{"id":1303,"date":"2019-05-17T06:06:51","date_gmt":"2019-05-17T10:06:51","guid":{"rendered":"https:\/\/ctlsites.uga.edu\/hprb7010may2019\/?page_id=1303"},"modified":"2019-06-06T08:12:44","modified_gmt":"2019-06-06T12:12:44","slug":"multicomponent-interventions-to-increase-breast-cancer-screening","status":"publish","type":"page","link":"https:\/\/ctlsites.uga.edu\/hprb7010may2019\/multicomponent-interventions-to-increase-breast-cancer-screening\/","title":{"rendered":"Multicomponent Interventions to Increase Breast Cancer Screening"},"content":{"rendered":"\n\n\n

Multicomponent Interventions to Increase Breast Cancer Screening<\/p>\n\n\n\n
Author & Year<\/strong><\/td>Intervention Setting, Description, and Comparison Group(s)<\/strong><\/td>Study Population Description and Sample Size<\/strong><\/td>Effect Measure (Variables)<\/strong><\/td>Results, including Test Statistics and Significance<\/strong><\/td>Follow-up Time<\/strong><\/td><\/tr>
Mohtasham Ghaffari et. al 2018<\/strong><\/td>This study was based in Karaj City, Iran  Cluster sampling was used to enroll participants from two urban health care centers, which were randomly split into an experimental group where participants attended two 50 minute educational sessions, and a control group. The integrated behavioral model was used. <\/strong><\/td>138 women above 35 years of age were enrolled from Karaj City attending two health centers in Mohammad Shahr City with the same social, economic and cultural conditions    <\/strong><\/td> Age, social, economic, cultural status, demography<\/strong><\/td>No statistically significant differences were found between the experimental and control group demographic variables based on chi square analysis There were statistically significant differences in  knowledge structure, perceived susceptibility, perceived severity, perceived benefits and perceived barriers, self-efficacy and perceived barriers for mammography, BSE and subjective norms after training compared with the control group. Behavioral intention, BSE behavioral intention and mammography behavioral intention also showed a statistically significant result following intervention. However, mammography behavior did not. This study concluded that there is a benefit to implementing an educational intervention to promote breast cancer screening among the population studied <\/strong><\/td>Questionnaires were given before the intervention, immediately after, and 2 months following the intervention<\/strong><\/td><\/tr>
Dunn, S.F. et al. 2017<\/td>Cancer Awareness: Ready for Education and Screening (CARES) was conducted in Toronto, Canada to improve breast and cervical screening among marginalized women. Based on provincial data collected from 1998-2014, participants were matched to up to 3 controls based on age, geography and pre-education screening status.<\/td>1993 women from around Toronto, Canada, participated in 145 educational sessions provided in 20 languages; 419 women were matched with controls based on age, geography, pre-education screening status  <\/td>Age, geography, pre-education screening status,  <\/td>Among UNS CARES participants: 26% had Pap conducted, and 36% received a mammogram vs. 9% and 14% in the control group. ORs for screening within 8 months of follow-up among UNS CARES participants: 5.1 (2.4, 10.9 CI) for Pap and 4.2 (2.3, 7.8 CI) for mammography <\/td>8 months<\/td><\/tr>
Elder, J.P. et al, 2017<\/strong><\/td>A randomized controlled trial was conducted with 436 women attending 16 Catholic churches who were split into a cancer screening group or physical activity intervention group.Those in the cancer screening intervention group received educational information about cancer screening through Promotoras. They also received up to two motivational interviewing calls over the course of the 1-year intervention  from the Promotoras and Promotoras were allowed to accompany the participants to screening appointments if desired. Churches also offered cancer screening classes<\/strong><\/td>436 adult Latina women attending 16 Catholic churches in San Diego County between the ages of 18-65 <\/strong><\/td>Age, church attendance, proximity to the church, education, household income, employment status, country of birth, years living in the US, health insurance status, health conditions, cancer knowledge<\/strong><\/td>Breast cancer screening rates improved  from 44% to 61% for mammograms, and 47-63% for breast exams in the 12-month follow-up assessment in the cancer screening group. This group also showed a decrease in scores for perceived barriers to breast cancer<\/strong>  <\/td>12 months follow-up following baseline and 24 month post baseline <\/strong><\/td><\/tr><\/tbody><\/table>\n\n\n\n

Based on the evidence found in recent studies, using a multicomponent intervention approach to helping increase breast cancer screening amongst women, is strongly recommended. Based on research conducted by the Community Guide, multicomponent interventions which may consist of educational components, client reminders, better delivery of screening services, and reduced economic or structural barriers, have proven to be effective in increasing screening rates among women who may not have previously received these services. These findings were supported by the resources summarized above. <\/p>\n\n\n\n

No changes were made to the recommendations to use a multicomponent approach in order to increase breast cancer screening. Educational strategies where women participated in courses appeared to increase the likelihood of women voluntarily receiving mammograms. (Elder et. al, 2017 & Mohtashem et. al, 2018) <\/strong>The information is often offered in multiple languages in order for it to be accessible by women of different backgrounds. In addition, reminders such as a letter or verbal communication about the benefits of breast screening from a health professional also proved effective in encouraging women to receive mammograms. Although the Community Guide suggests that there is limited information about the efficacy of interventions that provide language translation services, based on Dunn\u2019s study from 2017, I would categorize this strategy as \u201crecommended\u201d, although this may vary based on geographic location. There is still limited information on intervention costs in comparison with intervention benefits. <\/p>\n\n\n\n

Part II. Theoretical Framework\/Model <\/p>\n\n\n\n

  1. Briefly describe in text the theory you selected, including each of the constructs, and why. You may reference evidence from your table above or other sources.  (20 points)<\/li><\/ol>\n\n\n\n

    The Health Belief Model acts on the principle that people may change a behavior given that the perceived benefits of the behavioral change outweighs the perceived barriers associated with the change. This decision is also likely influenced by the consequences (threat) of not undergoing the behavior change. The Health Belief Model has been used in prevention of illness and can be used to predict breast cancer screening behaviors. (Jones et. al, 2015) <\/strong>The constructs that make up this model include perceived susceptibility, perceived severity of disease, perceived threat of disease, perceived benefits of the intervention, perceived barriers to the intervention, cues to action, age, sex, socioeconomics, knowledge, ethnicity, and personality. (Darvishpour et. al 2018)<\/p>\n\n\n\n

    Perceived susceptibility: This refers to a person\u2019s personal belief that they will get a disease. Specific to breast cancer, a woman is more likely to pursue breast cancer screening if her perception of the likelihood of getting breast cancer based on her demographic characteristics, is higher. <\/p>\n\n\n\n

    Perceived threat to disease: This refers to the awareness that one has of the consequences of a disease. If we consider breast cancer specifically, a woman who is aware of the prevalence of breast cancer amongst women and the increased likelihood of its occurrence with age is more likely to pursue breast cancer screening.<\/p>\n\n\n\n

    Cues to Action: These consist of education, symptoms, and media. Cues to Action influence one\u2019s perceived threat to disease. For example, if a woman is educated about the dangers and prevalence of breast cancer and the need to diagnose it early in order to treat it, then she is more likely to pursue breast cancer screening.<\/p>\n\n\n\n

    Age, sex, ethnicity, personality, socioeconomics, knowledge: These are modifying factors that influence the perceived susceptibility to disease, perceived severity to disease and perceived benefits or barriers of intervention. <\/p>\n\n\n\n

    Perceived benefits: The perceived benefits of an intervention strategy, when compared to an individual\u2019s perceived barriers, will determine the likelihood of behavior change. Someone who perceives the benefits of breast cancer screening to outweigh the barriers associated with it, will be more likely to pursue it.  <\/p>\n\n\n\n

    • Draw a diagram to illustrate your conceptual model, making sure to include an indication of the hypothesized direction of the relation (positive or inverse) between the constructs. You may use plus or minus signs, up and down arrows, or another method as long as it is clear. Do not create a logic model.  (16 points)<\/li><\/ul>\n\n\n\n
      \"\"<\/figure>\n\n\n\n

      Part III. Logic Model, Causal and Intervention Hypotheses, and Intervention Strategies <\/p>\n\n\n\n

      • Brieflydescribe the target population and program setting for your intervention. Think about the course materials and discussion of health disparities. Provide evidence for why your target population is a health disparate group. This can include, but is not limited to, description of greater risk or prevalence of disease or risk factors, being in a minority group or low-resource geographic area. Provide citations as appropriate. (5 points)<\/li><\/ul>\n\n\n\n

        The target population for my proposed intervention is women of minority backgrounds in Clarkston, Georgia. A majority of the population in Clarkston City is foreign-born, of refugee backgrounds, making health care harder to acquire, especially when taking into consideration social or cultural influences such as language barriers. This area is also of a lower-resource and lower socio-economic status. Clarkston has a population of 12,757 people of which 49.8% are female. 52.9% of the population is foreign born. 33.2% of the population does not have health insurance. 33% of the population is living in poverty. 66.5% of the population above the age of 25 has received high-school level education, and 21.6% of this demographic has a Bachelor\u2019s degree or higher. (US Census Bureau)<\/strong><\/p>\n\n\n\n

        • Explicitly state the Intervention Methods for the program (minimum of 3), the theory from which they are derived if different from your theoretical model in items 4 and 5, and a brief description of how they align with that theory. Use the Table template below. (18 points)<\/li><\/ul>\n\n\n\n
          • Explicitly describe the Intervention Strategies for each Intervention Method (should have at least one strategy per method). Enter this information into the table below. (9 points)<\/li><\/ul>\n\n\n\n
            Intervention Method<\/strong><\/td>Alignment with Theory<\/strong><\/td>Intervention Strategy<\/strong><\/td><\/tr>
            Increasing knowledge about breast cancer screening\/diagnosis\/treatment amongst women in Clarkston City (18+)<\/td>Providing educational support about breast cancer aligns with the \u201ccues to action\u201d part of the theory, where increased knowledge of the disease will likely have an effect on the perceived threat of breast cancer, increasing the likelihood of behavior change. This may also help promote the perceived benefits of breast cancer screening, also increasing the likelihood of choosing action (preventative measures).<\/td>Monthly educational courses will be provided to the public at the Clarkston Community Center<\/td><\/tr>
            Provision of Mammogram Services and self breast examination training<\/td>Providing mammogram services through the community health clinic aligns with \u201ccues to action\u201d, as well as \u201cperceived benefits\u201d vs. \u201cperceived barriers\u201d through allowing greater access to prevention services and through increasing knowledge of the importance of these services<\/td>The Clarkston Community Health Center will be provided the necessary tools for mammogram screening, including training of individuals on interpreting the results. Community members will be made aware of this service which will be provided for free for those above 40 years of age or those who are otherwise considered susceptible to developing breast cancer. <\/td><\/tr>
            Health Center reminders every 6 months for those above 40 years of age<\/td>This falls under the \u201ccues to action\u201d category as well, through encouraging women to continue performing breast cancer self examinations and mammograms where necessary.<\/td>Reminders should be sent out as text messages or as phone calls to women above the age of 40 in the Clarkston Community through the Community Health Center.<\/td><\/tr>
             <\/td> <\/td> <\/td><\/tr><\/tbody><\/table>\n\n\n\n
            • Provide the logic model for the program as a schematic. (24 points)<\/li><\/ul>\n\n\n\n
              \"\"<\/figure>\n\n\n\n

              <\/p>\n\n\n\n

              • Explicitly state the causal and intervention hypotheses. You should have an intervention hypothesis linking each item in your activities to one or more short-term outcomes, and a causal hypothesis linking each item in short-term outcomes to at least one intermediate or long-term outcome. (12 points)<\/li><\/ul>\n\n\n\n

                Intervention hypothesis example format: [Intervention activities] will lead to increases\/decreases\/improvements in [health behavior].<\/em><\/p>\n\n\n\n

                Intervention Hypothesis:<\/p>\n\n\n\n

                Provision of\neducation through courses by health professionals will <\/strong>Increase knowledge\nabout breast cancer screening\/diagnosis\/treatment amongst women in Clarkston\nCity (18+) which<\/strong> will lead to increases in breast cancer screening behavior\namong women.<\/p>\n\n\n\n

                Provision of Mammogram Services and self breast\nexamination training to women 18+ in the Clarkston Community, will increase the\nperceived benefits of performing mammograms\/self breast exams, and will\ndecrease the perceived barriers to these prevention measures, increasing the likelihood\nof women pursuing these diagnostic measures. <\/p>\n\n\n\n

                Providing Health Center reminders every 6 months\nfor those above 40 years of age to receive mammogram screening tests will help\nincrease \u201ccues to action\u201d, leading to an increased awareness of the dangers of\nbreast cancer, and an increased likelihood for women to receive regular\nmammogram testing.<\/p>\n\n\n\n

                Causal Hypothesis:<\/p>\n\n\n\n

                Increasing the knowledge about breast cancer among women in\nthe Clarkston Community will increase the perceived threat of disease,\nincreasing the likelihood of women performing self breast examinations and\npursuing mammogram testing, decreasing the incidence of breast-cancer related\nmortality in the long-term. <\/p>\n\n\n\n

                Goal 1: Increase knowledge of breast cancer prevention,\ndiagnosis, threats, and treatment. <\/p>\n\n\n\n

                Outcome: A questionnaire about breast cancer in\nmultiple languages will be distributed at the start of the educational program which\nwill consist of 1 educational course per month for 3 months. The same questionnaire\nshould be distributed at the end of the third session. We should see an overall\nincrease in knowledge (significantly different increase in scores) in at least 20%\nof women attending the session. The questionnaire will be distributed again 3\nmonths following the last session. (Dunn et. al, 2017) <\/strong><\/p>\n\n\n\n

                Goal 2: Increase breast cancer screening rates amongst\nwomen 40 years + in the Clarkston Community.<\/p>\n\n\n\n

                Outcome: At the end of each education session, the\nattendants will be given information about receiving a free mammogram through\nthe Women\u2019s Clinic if desired. Women will have access to a free screening for\nup to 6 months following the last education session at their convenience. At\nleast 30% of those who attended the education session should have received\nmammogram testing by 6 months following their educational session. A measure of\nthose in the control group undergoing mammogram screening will be kept as well.\n<\/strong><\/p>\n\n\n\n

                • <\/li><\/ul>\n\n\n\n

                  Part IV. Evaluation Design and Measures <\/p>\n\n\n\n

                  1. State the major stakeholders (minimum of 3) of your project, evaluation questions each stakeholder may want answered about the project, and how each group of stakeholders might be affected by the evaluation outcomes?  Be sure to consider any individual or group who you list on your Inputs column of your logic model. (15 points)<\/li><\/ol>\n\n\n\n
                    Stakeholder<\/strong><\/td>Role in Intervention<\/strong><\/td>Evaluation Questions from Stakeholder<\/strong><\/td>Effect on Stakeholder of a Successful Program<\/strong><\/td>Effect on Stakeholder of an Unsuccessful Program<\/strong><\/td><\/tr>
                    Community Health Center<\/td>Provision of free mammography services <\/td>Will this program support our existing work\/efforts to provide health care in the community? Will this program help prevent breast cancer in the Clarkston Community?Is this sustainable? <\/td>Better implementation of breast cancer awareness\/screening strategies     <\/td>No change in services offered and no change in mortality rates as a result of breast cancer<\/td><\/tr>
                    Women 40 yrs + in the Clarkston Community<\/td>Receivers of breast cancer educational training course, mammography service, breast self examination training<\/td>Wil my participation in this program help my overall health? Will my participation in this program improve my overall knowledge of breast cancer?  <\/td>Better awareness\/knowledge of breast cancer & the process of diagnosis\/early detection\/treatment; change in health behavior promoting regular screening for breast cancer and the encouragement of others to do the same; earlier detection of breast cancer in the community\/prevention of mortality associated with breast cancer <\/td>No change in behavior regarding screening for breast cancer; stagnant mortality rate in the community as a result of breast cancer<\/td><\/tr>
                    Health Professionals <\/td>Receive training in order to adequately interpret mammography screening results  Sending reminders to clients every 6 months to receive mammography screening <\/td>Am I adequately expanding my knowledge base about breast cancer, and accurately interpreting screening results as a result of the training received through this program? Am I getting positive results back from sending reminders to clients about receiving mammograms? <\/td>Better rates of mammography screening amongst women in the Clarkston Community. Gaining skills in mammogram screening interpretation. <\/td>Inadequate training in the field of screening interpretation.  <\/td><\/tr>
                    Grant Providers<\/td>Supply money for the acquisition of mammography supplies, for training health professionals in screening interpretation, and in conducting program evaluations<\/td>Am I seeing a positive return in investment? Are we helping reduce the mortality due to breast cancer in the Clarkston Community?<\/td>Increased awareness of the incidence of breast cancer amongst women in the Clarkston community Lower rates of mortality due to breast cancer  Earlier staging of breast cancer <\/td>No change in attitude\/perception toward breast cancer screening  Loss of profit over an unsuccessful program <\/td><\/tr><\/tbody><\/table>\n\n\n\n