Health Knowledge, Insurance, and Other Factors' Influence on Breast and Prostate Cancer Screening Behavior

The Helping You Take Care of Yourself (HYTCOY) curricula provides health education to encourage discussions with health care providers about cancer screening. Implemented within the environment of Massachusetts’ 2006 health care reform that mandates coverage for its citizens, the evaluation of the curriculum provides an opportunity to examine the role of health knowledge, coverage expansion, and other factors in screening behavior among disadvantaged populations.

Under agreement with the Massachusetts Department of Public Health, 14 community-based organizations delivered the HYTCOY breast and/or prostate health curricula from May 2011 to July 2012, educating 618 women ages 40 to 64 and 288 men ages 40 and older living in disadvantaged communities. A follow-up survey was conducted among participants (100 women and 102 men) indicated for a screening in the six months after the workshop. The survey assessed knowledge retention and screening behavior. Participants had short-term knowledge gain, but did not retain their knowledge after six months. Among those indicated for screening, nearly two-thirds received/scheduled a mammogram at follow-up. Although knowledge gained/retained was not correlated with screening behavior, participants indicated that the workshops influenced their decision to be screened. Other key factors related to screening behavior were enrollment in insurance, having few or no out-of-pocket costs, and having a regular health care provider.

As the Affordable Care Act will increase coverage for preventive health services, this study shows that health expansion alone might not be sufficient to change utilization and health behaviors. Disadvantaged populations might require systems that help enroll them in health insurance and promote community–clinical linkages.