Founded in 1894, the Seattle Young Women’s Christian Association (YWCA) was developed to support and empower women of all ages, races, and backgrounds. Since then, the Seattle YWCA has grown and focused its efforts on addressing racial and socioeconomic disparities, especially inequities found within the female homeless population (Andrews, 2004). Angeline’s Day Center is a program offered by YWCA and is located in downtown Seattle. It serves approximately 200 women a day by providing overnight shelter, breakfast and lunch services, healthcare access, and amenities like showers, bathrooms, and laundry (“Angeline’s Day Center”, 2022). After completing a windshield survey and speaking with Lilliann Hansell, the program lead at Angeline’s, our group realized that there was a need for social interaction and community-based engagement with the women. Early signs indicated knowledge deficits regarding skin protection and breast cancer prevention, therefore, producing our main goal; to increase health literacy about these issues through a community-focused engagement strategy.
According to the Seattle/King County count, the number of people experiencing homelessness rose 5% between 2019 and 2020, with a total of 11,751 people experiencing homelessness in 2020. Furthermore, the court determined that homelessness disproportionately affects people of color (POC). Though Black/African Americans constitute seven percent of the population in Seattle/King County, twenty-five percent of the respondents were constituted in January 2020 count (Constantine, 2020).
When reviewing the health needs of people experiencing homelessness, dermatological concerns ranked high in prevalence and relevance. The unhoused population is at higher risk for skin cancer due to excessive sun exposure, foot condition related to improper supplies and constant standing, and overall, infection (Adly et al., 2021, Skin cancer in people of color, 2022). According to the Skin Cancer Foundation, one in five Americans will develop skin cancer by the age of 70, however, black patients have only a 71% five-year melanoma survival rate in comparison with a 93% survival rate in white patients (Skin cancer facts & statistics, 2022). Lastly, it is reported that this population experiences higher rates of sexually transmitted infections (STIs) (Ady et al., 2021). Upon finding the data, it was evident that education regarding preventative and low-cost measures could be resourceful to the women of Angeline’s.
Activities with Rationale
According to a recent study, bingo showed to increase knowledge relating to health related topics (Flint et al., 2020). Participants reported enjoyment and high likelihood that they would attend the activity again. Using this research, bingo (see Appendix A) and “Fact or Cap” (see Appendix B) were chosen as our interactive interventions to educate women on skin health and breast cancer reduction. Supplemental to the games was an informational pamphlet (see Appendix C) highlighting key features that affect unhoused people of color such as sun protection, STI’s, vitamin D deficiency and written instructions on how to perform a self skin assessment monthly.
Bingo was created using a free bingo card generator. We created a four by five grid of facts, even including some fun facts about ourselves. Each participant was given two bingo boards and played three rounds with prizes to incentive and reward participation. Participation was abundant in their excitement and appreciation to play. However, hearing and reading difficulties were drawbacks to the joyous participation. To overcome this, we had one caller and two circulating students helping repeat and find facts with the women. “Fact or Cap” is a play on words using the colloquial term, “cap”, which is used to state that something is a lie. A slideshow was presented with each slide containing a sentence and the group must collaborate and determine whether the sentence was true or false. This game was developed to encourage teamwork and interpersonal communication amongst the group
While onsite, we wanted to focus on building therapeutic and trusting relationships with the women by talking with them and getting to know their stories. According to the Community and Public Health Nursing textbook, “active listening with nonjudgmental empathy helps to communicate acceptance and increase trust. It allows for an accurate understanding of another person’s viewpoint and helps to bring issues and concerns into the open, where they can be more easily resolved” (Rector, 2022).
Due to COVID-19 protocols, only three members of our team could present in the building at one time, splitting the day in half between the teams; morning and afternoon. In order to understand the women of Angeline’s, we conducted a pre-intervention survey (see Appendix D) upon entering and a post-intervention survey provided in the afternoon. The data showed that 100% of the women rated their skin five out of five, or “very important” to them. Happily enough, about 78% of women stated they knew the main cause of skin cancer and 66% of women stated they had seen a healthcare provider in the last six months.
Unfortunately, our second intervention visitation was canceled due to a positive COVID case at the shelter. In the following week, only the morning group was able to attend, obtaining a pre-intervention survey (see Appendix E). Minutes after arriving the second group was asked to leave the shelter. With that we were unable to conduct a post-intervention survey and consequently do not have quantitative data to support the effectiveness of the interventions. Results of pre-intervention surveys reflect a knowledge deficit of skin and breast cancer as well as a readiness to learn. Based on the surveys we were able to collect, 100% of women affirmed that playing games are helpful when learning about health-related topics. Second intervention day data: 33% of the women rated their knowledge of how to protect their skin at a 3 or below on a scale from 1 to 5 with one being completely unaware and five representing full knowledge of how to protect their skin. The surveys also affirmed that the use of games for education was valued by the women of Angeline’s.
In conversation with the women following the games they provided many compliments, shared their appreciation and even reported learning specific new facts. Notably, many women who reported not having done a breast exam previously affirmed that they would try one soon. Overall, their responses were incredibly positive regarding our interventions.
Our goal of empowering women with knowledge of the skin, breast, and sexual health by using interactive educational games is the primary impact of this project. It was received well based on active participation and verbalized compliments. The effects of the pandemic led to instability within planning for the intervention days. Limitations included being unable to attend full days, gather data, and feeling unable to create close and trusting relationships with the women. The women demonstrated a genuine eagerness to learn more about health promotion strategies during games, especially Bingo, and many stated that they now understand the importance of skin and breast self-exams and look forward to completing one themself.
Adly, M., Woo, T. E., Traboulsi, D., Klassen, D., & Hardin, J. (2021). Understanding dermatologic concerns among persons experiencing homelessness: A scoping review and discussion for improved delivery of care. Journal of Cutaneous Medicine and Surgery, 25(6), 616–626. https://doi.org/10.1177/12034754211004558
Andrews, M. (2004, September 1). YWCA -- Seattle-king county/Snohomish county. YWCA -- Seattle-King County/Snohomish County. Retrieved May 24, 2022, from https://www.historylink.org/File/290#:~:text=In%201894%2C%20a%20group%20of,working%20girl%22%20toward%20self%20support
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Ralston, Sinclair; Connolly, Carmen; Azcueta, Alexsis; Domingo, Theresa; Gray, Natalie; and Reola, Ashley, "Health Promotion by Using Collaborative Educational Games for the Women of Angeline’s" (2022). Nursing Leadership in Community Engagement Projects. 16.
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