Abstract
OBJECTIVE: To study the effects of three approaches to increasing utilization of screening mammography in a public hospital setting in Northwest Louisiana.
DESIGN: Randomized intervention study.
POPULATION: Four hundred forty-five women aged 40 years and over, predominantly low-income and with low literacy skills, who had not had a mammogram in the preceding year.
INTERVENTION: All interventions were chosen to motivate women to get a mammogram. Group 1 received a personal recommendation from one of the investigators. Group 2 received the recommendation plus an easy-to-read National Cancer Institute (NCI) brochure. Group 3 received the recommendation, the brochure, and a 12-minute interactive educational and motivational program, including a soap-operastyle video, developed in collaboration with women from the target population.
MEASUREMENTS AND MAIN RESULTS: Mammography utilization was determined at 6 months and 2 years after intervention. A significant increase (p=.05) in mammography utilization was observed after the intervention designed in collaboration with patients (29%) as compared with recommendation alone (21%) or recommendation with brochure (18%) at 6 months. However, at 2 years the difference favoring the custom-made intervention was no longer significant.
CONCLUSIONS: At 6 months there was at least a 30% increase in the mammography utilization rate in the group receiving the intervention designed in collaboration with patients as compared with those receiving the recommendation alone or recommendation with brochure. Giving patients an easy-to-read NCI brochure and a personal recommendation was no more effective than giving them a recommendation alone, suggesting that simply providing women in a public hospital with a low-literacy-level, culturally appropriate brochure is not sufficient to increase screening mammography rates. In a multivariate analysis, the only significant predictor of mammography use at 6 months was the custom-made intervention.
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References
Breen N, Kessler L. Changes in the use of screening mammography: evidence from the 1987 and 1990 National Health Interview Surveys. Am J Public Health. 1993;83:948–54.
Rakowski W, Rimer BK, Bryant SA. Integrating behavior and intention regarding mammography by respondents in the 1990 National Health Interview Survey of Health Promotion and Disease. Public Health Rep. 1994;84:62–7.
Calle EE, Flanders WD, Thun MJ, Martin LM. Demographic predictors of mammography and Pap smear screening in US women. Am J Public Health. 1993;83:53–60.
Rimer BK, Trock B, Engstrom PF, Lerman C, King E. Why do some women get regular mammograms? Am J Prev Med. 1991;7:697–74.
Zapka JG, Stoddard AM, Constanze JE, Greene HL. Breast cancer screening by mammography utilization and associated factors. Am J Public Health. 1989;79:1499–502.
Caplan L, Wells B, Haynes S. Breast cancer screening among older racial/ethnic minorities and whites: barriers to early detection. J Gerontol. 1992;47:101–10.
Moormeier J. Breast cancer in black women. Ann Intern Med. 1996;124:897–905.
Burns R, McCarthy E, Freund K, et al. Black women receive less mammography even with similar use of primary care. Ann Intern Med. 1996;125:173–82.
Mandelblatt J, Andrews H, Kao R, Wallave R, Kerner J. Impact of access and social context on breast cancer stage at diagnosis. J Health Care Poor Underserved. 1995;6:342–50.
Williams MV, Parker RM, Baker DW, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995;274:1677–82.
Miles S, Davis T. Patients who cannot read: implication for the Health Care System. JAMA. 1995;274:1719–20. Editorial.
Doak CC, Doak LG. Teaching Patients with Low-Literacy Skills, 2nd ed. Philadelphia, Pa: Lippincott; 1996.
National Work Group on Cancer and Literacy. Bethesda, Md: National Cancer Institute, May 7, 1992.
McCarthy B, Yood M, Bolton M, Boohaker E, MacWilliams C, Young M. Redesigning primary care processes to improve the offering of mammography. J Gen Intern Med. 1997;12:357–63.
Davis T, Arnold C, Berkel H, Nandy I, Jackson R, Glass J. Knowledge and attitude on screening mammography among low-literate, low-income women. Cancer. 1996;78:1912–20.
Davis TC, Long SW, Jackson RH, et al. Rapid Estimate of Adult Literacy in Medicine: a shortened screening instrument. Fam Med. 1993;25:256–60.
U.S. Department of Health and Human Services. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington DC: U.S. Printing Office; 1991:72, 114–5. DHHS publication (PHS) 91-50213.
Yancey A, Tanjasiri S, Klein M, Tunder J. Increased cancer screening behavior in women of color by culturally sensitive video exposure. Prev Med. 1995;24:142–8.
Rudd RE, Comings JP. Learner developed materials: an empowering product. Health Educ Q. 1994;21:313–27.
Eng E. The Save Our Sisters Project: a social network strategy for reaching rural black women. Cancer. 1993;72:1071–7.
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Supported in part by the National Cancer Institute, grant 1R03-CA59235, and by the Cancer Center for Excellence in Research, Treatment and Education, Louisiana State University Medical Center in Shreveport.
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Davis, T.C., Berkel, H.J., Arnold, C.L. et al. Intervention to increase mammography utilization in a public hospital. J GEN INTERN MED 13, 230–233 (1998). https://doi.org/10.1046/j.1525-1497.1998.00072.x
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DOI: https://doi.org/10.1046/j.1525-1497.1998.00072.x