Abstract B15: Effect of patient navigation on mammography screening among African American female Medicare beneficiaries at risk for low health literacy
Authors: Kimbrough-Sugick Jessie K. , Mbah Olive , Phelan Darcy , Shapiro Gary , Wenzel Jennifer , Bone Lee , Garza Mary , Johnson Lawrence , Howerton Mollie , Ford Jean G. 
Published: December 2010

Abstract
Context: African American older adult women are diagnosed with more advanced breast cancer and have lower survival rates than White women. While differences in health literacy may contribute to this disparity, there is limited information on intervention strategies to promote cancer screening among low-literate African American older adults.
Objective: To evaluate the effect of a patient navigator on adherence to mammography screening among African American female Medicare beneficiaries with low literacy scores. Design, Setting, and Participants: We analyzed data from the Cancer Prevention and Treatment Demonstration (CPTD) at Johns Hopkins, an ongoing community-based trial designed to determine whether patient navigation is an effective strategy for improving adherence to cancer screening among African American older adults. Participants are randomized to either a high intensity group (patient navigation = educational materials) or a low intensity group (educational materials only). This analysis included 272 women ages of 65 and older with low literacy scores, who were enrolled into the study between November 2006 and March 2010, and had at least one year of follow up data. Baseline and one year follow up interviews were conducted face to face by trained interviewers through standardized questionnaires. The REALM-R instrument was used to identify participants at risk for low health literacy, based on their score.
Main Outcome Measure: The outcome measure for this analysis was the between-group difference in the proportion of women receiving mammography screening during the follow up period. Multiple logistic regression was performed to control for potential confounders such as age, education, Medicaid coverage, and perceived health status.
Results: Compared to the educational materials only group (n=77), the patient navigation group (n=107) had a similar proportion of women who reported a mammogram at one year follow up (64% vs. 71 %, p-value = 0.32). However, after adjusting for baseline health and demographic characteristics, women in the patient navigation group were more likely to report a mammogram at one year follow up, compared to those in the educational materials group (OR 1.90 95% CI 1.01-3.54). Women who rated themselves as having excellent to good health at baseline were less likely to report a mammogram, than those who reported fair to poor health (OR 0.43 95% CI 0.21-0.87).
Conclusions: Use of a patient navigation-based intervention was positively associated with mammography screening adherence among African American older adult women with low literacy scores. In this study population, perception of health status may influence mammography screening adherence. Our findings underscore the need for tailored intervention strategies to reduce cancer screening disparities among low-literate African American older adults.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B15.