Improving mammography screening among the medically underserved

Terry C. Davis*, Alfred Rademaker, Charles L. Bennett, Michael S. Wolf, Edson Carias, Cristalyn Reynolds, Dachao Liu, Connie L. Arnold

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


BACKGROUND: We evaluated the effectiveness and cost-effectiveness of alternative interventions designed to promote mammography in safety-net settings. METHODS: A three-arm, quasi-experimental evaluation was conducted among eight federally qualified health clinics in predominately rural Louisiana. Mammography screening efforts included: 1) enhanced care, 2) health literacy-informed education of patients, and 3) education plus nurse support. Outcomes included mammography screening completion within 6 months and incremental cost-effectiveness. RESULTS: Overall, 1,181 female patients ages 40 and over who were eligible for routine mammography were recruited. Baseline screening rates were < 10 %. Post intervention screening rates were 55.7 % with enhanced care, 51.8 % with health literacy-informed education and 65.8 % with education and nurse support. After adjusting for race, marital status, self-efficacy and literacy, patients receiving health-literacy informed education were not more likely to complete mammographic screening than those receiving enhanced care; those additionally receiving nurse support were 1.37-fold more likely to complete mammographic screening than those receiving the brief education (95 % Confidence Interval 1.08-1.74, p=0.01). The incremental cost per additional women screened was $2,457 for literacy-informed education with nurse support over literacy-informed education alone. CONCLUSIONS: Mammography rates were increased substantially over existing baseline rates in all three arms with the educational initiative, with nurse support and follow-up being the most effective option. However, it is not likely to be cost-effective or affordable in resource-limited clinics.

Original languageEnglish (US)
Pages (from-to)628-635
Number of pages8
JournalJournal of general internal medicine
Issue number4
StatePublished - Apr 2014


  • cancer screening
  • community clinics
  • health literacy
  • mammography
  • underserved populations

ASJC Scopus subject areas

  • Internal Medicine


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