A CULTURALLY-TAILORED BROCHURE TO IMPROVE UNDERSTANDING AMONG WOMEN WITH AN INCOMPLETE MAMMOGRAM RESULT

Purpose: About 1 in 10 women are asked to return for more imaging after a routine screening mammogram. Many women are unaware of this fact and experience anxiety when asked to return early. "Result Communication Failures” are more common among minority women. With focus group input, we developed a culturally targeted brochure to improve awareness of the frequency of abnormal results and the importance of timely follow-up among black women. Our goals were to assess the brochure’s acceptability and effectiveness among black women with an incomplete result needing short-term follow-up.

 

 Method: A randomized controlled trial of the brochure (plus the usual result notification letter), versus usual care (the letter alone) at a safety net breast imaging center in Miami. Black English-speaking women with an incomplete result were randomized to an intervention or control group. Outcomes included awareness of result and anxiety level; for the intervention group, the brochure’s acceptability and cultural appropriateness was assessed. Chi-Square or Fisher’s Exact test were used and a univariate logistic regression performed for intervention and control odds ratios & 95 % CI.

 Result: 126 women were randomized. 51 women were reachable by phone and agreed to participate. Socio-economic variables were similar between the 2 groups. Overall, 24 % (n=12) reported less than a high school education. 90 % (46) had Medicaid or were uninsured.  65 % (33) were US-born. There was no significant difference between the groups in knowledge of their result and follow up plan or awareness of a number to call for more information (all p>0.05). Intervention subjects were more likely to disagree with the statement that “getting a follow up mammogram is scary” (Odds Radio 4.12, p=0.02). A majority of intervention subjects said the pamphlet helped them understand their result “a lot” (68 %, 19) and viewed it as “extremely” or “mostly” clear (82 %, 23).

  Conclusion: Our findings suggest that a simple, culturally targeted brochure explaining the frequency of abnormal mammograms may be effective in reducing anxiety among low-income black women asked to return early for more studies. Participants viewed the pamphlet as helpful in improving their understanding. This strategy should be considered to enhance understanding and reduce anxiety among women who need to return for more breast imaging studies.