Randomized Trial of a Lay Health Advisor and Computer Intervention to Increase Mammography Screening in African American Women

• Published in: Cancer epidemiology, biomarkers & prevention biomarkers & prevention, 2010-01, Vol.19 (1), p.201-210
• Main Authors: RUSSELL, Kathleen M, CHAMPION, Victoria L, MONAHAN, Patrick O, MILLON-UNDERWOOD, Sandra, QIANQIAN ZHAO, SPACEY, Nicole, RUSH, Nathan L, PASKETT, Electra D
• Format: Article
• Language: English
• Subjects: Adult; African Americans; Aged; Biological and medical sciences; Breast Neoplasms - prevention & control; computer-assisted instruction; Computers; Counseling; Female; Gynecology. Andrology. Obstetrics; Health Behavior; Humans; intervention study; lay health advisors; Mammary gland diseases; mammography; Mammography - psychology; Mammography - utilization; Mass Screening - psychology; Mass Screening - utilization; Medical sciences; Middle Aged; Patient Education as Topic - methods; Program Evaluation; Tumors
• ISSN: 1055-9965; 1538-7755
• DOI: 10.1158/1055-9965.EPI-09-0569

Background: Low-income African American women face numerous barriers to mammography screening. We tested the efficacy of a combined interactive computer program and lay health advisor intervention to increase mammography screening. Methods: In this randomized, single blind study, participants were 181 African American female health center patients of ages 41 to 75 years, at ≤250% of poverty level, with no breast cancer history, and with no screening mammogram in the past 15 months. They were assigned to either ( a ) a low-dose comparison group consisting of a culturally appropriate mammography screening pamphlet or ( b ) interactive, tailored computer instruction at baseline and four monthly lay health advisor counseling sessions. Self-reported screening data were collected at baseline and 6 months and verified by medical record. Results: For intent-to-treat analysis of primary outcome (medical record–verified mammography screening, available on all but two participants), the intervention group had increased screening to 51% (45 of 89) compared with 18% (16 of 90) for the comparison group at 6 months. When adjusted for employment status, disability, first-degree relatives with breast cancer, health insurance, and previous breast biopsies, the intervention group was three times more likely (adjusted relative risk, 2.7; 95% confidence interval, 1.8-3.7; P < 0.0001) to get screened than the low-dose comparison group. Similar results were found for self-reported mammography stage of screening adoption. Conclusions: The combined intervention was efficacious in improving mammography screening in low-income African American women, with an unadjusted effect size (relative risk, 2.84) significantly higher ( P < 0.05) than that in previous studies of each intervention alone. Cancer Epidemiol Biomarkers Prev; 19(1); 201–10