Although mammography for secondary prevention of breast cancer is widely practiced in the United States, such is not the case in many countries. In Chile, for example, screening mammography is a relatively recent phenomenon with fewer than 15% of age-eligible women ever having had a screening mammogram. A newly- established public health clinic in La Pintana, Chile has formed a relationship with a mammography provider to provide free mammograms to its women patients who are aged 50 through 70. Health care providers in the clinic are instructed to encourage women to receive these free mammograms. Unfortunately, evidence indicates that few women take advantage of the free mammograms. Whether this is due to inconsistent health care provider messages, barriers faced by the women, or other reasons is unclear. In this project, women will be encouraged to receive mammograms. Two hundred fifty five women aged 50 through 70, who have not had a mammogram in the past two years, in the Juan Pablo II Clinic in La Pintana, Chile will be randomized to one of three conditions. One-third of the women will receive """"""""usual care"""""""" which consists of messages to receive a mammogram from their health care provider at regular visits. A """"""""low intensity"""""""" arm will received a mailing from the primary health care provider. The mailing will include a letter asking the woman to receive a mammogram, a referral for the free mammogram, and a brochure addressing barriers and facilitators and the importance of mammography. A """"""""high intensity"""""""" arm will receive the low intensity treatment and will receive follow-up by a lay health educator in two contacts in which women will be verbally encouraged to seek mammography, women will be assisted in making an appointment to receive mammography, and women will be assisted in overcoming physical barriers (e.g., child care, transportation) to receive mammography. The endpoint of interest will be the proportion of women per arm who receive mammograms within six months of receiving the intervention. Focus groups will be conducted prior to intervention to assess barriers and facilitators relevant to this population. Arrangements have been made with the clinic to provide computerized data on mammography status of women participating in the study. Until recently, Chile has been less likely than the US to use screening mammography for early detection of breast cancer. With the new emphasis on mammography, it is necessary to test clinical interventions that will encourage women to seek mammograms. This project will help identify effective strategies that can be used by clinics to motivate women to seek mammograms. ? ? ?
