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Kumar K, Mohammadnezhad M. "Once you get cancer you die. There is no way to get saved from cancer." A qualitative exploration of patients' perceptions towards cancer in Fiji. PLoS One 2022; 17:e0277970. [PMID: 36525441 PMCID: PMC9757585 DOI: 10.1371/journal.pone.0277970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Understanding patients' perspective to get an insight into cancer, and how best the public health systems can battle with this disease is the way forward in this current world. This study aimed to explore patients' knowledge about common cancers, barriers to assessing cancer information and cancer preventative approaches in Fiji. METHODS The study used a qualitative method approach that was conducted among patients who attended Special Outpatients (SOPD) at the four selected health centres in Lautoka Subdivision, Fiji from 1st March to 30th April 2021. A semi-structured open-ended questionnaire was used to guide in-depth interviews. These audio recordings were transcribed and analysed using thematic analysis. All interview transcripts were read and similar words and phrases were assigned numbers which were grouped together to identify themes and sub themes. RESULTS Twenty-eight patients took part in the in-depth interview and the responses were grouped into four themes including; cancer knowledge, diagnosis of cancer in a close friend/family, barriers of communication and optimizing cancer awareness. Patients' awareness about common cancers and cancer risk factors was low. Many barriers for cancer screening were highlighted including stigmatization, fear, worry, death, lack of information, herbal medicine use, lack of resources and delay in diagnosis. Awareness strategies highlighted by participants included community outreach programs, house to house visits, opportunistic screening, engagement of community health care workers and the concept of a cancer hub centre. CONCLUSION It is evident that there is a range of views from patients towards cancer and it is important to understand these perceptions to better guide public health interventions concerning cancer. This puts more focus on the need to invest more in information, education, and communication material for public campaigns that target a variety of people for a wider reach.
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Affiliation(s)
- Kaushal Kumar
- Fiji Ministry of Health and Medical Services, Lautoka Hospital, Lautoka, Fiji Islands
| | - Masoud Mohammadnezhad
- School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Nakhon Pathom, Thailand
- * E-mail:
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Lamb RLB, Ramos Jaraba SM, Graciano Tangarife V, Garcés-Palacio IC. Evaluation of Entertainment Education Strategies to Promote Cervical Cancer Screening and Knowledge in Colombian Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1094-1101. [PMID: 28374230 DOI: 10.1007/s13187-017-1213-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Cervical cancer is considered to be a major health problem for women in developing countries, but it is also problematic for more developed countries as global migration increases and health behaviors move from the countries of origin to new places of residence. We designed and produced a testimonial video and a fotonovela (printed short story) to educate women about cervical cancer and screening. The development of the materials included formative research, production, pretesting, dissemination, and evaluation. The evaluation included 100 women that completed a pretest and a posttest at eight health clinics in Medellin. The pretest and posttest were analyzed using McNemar's test for categorical variables and paired t test for continuous variables. Women in the study had a high initial Stage of Change as defined by the Transtheoretical Model and a high baseline knowledge of HPV and cervical cancer, with the caveat of specific knowledge deficiencies especially for HPV. While not statistically significant, postintervention Transtheoretical Model status in both interventions changed towards higher stages, specifically, from Precontemplation to Contemplation and Preparation. Women who participated in the study liked the educational materials and their knowledge increased, especially for HPV. However, the perception of risk did not change.
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Affiliation(s)
- Roland Lincoln Boyden Lamb
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, USA
| | | | | | - Isabel C Garcés-Palacio
- Epidemiology Group, School of Public Health, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia.
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Abstract
Individuals who are given a preventive exam by a primary care provider are more likely to agree to cancer screening. The provider recommendation has been identified as the strongest factor associated with screening utilization. This article provides a framework for breast cancer risk assessment for an advanced practice registered nurse working in primary care practice.
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Ritvo P, Edwards SA, Glendon G, Mirea L, Knight JA, Andrulis IL, Chiarelli AM. Beliefs about optimal age and screening frequency predict breast screening adherence in a prospective study of female relatives from the Ontario site of the Breast Cancer Family Registry. BMC Public Health 2012; 12:518. [PMID: 22788119 PMCID: PMC3432622 DOI: 10.1186/1471-2458-12-518] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 07/12/2012] [Indexed: 11/13/2022] Open
Abstract
Background Although few studies have linked cognitive variables with adherence to mammography screening in women with family histories of breast and/or ovarian cancer, research studies suggest cognitive phenomena can be powerful adherence predictors. Methods This prospective study included 858 women aged 30 to 71 years from the Ontario site of the Breast Cancer Family Registry with at least one first-degree relative diagnosed with breast and/or ovarian cancer. Data on beliefs about breast cancer screening and use of mammography were obtained from annual telephone interviews spanning three consecutive years. Self-reported mammogram dates were confirmed with medical imaging reports. Associations between beliefs about breast cancer screening and adherence with annual mammography were estimated using polytomous logistic regression models corrected for familial correlation. Models compared adherers (N = 329) with late-screeners (N = 382) and never-screeners (N = 147). Results Women who believed mammography screening should occur annually were more likely to adhere to annual screening recommendations than women who believed it should happen less often (OR: 5.02; 95% CI: 2.97-8.49 for adherers versus late-screeners; OR: 6.82; 95% CI: 3.29-14.16 for adherers versus never-screeners). Women who believed mammography screening should start at or before age 50 (rather than after) (OR: 9.72; 95% CI: 3.26-29.02) were significantly more likely to adhere when compared with never-screeners. Conclusions Study results suggest that women with a family history of breast cancer should be strongly communicated recommendations about initial age of screening and screening intervals as related beliefs significantly predict adequate adherence.
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Affiliation(s)
- Paul Ritvo
- Research, Prevention and Cancer Control, Cancer Care Ontario, 620 University Ave, Toronto, ON M5G 2L7, Canada.
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Escoffery CT, Kegler MC, Glanz K, Graham TD, Blake SC, Shapiro JA, Mullen PD, Fernandez ME. Recruitment for the National Breast and Cervical Cancer Early Detection Program. Am J Prev Med 2012; 42:235-41. [PMID: 22341160 DOI: 10.1016/j.amepre.2011.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 11/08/2011] [Accepted: 11/09/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND To reduce disparities in breast and cervical cancer in the U.S., it is essential that programs such as CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) use evidence-based strategies. Recommendations for interventions to increase breast and cervical cancer screening have been disseminated by national public health organizations. To increase screening, cancer control planners would benefit from use of evidence-based strategies for recruitment of participants in their communities. PURPOSE The purpose of the study was to inventory recruitment activities for cancer screening within NBCCEDP programs and assess if activities used to increase cancer screening are evidence-based. METHODS Interviews were conducted with 61 recruitment coordinators in 2008 to elicit their recruitment activities, use of evidence-based resources, and barriers to using evidence-based interventions (EBIs). Study data were analyzed in 2009. RESULTS Of the 340 activities reported, many were categorized as educational materials, one-on-one education, mass media, group education, and special events. Two thirds of inventoried activities matched an EBI. Coordinators reported that colleagues and the CDC are their primary sources of information about EBIs and few coordinators had used evidence-based resources. Lack of money or funding, questionable applicability to priority populations, limited staffing or staff time, and insufficient evidence-based research were the most important barriers to EBI use. CONCLUSIONS Although the majority of NBCCEDP recruitment activities were evidence-based, one third were not. Additional training and technical assistance are recommended to help public health agencies adopt the use of these strategies.
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Affiliation(s)
- Cam T Escoffery
- Department of Behavioral Sciences and Health Education, CDC, Atlanta, Georgia, USA.
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O'Neill SC, Lipkus IM, Gierisch JM, Rimer BK, Bowling JM. It's the amount of thought that counts: when ambivalence contributes to mammography screening delay. Womens Health Issues 2011; 22:e189-94. [PMID: 22055988 DOI: 10.1016/j.whi.2011.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 05/25/2011] [Accepted: 08/09/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE This study examines whether ambivalence toward mammography screening, as moderated by total amount of thought given to the reasons for and against getting mammograms at recommended intervals, predicts greater delay in obtaining subsequent screening mammograms. METHODS A sample of 3,430 insured women with recent (within the last 8-9 months) screening mammograms completed telephone interviews as part of a 5-year intervention study to achieve sustained adherence to annual-interval mammography. Delay was assessed by the number of days between mammograms. RESULTS Controlling for demographic factors and perceived screening barriers, days between mammograms increased as ambivalence and thought increased. Thought moderated ambivalence: Among women who were most ambivalent, women obtained mammograms 1 month earlier for each unit increase in thought. CONCLUSION Future studies should test innovative ways to resolve ambivalence and increase thought about consequences of getting mammograms as a strategy to promote mammography screening adherence.
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Affiliation(s)
- Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
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Skinner CS, Buchanan A, Champion V, Monahan P, Rawl S, Springston J, Qianqian Z, Bourff S. Process outcomes from a randomized controlled trial comparing tailored mammography interventions delivered via telephone vs. DVD. PATIENT EDUCATION AND COUNSELING 2011; 85:308-312. [PMID: 21112173 PMCID: PMC3136570 DOI: 10.1016/j.pec.2010.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/09/2010] [Accepted: 10/20/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Tailored, interactive mammography-promotion interventions can increase adherence if women are exposed to and find them usable. We compare exposure to and usability of interventions delivered via telephone vs. DVD. METHODS Process evaluation measures from 926 women randomly assigned to telephone or DVD intervention and completing post-intervention surveys. RESULTS ∼83% of each group reported exposure to all content. Partial exposure was higher for DVD (9% vs. 0.4%; p<.01); no exposure was higher for phone (15% vs. 8%; p<.01). There were no differences in exposure by age or race. Full phone exposure was less likely for women who already made mammography appointments. Usability rating was higher for DVD (p<.05), driven by ratings of understandability and length. Usability of both interventions was correlated with lower baseline barriers, and higher fear, benefits, and self efficacy. Higher ratings for phone were associated with lower knowledge and contemplating mammography. Non-whites rated DVD better than whites. CONCLUSION Both tailored interactive interventions had wide reach and favorable ratings, but DVD recipients had greatest exposure to at least partial content and more favorable ratings, especially among non-white women. PRACTICE IMPLICATIONS This first evaluation of a tailored, interactive DVD provides promise for its use in mammography promotion.
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Affiliation(s)
- Celette Sugg Skinner
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9066, USA.
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Satisfaction with initial screen and compliance with biennial breast screening at centers with and without nurses. Cancer Nurs 2011; 34:293-301. [PMID: 21681146 DOI: 10.1097/ncc.0b013e3181f96bef] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A woman's experience during her initial breast screen can influence her participation in subsequent screening. OBJECTIVE The purpose of this study was to determine the association between a woman's satisfaction with her initial screening experience and compliance to biennial screening at centers with and without nurses. METHODS A stratified random sample of compliers and noncompliers to biennial screening was selected from a cohort of 16 858 eligible women aged 50 to 65 years attending centers with and without nurses for their initial screen at the Ontario Breast Screening Program in 2002. Of these eligible women, 3387 were sent questionnaires, 2640 (77.9%) were contacted, and 1901 (72.0%) were interviewed. The association between satisfaction with initial screen and compliance was estimated separately for centers with and without nurses using logistic regression. RESULTS Women attending centers with nurses were significantly less likely to comply with their next screen after their clinical breast examination if they were not completely satisfied with the service they received (odds ratio, 0.21; 95% confidence interval, 0.08-0.57) or agreed that the clinical breast examination caused discomfort to their breasts (odds ratio, 0.65; 95% confidence interval, 0.45-0.94). In addition, women attending centers with or without nurses were significantly less likely to comply if they did not understand why they needed to return for screening. CONCLUSIONS : Nurses at screening centers have an opportunity to significantly impact a woman's compliance to biennial breast screening by providing a positive initial screening experience. IMPLICATIONS FOR PRACTICE Emphasis should be placed on improving a woman's overall satisfaction with her initial screening experience.
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The interrelationships between and contributions of background, cognitive, and environmental factors to colorectal cancer screening adherence. Cancer Causes Control 2010; 21:1357-68. [DOI: 10.1007/s10552-010-9563-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 04/02/2010] [Indexed: 10/19/2022]
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Chiarelli AM, Majpruz V, Brown P, Theriault M, Edwards S, Shumak R, Mai V. Influence of Nurses on Compliance with Breast Screening Recommendations in an Organized Breast Screening Program. Cancer Epidemiol Biomarkers Prev 2010; 19:697-706. [DOI: 10.1158/1055-9965.epi-09-0884] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lopez EDS, Khoury AJ, Dailey AB, Hall AG, Chisholm LR. Screening mammography: a cross-sectional study to compare characteristics of women aged 40 and older from the deep South who are current, overdue, and never screeners. Womens Health Issues 2009; 19:434-45. [PMID: 19879455 DOI: 10.1016/j.whi.2009.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Revised: 07/25/2009] [Accepted: 07/27/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We sought to identify unique barriers and facilitators to breast cancer screening participation among women aged 40 and older from Mississippi who were categorized as current, overdue, and never screeners. METHODS Cross-sectional data from a 2003 population-based survey with 987 women aged 40 and older were analyzed. Chi-square analysis and multinomial logistic regression examined how factors organized under the guidance of the Model of Health Services Utilization were associated with mammography screening status. RESULTS Nearly one in four women was overdue or had never had a mammogram. Enabling factors, including poor access to care (no annual checkups, no health insurance) and to health information, lack of social support for screening, and competing needs, were significantly associated with being both overdue and never screeners. Pertaining to factors unique to each screening group, women were more likely to be overdue when they had no usual source of health care and believed that treatment was worse than the disease. In turn, women were more likely to be never screeners when they were African American, lacked a provider recommendation for screening, and held the fatalistic view that not much could be done to prevent breast cancer. CONCLUSION Similar and unique factors impact utilization of mammography screening services among women. Those factors could inform efforts to increase screening rates.
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Affiliation(s)
- Ellen D S Lopez
- Department of Psychology, and The Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska 99775-6480, USA.
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Gierisch JM, O'Neill SC, Rimer BK, DeFrank JT, Bowling JM, Skinner CS. Factors associated with annual-interval mammography for women in their 40s. Cancer Epidemiol 2009; 33:72-8. [PMID: 19481879 DOI: 10.1016/j.cdp.2009.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 02/24/2009] [Accepted: 03/08/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Evidence is mounting that annual mammography for women in their 40s may be the optimal schedule to reduce morbidity and mortality from breast cancer. Few studies have assessed predictors of repeat mammography on an annual interval among these women. METHODS We assessed mammography screening status among 596 insured Black and Non-Hispanic white women ages 43-49. Adherence was defined as having a second mammogram 10-14 months after a previous mammogram. We examined socio-demographic, medical and healthcare-related variables on receipt of annual-interval repeat mammograms. We also assessed barriers associated with screening. RESULTS 44.8% of the sample were adherent to annual-interval mammography. A history of self-reported abnormal mammograms, family history of breast cancer and never having smoked were associated with adherence. Saying they had not received mammography reminders and reporting barriers to mammography were associated with non-adherence. Four barrier categories were associated with women's non-adherence: lack of knowledge/not thinking mammograms are needed, cost, being too busy, and forgetting to make/keep appointments. CONCLUSIONS Barriers we identified are similar to those found in other studies. Health professionals may need to take extra care in discussing mammography screening risk and benefits due to ambiguity about screening guidelines for women in their 40s, especially for women without family histories of breast cancer or histories of abnormal mammograms. Reminders are important in promoting mammography and should be coupled with other strategies to help women maintain adherence to regular mammography.
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Affiliation(s)
- Jennifer M Gierisch
- Department of General Internal Medicine, Duke University Medical Center, Durham, NC 27707, USA.
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Mack KP, Pavao J, Tabnak F, Knutson K, Kimerling R. Adherence to Recent Screening Mammography among Latinas: Findings from the California Women's Health Survey. J Womens Health (Larchmt) 2009; 18:347-54. [DOI: 10.1089/jwh.2008.0793] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katelyn P. Mack
- Harvard School of Public Health, Department of Society, Human Development and Health; SM candidate
| | - Joanne Pavao
- VA Palo Alto Health Care System, Palo Alto, California
| | - Farzaneh Tabnak
- California Department of Public Health, Surveillance and Statistics Section, Infectious Diseases Branch, Sacramento, California
| | - Kirsten Knutson
- California Department of Public Health, Cancer Detection Section, Sacramento, California
| | - Rachel Kimerling
- VA Palo Alto Health Care System, Palo Alto, California
- National Center for Posttraumatic Stress Disorder, Menlo Park, California
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Edwards SA, Chiarelli AM, Stewart L, Majpruz V, Ritvo P, Mai V. Predisposing factors associated with compliance to biennial breast screening among centers with and without nurses. Cancer Epidemiol Biomarkers Prev 2009; 18:739-47. [PMID: 19240235 DOI: 10.1158/1055-9965.epi-08-0928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous research suggests that predisposing factors such as previous screening experience, participation in preventive health behaviors, and knowledge/beliefs about breast cancer and screening influence a woman's decision to make a timely return for a second screen. METHODS A stratified random sample of compliers and noncompliers to biennial screening were selected from a cohort of 51,242 women ages 50 to 65 years who had their initial screen at the Ontario Breast Screening Program. In total, 1,901 women were telephone-interviewed. The associations between predisposing factors and compliance were estimated separately for centers with and without nurses using logistic regression analyses adjusted for demographics and smoking status. RESULTS Women screened at nurse centers were less likely to comply if they thought women should stop having mammograms before age 70 years [odds ratio (OR), 0.39; 95% confidence interval (95% CI), 0.19-0.79], did not consider mammograms very likely to find cancer (OR, 0.73; 95% CI, 0.56-0.95), felt their likeliness of getting breast cancer was below average (OR, 0.69; 95% CI, 0.54-0.89), or believed a high-fat diet was not an important risk factor for breast cancer (OR, 0.59; 95% CI, 0.36-0.97). Women attending nurse centers were significantly more likely to comply if they sometimes had thoughts or worries about developing breast cancer (OR, 1.40; 95% CI, 1.10-1.80). CONCLUSIONS Nurses at screening centers may reinforce a woman's knowledge or beliefs about breast cancer or screening and as a result increase their compliance to biennial breast screening.
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Affiliation(s)
- Sarah A Edwards
- Population Studies and Surveillance, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario, Canada M5G 2L7
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Boudreau DM, Luce CL, Ludman E, Bonomi AE, Fishman PA. Concordance of population-based estimates of mammography screening. Prev Med 2007; 45:262-6. [PMID: 17698182 PMCID: PMC2065854 DOI: 10.1016/j.ypmed.2007.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Revised: 07/05/2007] [Accepted: 07/07/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Estimates of adherence to mammography screening guidelines vary, in part, due to lack of consensus on defining adherence. This study estimated adherence to repeat (two successive on-time screenings) and regular screening (three or more successive screenings) and evaluated the impact of varying operational definitions and evaluation periods. METHODS The study included women aged 50-80 without a history of breast cancer who: were on a biennial screening cycle and due for a screening mammogram between 1995 and 1996; underwent screening (index date) in response to a reminder letter; and belonged to Group Health, an integrated health care delivery system in Washington State, for 6 or more years after the index date. Automated records provided information on enrollment, health care utilization, and procedures. RESULTS Among 1336 women, 67-82% experienced a repeat screen. Adherence to regular screening over the 6-year evaluation period was 42-84%--and higher with longer allowable intervals between screenings, when definitions did not require on-schedule screenings, when intervals were reset after a diagnostic mammogram, and for shorter evaluation periods. CONCLUSION Estimates of adherence to screening guidelines varied by the operational definition of "success" and time period of evaluation. Consensus in definitions and terminology is needed to compare evaluations.
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Pavic D, Schell MJ, Dancel RD, Sultana S, Lin L, Sejpal SV, Pisano ED. Comparison of three methods to increase knowledge about breast cancer and breast cancer screening in screening mammography patients. Acad Radiol 2007; 14:553-60. [PMID: 17434069 DOI: 10.1016/j.acra.2007.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Revised: 01/08/2007] [Accepted: 01/09/2006] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES The specific aim of the study was to determine which of several cost-effective interventions is best able to improve the breast cancer knowledge of women who present for screening mammography. MATERIALS AND METHODS A total of 198 English-speaking women, with no personal or family history of breast cancer, were recruited and randomized to four groups when they presented to the clinic for a screening mammogram. All women filled in a demographic data form and answered a questionnaire containing nine questions about breast cancer, risk, and screening to assess their knowledge and perception. Three educational interventions were tested in this study. The first consisted of a brochure, which provided answers to the questionnaire items and addressed the issues in more depth. The second intervention was an educational conversation with a specially trained mammography technologist. She reviewed the subject's answers to the questionnaire items correcting and/or clarifying them. The third intervention consisted of the brochure together with the conversation with a trained technologist. There was also a control group that just filled in the study questionnaire but did not receive an educational intervention. The same questionnaire was administered by telephone 4 to 6 weeks after the screening experience to all study subjects. Changes in their knowledge and perceptions of breast cancer were measured and compared. RESULTS A statistically significant increase in knowledge was found in all of the three investigated groups compared to the control group. There were no statistically significant differences in the amount of increase between women who underwent different interventions. CONCLUSIONS All three interventions resulted in increased knowledge about breast cancer and screening. No differences in the amount of knowledge increase were found between three interventions tested. The educational brochure seems to represent the most convenient and least costly method to increase knowledge about breast cancer and screening among women who present for screening mammography.
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Affiliation(s)
- Dag Pavic
- Department of Radiology, University of North Carolina at Chapel Hill, CB# 7510, Chapel Hill, NC 27599-7510, USA.
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Champion V, Skinner CS, Hui S, Monahan P, Juliar B, Daggy J, Menon U. The effect of telephone versus print tailoring for mammography adherence. PATIENT EDUCATION AND COUNSELING 2007; 65:416-23. [PMID: 17196358 PMCID: PMC1858664 DOI: 10.1016/j.pec.2006.09.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 08/15/2006] [Accepted: 09/29/2006] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The purpose of this intervention was to increase mammography adherence in women who had not had a mammogram in the last 15 months. METHODS A prospective randomized intervention trial used four groups: (1) usual care, (2) tailored telephone counseling, (3) tailored print, (4) tailored telephone counseling and print. Participants included a total of 1244 women from two sites-a general medicine clinic setting serving predominately low-income clientele and a Health Maintenance Organization (HMO). Computer-tailored interventions addressed each woman's perceived risk of breast cancer, benefits and/or barriers and self-efficacy related to mammography screening comparing delivery by telephone and mail. RESULTS Compared to usual care all intervention groups increased mammography adherence significantly (odds ratio 1.60-1.91) when the entire sample was included. CONCLUSIONS All interventions groups demonstrated efficacy in increasing mammography adherence as compared to a usual care group. When the intervention analysis considered baseline stage, pre contemplators (women who did not intend to get a mammogram) did not significantly increase in mammography adherence as compared to usual care. PRACTICE IMPLICATIONS Women who are in pre contemplation stage may need a more intensive intervention.
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Affiliation(s)
- Victoria Champion
- Indiana University, School of Nursing, 1111 Middle Drive, Indianapolis, IN 46202, United States.
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Partin MR. A challenging but critical endeavor: balancing responsiveness and rigor in community-based participatory research. HEALTH EDUCATION & BEHAVIOR 2007; 33:574-7; discussion 578-9. [PMID: 16861588 DOI: 10.1177/1090198106288511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Melissa R Partin
- Minneapolis VA Medical Center, Center for Chronic Disease Outcomes Research, MN 55417, USA.
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Tolma EL, Reininger BM, Ureda J. What predicts a Cypriot woman's decision to obtain or not obtain a screening mammogram? Implications for the promotion of screening mammography in Cyprus. Eur J Cancer Prev 2006; 15:149-57. [PMID: 16523012 DOI: 10.1097/01.cej.0000186635.89377.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer is an important public health issue in Cyprus. The purpose of the study was to assess: (a) the differences in motivational beliefs between women who decided to obtain a mammogram and women who did not; and (b) which beliefs predict the decision to get a mammogram. METHODS Data were collected through face-to-face interviews from 293 women (mean age = 52) at the outpatient clinics of the General Hospital of Nicosia. Variables of interests include demographics, other preventive behaviours, and cognitions. T-tests for independent samples and multiple logistic regression were the primary analytic techniques. RESULTS One hundred and eight women decided to obtain their first mammogram within the next 6 months. Deciders were more motivated to obtain a mammogram than non-deciders. Significant statistical differences were found regarding women's attitude, perceived social pressure, perceived control over environmental factors, and self-efficacy towards obtaining a mammogram. The self-efficacy beliefs as well as the physician recommendation were the most predictive factors in the decision to obtain a mammogram. CONCLUSIONS In the planning of successful educational campaigns promoting breast cancer screening in Cyprus, practitioners could focus on the following: (a) enhancing self-efficacy, (b) promoting a clinical environment conducive to mammography screening, and (c) encouraging physician recommendation.
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Affiliation(s)
- Eleni L Tolma
- Department of Health Promotion Sciences, College of Public Health, The University of Oklahoma, Health Sciences Center, Oklahoma City, OK 73190, USA.
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Russell KM, Champion VL, Skinner CS. Psychosocial factors related to repeat mammography screening over 5 years in African American women. Cancer Nurs 2006; 29:236-43. [PMID: 16783125 DOI: 10.1097/00002820-200605000-00012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to investigate health beliefs associated with repeat mammography screening in African American women 51 years or older over a 5-year period. Long-term repeat mammography screening is inconsistent in African American women; therefore, this study measured demographic, knowledge, and health belief predictors of repeat screening. The theoretical framework for this study was the health belief model. Baseline data from a larger randomized controlled trial were analyzed using descriptive statistics and logistic regression. The sample consisted of 602 African American women with no breast cancer history and at least 1 reported screening mammogram in the past 5 years. They were recruited from 3 primary care health settings. Having been screened 4 to 5 times in the past 5 years was associated with more knowledge about screening guidelines and fewer perceived barriers to screening. Results point to the importance of collaborating with African American communities to promote life-long mammography screening by increasing access to culturally appropriate information on screening guidelines and ameliorating barriers to screening within the context of the African American experience.
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Mammography utilization in Canadian women aged 50 to 69: identification of factors that predict initiation and adherence. Canadian Journal of Public Health 2005. [PMID: 16238156 DOI: 10.1007/bf03404034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To identify factors that predict initiation of mammography and adherence with biennial screening among Canadian women aged 50-69 years. METHODS Using data from a longitudinal panel of Canadian women interviewed in the National Population Health Survey (NPHS) in 1994/95 and 2 and 4 years later, we estimated the relative risks (RR) of mammography initiation and adherence according to socio-demographic, health and lifestyle characteristics. RESULTS Among 505 women with no history of mammography use at baseline, 23.0% and 41.4% initiated mammography by 2 and 4 years, respectively. Urban residence (RR = 2.85) was most strongly associated with initiation by 2 years; younger age (50-54) and lower education also predicted initiation by 2 years. Younger age, birthplace outside Canada, and having a recent (< 2 years) blood pressure check were associated with initiation by 4 years. Among 873 women reporting a recent (< 2 years) mammogram at baseline, 88.7% also reported a recent mammogram within 2 years while 73.0% reported one at both the 2- and 4-year follow-up. Being a non-smoker was the strongest predictor of maintaining adherence both at the 2- (RR = 1.18) and the 4-year (RR = 1.37) follow-up. INTERPRETATION Previously identified underserved groups of Canadian women (e.g., those with lower educational levels or born outside of Canada) were most likely to initiate mammography. Approximately 1 in 6 women aged 50 to 69 years remained never-users during follow-up, and fewer than half reported recent mammograms at all three survey cycles, suggesting the need to reinforce regular screening participation.
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Partin MR, Slater JS, Caplan L. Randomized controlled trial of a repeat mammography intervention: effect of adherence definitions on results. Prev Med 2005; 41:734-40. [PMID: 16043216 DOI: 10.1016/j.ypmed.2005.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Revised: 04/26/2005] [Accepted: 05/30/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND As overall mammography rates approach national goals, mammography promotion efforts must increasingly focus on repeat adherence. This randomized controlled trial examined the effect of two interventions on repeat mammography utilization using various adherence definitions. METHODS 1,558 women aged 40-63 receiving a mammogram through a federally funded screening program were randomized to three groups: mailed reminder (minimum group); mailed thank you card, newsletters, and reminder (maximum group); no mailings (control). The primary outcome (repeat mammogram) was assessed 13, 15, 18, and 24 months after the qualifying mammogram using administrative data. RESULTS The proportions receiving a repeat mammogram within 13 months were 0.28, 0.30, and 0.32 for control, minimum, and maximum groups, respectively. The corresponding proportions were 0.38, 0.43, and 0.45 at 15 months; 0.43, 0.49, and 0.51 at 18 months; and 0.47, 0.52, and 0.54 at 24 months. There were no significant differences across study groups at 13 months. The differences between control and maximum subjects at 15, 18, and 24 months were statistically significant. The differences between control and minimum subjects were significant only at 18 months. CONCLUSIONS The two low-cost mailed interventions evaluated modestly increased repeat mammography utilization. However, effects were not visible until at least 15 months after the qualifying mammogram.
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Affiliation(s)
- Melissa R Partin
- Center for Chronic Disease Outcomes Research (152/2E), Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA.
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Saywell RM, Champion VL, Skinner CS, Menon U, Daggy J. A cost-effectiveness comparison of three tailored interventions to increase mammography screening. J Womens Health (Larchmt) 2005; 13:909-18. [PMID: 15671706 DOI: 10.1089/jwh.2004.13.909] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Mammography is the primary method used for breast cancer screening. However, adherence to recommended screening practices is still below acceptable levels. This study examined the cost-effectiveness of three combinations of tailored telephone and mailed intervention strategies for increasing adherence to mammography. METHODS There were 1044 participants who were randomly assigned to one of four groups. A logistic regression model with adherence as the dependent variable and group as the independent variable was used to test for significant differences, and a ratio of cost/improvement in mammogram adherence evaluated the cost-effectiveness. RESULTS All three of the interventions (tailored telephone, tailored mail, and tailored telephone and mail) had significantly better adherence rates compared with the control group (usual care). However, when also considering costs, one emerged as the superior strategy. The cost-effectiveness ratios for the three interventions show that the tailored mail (letter) was the most cost-effective strategy, achieving 43.3% mammography adherence at a marginal cost of dollar 0.39 per 1% increase in women screened. The tailored mail plus telephone achieved greater adherence (49.4%), but at a higher cost (dollar 0.56 per 1% increase in women screened). CONCLUSIONS A tailored mail reminder is an effective and economical intervention to increase mammography adherence. Future research should confirm this finding and address its applicability to practice in other settings.
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Affiliation(s)
- Robert M Saywell
- Department of Family Medicine and Bowen Research Center, Indiana University School of Medicine, Indianapolis, Indiana 46202-5102, USA.
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Pasick RJ, Hiatt RA, Paskett ED. Lessons learned from community-based cancer screening intervention research. Cancer 2004; 101:1146-64. [PMID: 15316912 DOI: 10.1002/cncr.20508] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Behaviors associated with cancer screening have been the focus of intensive research over the past 2 decades, primarily in the form of intervention trials to improve screening based in both clinical and community settings. Meta-analyses and literature reviews have synthesized and organized the resulting literature. From the accumulated work, this review distilled lessons learned from cancer screening intervention research in community settings. The authors posed the question, "What do we know about the development of effective community-based interventions (the level of good over harm achieved in real-world conditions)?" Framed around the concept of focal points (the simultaneous combination of target population, behavioral objective, and setting for an intervention), 13 lessons were derived. One lesson was cross-cutting, and the other lessons addressed the three focal-point components and the major intervention categories (access-enhancing strategies, mass media, small media, one-on-one and small-group education, and combinations of these categories). To build more systematically on existing research, recommendations are made for new directions in basic behavioral and intervention research.
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Affiliation(s)
- Rena J Pasick
- Comprehensive Cancer Center, University of California-San Francisco, San Francisco, California 94143-0981, USA.
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Rakowski W, Breen N, Meissner H, Rimer BK, Vernon SW, Clark MA, Freedman AN. Prevalence and correlates of repeat mammography among women aged 55-79 in the Year 2000 National Health Interview Survey. Prev Med 2004; 39:1-10. [PMID: 15207980 DOI: 10.1016/j.ypmed.2003.12.032] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Utilization of mammography has increased steadily since the early 1990s. It is now important to expand the attention given to obtaining repeat examination. This study examines the prevalence and cross-sectional correlates of repeat mammography, among women aged 55-79, using a 12-month (N = 3,502) and a 24-month interval (N = 3,491). METHODS Data were from the Year 2000 Cancer Control Module of the National Health Interview Survey (NHIS-CCM). The NHIS-CCM asked about the most recent mammogram and the total number of mammograms over the prior 6 years. An algorithm estimated repeat mammography for the two intervals. RESULTS Prevalence estimates were 49% for the 12-month interval, and 64.1% for the 24-month interval. Correlates of lower likelihood of repeat mammography for both indicators were: no regular source of care, having public or no health insurance, less than a college education, household income less than $45K, not being married, current or never smoking, age 65-79, and lower absolute risk of breast cancer (Gail Model score). CONCLUSIONS A substantial percentage of women do not receive repeat mammography. The correlates of repeat mammography were similar to those often found for ever-had and recent mammography. There is probably some imprecision in the prevalence estimates due to the nature of NHIS-CCM questions. Issues pertinent to the definition of repeat examination are addressed.
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Affiliation(s)
- William Rakowski
- Department of Community Health and The Center for Gerontology and Health Care Research, Brown University, Providence, RI 02912, USA.
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Partin MR, Malone M, Winnett M, Slater J, Bar-Cohen A, Caplan L. The impact of survey nonresponse bias on conclusions drawn from a mammography intervention trial. J Clin Epidemiol 2003; 56:867-73. [PMID: 14505772 DOI: 10.1016/s0895-4356(03)00061-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE This study demonstrates the impact of survey nonresponse bias on conclusions from a mammography trial targeting a disadvantaged population. METHODS The trial randomized 1558 women to three interventions designed to promote repeat mammography: mailed reminder (minimum group); mailed thank-you card, patient newsletters, and reminder (maximum group); and no mailings (control group). The primary outcome, repeat mammogram within 15 months, was assessed from administrative and phone survey data. RESULTS Administrative estimates revealed a statistically significant difference of 7% between the maximum and control groups on the primary outcome. Survey estimates (response rate 80%) revealed no significant differences. The differences by data source were traced to a survey nonresponse bias. There was a statistically significant difference of 16% between the maximum and control groups among survey nonrespondents for the primary outcome, but there were no differences among survey respondents. CONCLUSION The findings reiterate that even a low survey nonresponse rate can bias study conclusions and suggest studies targeting disadvantaged populations should avoid relying solely on survey data for outcome analyses.
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Affiliation(s)
- Melissa R Partin
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center (152/2E), 1 Veterans Drive, Minneapolis, MN 55417, USA.
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