Abnormal Mammogram Follow-Up: Do Community Lay Health Advocates Make a Difference?

Abstract

This pilot study evaluates a community lay health advocate (CLHA) intervention in promoting follow-up for abnormal mammograms among African American women. A controlled trial was implemented at an urban hospital in Atlanta, with 48 women in a CLHA intervention group and 35 in a usual care group. Participants were 25 or older and had an abnormal mammogram between March 25, 2002, and May 2, 2003. Intervention group women received CLHA support including encouragement of timely abnormal mammogram follow-up, reminders of follow-up appointments, identification and removal of barriers to follow-up, and accompaniment to follow-up appointments. Women in the intervention group were significantly more likely to keep their first abnormal mammogram follow-up appointment, all of their scheduled follow-up appointments, and their biopsy or fine needle aspiration appointment. CLHAs are effective in promoting abnormal mammogram followup among African American women and may be an important resource in reducing racial disparities in breast cancer mortality.

Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review

“…Of 67 articles, thirty studies involved CBHWs for cancer prevention for specific cancer types (cervical, 28,32,33,35-39,41-44,49-52 breast, 26,27,31,33,36,37,39-41,46,48,50,53-55 colorectal, 29,30,34,36,45 and oral 47 ). Twenty six studies focused on cardiovascular disease (CVD), 56-59,62,64,67,73,80 , and key risk factors such as diabetes, 63,69,70,76-79,81 and hypertension.…”

“…29,33,34,36,39,47,48,54,55,58,62,63,68,82 The two most common types of comparison groups were less intensive intervention (n=17 [28%]), 27,35,36,38,40,46,53,57,58,62,65-67,73,74,78,85 and usual care (n=16 [26%]) 31,32,37,41,44,47,51,55,60,64,71,72,76,77,83,86 or enhanced usual care (n=4 [7%]) 56,59,69,84 followed by wait-list control (n=7 [11%]), 42,45,48-50,63,77 and attention control (n=3 [5%]). 39,52,82 Eight studies involved more than one comparison group (e.g., usual care and minimal intervention).…”

“…For example, only about half of the studies (n=34) discussed using a theoretical framework to develop the intervention or from which to select study outcomes. 26-29,31-35,39,41-44,46,49,53-55,62-65,73-80,84,85 In addition, less than one third of the selected studies discussed conducting a power analysis a priori (n=21) and less than half of studies (n=30) clearly described how they randomized study participants. Similarly, less than one in five studies discussed any type of blinding (i.e., the outcome assessor was aware of the status of the participant's group assignment) (n=13).…”

Patient Barriers to Follow-Up Care for Breast and Cervical Cancer Abnormalities

“…Patient navigation programs contain a unique feature designed to garner information on barriers experienced by women during the process of follow-up care for screening abnormalities. 35,36,38,[41][42][43][44][45][46][47] This allows navigators to identify barriers that might impede timely care in real time rather than retrospectively.…”

Problematic Integration Theory: Implications of Supportive Communication for Breast Cancer Patients

“…The participants in the study were predominantly African American who, as a demographic, are far less likely to attend important yearly check ups. This makes them most vulnerable for late-stage identification of the cancer and, therefore, at a far greater risk of succumbing to the disease (high rate of mortality; Crump et al, 2008). Crump and colleagues documented the effects of CLHA intervention and support messages in 48 women in a CLHA care group and another 35 who received what is identified as "usual care" with abnormal mammogram results.…”