The primary goal of this project is to demonstrate how a consortium of community health and social service agencies can work together to implement and evaluate strategies which are aimed at decreasing mortality due to breast and cervical cancer by increasing the number of women who receive routine mammography, clinical breast exams, and Pap testing at recommended intervals. The proposed public health approaches to breast and cervical cancer screening are designed to reach all women 40 years and older in four rural counties in north central Wisconsin. Because they are at higher risk for late stage diagnosis of breast and cervical cancer, low income women and women aged 65 years and older will be specially targeted for interventions. An emphasis will also be placed on testing policy- relevant strategies designed to introduce structural modifications in the health care delivery and financing systems that are expected to improve rates of screening among low income and elderly rural women. Randomized controlled studies of one """"""""inreach"""""""" and two outreach intervention strategies will be conducted in two well-defined, low-income populations: 1) registered patients of a rural community health center, and 2) Medicaid beneficiaries in four rural counties. During the second year, the results from these studies will be incorporated into a community-wide screening program. This program will be coordinated through a Regional Consortium and will involve public and professional awareness and education programs. In addition to coordinating inreach and outreach activities, the Regional Consortium and local task forces will be charged with providing technical assistance and advocating for the implementation of reminder systems in isolated rural practices in the intervention counties. The Regional Consortium will also work with local service providers, insurers and other relevant parties to enhance screening capacity and develop financing mechanisms to meet the screening needs of all area residents. The impact of this community-wide intervention will be assessed by a quasi-experimental design, using population-wide telephone surveys in the intervention region and in a comparable region in the state. The evaluation of the proposed breast and cervical cancer screening project will assess the effectiveness of the combined strategies, as well as the effectiveness of selected proposed intervention methods, in overcoming individual, environmental, and systemic barriers to screening utilization and adequate follow-up.
