The Delta project: increasing breast cancer screening among rural minority and older women by targeting rural healthcare providers.

PURPOSE/
OBJECTIVES: To test a multimethod approach designed for rural healthcare providers to increase breast cancer screening among low-income, African American, and older women.
DESIGN: Two-year experimental pretest/post-test with random assignment by group.
SETTING: Primary healthcare providers' offices. SAMPLE: 224 nurses, physicians, and mammography technicians.
METHODS: Standardized patients to observe and record healthcare providers' performances, followed by direct feedback, newsletters, posters, pocket reminder cards, and lay literature about screening to use in clinics. MAIN RESEARCH VARIABLES: Healthcare providers' knowledge and attitudes as measured by survey responses, skills as measured by a checklist, and the provision of breast cancer screening as measured by mammography facilities' data.
FINDINGS: Healthcare providers significantly improved in demonstration of breast cancer screening practice after the intervention. Nurses performed significantly better than physicians on the breast examination during the post-test. More women older than 50 received mammograms in the experimental counties than in the comparison counties. Culturally sensitive lay literature is needed for African American women with low literacy.
CONCLUSIONS: Successful interventions included use of standardized patients to teach healthcare providers in their office settings, prompts such as posters and pocket reminder cards, and easy-to-read newsletters. IMPLICATIONS FOR NURSING: Physicians and nurses play a powerful role in motivating women to have mammograms and clinical breast examinations and to practice breast self-examination. Interventions that help these providers fulfill that role should be implemented.