Promoting Mammography in African American Women Visiting the Emergency Department

Breast cancer is a pressing public health concern. It is the most common cancer and the second leading cause of cancer death among African American women. Screening mammography is the single most effective method of early detection of breast cancer; however, African American women are screened at suboptimal rates, with only 53% of African American women aged 40 and older having had a mammogram within the past year. Low income women, women without health insurance, and those without a usual source of health care have even lower screening rates of 44%,34%, and 28% respectively. Many of these women use the Emergency Department as the only source of medical care. Through a training plan of mentoring by a team of interdisciplinary cancer control and nursing scientists, formal class work, and seminars, this K01 Award will provide the applicant with the opportunity to develop and conduct a study that pilot tests a culturally tailored, stage matched intervention delivered by peer educators to increase mammography use among African American women visiting the Emergency Department. The specific aims of the study are: (1) to examine the barriers and benefits that influence the use of screening mammography among African American women and develop a peer educator delivered intervention and tailored educational materials; (2) to develop and evaluate culturally tailored, stage appropriate mammography educational materials for African American women to determine cultural acceptability, readability, and applicability for women visiting the Emergency Department; and (3) to compare, in a randomized controlled trial with a sample of African American women, the effect of two different interventions (a culturally tailored, stage-matched peer educator breast cancer intervention versus tailored educational materials only) on receipt of a screening mammogram and knowledge of and intent to follow screening guidelines. The proposed study's conceptual framework integrates concepts from both the Health Belief Model and the Transtheoretical Model. These specific aims correspond to three phases: a qualitative phase, a developmental phase, and an intervention phase. The combination of this progressive research project and the structured training plan will prepare the applicant to meet the long-term goal of becoming an independent investigator, by allowing her to develop skills in mixed methodology, refine skills in advanced quantitative research methods, incorporate communication in cancer control theory and principles, and demonstrate the ability to integrate knowledge and experience related to health disparities and cancer control into the design and implementation of a randomized controlled clinical trial. In addition, the results from the proposed project will form the foundation for further research to promote the use of screening mammography among this vulnerable group of women.