Long-Term Impact of a Culturally Tailored Patient Navigation Program on Disparities in Breast Cancer Screening in Refugee Women After the Program's End

Abstract

Purpose: To examine the long-term effects of a patient navigation (PN) program for mammography screening tailored to refugee women and to assess screening utilization among these women after PN ended. Methods: We assessed the proportion of patients completing mammography screening during the prior 2 years during 2012-2016 for refugee women who had previously received PN compared with that of English-speaking women cared for at the same health center during the same period, both overall and stratifying by age. We used logistic regression to compare screening completion between refugees and English speakers, adjusting for age, race, insurance status, number of clinic visits, and clustering by primary care physician and to test trends in screening over time. Results: In 2012, the year when the funding for PN ceased, among 126 refugee women eligible for breast cancer screening, mammography screening rates were significantly higher among refugees (90.5%, 95% confidence interval [CI]: 83.5-94.7%) than among English speakers (81.9%, 95% CI: 76.2-86.5%, p=0.006). By 2016, screening rates decreased among refugee women (76.5%, 95% CI: 61.6-86.9%, p=0.023) but were not statistically significantly different from those among English-speaking women (80.5%, 95% CI: 74.4-85.3%, p=0.460). Screening prevalence for refugee women remained above the pre-PN program screening levels, and considerably so in women <50 years. Conclusion: The culturally and language-tailored PN program for refugee women appeared to have persistent effects, with refugee women maintaining similar levels of mammography screening to English-speaking patients 5 years after the PN program's end.

Keywords: breast health; mammography; minority health; patient navigation; preventative health; screening.

FIG. 1.

Mammography screening completion rate comparison. Mammography screening completion rates within the prior 2 years, along with sample size, p-values, and 95% confidence intervals for the English-speaking group compared with those of the referent group of refugees, calculated for each year for a 5-year period. Screening proportions are adjusted for patient age, race, insurance status, and number of clinic visits for the prior 3 years.