Abstract C86: Launch of an intervention to improve mammographic screening adherence in women of one Bemidji Area tribe: The “No squeeze can defeat me: Mammograms for life!” project
Authors: Petersen Wesley O. , Nicometo Ann M. , Vierkant Robert A. 
Published: February 2019

Abstract
Purpose: To increase women's adherence with one tribe's mammographic screening guidelines. This tribe recommends annual mammograms beginning at age 40. Currently, adherence stands at 36%. Our previous work identified a demographic feature and variables within four theoretical models of health behavior that significantly differentiated nonadherent women from adherent women. In “No Squeeze Can Defeat Me: Mammograms for Life!” (No Squeeze) we are developing a messaging menu (e.g., posters, pamphlets, videos, digital stories, articles, and letters) that is guided by the differentiating variables and features. The program also is developing a supplement to an existing intake form for women to complete before they see their providers for annual Well Woman exams. The supplement intake form will help providers tailor face-to-face messages to encourage screening of known nonscreeners, known nonadherent screeners, and women approaching screening age.
Procedures: This program works through a Community Advisory Project Board (CAPB) consisting of tribal health, Indian Health Service, and community members of varied ages, screening status, and cancer history status. The CAPB members take the lead on all aspects of messaging and intake form design. In their role, they have designed a logo, determined wording and design of posters; identified locations for messaging; recruited community women for video interviews and use of their images on materials; determined incentive amounts; and delegated tasks to a project implementation team (PIT) made of tribal and IHS staff. PIT members' responsibilities include posting new messages every six to eight weeks, obtaining feedback on messaging and intake forms, implementing the intake form, and organizing video interviews and photographic sessions. At this time, effort is being devoted to poster development, placement, and a refreshment schedule and to final design of intake forms. Evaluation of progress on this project involves collection and analysis of community women's surveys related to messaging and intake forms, CAPB feedback on messaging, documentation of poster placements and refresh dates, and tracking changes in screening participation. First-year analysis covers a seven-month period ending on June 30, 2017.
Data Summary: Early analysis shows that: 1) community women find poster messaging generally interesting, appealing, important, and mostly persuasive. They prefer images of community women and favor fewer words in most messages. 2) The intake form supplement is easy to answer (little time to complete), appropriate as an addition to the existing Well Woman intake questions, and noninvasive. The questions were considered reasonable and women held mixed opinions regarding whether the form should be self-administered or filled in during an interview by a nurse.
The CAPB assessments of messaging showed 19 of 78 posters were recommended for some revision and 10 posters were not liked at all. In general, wording was not offensive and more than half of the posters conveyed the central message in the fewest words possible. Half of the posters were rated visually attractive.
As of the first poster placement period, 5 posters have been placed in two of three targeted communities and in 38 individual locations, including clinic/hospitals, post office and grocery store bulletin boards, an exercise facility, and in one casino.
Between January 2017 and April 2017, radiology reported a 19% increase in screening.
Conclusions: While these data are from the early period of implementation, results show that developing messages and intake forms focused on influential variables derived from demographic and theoretical models of health behavior are generally well received by the community and with continued refinement could result in sustained increases in screening. At this point we cannot discern whether documented increases are from the existing population of nonadherent screeners.
Citation Format: Wesley O. Petersen, Ann M. Nicometo, Robert A. Vierkant. Launch of an intervention to improve mammographic screening adherence in women of one Bemidji Area tribe: The “No squeeze can defeat me: Mammograms for life!” project [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C86.