Promoting mammography adherence in underserved women: The telephone coaching adherence study

Abstract

BackgroundDespite interventions to promote regular mammography, underserved women face barriers to mammography. This is evident in high no-show appointment rates in community-based clinics. Understanding why women fail to follow-through with appointments may help improve adherence. ObjectivesWe conducted a focus group with women who were non-adherent to mammograms to evaluate psychosocial and structural barriers and design intervention messages. In phase two we conducted a small randomized controlled trial (RCT) to pilot test a brief telephone coaching adherence intervention (vs. control) to address barriers. MethodEligible women were non-adherent to their mammography screening appointment at a community-based setting. Psychosocial factors and perceptions of barriers were measured via a baseline survey and used to tailor the telephone coaching session. In the RCT, the primary outcome was whether women rescheduled and kept their appointment (yes vs. no). Descriptive statistics were used to summarize the results. ResultsFifty-four women participated in the study (17 in phase 1 and 31 in phase 2); 89% were Black and 11% were Latina. Overall, prior to the intervention, women had low perceptions of risk (m=4.2; SD=2.4) and cancer worry (m=4.2; SD=2.6) and these characteristics informed the telephone coaching. After the intervention, most women (94.5%) rescheduled their missed appointment. More women in the intervention group kept their appointment (54%) than those in the usual care group (46%). ConclusionIt appears feasible to implement a RCT in non-adherent underserved women. Addressing psychosocial and structural barriers in a brief telephone intervention may reduce non-adherence. Future studies that will test the efficacy of this approach are warranted.