To assess the efficacy of an intervention to promote mammography and Papanicolaou (Pap) testing among women with mobility impairments overdue for screenings.
Randomized controlled trial.
Urban and suburban Oregon.
Women aged 35 to 64 with mobility impairments who reported not receiving a Pap test in the past 3 years and/or mammogram (if age >40 years) in the last 2 years were eligible. A total of 211 women were randomized, and 156 completed the study (26% attrition). The majority were not employed and reported annual income <$10,000.
The Promoting Access to Health Services (PATHS) program is a 90-minute, small-group, participatory workshop with 6 months of structured telephone support, based on the health belief model and social cognitive theory.
Perceived susceptibility to breast and cervical cancer, perceived benefits of and self-efficacy for screening, intention to be screened, and self-reported receipt of mammography and Pap testing. ANALYSIS . Chi-square tests to examine the proportion of women obtaining screening; analysis of covariance to examine change in theoretical mediators.
The intervention group received more Pap tests than the control group at posttest (intervention 61%, control 27%, n = 71, p < .01). No significant group effect was observed for mammography (intervention 49%, control 42%, n = 125, p = .45).
Findings indicate that the PATHS intervention promotes Pap testing but not mammography among women with mobility impairments.
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[Show abstract][Hide abstract] ABSTRACT: To assess the barriers and facilitators to mammogram use in middle aged women with mobility limitations who had completed an educational workshop, Promoting Access to Health Service (PATHS), on clinical preventive services.
Women aged 40 to 64 with mobility impairments who reported not receiving a mammogram in the last 2 years were randomly assigned to a PATHS workshop and received follow-up monthly phone call interviews over 6 months.
Individual (eg, comorbidities, family responsibilities), interpersonal (eg, unclear provider communication, negative history), and environmental (eg, healthcare availability, insurance coverage, finances) factors were identified as unsolved barriers and potential facilitators (eg, reminders, physical proximity), to obtaining a mammogram.
A multi-level intervention approach is required to promote mammogram use by women with disabilities.
American journal of health behavior 09/2013; 37(5):711-8. DOI:10.5993/AJHB.37.5.15 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prior research has noted disparities between women with and without disabilities in receipt of timely screening for breast and cervical cancer. Some studies suggest greater disparities for women with more severe disabilities, but the research to date has yielded inconsistent findings. Our purpose was to further examine differences in receipt of breast and cervical cancer screening in relation to severity of disability.
We analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. Logistic regression analyses examined whether Pap smears and mammograms had been received within the recommended timeframe according to U.S. Preventive Services Task Force Guidelines. We compared four groups of women aged 18 to 64 years, categorized by presence and complexity of disability: 1) No limitations, 2) basic action difficulties only, 3) complex activity limitations only, and 4) both basic and complex activity limitations.
Women both with and without disabilities fell short of Healthy People 2020 goals for breast and cervical cancer screening. Overall, women with disabilities were less likely to be up to date with both mammograms and Pap tests. The magnitude of disparities was greater for women with complex limitations. Disparities in Pap testing, but not mammography, remained significant when controlling for demographic, geographic, and socioeconomic factors.
Women with more complex or severe disability were less likely to be up to date with breast and cervical cancer screenings. Targeted efforts are needed to reduce barriers to breast and cervical cancer screening for women with significant disabilities, especially those who also experience other socioecological disadvantages.
Women s Health Issues 01/2014; 24(1):e147-e153. DOI:10.1016/j.whi.2013.10.009 · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Women with disabilities often receive mammograms at lower rates than do nondisabled women, although this disparity varies by disability type and severity. Given the implementation of disability civil rights laws in the early 1990s, we examined whether disability disparities in mammogram use have diminished over time.
We analyzed National Health Interview Survey responses of civilian, noninstitutionalized United States female residents 50 to 74 years old from selected years between 1998 and 2010. We identified seven chronic disability types using self-reported functional impairments, activity/participation limitations, and expected duration. We conducted bivariable and multivariable logistic regression analyses examining associations of self-reported mammogram use within the previous two years with sociodemographic factors and disability.
Most chronic disability rates rose over time. The most common disability was movement difficulties, with rates increasing from 35.6% (1998) to 39.8% (2010). Mammogram rates for all women remained relatively stable over time, ranging from 72% to 75%. Bivariable analyses generally found statistically significantly lower mammogram rates for women with disability versus nondisabled women. Over time, disparities grew significantly between women with any basic action difficulty or complex activity limitation and nondisabled women (p<0.01). In multivariable logistic analyses, having any difficulty with basic actions was significantly associated with lower adjusted odds of mammography; for example, adjusted odds [95% confidence interval]=0.5 [0.3-0.8], p=0.006, in the model involving movement disability.
Little has changed since 1998 in mammogram rates for women with versus without disabilities. Women with certain disabilities continue to experience disparities in mammography testing.
Journal of Women's Health 06/2015; 24(7). DOI:10.1089/jwh.2014.5181 · 2.05 Impact Factor
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