Staging mammography nonadherent women: A qualitative study
ABSTRACT Few studies have related stages of mammography screening nonadherence with the rationale used by overdue women.
We used a grounded theory approach to obtain and analyze data from focus groups, telephone interviews, and surveys. Emergent specific themes were compared with emerging decision levels of nonadherence. Each decision level was then compared with the Precaution Adoption Process Model and the Transtheoretical Model.
A total of 6 key themes influencing mammogram nonadherence emerged as did 6 decision levels. Variability within themes was associated with specific decision levels. The decision levels were not adequately classified by either stage model.
Stage-based educational strategies may benefit by tailoring interventions to these 6 decision levels.
Education and Information Technologies 01/2014; DOI:10.1007/s10639-014-9349-1
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ABSTRACT: Despite the demonstrated need to increase screening mammography utilization and strong evidence that mail and telephone outreach to women can increase screening, most managed care organizations have not adopted comprehensive outreach programs. The uncertainty about optimum strategies and cost effectiveness have retarded widespread acceptance. While 70% of women report getting a mammogram within the prior 2 years, repeat mammography rates are less than 50%. This 5-year study is conducted though a Central Massachusetts healthcare plan and affiliated clinic. All women have adequate health insurance to cover the test. This randomized study compares 3 arms: reminder letter alone; reminder letter plus reminder call; reminder letter plus a second reminder and booklet plus a counselor call. All calls provide women with the opportunity to schedule a mammogram in a reasonable time. The invention period will span 4 years and include repeat attempts. The counselor arm is designed to educate, motivate and counsel women in an effort to alleviate PCP burden.All women who have been in the healthcare plan for 24 months and who have a current primary care provider (PCP) and who are aged 51-84 are randomized to 1 of 3 arms. Interventions are limited to women who become ≥ 18 months from a prior mammogram. Women and their physicians may opt out of the intervention study.Measurement of completed mammograms will use plan billing records and clinic electronic records. The primary outcome is the proportion of women continuously enrolled for ≥ 24 months who have had ≥ 1 mammogram in the last 24 months. Secondary outcomes include the number of women who need repeat interventions. The cost effectiveness analysis will measure all costs from the provider perspective. So far, 18,509 women aged 51-84 have been enrolled into our tracking database and were randomized into one of three arms. At baseline, 5,223 women were eligible for an intervention. We anticipate that the outcome will provide firm data about the maximal effectiveness as well as the cost effectiveness of the interventions both for increasing the mammography rate and the repeat mammography rate. http://clinicaltrials.gov/NCT01332032.BMC Health Services Research 06/2011; 11:145. DOI:10.1186/1472-6963-11-145 · 1.66 Impact FactorThis article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
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ABSTRACT: BackgroundEffective interventions are needed for women long overdue for screening mammography. PurposeThe purpose of this study is to pilot test an intervention for motivating overdue women to receive a mammogram. MethodsSubjects aged 45–79 without a mammogram in ≥27months and enrolled in study practices were identified from claims data. The intervention included a mailed, educational booklet, computer-assisted barrier-specific tailored counseling and motivational interviewing, and facilitated, short-interval mammography scheduling. ResultsOf 127 eligible women, 45 (35.4%) agreed to counseling and data collection. Most were ≥3years overdue. Twenty-six (57.8%) of the counseled women got a mammogram within 12months. Thirty-one (72.1%) of 43 counseled women moved ≥1 stage closer to screening, based on a modified Precaution Adoption Process Model. ConclusionIt is feasible to reach and counsel women who are long overdue for a mammogram and to advance their stage of adoption. The intervention should be formally evaluated in a prospective trial comparing it to control or to proven interventions.Annals of Behavioral Medicine 06/2009; 37(3):343-349. DOI:10.1007/s12160-009-9107-6 · 4.20 Impact Factor