals to practise this skill by giving a
two trainers from each region; and co-fa- presentation. The presentations were
cilitation of the workshop. done in teams of two and were critiqued
by the trainers and a group of their peers.
B. Content Although this exercise produced anxiety,
(a). Breast Health Content the insights and learnings gained were
Because breast health is a concept based valued. Participants were able to learn
on an evolving science, it was important from the techniques used by their peers,
to provide trainers with a clear under- the trainers and through the evaluations
standing of which areas are based on of their own styles.
proven research, which areas continue to A change in the agenda occurred when
be controversial, and the rationale behind the participants requested a demonstra-
the CCS Breast Health guidelines. tion by the trainers of a typical 30-minute
The trainer's resource manual/edu-kit breast health presentation. This proved to
was circulated prior to the workshop. Par- be a valuable addition to the agenda as it
ticipants were asked to familiarise them- provided an opportunity to role-model
selves with the content, the background excellence.
materials, and the resources. FACTORS FOR SUCCESS:
During the workshop, the factual con- Content: Pre-circulation and review of
tent on breast health was delivered by an resource materials; role model excellence;
external expert in a short presentation practical demonstration/ skill building;
with time for questions. The purpose of and immediate application, through pre-
this segment of the workshop was to sentation, of materials learned.
allow the participants to gain a comfort
level with the baseline information with- Evaluation
out providing an expectation of expertise. Four aspects/ components of the train-
The information was supported by ma- ing program were evaluated:
terials that had been reviewed by a num- (a) Knowledge-A pre- and post-test
ber of experts on the subject. These mate- were administered to assess the knowl-
rials are part of the trainer's resource edge component of the breast health pro-
manual. gramme. Key principles were tested and a
(b). Adult Education pass mark of 80% was required. All par-
The principles of adult education were ticipants passed the written test.
incorporated throughout the workshop. (b) Demonstration of Skills-Demon-
Participants learned through role mod- stration of one segment from the breast
THE JOURNAL OF VOLUNTEER ADMINISTRATION 25
Summer 1995health presentation in the Edu-Kit was total, 17 training workshops have been
used to evaluate the participant's ability held and well over 200 volunteers have
to deliver a message clearly and effec- been trained.
tively. Feedback was given to participants Ongoing supervision is provided by the
by both peers and the trainers. Valuable Health Promotion Consultants in the
learning occurred through the identifica- field. In some areas the trainers have held
tion of strengths and weaknesses in their meetings to share experiences, answer
presentation style. questions and address concerns of the
(c) Attitude-The trainers were evalu- local volunteers who deliver the program
ated on their ability to listen, to adapt ma- in the community.
terials to diverse audiences, and to be re- The CCS-Ontario Division Breast
spectful of different learning styles. The Health Working Group is available to an-
results indicated that the participants swer any volunteer and/ or trainer ques-
could apply the learning principles in dif- tions or concerns. There have been regu-
ferent situations, adapting to specific vol- lar mailings to update both groups on
unteer needs. new resources and initiatives.
(d) The Training Process-Each partici- The local volunteers have been ex-
pant completed an evaluation of the re- tremely active in delivering the breast
cruitment, selection and the training pro- health message to both women and
cess. Their comments are reflected in the mixed audiences, in community settings
following section on what we would do as well as in the workplace. Volunteers
differently. are asked to submit report forms and a
All participants successfully met the re- complete provincial tally indicates in the
quirements for the completion of the first year of the training program 225 local
training. The dedication of the volunteers volunteers have been trained. These vol-
is demonstrated by the example of one of unteers have been involved in 368 activi-
the participants who moved out of the ties including presentations, special
province but voluntarily returned to carry events, media promotions, mall displays,
out one training sessions. All others are etc. The estimated audience reached is ap-
still active as trainers a year-and-a-half proximately 15,000 people.
after the training.
The Breast Health Working Group, in WHAT WOULD WE DO DIFFERENTLY
conjunction with the Behavioural Re- NEXT TIME?
search and Program Evaluation Unit of The evaluations of the training were
the National Cancer Institute, are cur- overwhelmingly positive. However, there
rently developing various evaluation tools are a number of areas where we felt the
to assess the Breast Health Programme. training could and should be strength-
The evaluation is to measure the impact of ened.
the training on the intended audience. Resource materials need to be circu-
KEY FACTORS FOR SUCCESS: lated well in advance of the workshop.
Evaluation:Using a variety of evalua- This would allow more time for partici-
tion approaches-Le., knowledge test, pants to read and digest the content and
demonstration, observation and process; would facilitate learning during the actual
and evaluation of all aspects of the train- workshop. In addition, because of the
ing program. complexity of the manual, time should be
spent at the beginning of the workshop to
Implementationand Follow-up walk through the content and layout of
Since the training, held in the spring of the manual with the participants.
1993, all nine regions in the province have Secondly, time should be put into the
held at least one training session for lo- agenda for a model presentation using
cally recruited volunteers. To date, in the program content. Participants want to
26 THE JOURNAL OF VOLUNTEER ADMINISTRATION
Summer1995see how a "real" presentation is done. The gram at the community level. The impor-
model presentation supplements the peer tant factors to ensure the delivery of a
presentations, providing a large range of quality program include: (a) the clarity of
styles from which to choose. content area, (b) carefully recruited and
Thirdly, more time should be allowed selected candidates based on a set of iden-
in the training sessions to discuss and tified criteria, (c) offering skill building
plan how the training program will be opportunities in training, (d) testing to en-
implemented in the trainer's home re- sure competence and accuracy in message
gion. This preparation is essential to de- delivery, (e) evaluation, and (f) a mecha-
crease anxiety about the tasks ahead, to nism for follow-up support and updating
develop action plans and to anticipate of information.
road blocks and begin problem solving. People with skills and interest, given
The planning would be best facilitated training and support, can greatly con-
with a staff partner. tribute to a community-based program.
A Friday night startup was a struggle
for many of the participants. They were
tired and stressed from a busy work week. REFERENCE
An alternative proposal suggested a later The Workshop Group, Reducing Deaths
finishing time on Sunday afternoon. from Breast Cancer in Canada, Cana-
dianMedicalAssociationJournal,Vol. 141,
CONCLUSION August 1, 1989: 199-201.
There is a role for volunteers in the de-
livery of a breast health promotion pro-
THE JOURNAL OF VOLUNTEER ADMINISTRATION 27
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