title: Improving mammography screening among the medically underserved.
abstract: 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.affiliation: Department of Medicine and Pediatrics, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71130, USA, Tdavis1@lsuhsc.edu.
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Edson
authors.initials: E
authors.lastname: Carias
authors.forename: Cristalyn
authors.initials: C
authors.lastname: Reynolds
authors.forename: Dachao
authors.initials: D
authors.lastname: Liu
authors.forename: Connie L
authors.initials: CL
authors.lastname: Arnold
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer / Q000191:economics / Q000592:standards*; D005260:Female; D006801:Humans; D008145:Louisiana; D008327:Mammography / Q000191:economics / Q000592:standards*; D008507:Medically Underserved Area; D008875:Middle Aged; D012424:Rural Population; D012959:Socioeconomic Factors