An interactive multimedia CD-ROM program on mammography will be produced and evaluated for older African-American women. The computer software will be framed by theories of behavioral change with emphasis on dimensions previously documented to influence the target audience's use of mammograms including low priority given to personal health, sense of self- efficacy, and the importance of stage of behavioral change. The program will be jointly developed by staff from Opening Doors, the University of Illinois, and Carle Foundation representing a tertiary care center. Funded by the Robert Wood Johnson and Henry Kaiser Family Foundations to address non-financial barriers to health care for medically underserved people, the Champaign-Urbana Opening Doors program focuses on barriers to reproductive health for African- American women. The computer program will rely primarily on graphics and video (90 percent of program content) generic to the target audience and touch screens, thus requiring little reading or familiarity with computer technology. A hypermedia document will also be prepared for the Internet to advertise the CD-ROM's program's availability for the cost of materials through the university and documented effectiveness as an educational tool with African- American women. The CD-ROM will be evaluated with a prospective randomized lagged treatment control group design with 60 African-American women 50 years and older and determined to be in the contemplative or preparation phase of stage of behavioral change regarding use of mammograms. Self report outcome measures will include pre-post-test assessments of knowledge of mammograms, number of perceived barriers, perceived personal risk for breast cancer, patient-provider communication skills, stage of change regarding mammogram use. Actual use of mammograms in the evaluation year will be tracked as made available free of charge through the tertiary care center. Interviews will be conducted by Opening Doors staff. The CD-ROM program addresses the health education needs of a group of women already challenged by limited access to health care and known to have a recent increase in the incidence of breast cancer and mortality from breast cancer and to present with more advanced disease as compared to white women.
