BackgroundThe 2009 U.S. Preventive Services Task Force (USPSTF) changed mammography guidelines to recommend routine biennial screening starting at age 50. This study describes women’s awareness of, attitudes toward, and intention to comply with these new guidelines.MethodsWomen ages 40–50 years old were recruited from the Boston area to participate in focus groups (k = 8; n = 77). Groups were segmented by race/ethnicity (Caucasian = 39%; African American = 35%; Latina = 26%), audio-taped, and transcribed. Thematic content analysis was used.ResultsParticipants were largely unaware of the revised guidelines and suspicious that it was a cost-savings measure by insurers and/or providers. Most did not intend to comply with the change, viewing screening as obligatory. Few felt prepared to participate in shared decision-making or advocate for their preferences with respect to screening.ConclusionsCommunication about the rationale for mammography guideline changes has left many women unconvinced about potential disadvantages or limitations of screening. Since further guideline changes are likely to occur with advances in technology and science, it is important to help women become informed consumers of health information and active participants in shared decision-making with providers. Additional research is needed to determine the impact of the USPSTF change on women’s screening behaviors and on breast cancer outcomes.

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This study compares rates of completion of client intake forms (CIFs) collected via three interview modes: audio computer-assisted self-interview (ACASI), face-to-face interview (FFI), and self-administered paper-based interview (SAPI). A total of 303 clients served through the Avon Breast Health Outreach Program (BHOP) were sampled from three U.S. sites. Clients were randomly assigned to complete a standard CIF via one of the three interview modes. Logistic regression analyses demonstrated that clients were significantly more likely to complete the entire CIF via ACASI than either FFI or SAPI. The greatest observed differences were between ACASI and SAPI; clients were almost six times more likely to complete the CIF via ACASI as opposed to SAPI (AOR = 5.8, p < .001). We recommend that where feasible, ACASI be utilized as an effective means of collecting client-level data in healthcare settings. Adoption of ACASI in health centers may translate into higher completion rates of intake forms by clients, as well as reduced burden on clinic staff to enter data and review intake forms for completion.

Background The Avon Breast Health Outreach Program (BHOP) supports community-based organizations to conduct education and outreach to link low-income and uninsured women to routine breast cancer screening. These organizations capture health and demographic information for clients screened as a result of outreach using a standardized Client Intake Form (CIF). Prior research demonstrated higher rates of overall form completion for data collected via audio-computer assisted self-interview (ACASI) versus face-to-face or self-administered paper interview. Advances in tablet computer technology provide additional options and potential advantages for collecting client-level data electronically. Objective To determine if electronic CIF data collection via tablet is a practical alternative to paper-based data collection, and assess the relative administrative burden, advantages and disadvantages for Avon BHOP-funded organizations for each method. Methods English and Spanish copies of the CIF were created in iSurvey, an application developed for iPad. Currently funded grantees (n = 101) were invited to apply for the pilot; 34 of 38 applicants in 24 states were selected, with priority given to organizations with a majority of English- or Spanish-speaking clients, and greater annual client volume. Pilot sites received a tablet pre-loaded with iSurvey. Grantees received web-based training and individual technical assistance on tablet use, data collection and submission procedures. Avon BHOP staff conducted telephone follow-up to assess organizations’ feedback concerning acceptability to program staff and clients of CIF data collection using the tablet, and effects on data quality and administrative processes relative to paper CIFs. Quality assurance was conducted on all CIFs submitted via iSurvey to identify duplicate or invalid records. Results 948 CIFs (838 English, 110 Spanish) were submitted using the tablets during a two month period from March 21 to May 21, 2013. Five organizations submitted fewer than 5 CIFs, eight did not submit any CIFs, and three organizations discontinued participation; their tablets were reassigned to different organizations. Grantees using the tablets for CIF data collection found the program easy to use and data entry efficient. Challenges reported included difficulties integrating the tablets into clinic flow, lack of familiarity with tablet technology among clients and staff, and an inability to review data for errors or completeness prior to electronic submission. Conclusion CIF data collection via tablet is an option for electronic data capture for some organizations. However, many organizations reported challenges in effectively integrating this new technology into existing clinic flow and administrative processes. Discussion While tablets are a relatively inexpensive and practical option for electronic client data collection in some settings, some organizations reported a preference for paper forms. Many of the identified administrative barriers may be resolved through the provision of technical assistance and capacity building support to grantee organizations. Future analysis may focus on the completeness of data collected via tablet versus paper. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-15.

Background: Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health disparities in breast cancer screening related to multiple socioeconomic factors, including stigma and discrimination. Since 2001, the Avon Breast Health Outreach Program (Avon BHOP) has granted almost $60 million to 240+ organizations to promote breast cancer screening. Avon BHOP beneficiaries collect a standardized set of de-identified, self-reported client level health and demographic data to ensure that programs reach their target population. Prior to 2011, no data on client gender or sexual orientation were collected. Methods: From 2009–2010, the Avon BHOP conducted a review of the standard confidential client intake form (CIF), last revised in 2006. Based on stakeholder input, including the Avon Foundation for Women and Avon BHOP beneficiaries, the CIF was updated in 2011 to incorporate variables for gender and sexual orientation. Proposed revisions were presented to current beneficiaries in June 2010 for feedback. Although the CIF has historically included many sensitive elements such as race/ethnicity and income, several programs expressed concern that clients or program staff would be uncomfortable addressing questions on gender and sexual orientation in particular. In response, the Avon BHOP Coordinating Center provided standard language that programs could use to help ease the concerns of staff and clients that incorporated three key messages: 1) the same form is used for all clients and programs funded by the Avon BHOP to help ensure funds are reaching clients in need; 2) all responses are kept confidential; and 3) clients may skip any question they are not comfortable answering. Results: Preliminary CIF data for January-March 2011 were analyzed for 20,672 clients from 109 programs. Overall, 96.6% (n=19,966) indicated female gender; 0.5% (n=101) self-reported gender as follows: 75 male, 8 transgender, 12 “other”, and 6 “unknown”; and 2.9% (n=605) did not respond to this question. For sexual orientation, 77.7% (n=16,067) of clients selected “heterosexual”. Of the remaining 22.3% (n=4,606), 175 (0.8%) selected “lesbian, gay or bisexual”, 431 (2.1%) selected “other”, 1045 (5.1%) selected “unknown”, and 2,954 (14.3%) did not respond to this question. By program, the non-response rate ranged from 0% to 40.2% for gender, and from 0% to 81.9% for sexual orientation. Discussion: Avon BHOP programs were able to collect sensitive information on client gender and sexual orientation during the first three months during which this information was requested. Despite concerns expressed among staff, overall response rates were high and rates of “unknown” (which may indicate that a staff person did not ask a client to complete the question) were low. Beneficiaries receive a quarterly summary of their own CIF data, which allows program staff to review client responses and ensure that client needs are met in a culturally sensitive manner. The Avon BHOP is committed to supporting diversity among funded programs; requesting data on client gender and sexual orientation may help improve services for LGBT clients by giving them a voice and reducing stigma. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-11-14.