Cultural tailoring for mammography and fruit and vegetable intake among low-income African-American women in urban public health centers.
BACKGROUND
It is widely accepted that disease prevention efforts should consider cultural factors when addressing the needs of diverse populations, yet there is surprisingly little evidence that doing so enhances effectiveness. The Institute of Medicine has called for randomized studies directly comparing approaches that do and do not consider culture.


METHODS
In a randomized trial, 1227 lower-income African-American women from 10 urban public health centers were assigned to either a usual care control group, or to receive a series of six women's health magazines with content tailored to each individual. By random assignment, these magazines were generated from either behavioral construct tailoring (BCT), culturally relevant tailoring (CRT) or both (BCT + CRT). The CRT magazines were based on four cultural constructs: religiosity, collectivism, racial pride, and time orientation. All tailored magazines sent to women ages 40-65 promoted use of mammography; magazines sent to women ages 18-39 promoted fruit and vegetable (FV) intake. Analyses examined changes from baseline to 18-month follow-up in use of mammography and servings of FV consumed daily.


RESULTS
Women receiving BCT + CRT magazines were more likely than those in the BCT, CRT, and control groups to report getting a mammogram (76% vs. 65% vs. 64% vs. 55%, respectively), and had greater increases in FV servings consumed daily (+0.96 vs. + 0.43 vs. + 0.25 vs. + 0.59).


CONCLUSIONS
Systematically integrating culture into tailored cancer prevention and control interventions may enhance their effectiveness in diverse populations.
Kreuter
Matthew W
MW
Health Communication Research Laboratory and Center of Excellence in Cancer Communication Research, Department of Community Health, School of Public Health, Saint Louis University (SLU), 3545 Lafayette Avenue, St. Louis, MO 63104, USA. kreuter@slu.edu
Sugg-Skinner
Celette
C
Holt
Cheryl L
CL
Clark
Eddie M
EM
Haire-Joshu
Debra
D
Fu
Qiang
Q
Booker
Angela C
AC
Steger-May
Karen
K
Bucholtz
Dawn
D
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D001294:Attitude to Health / Q000208:ethnology*; D001521:Behavior Therapy / Q000379:methods; D001943:Breast Neoplasms / Q000208:ethnology / Q000517:prevention & control*; D003151:Community Health Centers; D018864:Cultural Diversity; D004032:Diet; D004522:Educational Status; D005260:Female; D005638:Fruit; D006266:Health Education / Q000379:methods*; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D011203:Poverty; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013664:Teaching Materials; D014481:United States; D014504:Urban Health; D014675:Vegetables