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Engaging Diverse Underserved Communities to Bridge the Mammography Divide
Engelman, Kimberly K. Cupertino, Ana Paula Daley, Christine Makosky Long, Trish Cully, Angelia Mayo, Matthew S. Ellerbeck, Edward F. Geana, Mugur V. Greiner, K. Allen
Engelman, Kimberly K.
Cupertino, Ana Paula
Daley, Christine Makosky
Long, Trish
Cully, Angelia
Mayo, Matthew S.
Ellerbeck, Edward F.
Geana, Mugur V.
Greiner, K. Allen
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Abstract
Background: Breast cancer screening continues to be underutilized by the population in general, but is particularly
underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are
American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year
cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among
Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/
ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their
intentions may not result in initiation or follow through of the examination process. An accumulating body of
research, however, demonstrates the efficacy of developing ‘implementation intentions’ that define when, where,
and how a specific behavior will be performed. The formulation of intended steps in addition to addressing
potential barriers to test completion can increase a person’s self-efficacy, operationalize and strengthen their
intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the
formulation of implementation intentions for breast cancer screening has not been conducted with minority
populations.
Methods/Design: In the proposed program, community health workers will meet with rural-dwelling Latina and
American Indian women one-on-one to educate them about breast cancer and screening and guide them
through a computerized and culturally tailored “implementation intentions” program, called Healthy Living Kansas -
Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two
distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and
be randomized to either a mammography “implementation intentions” (MI2) intervention or a comparison general
breast cancer prevention informational intervention (C). CHWs will be armed with notebook computers loaded
with our Healthy Living Kansas - Breast Health program and guide their peers through the program. Women in the
MI2 condition will receive assistance with operationalizing their screening intentions and identifying and
addressing their stated screening barriers with the goal of guiding them toward accessing screening services near
their community. Outcomes will be evaluated at 120-days post randomization via self-report and will include
mammography utilization status, barriers, and movement along a behavioral stages of readiness to screen model.
Discussion: This highly innovative project will be guided and initiated by AI/AN and Latina community members
and will test the practical application of emerging behavioral theory among minority persons living in rural
communities.
Trial Registration: ClinicalTrials (NCT): NCT01267110
Description
Date
2011
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BMC Public Health
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Engelman K., Cupertino A, Daley C., Long T., Cully A., Mayo M., Ellerbeck E., Geana M., Greiner A. (2011) Engaging Diverse Underserved Communities to Bridge the Mammography Divide. BMC Public Health 2011, 11 (47).