The Mary Babb Randolph Cancer Center (West Virginia University) is collaborating with a regional, multi-county health department and other public health service providers to demonstrate how a consortium of community agencies can develop and evaluate strategies to increase the availability, awareness, and utilization of breast and cervical cancer screening services. The target population is rural, low income, unscreened women 40 and over. Emphasis is placed on reaching women 65 years and above. We have overcome financial barriers by arranging to finance screening services for uninsured low income women through funds provided by the West Virginia Bureau of Public Health. We have commitments from the State Medicaid program and the West Virginia University Health. Sciences Center to finance necessary follow-up diagnostic and treatment services. Two counties will serve as test sites for inreach interventions. Interventions are theoretically grounded in a PROCEED framework and include: a) a tracking system; b) patient reminders; c) standing orders; and d) an innovative woman-to-woman effort which will recruit for screening older women who are mothers of women currently seeing providers. Providers in one of the two counties will also test outreach strategies including utilization of interpersonal communication networks such as church groups and non-health agency providers serving low-income groups. A third county not subjected to interventions will serve as a control. Our consortium includes all public health agencies in the study region, the Mary Babb Randolph Cancer Center, the West Virginia Bureau of Public Health, and other relevant groups. Evaluation occurs within a design that permits us to determine effects of inreach and effects of inreach combined with outreach. Two primary sources of data to measure the main effect of increasing screening are a population based pre- and post-baseline interview survey and a provider based pre- and post-baseline survey of client screening rates. The research design will permit a distinction of the effects from statewide intervention from the effects resulting from our project interventions in the demonstration region added to the statewide efforts.
