The overall goal of the proposed project is to increase early detection of breast cancer by increasing the proportion of low income rural women, age 50 and older, who receive clinical breast exams and mammograms at appropriate intervals, and return for follow-up care when necessary. The proposed project will be implemented in Robeson County, NC, a rural county with a population comprised of three principal ethic groups of approximately equal size: whites, African Americans, and Native Americans. The individualized health education program will be developed and compared to a brochure and letter in a randomized trial design among 1,000 women aged 50 and older who are patients of Robeson Health care Corporation, the principal provider of health care for this population. The education program will use two innovative strategies to address cultural barriers to breast cancer screening in rural women from three racial groups: 1) educational sessions will be at the individual level in the woman's home; and 2) lay health educators will deliver the education program.
Specific aims of the proposed project are to: 1) identify barriers to obtaining regular clinical breast exams and mammograms; 2) develop and evaluate an health education program to improve knowledge, to address the identified structural and personal barriers to behavior change, and to motivate women in the target populations to obtain clinical breast exams and mammograms; 3) evaluate, through use of a randomized design the impact of the health education program compared to a brochure and physician letter on the proportion of women obtaining regular clinical breast exam and mammography, overall, and within ethnic groups; and 4) to explore the differential effect of the health education intervention to enhance participation in breast cancer screening among white, African American, and Native American women. Secondary aims will relate to assuring adequate follow-up among women with abnormal test results. If this program is successful in improving breast cancer screening practices among this population of tri-racial rural women, lay health educators from a variety of community organizations can be trained and supervised by health departments to deliver similar programs to rural women.
