Evaluating a Tailored Intervention: DISCUSSION
This study examined the effectiveness of tailored telephone counseling designed to increase screening mammography among 354 women residing in south Los Angeles, a socioeconomically challenged inner-city area. We found that more women (36.8%) reported having screening mammograms in the intervention group than in the control group (29.0%) based on a six-month follow-up interview. Further analysis of the data revealed that in addition to group assignment, age, having prior mammograms and knowledge of age at when to start having screening mammograms increased the statistical power of the model to predict reports of having mammograms during the follow-up assessment.
Various strategies separately or in combination have been implemented to improve mammography utilization in the general population with varying degrees of success. These strategies have included physicians’ recommendations, in-person counseling by a nurse, chart assessments, individualized risk assessments, mass media campaigns, and personal letters of invitation from physicians. viagra jelly online
Mixed results have been reported within health maintenance organization (HMO) populations. Whereas sending letters of invitation increased screening mammography by 76% in one study, other studies have shown that birthday cards or invitations have limited impact when compared with a more personalized approach, such as phone counseling. Proactive phone counseling has proven effective in boosting adherence to mammography screening guidelines in diverse populations and healthcare settings. It is a cost-effective strategy for reaching larger segments of the population compared with more costly approaches. Thus, this strategy offers a great potential for promoting screening mammography at least among higher-income women.
The significant associations found for age in this study are consistent with literature on self-report of mammogram screening. In this study, the youngest age group (40^19) was twice as likely to report having a mammogram in the follow-up assessment. One possible explanation could be that younger people have a more favorable attitude toward screenings for breast cancer and/or have a higher perception of the risk of breast cancer. However, Friedman and colleagues examination of age differences in breast cancer knowledge, attitudes and early detection behaviors in a multiethnic sample of economically disadvantaged women concluded that there was no significant age difference in breast cancer knowledge or perceptions of personal risks of breast cancer. The authors concluded the fact that the three age groups were similar in their perceptions of personal risk of breast cancer suggests that older women may not be accurately assessing their risk and, thus, may be obtaining screening mammography at less-than-optimal levels. In our study, we did not detect a statistically significant difference between age groups and perceptions of risk, knowledge of age to begin mammograms and perceptions of accuracy of mammograms (data not shown). Taken together, these findings suggest that more studies are needed to investigate the role of age and perceptions of risk in mammography screening. Your life is worth living. Buy requip online
This study also found that reports of prior mammograms were a strong and independent predictor of having follow-up screening mammograms. One plausible explanation is that once a woman has a mammogram she will continue to practice this health-protective behavior. Further analyses of our data revealed that over 60% of women in the “prior mammogram” category (n=229) reported having more than one mammogram and 26% reported having more than three (data not shown). Whether having positive experiences through repeated mammograms or repeated exposure to healthcare providers are related to having repeated mammograms needs further investigation in women <55 years of age. Rakowski et al. examined the prevalence and correlates of repeat mammography among women aged 55-79 in a large cross-sectional sample of the 2000 National Health Interview Survey. The 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 $45,000, not being married, current or never smoking, age 65-79 and lower absolute risk of breast cancer (Gail Model score). They found that a substantial percentage of women do not receive repeat mammograms.
Lack of knowledge and information regarding breast cancer screening have often been cited in the literature as barriers to having mammograms. Conversely, knowledge of mammography guidelines has been cited as one of the major predictors of regular screening. However, in this study, participants who correctly understood the age that a woman should begin regular mammography screening (>40) were less likely to report having mammograms during the follow-up period. This suggests that knowledge of the mammogram guidelines does not necessarily lead to adhering to those guidelines. These women potentially could be motivated to convert their knowledge into action. Our data revealed that 40-49-year-old women constituted nearly 59% of the sample who had responded correctly to the guideline question. However, over 75% of this group knew they should have a mammogram but have not done so. These findings suggests that healthcare providers should reach out to younger women to encourage them to get mammograms early and repeatedly. buy skelaxin online
Several factors should be considered when assessing the effectiveness of this study. First, for financial reasons, we utilized self-reports of screening mammography instead of the more expensive method of medical records verifications. However, previous studies have shown that self-reports of health behaviors are generally accurate and that self-reports of screening mammography use are acceptable (about 83% concordance with medical records). Second, a total of three phone calls were made to respondents who completed the study that undoubtedly heightened respondents’ awareness of the problem of breast cancer and the need to have mammograms. A 54-item breast cancer questionnaire was administered during the initial community-based random-digit-dialing phone call. During the second call, we asked participants if they had gotten mammograms since our initial call, and the third call was to determine if they had gotten mammograms since the second call. Although methodologically essential to assess the impact of the intervention, it is reasonable to suspect that these phone calls may have had a minimal affect on the results of our study. Randomization, however, seems to have minimized this potential affect.
It is encouraging to note that a higher percentage of previously noncompliant participants in our intervention group reported having mammograms at follow-up (36.8% vs. 29.0%). It is also noteworthy that this result was achieved in an urban population that had not had mammograms in the year preceding our inquiry. Further, it should be noted that this result was achieved in a shortened follow-up period of only six months. A longer follow-up period of one or two years, which would have been consistent with current screening mammography recommendations, would have been ideal. Were we to assume that our tailored intervention maintained at least half of its effectiveness over the next six months, then greater than half (55.2%) of the participants in the intervention group would have gotten screening mammograms. Viagra Super Active