Native American recruitment into breast cancer screening: The NAWWA project

Background. American Indian women's historically low breast cancer incidence and mortality rates have gradually increased such that in many parts of the United States they equal 'U.S. All Races' rates. Thus, American Indian women need screening to maintain their low rates. Methods. In an outreach program, local American Indian women were trained as lay health advisers, 'Native Sisters,' to locate and contact American Indian women in the Denver metropolitan area and provide education and encouragement to increase participation in mammography screening. Participation was monitored and interviews collected descriptive information and information about risk factors for breast cancer. An interrupted-time-series design was used to assess changes in mammography participation. Results. The NAWWA program increased recruitment of American Indian women (p < 0.05). Women recruited by the Native Sisters were more likely to be currently on hormone replacement therapy and to be menopausal. Conclusions. The lay health adviser program was effective in recruiting American Indian women to have screening mammography. Barriers to participation were complex and often involved cultural values and beliefs.