Strategies to improve survival from breast and cervical cancer have not successfully addressed the needs of low-income and ethnically diverse women. The goal of this project is to improve initial breast and cervical cancer screening and maintenance of interval screening under conditions of shifting access to medical care in low-income, multi-ethnic sample of women in Alameda County, California.
The specific aims of this study are: 1) in a randomized controlled trial, to develop and test the impact of a phased, access-oriented intervention, individually tailored in both content and intensity, """"""""managed outreach""""""""; 2) to evaluate the cost- effectiveness of the intervention; 3) to prospectively assess the association between cost of outreach and women's characteristics (including insurance status, positive/negative perceptions toward screening); 4) to identify and measure positive/negative perceptions in an under-served, multi-ethnic population. The proposed intervention, informed by a conceptual framework anchored in the Trans-theoretical Model and Precede-Proceed, is designed to achieve maximum impact at a minimum cost in an effort to make the intervention affordable to agencies serve low- income communities. A cohort of 1,500 ethnically diverse women, ages 45- 74, will be recruited from low-income census tracts, randomized to intervention of control group, and followed over 3 years. Throughout the intervention, women will be linked with resources from provider systems and insurance plans. The phases have been designed such that a costly, but effective, lay health work component is combined with less expensive but complementary activities. Computer-generated tailored letters, along with audio tapes for women of low literacy, will be sent every 6 months throughout the intervention based on data from follow-up surveys, insurance plans, and providers. Phase I combines letters and telephone counseling by Lay Wealth Workers (LHWs), or in-person support if needed. In Phase II, to reduce the cost and intensity of the intervention yet still make language-appropriate information and support available, LHWs will be phased out and women will be encouraged to use a multi-lingual telephone help-line for screening and access assistance. For the final 6 months of the intervention, the help-line will be phased out and women will be referred to existing community resources. We expect that this phased intervention will result in significant improvements in consumer skills and maintenance screening. The innovations of this study are to provide women tailored outreach at the lowest possible cost, and to associate outreach cost with individual pros/cons for screening.
| Pérez-Stable, Eliseo J; Afable-Munsuz, Aimee; Kaplan, Celia Patricia et al. (2013) Factors influencing time to diagnosis after abnormal mammography in diverse women. J Womens Health (Larchmt) 22:159-66 |
| Stewart, Susan L; Rakowski, William; Pasick, Rena J (2009) Behavioral constructs and mammography in five ethnic groups. Health Educ Behav 36:36S-54S |
| Otero-Sabogal, Regina; Stewart, Susan; Shema, Sarah J et al. (2007) Ethnic differences in decisional balance and stages of mammography adoption. Health Educ Behav 34:278-96 |
| Wagner, Todd H; Engelstad, Linda P; McPhee, Stephen J et al. (2007) The costs of an outreach intervention for low-income women with abnormal Pap smears. Prev Chronic Dis 4:A11 |
| Alderete, Ethel; Juarbe, Teresa C; Kaplan, Celia Patricia et al. (2006) Depressive symptoms among women with an abnormal mammogram. Psychooncology 15:66-78 |
| Juarbe, Teresa C; Kaplan, Celia Patricia; Somkin, Carol P et al. (2005) Are risk factors for breast cancer associated with follow-up procedures in diverse women with abnormal mammography? Cancer Causes Control 16:245-53 |
| Karliner, Leah S; Patricia Kaplan, Celia; Juarbe, Teresa et al. (2005) Poor patient comprehension of abnormal mammography results. J Gen Intern Med 20:432-7 |
| Engelstad, Linda P; Stewart, Susan; Otero-Sabogal, Regina et al. (2005) The effectiveness of a community outreach intervention to improve follow-up among underserved women at highest risk for cervical cancer. Prev Med 41:741-8 |
| Wagner, Todd H; Goldstein, Mary K (2004) Behavioral interventions and cost-effectiveness analysis. Prev Med 39:1208-14 |
| Somkin, Carol P; McPhee, Stephen J; Nguyen, Tung et al. (2004) The effect of access and satisfaction on regular mammogram and Papanicolaou test screening in a multiethnic population. Med Care 42:914-26 |
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