Interventions to improve cancer screening: commentary from a health services research perspective.
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ABSTRACT: Latinas are less likely than other racial/ethnic groups to engage in mammography rescreening, but little research has examined why Latinas overdue for screening have not had a mammogram recently. This study investigates the factors that affect adherence to screening mammography guidelines among previously screened Latinas. Data are from a population-based, random-digit-dial annual probability survey of California women. Participants included 1298 Latinas aged > or =40 who ever had a mammogram. Multivariate logistic regression was used to examine what factors differentiate adherence to recent screening (having a mammogram < or =2 years ago) from being overdue for screening (having a last mammogram >2 years ago). Perceived barriers to screening were also examined among women overdue for a mammogram. Relationships between self-reported perceived barriers to screening and the identified differentiating factors were assessed using chi-square tests. Adherence to recent mammography was reported by 83.9% of previously screened Latinas. When controlling for significant covariates, factors associated with adherence to recent screening included being aged 50-64, having a college education, preferring to interview in Spanish, having health insurance, and reporting a usual source of care (p < 0.05). Lack of affordability was the most frequently cited perceived barrier to screening among Latinas overdue for screening. Age, education, health insurance, and usual source of care were significantly associated with specific perceived barriers to screening mammography. Results underscore the impact that affordability of, knowledge about, and convenience in obtaining mammograms have on adherence to recent screening. Strategies to improve mammography adherence among Latinas may need to consider that solely improving access to insurance or a regular source of healthcare, although important, may not be sufficient to improve rates of Latinas' screening mammography adherence.Journal of Women's Health 03/2009; 18(3):347-54. DOI:10.1089/jwh.2008.0793 · 1.90 Impact Factor
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ABSTRACT: Recent guidelines recommend longer Pap test intervals. However, physicians and patients may not be adopting these recommendations. Identify (1) physician and practice characteristics associated with recommending a less frequent interval, and (2) characteristics associated with women's willingness to adhere to a 3-year interval. We used 2 national surveys: (1) a 2006/2007 National Survey of Primary Care Physicians for physician cervical cancer screening practices (N = 1114), and (2) the 2005 Health Information Trends Survey for women's acceptance of longer Pap intervals (N = 2206). MEASURES AND METHODS: Physician recommendation regarding Pap intervals was measured using a clinical vignette involving a 35-year-old with no new sexual partners and 3 consecutive negative Pap tests; associations with independent variables were evaluated with logistic regression. In parallel models, we evaluated women's willingness to follow a 3-year Pap test interval. A minority of physicians (32%) have adopted-but more than half of women are willing to adopt-3-year Pap test intervals. In adjusted models, physician factors associated with less frequent screening were: serving a higher proportion of Medicaid patients, white, non-Hispanic race, fewer years since medical school graduation, and US Preventive Services Task Force being very influential in physician clinical practice. Women were more willing to follow a 3-year interval if they were older, but less willing if they had personal or family experiences with cancer or followed an annual Pap test schedule. Many women are accepting of a 3-year interval for Pap tests, although most primary care physicians continue to recommend shorter intervals.Medical care 03/2010; 48(3):249-59. DOI:10.1097/MLR.0b013e3181ca4015 · 2.94 Impact Factor
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ABSTRACT: Cancer screening is a process of care consisting of several steps and interfaces. This article reviews what is known about the association between organizational factors and cancer screening rates and examines how organizational strategies can address the steps and interfaces of cancer screening in the context of both intraorganizational and interorganizational processes. We reviewed 79 studies assessing the relationship between organizational factors and cancer screening. Screening rates are largely driven by strategies to 1) limit the number of interfaces across organizational boundaries; 2) recruit patients, promote referrals, and facilitate appointment scheduling; and 3) promote continuous patient care. Optimal screening rates can be achieved when health-care organizations tailor strategies to the steps and interfaces in the cancer screening process that are most critical for their organizations, the providers who work within them, and the patients they serve.JNCI Monographs 04/2010; 2010(40):38-57. DOI:10.1093/jncimonographs/lgq008