Evaluation of the Effectiveness and Implementation of an Adapted Evidence-Based Mammography Intervention for African American Women.
Breast cancer mortality disparities continue, particularly for uninsured and minority women. A number of effective evidence-based interventions (EBIs) exist for addressing barriers to mammography screening; however, their uptake and use in community has been limited. Few cancer-specific studies have evaluated adapted EBIs in new contexts, and fewer still have considered implementation. This study sought to (1) evaluate the effectiveness of an adapted mammography EBI in improving appointment keeping in African American women and (2) describe processes of implementation in a new practice setting. We used the type 1 hybrid design to test effectiveness and implementation using a quasi-experimental design. Logistic regression and intent-to-treat analysis were used to evaluate mammography appointment attendance. The no-show rate was 44% (comparison) versus 19% (intervention). The adjusted odds of a woman in the intervention group attending her appointment were 3.88 (p < 0.001). The adjusted odds of a woman attending her appointment in the intent-to-treat analysis were 2.31 (p < 0.05). Adapted EBI effectiveness was 3.88 (adjusted OR) versus 2.10 (OR) for the original program, indicating enhanced program effect. A number of implementation barriers and facilitators were identified. Our findings support previous studies noting that sequentially measuring EBI efficacy and effectiveness, followed by implementation, may be missing important contextual information.
Department of Management, Policy and Community Health, School of Public Health, University of Texas, 1200 Pressler Street, Houston, TX 77030, USA.
Linda
L
Highfield
Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas, 7000 Fannin Street, Houston, TX 77030, USA.
Marieke A
MA
Hartman
Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas, 7000 Fannin Street, Houston, TX 77030, USA.
L Kay
LK
Bartholomew
Episcopal Health Foundation, 500 Fannin Street, Suite 300, Houston, TX 77002, USA.
Philomene
P
Balihe
Episcopal Health Foundation, 500 Fannin Street, Suite 300, Houston, TX 77002, USA.
Valerie A
VA
Ausborn
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D015397:Program Evaluation; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D014600:Utilization Review; D016387:Women's Health / Q000706:statistics & numerical data