Usha Menon

Comparison of tailored interventions to increase mammography screening in nonadherent older women

BACKGROUNDnRecent increases in mammography use have led to a decrease in mortality from breast cancer.nnnMETHODSnBuilding on the Health Belief Model, the Transtheoretical Model, and past effectiveness of tailored interventions, we conducted a prospective randomized trial (n = 773) to test the efficacy on mammography adherence of tailored interventions delivered by five different methods, i.e., telephone counseling, in-person counseling, physician letter, and combinations of telephone with letter and in-person with letter.nnnRESULTSnAll five interventions increased mammography adherence significantly relative to usual care (odds ratios, 1.93 to 3.55) at 6 months post intervention. The combination of in-person with physician letter was significantly more effective than telephone alone or letter alone. Women thinking about getting a mammogram at baseline were more likely to be adherent by 6 months; even those in usual care achieved 48% adherence compared with 50-70% in the intervention groups. In contrast, women not thinking about getting a mammogram needed the interventions to increase their adherence from 13% to over 30%.nnnCONCLUSIONSnAll five interventions were effective at increasing mammography adherence. Women not thinking about getting a mammogram were most likely to benefit from these tailored interventions while other women might need less intensive interventions.

A breast cancer fear scale: psychometric development.

Fear of breast cancer has been inversely associated with participation in screening. However, investigators have generally used only one item or global scales to measure fear. This report describes development of a fear scale specific to breast cancer. Data from a large study involving mammography adherence were used to test the breast cancer fear scale for validity and reliability. Construct validity was verified through factor analysis and regression analysis predicting mammography. All items loaded on a single factor and theoretical relationships were verified by linear and logistic regression. The Cronbach alpha for the scale was .91.

Health Behaviors in Cancer Survivors

PURPOSE/OBJECTIVESnTo describe health behaviors of cancer survivors by cancer diagnosis and to compare them to people without a personal or family cancer history.nnnDESIGNnCross-sectional secondary data analysis.nnnSETTINGnA national, list-assisted telephone survey using random-digit dialing of U.S. adults about use of cancer-related information and cancer beliefs.nnnSAMPLEn619 cancer survivors and 2,141 participants without a history of cancer from the original 6,369 Health Information National Trends Survey (HINTS) respondents.nnnMETHODSnUsing the National Cancer Institutes 2003 HINTS, further analyses were conducted.nnnMAIN RESEARCH VARIABLESnCancer history, current smoking, fruit and vegetable consumption, physical activity, and body mass index (BMI).nnnFINDINGSnWhen controlling for demographic variables, no differences were found in self-reported health behaviors between survivors and those without cancer: 22.5% of survivors and 18.4% of those without cancer were current smokers, 18% of survivors and 14.9% of those without cancer consumed at least five fruits or vegetables per day, 45.3% of survivors and 53% of those without cancer were physically active at least weekly, and 58% of survivors and 54.9% of those without cancer were overweight or obese (i.e., BMI > 25). Only 7.4% of survivors and 6.4% of participants without cancer reported positively on all three health behaviors and had a healthy or normal weight.nnnCONCLUSIONSnSurvivors did not have different health behaviors when compared to participants without a history of cancer. Neither group met the American Cancer Society or Healthy People 2010 objectives for these behaviors. Adoption of healthy lifestyle behaviors should be addressed in cancer survivors.nnnIMPLICATIONS FOR NURSINGnCancer survivors need to be assessed for current smoking, dietary habits, physical activity, and weight. Information and resources should be made available, if needed, to promote the adoption of healthy lifestyle behaviors.

Comparisons of tailored mammography interventions at two months postintervention

The recent decrease in breast cancer mortality has been linked in part to increased breast cancer screening. Although the percentage of women screened once is rising, rate of continued adherence is poor. The purpose of this article is to assess the effects of tailored mammography interventions implemented prospectively in a factorial design contrasting groups receiving either (a) usual care (no intervention), (b) tailored telephone counseling for mammography, (c) tailored mailed materials promoting mammography, or (d) a combination of tailored mail and telephone counseling. This prospective, randomized study with a 2 x 2 factorial design included women 51 years and older (N = 1,367) who were not adherent with mammography at baseline. The intervention is based on integration of the Transtheoretical and Health Belief Models. Participants were enrolled in one of two health maintenance organizations or seen in a university-related primary care clinic. Baseline data were collected on mammography history and beliefs and knowledge related to mammography. Data were collected via telephone interviews using previously developed scales. The follow-up interviewers were conducted with 976 women. The sample was 41% White, 56% African American, and 3% other. Mean age at baseline was 66.5. Logistic regression indicates that postintervention mammography status in all three intervention groups was significantly better than usual care, with odds ratios ranging from 1.66 (telephone only) to 2.16 (telephone plus mail).

CERVICAL CANCER BELIEFS AND PAP TEST SCREENING PRACTICES AMONG CHINESE AMERICAN IMMIGRANTS

PURPOSE/OBJECTIVESnTo examine beliefs and Pap test utilization among Chinese American women, the largest Asian female population in the United States.nnnRESEARCH APPROACHnCross-sectional descriptive, correlational study.nnnSETTINGnMetropolitan areas of Portland, OR.nnnPARTICIPANTSn100 foreign-born Chinese women aged 40 years and older.nnnMETHODOLOGIC APPROACHnThree questionnaires were modified, translated, combined, and pretested. Participants completed the self-administered questionnaire in a group setting.nnnMAIN RESEARCH VARIABLESnUtilization of Pap test screening, health beliefs, and cultural and sociodemographic variables.nnnFINDINGSnSixty-eight percent reported having a Pap test within the prior three years (adherence), and 84% reported ever having a Pap test. The odds of Pap test use and adherence decreased with increasing age. Women with insurance or a regular healthcare provider had better odds of Pap test use and adherence. Older age, older age when a participant moved to the United States, and increased modesty were negatively associated with ever having had a Pap test.nnnCONCLUSIONSnAge and cultural beliefs influence Pap test use and adherence. The strength of provider recommendation and healthcare access as predictors suggest areas for interventions designed to increase screening for cervical cancer.nnnINTERPRETATIONnNurses play a vital role in preventive health care, especially with the growing number of advanced practice nurses delivering primary care. Primary healthcare providers should be reminded of their influential role in increasing adherence to cancer screening. Further health policy action is necessary to extend screening coverage to those who do not have adequate health insurance.

Beliefs Associated With Fecal Occult Blood Test and Colonoscopy Use at a Worksite Colon Cancer Screening Program

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Although regular screening can decrease morbidity and mortality from CRC, screening rates nationwide are very low. This descriptive study assessed beliefs associated with fecal occult blood test and colonoscopy use among participants of a worksite colon cancer screening program. Randomly selected employees, aged 40 and older, were mailed a survey on CRC screening-related beliefs. Instruments were tested for reliability and validity. Results indicated that fecal occult blood test use was significantly associated with being female, Caucasian, having low perceived barriers, and provider recommendation. Colonoscopy use was significantly associated with higher knowledge, lower barriers, higher benefits, higher self-efficacy, and provider recommendation. Findings may be used to develop interventions designed to improve CRC screening rates.

Health belief model variables as predictors of progression in stage of mammography adoption

Purpose. Identify predictors of change in mammography stage for nonadherent women so that appropriate stage-based interventions can be developed. Design. Participants were randomly assigned to one of four groups in a randomized clinical trial to increase mammography screening. This report focuses on predictors of stages of change of mammography behavior; intervention results are reported elsewhere.1 Setting. Indigent clinic and health maintenance organization. Subjects. Women, 50 or older, with no breast cancer diagnosis and nonadherent with mammography screening. Intervention. The intervention and results are described elsewhere.1 Measures. Previously validated belief scales. Results. Results showed that precontemplators and contemplators differed significantly at baseline and follow-up on all breast cancer beliefs except fear. Changes in barriers, benefits, and self-efficacy scores significantly predicted forward stage movement for women entering the study in precontemplation or contemplation (p = .0009, p = .037, and p = .048, respectively). Conclusions. Changes in beliefs predict stage movement, and beliefs differ significantly among stages, leading the way for interventions tailored to both beliefs and stages of behavior adoption. In practical terms, we may be able to cut down on the “bulkiness” of our interventions and the number of tailoring variables, focusing more intensively on tailoring interventions to the beliefs whose changes have now been shown to predict stage advancement. These predictions are in addition to intervention effect which is reported elsewhere.1

Patient-Centered Care for Muslim Women: Provider and Patient Perspectives

OBJECTIVEnThe purpose of this study was twofold: (1) to address the gap in existing literature regarding provider perspectives about provision of high-quality, culturally appropriate, patient-centered care to Muslim women in the United States and (2) to explore congruence between provider and patient perceptions regarding barriers to and recommendations for providing such care.nnnMETHODSnUsing a cross-sectional study design, a written survey was administered to a convenience sample of healthcare providers (nu2009=u200980) and Muslim women (nu2009=u200927).nnnRESULTSnThere was considerable congruence among patients and providers regarding healthcare needs of Muslim women. A majority (83.3%) of responding providers reported encountering challenges while providing care to Muslim women. A majority (93.8%) of responding patients reported that their healthcare provider did not understand their religious or cultural needs. Providers and patients outlined similar barriers/challenges and recommendations. Key challenges included lack of providers understanding of patients religious and cultural beliefs; language-related patient-provider communication barriers; patients modesty needs; patients lack of understanding of disease processes and the healthcare system; patients lack of trust and suspicion about the healthcare system, including providers; and system-related barriers. Key recommendations included provider education about basic religious and cultural beliefs of Muslim patients, provider training regarding facilitation of a collaborative patient-provider relationship, addressing language-related communication barriers, and patient education about disease processes and preventive healthcare.nnnCONCLUSIONSnBoth providers and patients identify significant barriers to the provision of culturally appropriate care to Muslim women. Improving care would require a flexible and collaborative care model that respects and accommodates the needs of patients, provides opportunities for training providers and educating patients, and makes necessary adjustments in the healthcare system. The findings of this study can guide future research aimed at ensuring high-quality, culturally appropriate, patient-centered healthcare for Muslim women in the United States and other western countries.

Knowledge and Beliefs Related to Cervical Cancer and Screening Among Korean American Women

The purpose of this article is to examine knowledge and health beliefs associated with cervical cancer screening among Korean American women. A telephone survey was conducted with 189 Korean American women in the Chicago area. Age, marital status, income, knowledge of early detection method for cervical cancer, and perceived beliefs about benefits of and barriers to receiving Pap tests were all related to outcomes of ever having a Pap test and having had one in the preceding 3 years. Variables uniquely related to ever having a Pap test were education, employment status, fluency in English, and proportion of life spent in the United States. Variables uniquely related to having had the test during the preceding 3 years were having a usual source of care and regular checkups. Different intervention components are suggested for the groups of Korean American women who have never had a Pap smear and for those who have not had one in the preceding 3 years, in addition to common intervention strategies that aim to increase knowledge and perceived benefit and to decrease perceived barriers to receiving Pap tests.

Screening practices in cancer survivors

IntroductionTen percent of all new cancers are diagnosed in cancer survivors and second cancers are the sixth leading cause of cancer deaths. Little is known, however, about survivors’ screening practices for other cancers. The purpose of this study was to examine the impact of a cancer diagnosis on survivors’ screening beliefs and practices compared to those without a cancer history.Materials and methodsThis study examined cancer survivors’ (nu2009=u2009619) screening beliefs and practices compared to those without cancer (nu2009=u20092,141) using the National Cancer Institute’s 2003 Health Information National Trends Survey (HINTS).ResultsThe typical participant was Caucasian, employed, married, and female with at least a high school education, having a regular health care provider and health insurance. Being a cancer survivor was significantly associated with screening for colorectal cancer but not for breast or prostate cancer screening. Screening adherence exceeded American Cancer Society recommendations, national prevalence data, and Healthy People 2010 goals for individual tests for both groups. Physician recommendations were associated with a higher level of screening but recommendations varied (highest for breast cancer and lowest for colorectal cancer screening).ConclusionsCancer survivors had different health beliefs and risk perceptions for screening compared to the NoCancer group. While there were no differences between survivors’ screening for breast and prostate cancer, survivors were more likely to screen for colorectal cancer than the comparison group. Screening adherence met or exceeded recommendations for individual tests for both cancer survivors and the comparison group.Implications for cancer survivorsCancer survivors should continue to work with their health care providers to receive age and gender appropriate screening for many types of cancers. Screening for other cancers should also be included in cancer survivorship care plans.