Semester

Summer

Date of Graduation

2012

Document Type

Thesis

Degree Type

MS

College

School of Pharmacy

Department

Pharmaceutical Systems and Policy

Committee Chair

Suresh Madhavan

Abstract

Early detection of breast cancer (BC) in women can lead to long-term survival and better quality of life. Mammography screening is considered to be the 'gold standard' for women at an average risk to detect BC early and hence reduce BC-related mortality. West Virginia (WV) has a lower incidence of BC but higher rates of advanced and unstaged BC which has been attributed to lower mammography screening rates in women in WV. Mobile mammography programs have been in use for more than two decades to overcome barriers and increase mammography screening rates in rural and hard-to-reach populations. WV has one such mobile mammography program named Bonnie Wells Wilson Mobile Mammography Program (called Bonnie's Bus hereafter). There are no reported studies on the profiles of women who utilize mobile mammography services and those who utilize stationary mammography facility and predictors of adherence to mammography screening guidelines in these two populations. Not much has been reported about what types of intervention strategies linked with mobile mammography are likely to improve screening rates thereby the effectiveness of a mobile mammography program. Though, many interventions effective in increasing screening rates have been reported in the literature, no studies have assessed the perspective of women at whom these interventions are targeted, such as their receptiveness towards these interventions and their perception of whether they would be successful with their peers and in their communities. Therefore, the objectives of this research study were: (1) to describe the profiles of women who utilize mobile mammography services, at the Bonnie's Bus and those who utilize a stationary mammography facility, Betty Puskar Breast Care Center (BPBCC) in Morgantown, WV, and to identify the predictors of adherence to mammography screening guidelines in these populations, and (2) to determine what types of targeted educational interventions coupled with mobile mammography are perceived as likely to be acceptable and effective by women who had their first mammogram at the Bonnie's Bus. A cross-sectional study was conducted with the primary data collected from 1,161 women age 40 years and above who utilized Bonnie's Bus and 1,104 women age 40 years and above who utilized BPBCC using the 'Mammography Screening and Preventive Care Survey'. The 'expanded' version of Andersen Behavioral Model for Health Services Utilization was utilized as the conceptual model. Structured telephone interviews of 16 women age 40 years and above residing in WV who reported never having had a mammogram prior to getting one through the Bonnie's Bus were conducted. Descriptive statistics were used to separately describe the characteristics of women who utilized Bonnie's Bus and the BPBCC. Chi-square statistics for categorical variables and t-tests for continuous variables were used separately in both the study samples to determine significant differences between self-reported adherent and non-adherent groups. Logistic regressions were also performed to analyze the relationship between self-reported adherence with all the constructs of Andersen model, after controlling for all the independent variables, separately for both the study samples. To determine whether or not women who did not participate in the study were different from women who participated, non-response bias was assessed in both the study samples. Thematic analysis of audio-recorded data from the telephone interviews was conducted to identify women's receptiveness and preferences for various interventions. Among women who utilized mobile mammography unit, only 48.15% were adherent to mammography screening guidelines and among women who utilized stationary mammography facility, an overwhelming 92.3% were adherent to mammography screening guidelines. The predictors of self-reported adherence to mammography screening guidelines in women who utilized mobile mammography services were older age (adjusted odds ratio (AOR) = 2.025, 95% confidence interval (CI) = 1.489-2.754 for age group 50-64 years; AOR = 3.181, 95% CI = 1.904-5.314 for age 65 and above), unemployed status, extreme obesity (AOR = 1.880, 95% CI = 1.161-3.046) and morbid obesity (AOR = 1.918, 95% CI = 1.128-3.261), no reported delay in care due to transportation problem, family history of BC, breast biopsy in the past, and adherence to Pap test and routine screenings such as blood glucose, blood cholesterol, blood pressure and bone mineral density test. While the predictors of adherence to mammography screening guidelines in women who utilized stationary mammography facility were health insurance coverage, no reported delay in care due transportation problem, adherence to clinical breast exam (CBE), Pap test and other routine screenings, and having strong agreement with the positive views about mammography screening. The sources of information about health and mammography screening used by rural women who had their first mammogram at the Bonnie's Bus mostly included doctors or obstetrician / gynecologist (OB/GYN), materials from library, health fairs, and internet. Among community-based interventions, community-based health educational programs that could be held at public places such as library or church or work-sites and among individual-level interventions, mailed educational materials were perceived to be the most helpful interventions. BC-related events such as family history of BC and having had biopsy, and adherence to screening tests were associated with adherence to mammography screening guidelines in older women who utilized mobile mammography services. While access factors, adherence to other screening tests such as CBE, Pap test and having strong positive views about mammography screening were associated with adherence to mammography screening guidelines in women who utilized stationary mammography facility. Intervention strategies such as community-based educational programs and mailed educational materials could be developed along with the mobile mammography unit that may be effective in attracting rural and underserved women in WV. Incorporating various information sources such doctor and/or OB/GYN, and internet in the intervention strategies may help gain synergistic effect on the mammography screening rates in women in WV.

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