Abstract B094: Impact of a multi-theory-driven community-based intervention to increase mammographic screening in a Midwest American Indian tribe
Authors: Petersen Wesley , Nicometo Ann , Vierkant Robert A. 
Published: August 2020

Abstract
Purpose: The “No Squeeze Can Defeat Me: Mammograms for Life!” study is locally known as “My Life Matters: Mammograms for Life!” and is funded by the Minnesota Department of Health. The intervention's purpose with one Midwest tribe is to increase American Indian women's regular participation in yearly mammographic screening beginning at age 40. At study initiation, mid-year 2016, adherence with annual screening guidelines stood at 36% for women 40 and older. Using previous work that significantly differentiated nonadherent women from adherent women, we are working with tribal health and the Indian Health Service partners to utilize differentiating theoretical models and elements of those models in an attempt to increase screening and adherence through poster messaging. Posters incorporated six elements of the Health Beliefs Model, two components of the Social Norms and Social Support Models, and three features of the Theory of Planned Behavior model. Multiple elements or features of each model are employed in the poster messaging.
Procedures: No Squeeze works through a Community Advisory Project Board (CAPB) and a Project Implementation Team (PIT) consisting of tribal health, Indian Health Service, and community members of varied ages, screening status, and cancer history status. CAPB members take the lead on all decisions regarding messaging, message placement, frequency of new message placements, messaging evaluation and radiology performance figures. The PIT is responsible for executing CAPB decisions. Mayo Clinic is responsible for development of poster messages and data analysis. Evaluation of the intervention considers changes in screening participation and no-show (unfilled scheduled appointments) rates and collection and analysis of community women's evaluations of posted messages. The intermediate analysis takes into account comparable months from July-June of 2016/17 and 2017/18. Analysis is primarily descriptive. Where appropriate, chi-square statistics are calculated.
Results: In the first half of each of the two years of the intervention (2017 and 2018), the average number of mammograms increased by 8 and 10, respectively, over an average of 36 at baseline (2016). In the same period, monthly no-show mammogram appointment rates decreased from an average of 47% to 39%. Community women's poster evaluations indicate that messages are likely to contribute to increased mammogram screening (p = &lt;0.004). Among notable evaluation findings: Women of all ages like the posters and will continue to read them. They find the messages personally important and important to other women of the tribe. Use of community women's images in the posters adds interest in the posters and has a positive effect on women's future screening (p = 0.0002).
Conclusions: To date, poster messaging appears to be associated with increased screening, decreased no-show rates and community receptiveness. Further study will be necessary to determine whether it can be employed with other tribes.
Citation Format: Wesley Petersen, Ann Nicometo, Robert A. Vierkant. Impact of a multi-theory-driven community-based intervention to increase mammographic screening in a Midwest American Indian tribe [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B094.