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    Research Grants Awarded

    Telephone Counseling to Increase the Use of Screening Mammography in Hispanic, African American, and African Immigrant Populations

    Study Section:
    Breast Cancer Disparities

    Scientific Abstract:
    For women age 40 and older screening mammography has been shown to reduce breast cancer mortality, but underutilization of mammography by women in some racial/ethnic minority groups remains a significant problem, especially for women with limited education and income. For African Americans (AA) a relatively low screening rate is one cause of persistently elevated breast cancer mortality. Immigrants from Sub-Saharan Africa may share AAs? genetic risk for more aggressive breast cancer and their tendency to underutilize mammography. Hispanic women, like AAs, are less well screened than whites. Interventions are needed to increase use of mammography in these and other minority populations. After more than a decade of research, tailored telephone counseling (TTC) has emerged as one of the most promising and cost-effective interventions for promoting mammography. Research suggests that to maximize success TTC should have 4 features: a connection to a woman's primary care provider, facilitated and timely mammography scheduling, supplementation with print materials, and a theory-based counseling protocol. To reach racial/ethnic minority groups TTC must also be offered in many languages, be accessible to women with low literacy, and be sensitive to common cultural concerns. We have developed and pilot tested a computer-assisted TTC protocol that, to our knowledge, is the first TTC program to include all 4 of the evidence-based elements of successful TTC. We believe the program has the potential for widespread adoption because it could efficiently serve multiple clinical sites from a counseling "center" through use of information and communication technology. Before the program is ready for a large scale demonstration, a pilot study is needed to develop and test features required for effectiveness in racial/ethnic minorities. Partnering with a Community Health Center and a local community-based health education organization and under the supervision of advisory groups, we will refine and translate our existing TTC program to meet the needs of Hispanics, AAs, and African immigrants. We will then pilot test the TTC program in 3 samples of women (Hispanic, AA, and African immigrant) overdue for a mammogram and cared for at the Worcester Family Health Center and two other Worcester primary care clinics. We aim to complete 20-30 counseling calls in each population group. We will examine counseling and mammography rates in each sample and gather information on change in stage of adoption related to the counseling. We will also perform post-counseling interviews in a sample of patients to assess the patient experience of the counseling. With the help of Massachusetts Area Health Education Center (AHEC) leadership, we will organize a meeting of community health professionals to explore developing a proposal for a statewide demonstration project of a centralized TTC program for mammography aimed at underserved populations in Massachusetts.

    Lay Abstract:
    Women in racial/ethnic minorities, especially African American (AA) and Hispanic women are less likely to get regular screening mammography than whites. Although interventions to increase screening have been studied, effective interventions for minority women and other underusers have not been widely adopted. An intervention is needed that is both effective in minority women and is likely to be widely implemented. Tailored telephone counseling (TTC) may be such an intervention. TTC to promote mammography involves a discussion between a woman, typically overdue for a mammogram, and a counselor that addresses the woman?s needs for knowledge about her risks and about the process and benefits of mammography. TTC also deals with logistical, attitudinal, and belief-related barriers to screening and aims to increase the motivation to be screened. A counselor may also help by scheduling a timely mammogram and directly assisting with transportation or other logistic barriers. We have developed and pilot-tested a computer-assisted TTC program that includes all the features that research has shown work best to maximize TTC effectiveness. This program was designed to be efficiently delivered to many clinical sites from a single counseling center, so it has the potential to be cost-effective and widely adopted. Before we can undertake a large scale demonstration of the program, it is essential that we tailor print materials and scripts to meet the educational, cultural and language needs of minorities. We propose to focus on AA, Hispanic, and African immigrant women. With the help of a local Community Health Center and a community-based health education organization, we will form 3 race/ethnicity-specific advisory groups to refine our existing TTC program materials to meet the needs of their communities. We will then pilot test the revised TTC program with women from each community. Women overdue for a mammogram will be referred for TTC by providers in 3 local clinics. We will track the numbers of women called and reached by the counselor, and the responses of the women to counseling. The counselor will offer to schedule women for a mammogram within a 2 week period, and if needed, provide additional help in getting her to the appointment. We will review records to see how many women get a mammogram. The pilot test will tell us if we need to further revise the TTC program for minorities before we go ahead with a larger scale project. After the pilot test, we will work with community organizations to develop a plan for a much bigger study involving clinics all over Massachusetts that take care of underserved populations.