A combined lay health advisor and interactive tailored media intervention to increase mammography screening in medically underserved African American women

BACKGROUND: Over the past two decades, randomized controlled trials of lay health advisor (LHA) interventions among African American populations have been efficacious, but mammography screening rates in the intervention group were at most 25% (except 43% in one tri-racial study) above baseline rates. A combination of interventions may be required. A combined LHA and interactive tailored computer intervention was investigated in low-income African American women. METHODS: Analyses included 145 African American women ages 41-75, <250% of poverty, no breast cancer history, and no screening mammogram in past 15 months. Participants were randomly assigned to either (a) usual care consisting of a culturally targeted brochure about mammography screening or (b) intervention consisting of 4 monthly LHA counseling sessions enhanced with an interactive computer program tailored on health and cultural beliefs. Self reported screening data were collected (baseline, 6 months) and verified by medical records. RESULTS: At 6 months the intervention group had increased screening by 65% compared to 26% for usual care and was five times more likely to get screened (OR=5.2, [95% CI: 2.6,10.8], p<.0001). Pre-to-post intervention screening improvement (65%) was significantly higher than the best known population LHA increase of 43% (p=0.0003). Compared to usual care (37%), the intervention group (75%) was five times more likely to report forward stage movement (OR=5.1, [95% CI: 2.5,10.5], p<.0001). CONCLUSIONS: The combined LHA and interactive tailored computer program is efficacious for improving mammography screening in low income African American women with an effect size significantly higher than previous LHA-alone interventions.