title: Improving female preventive health care delivery through practice change: an Every Woman Matters study.
abstract: BACKGROUND
  The levels of breast and cervical cancer screening in Nebraska primary care remain suboptimal despite awareness of their importance, and despite implementation of the Every Woman Matters program to assist low-income women. The GAPS model was used to develop a practice-based intervention to identify and reduce barriers to delivery of breast and cervical cancer screening services.
  
  
  METHODS
  Seven primary care practices actively participated in this multimethod case study. A research nurse collected data and facilitated the intervention process at each site. Qualitative data from field notes, patient encounters, and in-depth interviews of physicians and key informants were collected to describe the process of Papanicolaou and mammogram service delivery, and to identify barriers/facilitators to screening, and potential change areas. Chart reviews provided information regarding the preintervention and postintervention identification/execution of Papanicolaou smears and mammograms. Qualitative and quantitative analyses led to individual practice case studies. Cross case comparisons identified common themes.
  
  
  RESULTS
  The individual practice plans for change had many commonalities, ie, developing screening databases and reminder systems. The biggest differences involved practice contexts. Despite use of the GAPS model and a financial incentive to obtain "buy in" from providers and staff, change was difficult for all but 2 of the practices.
  
  
  CONCLUSIONS
  The complexity of practice context and its effect on change cannot be underestimated. Individual practice providers and staff are often unaware of the potential challenges, and unable/unwilling to overcome them.
authors.affiliation: Department of Family Medicine, University of Nebraska Medical Center, Omaha, NE 68198-3075, USA. ebacker@unmc.edu
authors.forename: Elisabeth L
authors.initials: EL
authors.lastname: Backer
authors.forename: Jenenne A
authors.initials: JA
authors.lastname: Geske
authors.forename: Helen E
authors.initials: HE
authors.lastname: McIlvain
authors.forename: Diane M
authors.initials: DM
authors.lastname: Dodendorf
authors.forename: William C
authors.initials: WC
authors.lastname: Minier
mesh_terms: D001943:Breast Neoplasms / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data; D009937:Organizational Objectives; D065006:Papanicolaou Test; D011314:Preventive Health Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D014932:Women's Health Services / Q000458:organization & administration*