A community intervention is proposed to promote utilization of regular mammography and breast palpation among women aged 50 and above, in an effort to ultimately reduce breast cancer mortality. The proposed intervention includes a community organization component and specific behavioral interventions targeting radiologists, primary care physicians, and women. The intervention package is designed to be not only effective, but also exportable. It is to be implemented in a defined population to ensure generalizability of the results. The community organization framework provides a mode of delivery for the content of the specific behavioral interventions. The intervention is designed for use in a typical medium-sized Washington State community. The Greater Everett area was selected as the intervention site based on 1) it being representative of medium-sized cities in Washington State and the U.S., 2) its """"""""typical"""""""" position with respect to promotion of mammography by the service provider community. Screening activities and utilization will be monitored in the Everett community as well in three comparison communities, two of which are currently somewhat ahead of Everett in terms of the availability and utilization of screening mammography services, and one of which is behind. Evaluation of the community intervention will include 1) descriptive evaluation of intermediate outcomes associated with specific behavioral interventions, and 2) hypothesis testing of the effect of the intervention effort as a whole on primary outcomes. The primary outcomes of interest are: 1) establishment of a community """"""""norm"""""""" of regular mammography and breast palpation for women aged 50 and above; 2) increased rates of utilization of mammography and breast palpation; and 3) increased quality of mammography and breast palpation as the rate of utilization changes.
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