Abstract A29: Native women's health project: An innovative approach toward promoting screening mammography in an American Indian community in Oklahoma
Authors: Tolma Eleni L. , Thomas Cara , Stoner Julie , Joseph Stephanie , Engelman Kimberly , Li Ji 
Published: October 2015

Background: There are significant disparities in breast cancer screening for American Indian (AI) relative to non-Hispanic white women. In Oklahoma, the incidence rate of breast cancer among AI women was 140.5/100,000 compared to 121.5/100,000 among non-Hispanic white women for 2005-2009. The current 3-year study is a continuation of two preliminary studies that took place at a rural tribal clinic in Oklahoma in 2005-2006 and 2011-2012. During the first study, we developed a culturally-sensitive survey of mammography screening practices and beliefs, entitled Women's Health Survey, based on the Theory of Planned Behavior. During the second study, we identified the salient mammography screening beliefs held by AI women. The results led to the development of a Logic Model, involving both clinical and community components, for the proposed intervention. In the current study, we hypothesize that a sustained multi-component intervention based on our developed Logic Model will yield higher mammography rates compared to the standard practices employed at this and other clinics.

Methods: A Community Steering Committee (CSC), representing the tribal government, tribal clinic, other community partners, and individual community members (including breast cancer survivors), was formed and provides project direction. The priority population consists of AI women without a history of breast cancer who live in the target region between the ages of 52-74, and who have not had a screening mammogram within the last 2 years. The study, utilizing a Community Based Participatory Research approach has four aims: 1) Conduct a needs and resource assessment of the priority population, 2) Utilize the needs and resource assessment data to develop a community-driven intervention program, 3) Pilot-test and refine the intervention, and 4) Evaluate the intervention using a quasi-experimental evaluation design.

Results: Aims 1, 2, and 3 have been completed and Aim 4 is underway. The results of the formative research (Aim 1) indicated that: a) AI women lack knowledge of mammograms, b) Many AI women prefer a holistic approach to their health, c) Fatalistic attitudes toward breast cancer do exist among AI women, d) Physicians influence women's screening mammography decisions, and e) Social modeling is an important motivating factor. Using a prioritization process through the CSC and data triangulation, we concluded that the intervention would center on the concepts of social modeling, physician recommendation, breast cancer fatalism, and lack of knowledge about mammography screening. The Logic Model was finalized, educational materials and intervention strategies were developed, and alliances were built with regional grassroots initiatives to promote long-term project sustainability (Aim 2). The intervention includes four main strategies: a) Structured communication between medical practitioner and patient about screening mammography; b) Receipt of a breast cancer brochure and subsequent follow-up letter from the medical provider; c) Participation in a mammography screening and breast cancer discussion group at a community setting; and d) Receipt of a congratulatory bracelet upon receipt of a mammogram. The intervention pilot testing is complete (Aim 3). The results indicated that modifications are needed to the discussion group component, and the recruitment process. Intervention modifications and project implementation are underway.

Conclusions: Creating a theory-based culturally-sensitive multi-component intervention within a Native American community and translating research results into practical applications is an exciting, yet challenging process. The direct involvement of the community was instrumental for developing an intervention that was culturally-sensitive, responsive to community needs, and sustainable.

Citation Format: Eleni L. Tolma, Cara Thomas, Julie Stoner, Stephanie Joseph, Kimberly Engelman, Ji Li. Native women's health project: An innovative approach toward promoting screening mammography in an American Indian community in Oklahoma. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A29.