title: Randomized trial of an intervention to improve mammography utilization among a triracial rural population of women.
abstract: BACKGROUND
  Mammography is underused by certain groups of women, in particular poor and minority women. We developed a lay health advisor (LHA) intervention based on behavioral theories and tested whether it improved mammography attendance in Robeson County, NC, a rural, low-income, triracial (white, Native American, African American) population.
  
  
  METHODS
  A total of 851 women who had not had a mammogram within the past year were randomly assigned to the LHA intervention (n = 433) or to a comparison arm (n = 418) during 1998-2002. Rates of mammography use after 12-14 months (as verified by medical record review) were compared using a chi-square test. Baseline and follow-up (at 12-14 months) surveys were used to obtain information on demographics, risk factors, and barriers, beliefs, and knowledge about mammography. Linear regression, Mantel-Haenszel statistics, and logistic regression were used to compare barriers, beliefs, and knowledge from baseline to follow-up and to identify baseline factors associated with mammography.
  
  
  RESULTS
  At follow-up, 42.5% of the women in the LHA group and 27.3% of those in the comparison group had had a mammogram in the previous 12 months (relative risk = 1.56, 95% confidence interval [CI] = 1.29 to 1.87). Compared with those in the comparison group, women in the LHA group displayed statistically significantly better belief scores (difference = 0.46 points on a 0-10 scale, 95% CI = 0.15 to 0.77) and reduced barriers at follow-up (difference = -0.77 points, 95% CI = -1.02 to -0.53), after adjusting for baseline scores.
  
  
  CONCLUSIONS
  LHA interventions can improve mammography utilization. Future studies are needed to assess strategies to disseminate effective LHA interventions to underserved populations.
authors.affiliation: Division of Epidemiology, The Ohio State University School of Public Health, Columbus, OH 43210, USA. electra.paskett@osumc.edu
authors.forename: Electra
authors.initials: E
authors.lastname: Paskett
authors.forename: Cathy
authors.initials: C
authors.lastname: Tatum
authors.forename: Julia
authors.initials: J
authors.lastname: Rushing
authors.forename: Robert
authors.initials: R
authors.lastname: Michielutte
authors.forename: Ronny
authors.initials: R
authors.lastname: Bell
authors.forename: Kristie
authors.initials: K
authors.lastname: Long Foley
authors.forename: Marisa
authors.initials: M
authors.lastname: Bittoni
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Dickinson
authors.forename: Ann Scheck
authors.initials: AS
authors.lastname: McAlearney
authors.forename: Katherine
authors.initials: K
authors.lastname: Reeves
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods / Q000706:statistics & numerical data; D006293:Health Promotion / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D009657:North Carolina; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome