Top

Published in:

01-04-2014 | Original Research

Improving Mammography Screening Among the Medically Underserved

Authors: Terry C. Davis, PhD, Alfred Rademaker, PhD, Charles L. Bennett, MD, PhD, MPH, Michael S. Wolf, PhD, MPH, Edson Carias, BS, Cristalyn Reynolds, MA, Dachao Liu, MS, Connie L. Arnold, PhD

Published in: Journal of General Internal Medicine | Issue 4/2014

ABSTRACT

BACKGROUND

We evaluated the effectiveness and cost-effectiveness of alternative interventions designed to promote mammography in safety-net settings.

METHODS

A three-arm, quasi-experimental evaluation was conducted among eight federally qualified health clinics in predominately rural Louisiana. Mammography screening efforts included: 1) enhanced care, 2) health literacy-informed education of patients, and 3) education plus nurse support. Outcomes included mammography screening completion within 6 months and incremental cost-effectiveness.

RESULTS

Overall, 1,181 female patients ages 40 and over who were eligible for routine mammography were recruited. Baseline screening rates were < 10 %. Post intervention screening rates were 55.7 % with enhanced care, 51.8 % with health literacy-informed education and 65.8 % with education and nurse support. After adjusting for race, marital status, self-efficacy and literacy, patients receiving health-literacy informed education were not more likely to complete mammographic screening than those receiving enhanced care; those additionally receiving nurse support were 1.37-fold more likely to complete mammographic screening than those receiving the brief education (95 % Confidence Interval 1.08–1.74, p = 0.01). The incremental cost per additional women screened was $2,457 for literacy-informed education with nurse support over literacy-informed education alone.

CONCLUSIONS

Mammography rates were increased substantially over existing baseline rates in all three arms with the educational initiative, with nurse support and follow-up being the most effective option. However, it is not likely to be cost-effective or affordable in resource-limited clinics.

American Cancer Society. Cancer facts & figures 2011–2012. Atlanta: ACS; 2012.

Cho Y, Lee S, Arozullah A, et al. Effects of health literacy on health status and health service utilization amongst the elderly. Soc Sci Med. 2008;66:1809–16.PubMedCrossRef

White S, Chen J, Atchinson R. Relationship of Preventive Health Practices and Health Literacy: A National Study. Am J Health Behav. 2008;32(3):227–42.PubMedCrossRef

Alexandraki I, Mooradian AD. Barriers related to mammography use for breast cancer screening among minority women. J Natl Med Assoc. 2010;102(3):206–18.PubMed

Kagawa-Singer M, Valdez Dadia A, Yu MC, et al. Cancer, culture, and health disparities: Time to chart a new course? CA: A Cancer Journal for Clinicians. 2010;60(1):12–39.

Rayman KM, Edwards J. Rural primary care providers’ perceptions of their role in the breast cancer care continuum. J Rural Health. 2010;26(2):189–95.PubMedCrossRef

Edwards JB, Tudiver F. Women’s preventive screening in rural health clinics. Women’s Health Issues. 2008;18(3):155–66.PubMedCrossRef

American Cancer Society. Breast Cancer Facts & Figures 2009-2010. Atlanta: American Cancer Society.

Brown KC, Fitzhugh EC, Neutens JJ, et al.Screening mammography utilization in Tennessee women: the association with residence. J Rural Health. 2009;25(2):167–73.PubMedCrossRef

10.

Cummings DM, Whetstone LM, Earp JA, et al. Disparities in mammography screening in rural areas: analysis of county differences in North Carolina. J Rural Health. 2002;18(1):77–83.PubMedCrossRef

11.

Harris DM, Miller JE, Davis DM. Racial differences in breast cancer screening, knowledge and compliance. J Nat Med Assoc. 2003;95(8):693–701.

12.

Cronan T, Villalta I, Gottfried E, et al. Predictors of mammography screening among ethnically diverse low-income women. Journal of Women’s Health. 2008;17(4):527–37.PubMedCrossRef

13.

Davis TC, Arnold C, Berkel HJ, et al. Knowledge and attitude on screening mammography among low literate, low income women. Cancer. 1996;78(9):1912–20.PubMedCrossRef

14.

Eheman C, Benard V, Blackman D, et al. Breast Cancer Screening among Low-Income or Uninsured Women: Results from the National Breast and Cervical Cancer Early Detection Program, July 1995 to March 2002 (United States). Canc Causes Contr. 2006;17(1):29–38.CrossRef

15.

U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=5 Accessed December 4, 2013.

16.

Agency for Healthcare Research and Quality. National Health Disparities Report 2011.

17.

Champion V, Skinner C, Menon U. Development of a self efficacy scale for mammography. Res Nurse Health. 2005;28(4):329–36.CrossRef

18.

Clark M, Rakowski W, Bonacore L. Repeat mammography: Prevalence estimates and considerations for assessment. Ann Behav Med. 2003;26(3):201–11.PubMedCrossRef

19.

Elting LS, Cooksley CD, Bekele BN, et al. Mammography capacity: impact on screening rates and breast cancer stage at diagnosis. Am J Prev Med. 2009;37(2):102–8.PubMedCrossRef

20.

Ogedegbe G, Cassells AN, Robinson CM, et al. Perceptions of barriers and facilitators of cancer early detection among low-income minority women in community health centers. J Natl Med Assoc. 2005;97(2):162–70.PubMedCentralPubMed

21.

Rauscher GH, Hawley ST, Earp JAL. Baseline predictors of initiation vs. maintenance of regular mammography use among rural women. Prev Med. 2005;40(6):822–30.PubMedCrossRef

22.

O’Malley AS, Forrest CB, Mandelblatt J. Adherence of low-income women to cancer screening recommendations. J Gen Intern Med. 2002;17(2):144–55.PubMedCentralPubMedCrossRef

23.

Engelman KK, Ellerbeck EF, Perpich D, et al. Office systems and their influence on mammography use in rural and urban primary care. J Rural Health. 2004;20(1):36–42.PubMedCrossRef

24.

Lyttle NL, Stadelman K. Assessing awareness and knowledge of breast and cervical cancer among Appalachian women. Prev Chronic Dis. 2006;3(4):A125.PubMedCentralPubMed

25.

Lopez EDS, Khoury AJ, Dailey AB, et al. Screening mammography: A cross-sectional study to compare characteristics of women aged 40 and older from the deep south who are current, overdue, and never screeners. Women’s Health Issues. 2009;19(6):434–45.PubMedCrossRef

26.

Tejeda S, Thompson B, Coronado GD, et al.Predisposing and enabling factors associated with mammography use among Hispanic and non-Hispanic white women living in a rural area. J Rural Health. 2009;25(1):85–92.PubMedCentralPubMedCrossRef

27.

McAlearney AS, Reeves K, Tatum C, et al. Cost as a barrier to screening mammography among underserved women. Ethn Health. 2007;12(2):189–203.PubMedCrossRef

28.

Bennett I, Chen J, Soroui J, et al. The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. Ann Fam Med. 2009;7:204–11.PubMedCentralPubMedCrossRef

29.

Guerra C, Krumholz M, Shea J.Literacy and knowledge, attitudes and behavior about mammography in Latinas. J Health Care Poor Underserved. 2005;16:152–66.PubMedCrossRef

30.

U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion: National Action Plan to Improve Health Literacy. Washington, D.C.: U.S. Department of Health and Human Services, 2010.

31.

Davis TC, Berkel HJ, Arnold CL, et al. Intervention to increase mammography utilization in a public hospital. J Gen Intern Med. 1998;13(4):230–3.PubMedCentralPubMedCrossRef

32.

Health Resources and Services Administration. www.hrsa.gov/. Accessed December 4, 2013.

33.

Weiss B, Schwartzberg J, Davis T, et al. Health literacy and patient safety: Help patients understand: manual for clinicians. AMA Foundation, 2007.

34.

U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2009 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2013. Available at: www.cdc.gov/uscs. Accessed December 4, 2013.

35.

Ferreira MR, Dolan NC, Fitzgibbon ML, et al. Health care provider-directed intervention to increase colorectal cancer screening among veterans: Results of a randomized controlled trial. J Clin Oncol. 2005;23:1548–54.PubMedCrossRef

36.

Davis T, Arnold C, Rademaker A, et al. Improving colon cancer screening in community clinics. Cancer. 2013;119(21):3879–86.PubMedCrossRef

37.

US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2009;151:716–26.CrossRef

38.

Champion V, Skinner C, Menon U. Development of a self-efficacy scale for mammography. Res Nurs Health. 2005;28:329–36.PubMedCrossRef

39.

Janz NK, Champion VL, Strecher VJ. The health belief model. In: Glanz K, Lewis F, Rimer B (eds.), Health Education Behavior, San Francisco: Jossey-Bass.

40.

Rosenstock I. The health belief model: origins and correlates. Health Educ Monogr. 1974;2:336–53.

41.

Rosenstock I, Strecher V, Becker M. Social learning theory and the health belief model. Health Educ Q. 1988;15(2):175–83.PubMedCrossRef

42.

Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–64.PubMedCrossRef

43.

Davis TC, Arnold CL, Rademaker A, et al. Differences in Barriers to Mammography between Rural and Urban Women. Journal of Women’s Health. July 2012; 748-55.

44.

Davis T, Long S, Jackson R, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25(6):391.PubMed

45.

Hecht J, Borrelli B, Breger R, et al. Motivational interviewing in community-based research: Experiences from the field. Ann Behav Med. 2005;9(2):29–34.CrossRef

46.

Wolf MS, Wilson EA, Rapp DN, et al. Literacy and learning in health care. Pediatrics. 2009;124(Suppl 3):S275–81.PubMedCrossRef

47.

Phillips C, Rothstein J, Beaver K, et al.Patient navigation to increase mammography screening among inner city women. J Gen Intern Med. 2011;26(2):123–9.PubMedCentralPubMedCrossRef

48.

Lipkus I, Rimer B, Halabi S, et al. Can tailored interventions increase mammography use among HMO women? Am J Prev Med. 2000;18(1):1–10.PubMedCrossRef

49.

Legler J, Meissner H, Coyne C, et al. The effectiveness of interventions to promote mammography among women with historically lower rates of screening. Cancer Epidemiol Biomarkers Prev. 2002;11(1):59–71.PubMed

50.

Dietrich A, Tobin J, Cassells A, et al. Translation of an efficacious cancer-screening intervention to women enrolled in a Medicaid managed care organization. Ann of Fam Med. 2007;5(4):320–7.CrossRef

51.

Saywell R, Champion V, Skinner C, et al. A cost-effectiveness comparison of three tailored interventions to increase mammography screening. J Womens Health. 2004;13(8):909–18.CrossRef

52.

Saywell R, Champion V, Zollinger T, et al. The cost effectiveness of 5 interventions to increase mammography adherence in a managed care population. Am J Manag Care. 2003;9(1):33–44.PubMed

Title: Improving Mammography Screening Among the Medically Underserved
Authors: Terry C. Davis, PhD
Alfred Rademaker, PhD
Charles L. Bennett, MD, PhD, MPH
Michael S. Wolf, PhD, MPH
Edson Carias, BS
Cristalyn Reynolds, MA
Dachao Liu, MS
Connie L. Arnold, PhD
Publication date: 01-04-2014
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 4/2014
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-013-2743-3

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

ABSTRACT

BACKGROUND

METHODS

RESULTS

CONCLUSIONS

Please log in to get access to this content

Other articles of this Issue 4/2014

Capsule Commentary on Stephens et al., Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification

The Mini Mental Status Exam as a Surrogate Measure of Health Literacy

A Better Way to Know What Patients Believe and Value about Health

Capsule Commentary on Michaelidis et al., Cost-Effectiveness of Procalcitonin-Guided Antibiotic Therapy for Outpatient Management of Acute Respiratory Tract Infections in Adults

Fungating Mass as First Presentation of Advanced Breast Cancer

Addressing Multimorbidity in Evidence Integration and Synthesis

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials