title: Overcoming Barriers to Mammography Screening: A Quasi-randomised Pragmatic Trial in a Community-based Primary Care Setting.
abstract: BACKGROUND
  Breast cancer is the leading cancer among women in Singapore. Five years after a population-wide breast cancer screening programme was introduced, screening rates remained relatively low at 41%. Studies have shown decreased screening propensity among medically underserved women typically of minority or socioeconomically disadvantaged status. We conducted a quasi-randomised pragmatic trial aimed at encouraging mammography screening among underscreened or unscreened women in a publicly funded primary care facility in Singapore.
  
  
  METHODS
  The study was conducted from May to August 2010. Components of intervention included (1) tailored education, (2) doctor's reminder, and (3) cost reduction. Researchers administered a structured questionnaire to eligible female polyclinic attendees and patient companions aged 40 to 69 years. Individual knowledge, attitudes, beliefs, and barriers towards mammography screening were identified and educational messages tailored. Doctor's reminder and cost reduction were implemented additively.
  
  
  RESULTS
  Overall, out of 448 participants, 87 (19.4%, 95% confidence interval (CI), 15.8% to 23.1%) completed mammography screening across 3 arms of study. Participants who received a cost reduction were more likely to attend screening compared to participants in other intervention arms (adjusted odds ratio (OR) 2.4, 95% CI, 1.2 to 4.5, P = 0.009). Cost of screening, ethnicity, prior screening history, and attitudes towards mammography screening were identified as significant factors predicting mammogram attendance.
  
  
  CONCLUSIONS
  Including a cost reduction component was the most effective intervention that increased mammography screening rates. Women's underlying beliefs, attitudes, and other predisposing factors should also be considered for integration into existing breast cancer screening programmes.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Theresa
authors.initials: T
authors.lastname: Seetoh
authors.forename: Wei Fong
authors.initials: WF
authors.lastname: Siew
authors.forename: Alvin
authors.initials: A
authors.lastname: Koh
authors.forename: Wei Fong
authors.initials: WF
authors.lastname: Liau
authors.forename: Gerald C H
authors.initials: GC
authors.lastname: Koh
authors.forename: Jeannette J M
authors.initials: JJ
authors.lastname: Lee
authors.forename: Mee Lian
authors.initials: ML
authors.lastname: Wong
authors.forename: Adeline
authors.initials: A
authors.lastname: Seow
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics; D003153:Community Health Services; D003365:Costs and Cost Analysis; D055088:Early Detection of Cancer / Q000191:economics; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008327:Mammography / Q000191:economics; D008875:Middle Aged; D010353:Patient Education as Topic; D010865:Pilot Projects; D011320:Primary Health Care; D017010:Reminder Systems; D012846:Singapore