Table 4.

^* Summaries of Studies by Type of Intervention

Author and Year	Population and Setting	Sample Size	Intervention Components, Duration, and Mode of Delivery	Follow-up Period	Outcome Measures	Outcomes
Skinner et al.2	Low-income elderly, mostly African-Americans Senior center, St. Louis	N = 240	(1) Community-based education (2) Done through an urban social service organization Half d, one time taught by health professionals Control = core education (no van)	2 and 3 y	Breast cancer knowledge, mammography benefits/ barriers, stage of adoption, mammography rates	Control: Baseline = 57% y 2 = 52% Experimental: Baseline = 49% y 2 = 68% (p = 0.001)
Rimer et al.6	Elderly in 8 retirement communities, Philadelphia	N = 412	(1) Letter from retirement community medical director announcing education session and mobile mammography unit (2) Letter to primary care physician (3) Educational program with video, print materials, group discussion, opportunity to schedule mammography appointment (4) Reduced cost mammography Duration not stated; conducted by health workers Control = baseline interview, posters and materials to promote availability of $40 vouchers (with $10 copay) for mammography	3 mo	Mammography rates	Control = 12% Experimental = 45% (p = 0.001)
Reuben et al.7	Older women, mostly low-income 60 Los Angeles community based meal sites, senior centers and clubs	N = 463	Educational sessions about breast cancer, mammography, stroke prevention, and effect of exercise on arthritic joints. Participants were given the following and sent reminder 2 wks post: (1) Health education pamphlet (2) Educational videotape (3) Directory of community-based mammography sites 1.5 h, one time; conducted by health education facilitators Control = health education only	3 mo	Mammography use	Control = 40% Experimental = 55% (p < 0.001)
Slater et al.3	Low-income women in public housing	N = 314	(1) 10 minute oral presentation about benefits of mammography (2) Facilitator led small group discussions to motivate screening (3) Physician prompting to order a mammogram (eg subjects sent letters to their doctors) (4) Free mammogram for under or uninsured 1 h, one time conducted by health professionals and peers in public housing Control = no treatment initially, received intervention afterwards	6–18 mo	Mammogram within the last 15 mo	Control = 52% Experimental = 64% (p = 0.04)
Skaer et al.4	Hispanic migrants, low income; Non-profit, rural, migrant clinics in Washington State	N = 160	(1) Standard clinical education about breast cancer and importance of screening (2) Free voucher for mammography. Controls had standard clinical education only 4 wk; taught by bilingual nurses	4 wk	Mammography completion	Control = 18% Experimental = 88% (p = 0.0001)
Fletcher et al.5	Broad community North Carolina rural communities	N = 970	(1) One h small group training for MDs and letter to MDs (2) Prompting system in medical record (3) TV and radio advertisements; 29 newspaper articles (4) Community groups were addressed (5) Minority task force coordinated media and social events (6) Free or half price mammograms for low SES subjects Control = comparison community without any intervention 1–2 h over the course of 1 y; Media and MDs provided health messages	2 y	Knowledge, Attitude and Behavior survey mammogram use	Control = 30–40% Experimental = 35–55% (p = 0.03) African Americans had lower % increase in mammography adherence
Zhu et al.8	African Americans without spouses; 10 public housing complexes in Tennessee	N = 540	Interview before the intervention (1) Education focusing on women’s cognition, psychological adjustment, significant other’s role in assisting the subject (2) Lay health educator did one on one teaching. (3) Messages were culturally and educationally appropriate Control = received nothing Assuming about 1 h; taught by health educators	1 and 2 y	Clinical and breast self exam, mammography. Breast health knowledge, attitudes and behavior	y 1: Control = 53% Experimental = 55% (p > 0.50) y 2: Control = 68% Experimental = 66% (p > 0.50)
Champion9	Income not stated, Midwest metropolitan area	N = 301	Guided script individualized according to responses to questions about stage of adoption for mammography 2 in-home interviews conducted by graduate nurse research assistants	2 y	Mammography rates	Belief vs. Control OR = 1.83 (p = 0.12) Information vs. Control OR = 1.47 (p = 0.32) Belief/Information vs. Control OR = 3.75 (p = 0.004)
Champion10	Income not stated, mostly Euro-American Midwest metropolitan area	N = 405	Guided script individualized according to responses to questions about stage of adoption for mammography. Group 1 = control received nothing; Group 2 = belief information; Group 3 = informational intervention; Group 4 = belief/informational 1 in-home interview conducted by graduate nurse assistants.	1 y	Mammography rates and stage of adoption	Belief vs. Control OR = 1.96 (p = 0.05) Information vs. Control = 1.50 (p = 0.22) Belief/Information vs. Control OR = 2.26 (p = 0.02)
Segura et al.11	Mixed SES but mostly low SES	N = 1507	Women were received an invitation to participate via: (1) Mailing from research staff; (2) Mailing from family doctor and program nursing staff or; (3) Home visit explaining benefits of early detection, screening process, and how to obtain a mammogram Compared 3 invitation strategies One time contact via mail or home direct contact; conducted by non health professionals	2–3 mo	Response rate to 3 invitation types	Mailed letter = 52.1% (p = 0.003) Primary health care team invitation = 55.6% (p = 0.037) Direct contact = 63.5% p values refer to the comparison of mailed or primary health invitation vs. direct contact invitation
Type of intervention: community education alone
Mishra et al.12	Low-income Latinas, Orange County, California 2 community and 1 university affiliated organization	N = 88	(1) Question and answer with health educator (2) Solutions for breast cancer control. (3) Breast cancer control modules (empowerment, knowledge, breast cancer detection tools, how to perform breast self-exam) 2 wks, 4 education sessions, twice per wk (each 2 h); taught by health educators Control = received nothing	Immediate and 6 wk post intervention	Knowledge, self-efficacy, attitudes, breast self-exam skills, and mammography use	Control: Baseline = 0% 6 wk post = 11% Experimental: Baseline = 0% 6 wk post = 10% (p = 0.25)
Type of intervention: referrals
Navarro et al.13	Low-income Latinas San Diego, California	N = 364	(1) Breast and cervical cancer early detection (2) Importance of screening tests, nutrition (3) Skills training in breast self-exam (4) Obtaining services 12 wk; taught by peer educators (consejeras) Control = received “Community Living Skills” which is health information but not specific to cancer prevention and treatment	2 y	Percentage of women who had breast and cervical cancer screening tests within the past y	Control = 7% Experimental = 21% (p = 0.029)
Type of intervention: multi-component
Weber et al.14	Urban poor Rochester, New York	N = 217	(1) Reminder letter from MD (2) Standardized case management protocol (another letter, phone call, home visits, logistical help in getting woman to mammography screening) 3 mo; conducted by community health educator Control = usual primary care plus reminder letter	1 y	Mammography completion, mammography results, and incremental intervention cost effectiveness	Control = 14% Experimental = 41% (p < 0.001)
Burack et al.15	Innercity women, Detroit. Innercity Health Department, HMO, or private hospital	N = 2725	(1) MD and staff breast cancer control education (2) Facilitated mammography appointment scheduling (3) Elimination of out-of-pocket patient cost for mammography (4) Mammography reminder form in medical record (5) Patient reminders for mammography Duration: approximately 2 h; MD-delivered messages and appointment, staff-placed reminders Control was items 1–3 above.	1 y	Mammography rates	18% increase from base-line to 12-mo follow-up (p = 0.348)
Clover et al.16	Lower income and educational attainment. Australians. 2 matched small and 2 matched large rural towns per trial (2 trials)	N = 16,884	Two trials: trail 1 = media vs. community participation (CP); trial 2 = CP vs. Family Practitioner (FP) CP (9–18 d duration): Formation of committee of representatives; promotion of screening service visit by community committee through local networks; and implementation of appointment system FP (duration, 2 mo): mammogram recommendation by MD; ancillary promotion including peer (MD) support, reminder in medical record Media: Newspaper and radio advertisements and other publicity Control was media group.	3 mo	Mammography rate and various process measures	Trial 1: CP (both towns) = 63% and 51% vs. media = 34% and 34% (p < 0.01) Trial 2: FP (one town) = 68% vs. CP = 51% (p < 0.01) FP (other town) = 68% vs. CP = 58% (p = 0.11)
Champion et al.17	Primarily African-American indigent patients in GM clinic. HMO for upper SES group; General Medicine clinic for lower SES group	N = 773	(1) Tailored telephone counseling (2) Tailored in-person counseling (3) Nontailored recommendation letter signed by PCP (4) Tailored telephone counseling plus nontailored MD recommendation letter (5) Tailored in-person counseling plus nontailored MD recommendation letter (5) Tailored in-person counseling plus nontailored MD recommendation letter Both sites included a free mammogram. One time (approx. 20–30 min); taught by graduate nurse reserch assistants Control (standard care) was general postcard reminder to schedule a mammogram.	2, 4, 6 mo	Mammography rates	At 6 mo: usual care = 26%; phone = 41%; person = 51%; MD letter = 40%; phone and MD letter = 49%; person and MD letter = 55% (p < 0.001)
Lauver et al.18	Mostly white with sub-sample of African-Americans, Midwest	N = 728	(1) Phone call with screening recommendations plus a nontailored pamphlet mailed after the phone call (2) Phone call with screening recommendations plus tailored discussion (on beliefs, feelings, costs, and access) and tailored pamphlet mailed after the phone call One-time call and pamphlet mailing; advanced practice nurses made the calls Control: No message at all.	3–6 mo and 13–16 mo	Mammography rates	3–6 mo: control = 21% recomm + nontailored message = 29%; recomm + tailored message = 29%. 13–16 mo: control = 47%; recomm + nontailored message = 47%; recomm + tailored message = 57%. No p values provided
Type of intervention: phone calls
Crane et al.19	Low income. Colorado low-income and minority neighborhoods	N = 3080	3 groups (2 experimental, 1 control): (1) Outcall promoting mammography screening (2) Outcall preceded by a mailed invitation to participate in the program (3) Control received nothing Duration: not stated; trained callers did education and invitations	6 mo and 2 y	Mammography rates	6-mo follow-up: control = 21%; outcall only = 20%; advance invite and outcall = 21% (p > 0.05)
Calle and Miracle-McMahill20	Low- and middle-income women, Jacsonville and Orlando, Florida	N = 594	Up to 3 phone calls peer educators made to 5 of the 10 friends they listed as candidates for mammography. Control = nothing. Up to 3 phone calls over a 3-mo period; taught by peer educators	2–8 mo after phone calls	Mammography rates	Control = 34%; experimental = 49% (p < 0.01)
Type of intervention: video and print
Schneider et al.21	Low-income women, mostly African-American and Hispanic community health clinics and public housing developments	N = 752	Women randomized to view one of four videos with corresponding flyer: (1) Gain-framed message (positive outcomes of obtaining a mammogram) (2) Loss-framed message (dangers of not obtaining a mammogram) (3) Multiculturally targeted (4) Ethnically targeted No real control (groups just compared to one another). 10-min video plus questionnaire time; conducted by research assistants	6 and 12 mo	Mammography adherence rate	At 6-mo follow-up: whites 3.04 times more likely to report receiving a mammogram when message was loss framed vs. gain framed (p < 0.01); Latinas 7.67 times more likely to report receiving a mammogram when message loss framed vs. gain framed (p < 0.001); no difference for AA (p > 0.10); overall, 1.81 OR (p < 0.01)
Type of intervention: print only
Newell et al.22	Small town, low-income Australia small, rural towns	N = 47,989	(1) Media campaign 10 d before booklets mailed (2) Explanatory letter (3) Gender-specific better health booklet (4) Gender-specific better health diary Mailed booklets once Control = nothing	3 and 12 mo	Papanicolaou test rate, mammography rates, skin operations	10 sets of expected/observed ratios; combined (p = 0.73)
Fox et al.23	Elderly white, African-Americans and Hispanic women, California	N = 917	Letter mailed to Medicare benficiaries notifying of Medicare-subsidized mammograms (plus other educational and referral information) Control = no letter One-time letter mailed out; letter to participants	2 y	Mammography rates	African-Americans OR = 1.97 (vs. control; p < 0.05) Hispanics OR = 2.33 (vs. control; p < 0.05)
Simon et al.24	Mostly African-Americans; 2 innercity health departments in Detroit	N = 1966	3 groups: (1) Letter mailed to prompt MD visit (2) Letter mailed instructing participants to contact the mammography site directly to obtain a mammogram (3) No letter mailed = control Also, out-of-pocket costs eliminated and automatic reminder in patient record as part of another CDC intervention for all participants One-time letter mailed out	1 y	Mammography rates	Site 1: letter to visit MD = 19%; letter to contract mammography site = 20%; control = 17% (p = 0.743). Site 2: letter to visit MD = 11%; letter to contact mammography site = 14%; control = 11% (p = 0.376)
Skinner et al.25	African-Americans and whites, North Carolina	N = 435	Tailored letter sent by FP of patient Control = standard letter sent by FP of patient. One-time letter	8 mo	Stage of adoption, mammography rates	All women: baseline = 64%; follow-up = 68%. For those due for screening at baseline having mammograms at follow-up: tailored = 44%; standard = 31% (p = 0.16)
Segnan et al.26	Lower-educational-level women in Italy: Turin, Italy	N = 8069	4 groups: (1) Personal invitation letter signed by the GP with a prefixed appointment date for a mammogram (2) Open-ended personal invitation letter signed by the GP prompting women to contact the screening center within 3 wk to arrange for an appointment (3) Peronal invitation letter signed by the program coordinator with prefixed appointment for screening (4) Personal invitation letter with extended text focusing on the women’s health signed by the GP with a pre-fixed mammography appointment Group 1 used as reference group (no real control). One-time mailing (no one-on-one contact); letter sent to participants	12 mo	Attendance at mammography appointment	At 12-mo follow-up: Grp 1: RR = 1; Grp 2: RR = 0.72 (CI, 0.67–0.78); Grp 3: RR = 0.88 (CI, 0.83–0.95); Grp 4: RR = 1.02 (CI, 0.95–1.10)

^*SES indicates socioeconomic status; PCP, primary care physician; recomm, recommendations; AA, African-American; MD, medical doctor; RR, relative risk; OR, odds ratio; CI, confidence interval; GP, general practitioner; and FP, family practitioner.