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. 2016 Nov 18;3(4):933-955.
doi: 10.3934/publichealth.2016.4.933. eCollection 2016.

The Design of a Multi-component Intervention to Promote Screening Mammography in an American Indian Community: The Native Women's Health Project

Eleni L Tolma  1 , Kimberly Engelman  2 , Julie A Stoner  3 , Cara Thomas  4 , Stephanie Joseph  1 , Ji Li  3 , Cecily Blackwater  5 , J Neil Henderson  1 , L D Carson  1 , Norma Neely  6 , Tewanna Edwards  7
Affiliations

The Design of a Multi-component Intervention to Promote Screening Mammography in an American Indian Community: The Native Women's Health Project

Eleni L Tolma et al. AIMS Public Health. .

Abstract

Background: Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women in the US. This article describes the design and implementation of a culturally sensitive intervention to promote breast health among AI/AN women through a hybrid model that incorporates clinical and community-based approaches. This is one of the first studies using this model addressing breast cancer disparities among AI/AN populations in the US.

Methods: The Theory of Planned Behavior was used as the guiding framework of the intervention and Community Based Participatory Research was the primary vehicle for the intervention planning and implementation. Three preliminary studies took place that aimed to identify qualitatively and quantitatively what deterred or encouraged AI women to get past or future mammograms. The research results were shared with community members who, through a prioritization process, identified the theoretical focus of the intervention and its corresponding activities. The priority population consisted of AI women ages 40-74, with no recent mammogram, and no breast cancer history.

Results: The intervention centered on the promotion of social modeling and physician recommendation. The main corresponding activities included enhancing patient-physician communication about screening mammography through a structured dialogue, receipt of a breast cancer brochure, participation in an inter-generational discussion group, and a congratulatory bracelet upon receipt of a mammogram. Environmental and policy related changes also were developed.

Conclusion: Creating a theory-based, culturally-sensitive intervention through tribal participatory research is a challenging approach towards eliminating breast cancer disparities among hard-to-reach populations.

Keywords: American Indians; Native Americans; breast cancer; mammography; participatory research; socio-ecological model; theory of planned behavior.

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Conflict of interest statement

Conflict of Interest: There is no conflict of interest to disclose.

Figures

Figure 1.
Figure 1.. Theoretical framework: The proposed expanded model of the Theory of Planned Behavior (TPB) and the hybrid intervention approach.
The squares refer to the TPB, the circles to the secondary constructs, the 3-D diagrams to the constructs addressed in the intervention, the diamonds to the clinic-based activities and the hexagons to the community-based activities.
Figure 2.
Figure 2.. Culturally sensitive brochures on mammography screening and the bracelet given upon receipt of a mammogram that were developed for the Native Women's Health Project. You can also see the logo of the project.
Figure 3.
Figure 3.. Flow of the intervention activities of the Native Women's Health Project.
See this image and copyright information in PMC

References

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