Intervention to Increase Mammography Utilization in a Public Hospital

Authors

  • Terry C. Davis PhD,

    1. Department of Internal Medicine, Louisiana State University Medical Center School of Medicine in Shreveport.,
    2. Department of Pediatrics, Louisiana State University Medical Center School of Medicine in Shreveport.,
    Search for more papers by this author
  • Hans J. Berkel MD, PhD,

    1. Section of Cancer Prevention and Control, Department of Medicine, Louisiana State University Medical Center School of Medicine in Shreveport.,
    Search for more papers by this author
  • Connie L. Arnold PhD,

    1. Department of Pediatrics, Louisiana State University Medical Center School of Medicine in Shreveport.,
    Search for more papers by this author
  • Indrani Nandy PhD,

    1. Department of Biometry, Louisiana State University Medical Center School of Medicine in Shreveport.
    Search for more papers by this author
  • Robert H. Jackson MD,

    1. Department of Internal Medicine, Louisiana State University Medical Center School of Medicine in Shreveport.,
    Search for more papers by this author
  • Peggy W. Murphy PhD

    1. Department of Internal Medicine, Louisiana State University Medical Center School of Medicine in Shreveport.,
    Search for more papers by this author

Dr. Davis: Louisiana State University Medical Center, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932.

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-opera-style 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.

Ancillary