BACKGROUND: We evaluated the effectiveness and cost-effectiveness of alternative interventions designed to promote mammography in safety-net settings. METHODS: A three-arm, quasi-experimental evaluation was conducted among eight federally qualified health clinics in predominately rural Louisiana. Mammography screening efforts included: 1) enhanced care, 2) health literacy-informed education of patients, and 3) education plus nurse support. Outcomes included mammography screening completion within 6 months and incremental cost-effectiveness. RESULTS: Overall, 1,181 female patients ages 40 and over who were eligible for routine mammography were recruited. Baseline screening rates were < 10%. Post intervention screening rates were 55.7% with enhanced care, 51.8% with health literacy-informed education and 65.8% with education and nurse support. After adjusting for race, marital status, self-efficacy and literacy, patients receiving health-literacy informed education were not more likely to complete mammographic screening than those receiving enhanced care; those additionally receiving nurse support were 1.37-fold more likely to complete mammographic screening than those receiving the brief education (95% Confidence Interval 1.08-1.74, p = 0.01). The incremental cost per additional women screened was $2,457 for literacy-informed education with nurse support over literacy-informed education alone. CONCLUSIONS:Mammography rates were increased substantially over existing baseline rates in all three arms with the educational initiative, with nurse support and follow-up being the most effective option. However, it is not likely to be cost-effective or affordable in resource-limited clinics.
RCT Entities:
BACKGROUND: We evaluated the effectiveness and cost-effectiveness of alternative interventions designed to promote mammography in safety-net settings. METHODS: A three-arm, quasi-experimental evaluation was conducted among eight federally qualified health clinics in predominately rural Louisiana. Mammography screening efforts included: 1) enhanced care, 2) health literacy-informed education of patients, and 3) education plus nurse support. Outcomes included mammography screening completion within 6 months and incremental cost-effectiveness. RESULTS: Overall, 1,181 female patients ages 40 and over who were eligible for routine mammography were recruited. Baseline screening rates were < 10%. Post intervention screening rates were 55.7% with enhanced care, 51.8% with health literacy-informed education and 65.8% with education and nurse support. After adjusting for race, marital status, self-efficacy and literacy, patients receiving health-literacy informed education were not more likely to complete mammographic screening than those receiving enhanced care; those additionally receiving nurse support were 1.37-fold more likely to complete mammographic screening than those receiving the brief education (95% Confidence Interval 1.08-1.74, p = 0.01). The incremental cost per additional women screened was $2,457 for literacy-informed education with nurse support over literacy-informed education alone. CONCLUSIONS: Mammography rates were increased substantially over existing baseline rates in all three arms with the educational initiative, with nurse support and follow-up being the most effective option. However, it is not likely to be cost-effective or affordable in resource-limited clinics.
Authors: Julie Legler; Helen I Meissner; Cathy Coyne; Nancy Breen; Veronica Chollette; Barbara K Rimer Journal: Cancer Epidemiol Biomarkers Prev Date: 2002-01 Impact factor: 4.254
Authors: Christine E Phillips; Jessica D Rothstein; Kristine Beaver; Bonnie J Sherman; Karen M Freund; Tracy A Battaglia Journal: J Gen Intern Med Date: 2010-10-08 Impact factor: 5.128
Authors: Terry C Davis; Connie L Arnold; Alfred Rademaker; Stacy C Bailey; Daci J Platt; Cristalyn Reynolds; Julie Esparza; Dachao Liu; Michael S Wolf Journal: J Womens Health (Larchmt) Date: 2012-04-20 Impact factor: 2.681
Authors: Robert M Saywell; Victoria L Champion; Terrell W Zollinger; Maltie Maraj; Celette Sugg Skinner; Kathleen A Zoppi; Carolyn M Muegge Journal: Am J Manag Care Date: 2003-01 Impact factor: 2.229
Authors: Terry Davis; Connie Arnold; Alfred Rademaker; Charles Bennett; Stacy Bailey; Daci Platt; Cristalyn Reynolds; Dachao Liu; Edson Carias; Pat Bass; Michael Wolf Journal: Cancer Date: 2013-08-20 Impact factor: 6.860
Authors: B A Mahal; M-H Chen; C L Bennett; M W Kattan; O Sartor; K Stein; A V D'Amico; P L Nguyen Journal: Ann Oncol Date: 2015-04-28 Impact factor: 32.976
Authors: Derek Falk; Catherine Cubbin; Barbara Jones; Kristen Carrillo-Kappus; Andrew Crocker; Carol Rice Journal: J Cancer Educ Date: 2018-08 Impact factor: 2.037
Authors: Terry C Davis; Connie L Arnold; Charles L Bennett; Michael S Wolf; Dachao Liu; Alfred Rademaker Journal: J Womens Health (Larchmt) Date: 2015-02-18 Impact factor: 2.681
Authors: John R Scheel; Allison A Tillack; Lauren Mercer; Gloria D Coronado; Shirley A A Beresford; Yamile Molina; Beti Thompson Journal: J Am Coll Radiol Date: 2017-10-19 Impact factor: 5.532
Authors: Bettina F Drake; Salmafatima S Abadin; Sarah Lyons; Su-Hsin Chang; Lauren T Steward; Susan Kraenzle; Melody S Goodman Journal: BMJ Open Date: 2015-03-20 Impact factor: 2.692
Authors: Terry C Davis; Connie L Arnold; Glenn Mills; Glenn J Lesser; W Mark Brown; Richard Schulz; Kathryn E Weaver; Pamala A Pawloski Journal: Int J Environ Res Public Health Date: 2021-10-21 Impact factor: 4.614
Authors: Victoria L Champion; Patrick O Monahan; Timothy E Stump; Erika B Biederman; Eric Vachon; Mira L Katz; Susan M Rawl; Ryan D Baltic; Carla D Kettler; Natalie L Zaborski; Electra D Paskett Journal: Cancers (Basel) Date: 2022-09-07 Impact factor: 6.575