Randomized Trial of an Intervention to Improve Mammography Utilization Among a Triracial Rural Population of Women

Introduction: Mammography is underused by certain groups of women, in particular poor and minority women. We developed a lay health advisor (LHA) intervention based on behavioral theories and tested whether it improved mammography attendance in Robeson County, NC, a rural, low-income, triracial (white, Native American, African American) population. Methods: A total of 851 women who had not had a mammogram within the past year were randomly assigned to the LHA intervention (n = 433) or to a comparison arm (n = 418) during 1998–2002. Rates of mammography use after 12–14 months (as verified by medical record review) were compared using a chi-square test. Baseline and follow-up (at 12–14 months) surveys were used to obtain information on demographics, risk factors, and barriers, beliefs, and knowledge about mammography. Linear regression, Mantel–Haenszel statistics, and logistic regression were used to compare barriers, beliefs, and knowledge from baseline to follow-up and to identify baseline factors associated with mammography. Results: At follow-up, 42.5% of the women in the LHA group and 27.3% of those in the comparison group had had a mammogram in the previous 12 months (relative risk = 1.56, 95% confidence interval [CI] = 1.29 to 1.87). Compared with those in the comparison group, women in the LHA group displayed statistically significantly better belief scores (difference = 0.46 points on a 0–10 scale, 95% CI = 0.15 to 0.77) and reduced barriers at follow-up (difference = −0.77 points, 95% CI = −1.02 to −0.53), after adjusting for baseline scores. Conclusions: LHA interventions can improve mammography utilization. Future studies are needed to assess strategies to disseminate effective LHA interventions to underserved populations.