Abstract
Background
Effective interventions are needed for women long overdue for screening mammography.
Purpose
The purpose of this study is to pilot test an intervention for motivating overdue women to receive a mammogram.
Methods
Subjects aged 45–79 without a mammogram in ≥27 months and enrolled in study practices were identified from claims data. The intervention included a mailed, educational booklet, computer-assisted barrier-specific tailored counseling and motivational interviewing, and facilitated, short-interval mammography scheduling.
Results
Of 127 eligible women, 45 (35.4%) agreed to counseling and data collection. Most were ≥3 years overdue. Twenty-six (57.8%) of the counseled women got a mammogram within 12 months. Thirty-one (72.1%) of 43 counseled women moved ≥1 stage closer to screening, based on a modified Precaution Adoption Process Model.
Conclusion
It is feasible to reach and counsel women who are long overdue for a mammogram and to advance their stage of adoption. The intervention should be formally evaluated in a prospective trial comparing it to control or to proven interventions.
This is a preview of subscription content, log in via an institution to check access.
References
Nystrom L, Rutquist LE, Wall S, et al. Breast cancer screening with mammography: An overview of Swedish randomized trials. Lancet. 1993;341:973-978.
Jonsson H, Tornberg S, Nystrom L, Lenner P. Service screening with mammography of women aged 70–74 years in Sweden: Effects on breast cancer mortality. Cancer Detect Prev. 2003;27(5):360-369.
Rakowski W, Breslau ES. Perspectives on behavioral and social science research on cancer screening. Cancer. 2004;1(5 Suppl):1118-1130.
Centers for Disease Control and Prevention (CDC). Use of mammograms among women aged >/= 40 years—United States, 2000–2005. MMWR. 2007;56(3):49-51.
U.S. Census Bureau. Statistical abstract of the United States: 2001.
Breen N, Cronin KA, Meissner HI, et al. Reported drop in mammography: Is this cause for concern? Cancer. 2007;109:2405-2409.
NCI Breast Cancer Screening Consortium. Screening mammography: A missed clinical opportunity. Results of the NCI Breast Cancer Screening and National Health Interview Studies. JAMA. 1990;264(1):54-55.
Costanza ME. The extent of breast cancer screening in older women. Cancer. 1994;74(7 suppl):2046-2050.
Clemow L, Costanza ME, Haddad WP, et al. Underutilizers of mammography screening today: Characteristics of women planning, undecided about, and not planning a mammogram. Ann Behav Med. 2000;22(1):80-88.
Rimer BK, Ross E, Cristinzio CS, King E. Older women's participation in breast screening. Gerontology. 1992;47:85-91.
Glasgow RE, Whitlock EP, Valanis BG, Vogt TM. Barriers to mammography and pap smear screening among women who recently had neither, one or both types of screening. Ann Behav Med. 2000;22(3):223-228.
Burton MV, Warren R, Price D, Earl H. Psychological predictors of attendance at annual breast screening examinations. Br J Cancer. 1998;77(11):2014-2019.
Yabroff KR, Mandelblatt JS. Interventions targeted towards patients to increase mammography use. Cancer Epidemiol Biomarkers Prev. 1999;8:749-757.
Legler J, Breen N, Meissner H, et al. Predicting patterns of mammography use: A geographic perspective on national needs for intervention research. Health Serv Res. 2002;37(4):929-947.
Weinstein ND. The precaution adoption process. Health Psychol. 1988;7:355-386.
Prochaska JO, DiClemente C. Stages and processes of self-change of smoking: Toward an integrative model. J Consult Clin Psychol. 1983;51:390-393.
LaPelle N, Costanza ME, Luckmann R, et al. Staging mammography non-adherent women: A qualitative study. J Cancer Educ. 2008;23(2):114-121.
Miller W, Rollnick S. Motivational Interviewing: Preparing People to Change Addictive Behaviors. New York, NY: Guilford; 1991.
Rosal MC, Ebbeling CB, Ockene JK, et al. Facilitating dietary change: The patient-centered counseling model. J Am Diet Assoc. 2001;101(3):332-341.
Emmons KM, Hammond K, Fava JL, et al. A randomized trial to reduce passive smoke exposure in low-income households with young children. Pediatrics. 2001;108(1):18-24.
Emmons KM, Rollnick S. Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med. 2001;20(1):68-74.
Costanza ME, Stoddard AM, Luckmann R, et al. Promoting mammography: Results of a randomized trial of telephone counseling and a medical practice intervention. Am J Prev Med. 2000;19(1):39-46.
White MJ, Stark JR, Luckmann R, et al. Implementing a computer-assisted telephone interview (CATI) system to increase colorectal cancer screening: A process evaluation. Patient Educ Couns. 2006;61:419-428.
Rimer BK, Conaway M, Lyna P, et al. The impact of tailored interventions on a community health center population. Patient Educ Couns. 1999;37(2):125-140.
Taplin SB, Barlow WE, Ludman E, et al. Testing reminder and motivational telephone calls to increase screening mammography: A randomized study. J Natl Cancer Inst. 2000;92(3):233-242.
VassarStats. The confidence interval of a proportion. Available at: http://faculty.vassar.edu/lowry/prop1.html. Accessibility verified March 24, 2008.
Newcombe RG. Two-sided confidence intervals for the single proportion: Comparison of seven methods. Stat Med. 1998;17:857-872.
Acknowledgements
This work was supported by the National Institutes of Health, National Cancer Institute Grant: R21 100286. We thank Amin Vidal for his technical expertise in developing the CATI system. All patient/personal identifiers have been removed or disguised so the participants described are not identifiable. All participants gave their informed consent to data collection and, if appropriate, to telephone counseling.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Costanza, M.E., Luckmann, R., White, M.J. et al. Moving Mammogram-Reluctant Women to Screening: A Pilot Study. ann. behav. med. 37, 343–349 (2009). https://doi.org/10.1007/s12160-009-9107-6
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12160-009-9107-6