The Cancer Information Service (CIS) has historically been most effective in eliciting calls from middle income, white women. Yet, research indicates that low income and minority populations are less likely than whites to receive cancer screening services and more likely than whites to be diagnosed with cancer at a later stage. The overall goal of this project is to reach a population underserved by the CIS - low income women - using an innovative outreach approach which consists of CIS staff conducting outcalls to women in low income neighborhoods. This outreach approach will be used to implement an interactive barriers counseling intervention, based on Prochaska and DiClemente's Transtheoretical Model, designed to increase the use of screening mammography. Included in the intervention will be referral to the low and no-cost cancer screening services provided by the Breast and Cervical Cancer Mortality Reduction Act of 1990 in the State of Colorado. Residents within low income neighborhoods will be identified using a commercially available, database, INFORUM, and randomly assigned to three study groups: (I)control; (II)outcall only; and (III) advance letter + outcall. The impact of the intervention will be evaluated using data collected at baseline (immediately prior to the outcall) and in a six months post-intervention survey. It is hypothesized that progression through the stages of change (according to the Transtheoretical Model) will be greater and rates of screening mammography will be higher in the outcall and advance letter + outcall groups compared to the control group. Self-reports of receipt of screening mammography will be validated through the registry of the Colorado Mammography Advocacy Program. This represents the first validation of self-reports of mammography use within a low income population, and strengthens the test of effectiveness of the outcall intervention.
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