Fortaleza Latina! - Using promotoras to increase mammography screening in Latinas

Promotoras, also known as community or lay health workers, have been widely used to promote Latino use of preventive services, including screening mammography. Yet, little is known about the fidelity of interventions delivered by promotoras.¡Fortaleza Latina! is a multi-level clinical trial to increase mammography screening among Latinas who seek care at a community health center. The study enrolled Latina patients (n = 542) aged 42 – 74 who had a clinic visit in the past 5 years and no mammogram in the past 2 years. At the patient-level, the intervention group received a home visit from a promotora who engaged them in a conversation about mammography using a motivational interviewing (MI) approach, as well as a brief phone call two weeks after the visit to provide support and accountability.  Promotoras received training in breast cancer, mammography, and MI. Training included role playing the protocol, which consisted of building rapport, assessing readiness to change, and developing a plan based on readiness.  Promotoras recorded a subset of their conversations, which were reviewed by program staff to evaluate fidelity to the MI approach. The review included counting the number of open-ended and close-ended questions, reflections, and the ratio of reflections to total questions, as well as identifying MI adherent and non-adherent behaviors.  Recordings were also used to provide ongoing feedback to promotoras throughout the intervention.  All promotoras met minimum proficiency for MI, which indicates the feasibility of this approach.  Future analyses will assess the impact of the intervention on mammography screening.