Developing and evaluating scalable and culturally relevant interventions to improve breast cancer screening among White Mountain Apache women

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PROJECT SUMMARY White Mountain Apache (WMA) leaders have voiced an urgent need to prioritize breast cancer screening research in NARCH XI due to concern about low screening rates. As of 2018, screening rates among eligible WMA women were more than 2 times lower than the Healthy People 2020 target, 39.1% compared to 81.1%, and substantially lower than screening rates among AI/AN women nationally. In Arizona (AZ), where the WMA tribal lands are located, 32% of AI women are diagnosed at later stage disease (i.e., either regional or distant vs. local disease) compared to 25% of AZ women overall. There is a great need for culturally appropriate interventions to improve screening rates and reduce mortality and morbidity from breast cancer in the WMAT population. This project will support the WMA-JHU partners and our established cancer care Community Advisory Board to design two motivational tools based on findings regarding barriers and facilitators to breast screening among Apache women, and he shortage of providers’ time and resources to provide clinic- based education. The first tool will be delivered on a tablet in the clinic with highly graphic, culturally congruent breast-cancer screening information. It is named Tablet-based Education to improve Acceptance of Mammography” or “TEAM.” The second tool will be an Individual-based one-to-one peer-educational module delivered by a paraprofessional Apache women’s health coach, called “COACH,” to address individuals’ personal barriers and facilitators to breast cancer and screening concerns and provide one-to-one support for scheduling, transportation and completing a mammogram. We will evaluate these intervention tools through an RCT with n= 500 women aged 50+ who receive a mammography referral after a local outpatient visit. Women will be stratified by prior history of mammography (never or ever) and age (<65 or 65+), and then randomized 1:1 to receive either TEAM alone or TEAM+Coach. The WMA-JHU partners bring extensive experience building and evaluating motivational behavior change curricula delivered one-on-one and with mobile health tools that have now been scaled to >140 tribal communities across 21 states.