The goal of this study is to develop, implement and evaluate a program designed to increase utilization of cervical and breast cancer screening among low income, low education, minority women. This goal will be achieved through the work of a consortium led by Reynolds Health Center, a clinic dedicated to serving lowincome residents of Forsyth County, NC. Women over the age of 40 who reside in subsidized housing communities in Winston-Salem will be specifically targeted. Women who reside in similar housing communities in Greensboro will serve as the comparison group. The specific objectives of this program are to: 1) assess baseline knowledge, attitudes, and use of breast and cervical cancer screening in: a) the target population and b) health care providers; 2) identify barriers to early cancer detection by the target population and health care providers; 3) assess compliance to follow-up recommendations for abnormal findings from screening; 4) improve knowledge and attitudes about cancer screening in the target population; 5) increase the use of early detection procedures in these women (i.e., mammography, clinical breast examination, and Pap smears) and 6) improve compliance to treatment recommendations following an abnormal screening test. A mixed cohort/cross-sectional design will be used to evaluate the success of the intervention since each portion will provide different information. The cohort component will more accurately assess the effects on individuals over time, while the independent cross-sectional surveys will be used to more completely assess community trends over time. Analysis will be ongoing during all Phases of the project in the form of 1) analysis of baseline surveys for baseline rates and information to aid in the refinement of the proposed Interventions; 2) monthly monitoring of rates of screening procedures at health care facilities; and 3) analysis of the follow-up survey. Interventions for the target population will include community out-reach strategies and clinic in-reach. A community advisory board will advise the investigators on all aspects of the study relating to the target population. Health care providers will receive interventions in the form of continuing education seminars and reminder systems with feedback. This study builds on the previous work of the investigators and the working relationship that Reynolds Health Center and the Bowman Gray School of Medicine have established with the community and community agencies that are part of the consortium. Successful interventions will be assimilated into the comparison community in Year 04, and members of the consortium in each community will assume the responsibility of continuing to implement successful strategies in the communities after the funding for this study has completed.
