Export file:


  • RIS(for EndNote,Reference Manager,ProCite)
  • BibTex
  • Text


  • Citation Only
  • Citation and Abstract

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.
  Article Metrics


1. American Cancer Society. Breast Cancer Facts & Figures 2015–2016. Atlanta: American Cancer Society . 2016. Available from: http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-046381.pdf.

2. National Cancer Institute. SEER Stat Fact Sheets: Breast 2016. Available from: http://seer.cancer.gov/faststats/index.php.

3. White A, Richardson L, Li C, et al. (2014) Breast cancer mortality among American Indian and Alaska Native women 1990–2009. Am J Public Health 104: S432-S438.    

4. Oi S, Martinez M, Li C (2010) Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat 127: 727-738.

5. Indian Health Service. Government Performance and Results Act (GPRA) 2015 National Dashboard. Available from: https://www.ihs.gov/crs/includes/themes/newihstheme/display_objects/documents/gpra/2015EndOfYearDashboard.pdf.

6. Indian Health Service. Area Summary Report Government Performance and Results Act [GPRA], 2010. Available from: https://www.ihs.gov/crs/includes/themes/newihstheme/display_objects/documents/gpra/201012AreaReport.pdf.

7. Campbell J, Martinez S, Janitz A, et al. (2014) Cancer incidence and staging among American Indians in Oklahoma. J Okla State Med Assoc 107: 99-107.

8. Campbell J, Gandi K, Pate A, et al. (2016) Five-Year cancer survival rates in Oklahoma from 1997 to 2008. J Okla State Med Assoc 109: 318-332.

9. Martinez S, Janitz A, Erb-Alvarez J, et al. (2016) Cancer among American Indians Identifying priority areas in Oklahoma. J Okla State Med Assoc 109: 374-384.

10. Burhansstipanov L, Krebs LU, Grass R, et al. (2005) A review of effective strategies for native women's breast health outreach and education. J Cancer Educ 20 (Suppl.): 71-79.

11. American Cancer Society. Circle of Life: A breast cancer awareness project for Native American women, a handbook for program planners. Atlanta, Georgia: American Cancer Society, 2001. Available from: http://www.cancer.org/circleoflife/app/index.

12. Banner R, DeCambra H, Enos R (1995) A breast and cervical cancer project in a Native Hawaiian community: Wainee Cancer Research Project. Prev Med 24: 447-453.    

13. Haozous E, Eschiti V, Lauderdale J (2010) Use of Talking Circle for Comanche Women's breast health education. J Transcult Nurs 21: 377-385.

14. Burhansstipanov L, Bad WD, Capelouto N, et al. (1998). Culturally relevant "Navigator", patient support: The Native Sisters. Cancer Pract 6: 191-194.

15. Peterson W, Trapp M, Sellers T, et al. (2004) Evaluation of a training program to prepare community health representatives to promote breast and cervix cancer screening among Native American women. J Cancer Educ 19: 237-243.

16. McLeroy K, Bibeau D, Steckler A, et al. (1988) An ecological perspective on health promotion programs. Health Educ Q 15: 351-377.

17. Legler J, Meissner H, Coyne C, et al. (2002) The effectiveness of interventions to promote mammography among women with historically lower rates of screening. Cancer Epidemiol Biomarkers Prev 11: 59-71.

18. Institute of Medicine. Challenges and successes in reducing health disparities. Workshop summary. Washington, DC, 2008. Available from: http://www.nap.edu/read/12154/chapter/1.

19. Minkler M, Wallerstein N (Eds.) (2003) Community-based participatory research for health. San Francisco, CA, Jossey-Bass.

20. Mihesuah D (1993) Suggested guidelines for institutions with scholars who conduct research on American Indians. Am Indian Cult Res 17: 131-139.

21. Christopher S, Gidley A, Letiecq B, et al. (2008) A cervical cancer community-based participatory research project in a Native American community. Health Educ Behav 35: 821-834.

22. Holkup P, Tripp-Reimer T, Salois E, et al. (2004) Community-based participatory research: An approach to intervention research with a Native American community. Adv Nurs Sci 27: 162-173.

23. American Cancer Society (2008) Breast Cancer Facts and Figures 2007–2008. Atlanta (GA): The American Cancer Society, Inc.

24. US Preventive Services Task Force. Breast Cancer Screening Final Recommendations, 2015. Available from: http://screeningforbreastcancer.org/.

25. Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50: 179-211.

26. Fishbein M, Ajzen I (1975) Belief, Attitude, Intention and Behavior: An Introduction to Theory and Research. Reading, Addison-Wesley.

27. Bandura A (1986) Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ, Prentice-Hall, Inc.

28. Becker M (1974) The Health Belief Model and Personal Health Behavior. Health Educ Monogr 2 (entire issue).

29. Tolma E, Stoner J, Li J, et al. (2014) Predictors of regular mammography use among American Indian women in Oklahoma: a cross-sectional study. BMC Womens Health 14: 1-12.

30. Canales M, Geller B (2004) Moving in between mammography: Screening decisions of American Indian women in Vermont. Qual Health Res 14: 836-857.

31. Dettenborn L, Duhamel K, Butts G, et al. (2005) Cancer fatalism and its demographics correlates among African American and Hispanic women. J Psychosoc Oncol 22: 47-60.

32. Facione N, Katapodi M (2000) Culture as an influence on breast cancer screening and early detection. Semin Oncol Nurs 16: 238-247.

33. Becker A, Israel B, Allen A III (2005) Strategies and techniques for effective group process in CBPR partnerships. In Israel BA, Eng E, Schulz AJ et al., editors. Methods incommunity-based participatory research for health. San Francisco: Jossey-Bass, 52-73.

34. Tolma E, Batterton C, Hamm R, et al. (2012) American Indian women and screening mammography: Findings from a qualitative study in Oklahoma. Am J Health Educ 43: 18-30.

35. Kreuger R, Casey M (2009) Focus Groups: A practical guide for applied research (3rd ed.). Thousand Oaks, CA, Sage.

36. Ulin P, Robinson E, Tolley E (2005) Qualitative Methods in Public Health. A field guide for applied research. San Francisco, CA, Jossey-Bass.

37. Green L, Kreuter M (2005) Ecological and Educational diagnosis. In Health Program Planning: An educational and ecological approach, 4th ed. New York, NY: McGraw-Hill, 146-189.

38. Goodman R, Smith D, Dawson L, et al. (1991) Recruiting school districts into a dissemination study, Health Educ Res 6: 373-385.

39. Oeffinger K, Fontham E, Etzioni R, et al. (2015) Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA 314: 1599-1614.

40. Sarfaty M (2008) How to increase colorectal cancer screening rates in practice: A primary care clinician's evidence-based toolbox and guide. Washington, DC: American Cancer Society and The Centers for Disease Control and Prevention. Retrieved from: http://www.cancer.org/acs/groups/content/documents/document/acspc-024588.pdf.

41. Hinyard L, Kreuter M (2006) Using Narrative Communication as a tool for health behavior change: A conceptual, theoretical and empirical overview. Health Educ Behav 34: 777-792.

42. Goodman A (2015) Storytelling as Best Practice. (7th ed) L.A, California, The Goodman Center.

43. Weinstein N, Sandman P, Blalock S (2008) The precaution adoption process model. In: Glanz K, Rimer BK, Viswanath K, eds. Health Behavior and Health Education: Theory and Practice. 4th ed. San Francisco, CA: John Wiley, 123-145.

44. Freire P (1970) Pedadogy of the oppressed. New York, Seabury Press.

45. Freire P (1973) Education for critical consciousness. New York, Seabury Press.

46. Wallerstein N, Sanchez-Merki V (1994) Freirian praxis in health education: research results from an adolescent prevention program. Health Educ Res 9: 105-118.

47. Hodge F, Pasqua A, Marquez C, et al. (2002) Utilizing traditional storytelling to promote wellness in American Indian communities J Transcult Nurs 13: 6-11.

48. Evans-Campbell T (2008) Historical trauma in American Indian/Native Alaska communities: A multi-level framework for exploring impacts on individuals, families, and communities. J Interpers Violence 23: 316-338

49. Winer R, Gonzales A, Noonan C, et al. (2016) A cluster-randomized trial to evaluate a mother-daughter dyadic educational intervention for increasing HPV vaccination coverage in American Indian girls. J Commun Health 41: 274-281.

50. Warne D, Kaur J, Perdue D (2012) American Indian/Alaska Native Cancer Policy: Systematic approaches to reducing cancer disparities. J Cancer Educ 27: S18-S23.

51. Lantz P, Mullen J (2015) The National Breast and Cervical Cancer Early Detection Program: 25 Years of public health service to low-income women. CCC 26: 653-656.

52. Robbins H, Krakow M, Warner D (2002) Adult smoking intervention programs in Massachusetts: a comprehensive approach with promising results. Tob Control 11 (suppl2): 4-7.

53. Community Preventive Services Task Force (2012) Updated Recommendations for client- and provider-oriented interventions to increase breast, cervical and colorectal cancer screening. Am J Prev Med 43: 92-96.

54. Burhansstipanov L, Christopher S, Schumacher A (2005) Lessons learned from community-based participatory research in Indian Country. Cancer Control 12 (Suppl 2): 70-76.

55. Becker S, Affonso D, Madonna B (2006) Talking Circles: Northern Plains Tribes American Indian women's views of cancer as a health issue. Public Health Nurs 23: 27-36.

56. Thomas L, Donovan D, Sigo R, et al. (2011) Community-based participatory research in indian country: definitions, theory,rationale, examples and principles. In: Sarche MC, Spicer P, Farrell P, Fitzgerald HE, eds. American Indian and Alaska Native Children and Mental Health. Santa Barbara, California: Praeger, 165-186.

57. McNight J, Kretzmann J (2012) Mapping Community Capacity In: Minkler M, ed. Community Organizing and Community Building for Health and Welfare. 3rd ed. New Brunswick, New Jersey: Rugers University Press, 171-186.

58. Towne S, Smith M, Ory M (2014) Geographic variations in access and utilization of cancer screening services: examining disparities among American Indian and Alaska Native Elders. Int J Health Geogr 13: 1-11.

59. Yabroff R, Mandelblatt J (1999) Interventions targeted toward patients to increase mammography use. Cancer Epidemiol Biomarkers Prev 8:749-757.

60. Hardeman W, Johnston M, Johnston D, et al. (2002) Application of the theory of planned behavior in behavior change interventions: A systematic review. Psychol Health 17: 123-158.

61. Fishbein M (2008) A reasoned action approach to health promotion. Med Decis Making 28: 834-844.

62. Markus S (2012) Photovoice for healthy relationships: community-based participatory HIV prevention in a rural American Indian community. Am Indian Alsk Native Ment Health Res 19: 102-123.

63. McLean S (1997) A communication analysis of community mobilization on the Warm Springs Indian Reservation. J Health Commun 2: 113-125.

Copyright Info: © 2016, Eleni L. Tolma, et al., licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Article outline

Show full outline
Copyright © AIMS Press All Rights Reserved