A model for community participation in breast cancer prevention in Iran

Context: Genuine community participation does not denote taking part in an action planned by healthcare professionals in a medical or top-down approach. Further, community participation and health educationon breast cancer prevention are not similar to other activities incorporated in primary health care services inIran. Objective: To propose a model that provides a methodological tool to increase women’s participation inthe decision making process towards breast cancer prevention. To address this, an evaluation framework wasdeveloped that includes a typology of community participation approaches (models) in health, as well as fivelevels of participation in health programs proposed by Rifkin (1985&1991). Method: This model explains thecommunity participation approaches in breast cancer prevention in Iran. In a ‘medical approach’, participationoccurs in the form of women’s adherence to mammography recommendations. As a ‘health services approach’,women get the benefits of a health project or participate in the available program activities related to breastcancer prevention. The model provides the five levels of participation in health programs along with the ‘healthservices approach’ and explains how to implement those levels for women’s participation in available breast cancerprevention programs at the local level. Conclusion: It is hoped that a focus on the ‘medical approach’ (top-down)and the ‘health services approach’ (top-down) will bring sustainable changes in breast cancer prevention andwill consequently produce the ‘community development approach’ (bottom-up). This could be achieved usinga comprehensive approach to breast cancer prevention by combining the individual and community strategiesin designing an intervention program for breast cancer prevention.