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The Design of a Multi-component Intervention to Promote Screening Mammography in an American Indian Community: The Native Women’s Health Project

1 Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
2 Department of Preventive Medicine and Public Health, University of Kansas, Kansas City, KS, USA
3 Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
4 Tecumseh Early Head Start, Tecumseh, OK, USA
5 American Cancer Society, Atlanta, GA, USA
6 American Indian Institute, University of Oklahoma, Norman, OK, USA
7 Oklahoma Health Care Authority, Oklahoma City, OK, USA

# Former name: L. Carson Henderson

Special Issues: Cancer screening in hard-to-reach populations

Background: Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women in the US. This article describes the design and implementation of a culturally sensitive intervention to promote breast health among AI/AN women through a hybrid model that incorporates clinical and community-based approaches. This is one of the first studies using this model addressing breast cancer disparities among AI/AN populations in the US. Methods: The Theory of Planned Behavior was used as the guiding framework of the intervention and Community Based Participatory Research was the primary vehicle for the intervention planning and implementation. Three preliminary studies took place that aimed to identify qualitatively and quantitatively what deterred or encouraged AI women to get past or future mammograms. The research results were shared with community members who, through a prioritization process, identified the theoretical focus of the intervention and its corresponding activities. The priority population consisted of AI women ages 40–74, with no recent mammogram, and no breast cancer history. Results: The intervention centered on the promotion of social modeling and physician recommendation. The main corresponding activities included enhancing patient-physician communication about screening mammography through a structured dialogue, receipt of a breast cancer brochure, participation in an inter-generational discussion group, and a congratulatory bracelet upon receipt of a mammogram. Environmental and policy related changes also were developed. Conclusion: Creating a theory-based, culturally-sensitive intervention through tribal participatory research is a challenging approach towards eliminating breast cancer disparities among hard-to-reach populations.
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Keywords breast cancer; mammography; participatory research; American Indians; Native Americans; theory of planned behavior; socio-ecological model

Citation: Eleni L. Tolma, Kimberly Engelman, Julie A. Stoner, Cara Thomas, Stephanie Joseph, Ji Li, Cecily Blackwater, J. Neil Henderson, L. D. Carson, Norma Neely, Tewanna Edwards. The Design of a Multi-component Intervention to Promote Screening Mammography in an American Indian Community: The Native Women’s Health Project. AIMS Public Health , 2016, 3(4): 933-955. doi: 10.3934/publichealth.2016.4.933


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This article has been cited by

  • 1. Paul D. Terry, Cancer Screening in Hard-to-Reach Populations, AIMS Public Health, 2017, 4, 4, 399, 10.3934/publichealth.2017.4.399
  • 2. Eleni L. Tolma, Julie A. Stoner, Cara Thomas, Kimberly Engelman, Ji Li, Aleksandar Dichkov, Norma Neely, Conducting a Formative Evaluation of an Intervention Promoting Mammography Screening in an American Indian Community: The Native Women’s Health Project, American Journal of Health Education, 2018, 1, 10.1080/19325037.2018.1552216

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