A community-based intervention to increase screening mammography among disadvantaged women at an inner-city drop-in center.
OBJECTIVE
To determine the effectiveness of a community- based intervention to increase the use of screening mammography among disadvantaged women at an inner-city drop-in center.


METHODS
This study involved women 50 to 70 years old who were clients of an inner-city drop-in center in Toronto, Canada, during the years 1995-2002 (N = 158 in 1995-2001 and N = 89 in 2002). In 2002, the drop-in center and a nearby hospital initiated a collaborative breast cancer screening project in which a staff member of the drop-in center accompanied small groups of women for mammography visits at a weekly pre-arranged time. Interrupted time series analysis was used to examine the effect of this intervention on the annual rate of screening mammography, as determined by review of medical records.


RESULTS
More than half of the women 50 to 70 years old who used the drop-in center in 2002 had been diagnosed with a major mental illness, and one-third were either homeless or living in supportive housing. In the 7 years before the introduction of the intervention, annual mammography rates among women using the drop-in center averaged 4.7%. During the intervention year, 26 (29.2%) of 89 women underwent mammography (p = 0.0001 for the change from pre-to post-intervention).


CONCLUSIONS
The introduction of accompanied small-group visits was associated with significantly increased use of mammography in a group of disadvantaged women who were clients of an inner-city drop-in center. This approach may be useful to promote breast cancer screening among women affected by mental illness or homelessness who have contact with community-based agencies.
Heyding
Robert K
RK
Leaside Health Centre and the Department of Family and Community Medicine, Toronto, ON, M4G 4E4, Canada.
Cheung
Angela M
AM
Mocarski
Eva J M
EJ
Moineddin
Rahim
R
Hwang
Stephen W
SW
D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control; D003151:Community Health Centers / Q000706:statistics & numerical data; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000592:standards; D012189:Retrospective Studies; D019037:Urban Health Services / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data*; D016387:Women's Health; D014932:Women's Health Services / Q000706:statistics & numerical data