Cancer Control Research
1R03CA059235-01A1
Davis, Terry C.
IMPROVING SCREENING MAMMOGRAPHY USE
AbstractLow literacy has received limited attention in the "Year 2000" objective to
increase screening mammography utilization by low-income women. Inaccurate
knowledge and negative attitudes associated with low literacy may result in
underutilization of screening mammography. The objectives of the proposed
project are to increase utilization of screening mammography by women with
low literacy skills and to provide information about factors associated
with the decision to be screened. Specific aims are: 1 to develop a
screening mammography educational program appropriate for women with low
literacy skills; 2) to compare the efficacy of th tailored educational
program with that of National Cancer Institute (NCI) printed materials in
improving utilization of screening mammography by women with low literacy
skills; and 3) to provide more information about the relationship of
literacy an a woman's knowledge, attitudes, and decision to obtain a
mammogram.
The study will be conducted in three stages: materials development, program
implementation, and evaluation. Materials development will involve focus
groups of women aged 40 years and older who live in a housing project.
Groups of women who have had a mammogram and groups who have not had a
mammogram will discuss facilitators and barriers to use and possibilities
for improving screening mammography utilization in their communities. The
information will be used to refine a Screening Mammography Knowledge nd
Attitudes Questionnaire (SMKAQ) based upon national survey questions and
guidance from earlier focus groups. The information will also be used to
develop a twenty minute educational program, which will contain a videotape
as well as written and verbal material. The program will be implemented in
small groups of women aged 40 to 75 years who are consecutive registrants
at one of two outpatient clinics that serve a low-income population. A
reading screening test and the SMKAQ will be administered to these women in
a standardized manner. The women will then receive one of three
interventions; 1) The developed education program, 2) NCI printed
material, or 3) recommendation and referral only. Interventions will be
systematically assigned to specific clinic days. Evaluation will be
conducted using a telephone interview six months after the interventions.
Subjects will be asked whether they obtained a mammogram (verified by
medical records) and what factors influenced the decision. Data will be
analyzed to determine: 1) if intervention groups differ in terms of
obtaining screening mammography within six months of intervention; 2)
which responses to the questionnaire best predict screening mammography
utilization; 3) if literacy level is associated with mammography
utilization; and 4) if questionnaire responses which predict utilization of
the test are associated with literacy level.
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