Efficacy of the Promoting Access to Health Services (PATHS) intervention

Recommended screening can improve cancer detection and diagnosis, resulting in lower cancer mortality. The purpose of this study was to assess the efficacy of a theory-based program to promote regular mammography and Papanicolou (Pap) testing among women with mobility impairments who are overdue for screenings. Promoting Access to Health Services (PATHS) is an intervention designed to increase receipt of mammography and Pap tests among women with mobility impairments. PATHS is based on the Health Belief Model and Social Cognitive theory. It consists of a 90-minute participatory small-group workshop, followed by six months of structured telephone support. We evaluated the efficacy of PATHS through a randomized controlled trial. Women aged 35 – 64 with mobility impairments were recruited through a Medicaid managed care organization and a durable medical equipment vendor in Oregon during 2008 and 2009. Women who reported not receiving a Pap test in the past three years and/or a mammogram (if age >40 years) in the last two years were eligible. Of 211 women randomized, 156 completed the study (26% attrition). We used chi-square testing to compare the intervention and control groups for self-reported receipt of screenings at six-month follow-up. The intervention group was more likely to have received a Pap test (n=71, X2=8.2, p<.01). No significant group effect was observed for mammography (n=125, X2 = 0.6, p=.45). Intervention influences on theoretical mediators (e.g. self-efficacy) will also be presented. We will discuss potential explanations for differences in mammography and Pap test effects, and implications for health promotion programs.