Randomized trial of a lay health advisor and computer intervention to increase mammography screening in African American women.
Randomized trial of a lay health advisor and computer intervention to increase mammography screening in African American women.
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DOI：
10.1158/1055-9965.epi-09-0569
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发表时间：
2010-01
期刊：
影响因子：
--
通讯作者：
Paskett ED
中科院分区：
文献类型：
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作者：
Russell KM;Champion VL;Monahan PO;Millon-Underwood S;Zhao Q;Spacey N;Rush NL;Paskett ED
低收入的非洲裔美国妇女在进行乳房X光检查时面临许多障碍。我们测试了交互式计算机程序和非专业健康顾问（LHA）干预相结合的有效性，以增加乳房X线摄影筛查。在这项随机、单盲研究中，参与者是181名年龄在41-75岁之间的非洲裔美国女性健康中心患者，贫困水平≤250%，无乳腺癌病史，过去15个月内未进行筛查性乳房X线检查。他们被分配到（a）低剂量对照组，包括文化上适当的乳房X线摄影筛查小册子或（B）互动，定制的计算机指导在基线和4个月的LHA咨询会议。在基线和6个月时收集自我报告的筛选数据，并通过病历进行验证。对于主要结局的意向治疗分析（医疗记录验证的乳房X线摄影筛查，除两名参与者外，其他所有参与者均可获得），干预组在6个月时将筛查增加至51%（45/89），而对照组为18%（16/90）。当调整了就业状况、残疾、患乳腺癌的一级亲属、健康保险和既往乳腺活检后，干预组接受筛查的可能性是低剂量对照组的3倍（调整后的相对风险[RR]=2.7 [95%CI：1.8，3.7]，p<.0001）。在自我报告的乳腺X线摄影筛查阶段也发现了类似的结果。联合干预在改善低收入非洲裔美国妇女的乳腺X线摄影筛查方面是有效的，未调整的效应量（RR = 2.84）显著高于（p <0.05）先前单独进行的每种干预的研究。
Low-income African American women face numerous barriers to mammography screening. We tested the efficacy of a combined interactive computer program and lay health advisor (LHA) intervention to increase mammography screening. In this randomized, single blind study, participants were 181 African American female health center patients ages 41-75, ≤250% of poverty level with no breast cancer history and no screening mammogram in the past 15 months. They were assigned to either (a) a low dose comparison group consisting of a culturally appropriate mammography screening pamphlet or (b) interactive, tailored computer instruction at baseline and 4 monthly LHA counseling sessions. Self-reported screening data were collected at baseline and 6 months and verified by medical record. For intent-to-treat analysis of primary outcome (medical-record-verified mammography screening, available on all but two participants), the intervention group had increased screening to 51% (45/89) compared to 18% (16/90) for the comparison group at 6 months. When adjusted for employment status, disability, first-degree relatives with breast cancer, health insurance, and previous breast biopsies, the intervention group was three times more likely (adjusted relative risk [RR]=2.7 [95% CI: 1.8, 3.7], p<.0001) to get screened than the low dose comparison group. Similar results were found for self-reported mammography stage of screening adoption. The combined intervention was efficacious in improving mammography screening in low-income African American women, with an unadjusted effect size (RR = 2.84) significantly higher (p < .05) than previous studies of each intervention alone.