ORIGINAL ANALYSIS The End Result of Two Church-based Interventions on Breast Cancer Screening Rates Among Medicaid-Insured Latinas

Adrienne L. Welsh, PhD, MSPH, Angela Sauaia, MD, PhD, Jillian Jacobellis, PhD, MS, Sung-joon Min, PhD, Tim Byers, MD, MPH

Recommended citation with this article: Welsh AL, Sauaia the, Jacobellis J, Min S, Byers T. the result of two church-based interventions on breast cancer screening prices among Medicaid-insured Latinas. Prev Chronic Dis serial on line 2005 Oct date cited.

Abstract

Introduction Latinas face disparities in cancer testing prices weighed against non-Latina whites. The Tepeyac Project aims to reduce these disparities simply by using a church-based approach to increase breast cancer assessment among Latinas in Colorado. The aim of this research would be to compare the result of two Tepeyac venture interventions regarding the mammogram prices of Latinas and non-Latina whites enrolled in the Medicaid fee-for-service system.

Methods Two intervention teams had been contrasted: 209 churches in Colorado that received academic im im printed materials in Spanish and English (the printed statewide intervention) and four churches when you look at the Denver area that received customized training from promotoras , or peer counselors (the promotora intervention), besides the printed intervention that is statewide. Biennial Medicaid mammogram claim prices in Colorado prior to the interventions (1998–1999) and after (2000–2001) had been utilized to compare the result associated with interventions on mammogram usage among Latinas and whites that are non-Latina 50 to 64 years have been signed up for the Medicaid fee-for-service system. Modified prices were computed utilizing general estimating equations.

Outcomes Small, nonsignificant increases in testing had been observed among Latinas exposed to your promotora intervention (from 25% at standard to 30per cent at follow-up P = .30) in comparison with 45% at standard and 43% at follow-up for the printed statewide intervention (P = .27). Assessment among non-Latina whites increased by 6% within the intervention that is promotora (from 32% at standard to 38per cent at follow-up P = .40) and also by 3% when you look at the printed intervention that is statewidefrom 41% at standard to 44per cent at follow-up P = .02). No significant disparities in cancer of the breast assessment were detected between Latinas and whites that are non-Latina. After modification when it comes to confounders by general estimating equations, the promotora intervention possessed a marginally greater effect as compared to printed statewide intervention in increasing mammogram use among Latinas (generalized estimating equation, P = .07).

Summary an individualized community-based education had been just modestly effective in increasing cancer of the breast testing among Medicaid-insured Latinas. Education alone might not be the clear answer because of this populace. The obstacles of these Medicaid enrollees should be examined in order that interventions could be tailored to deal with their requirements.

Introduction

Disparities in mammogram assessment prices have already been identified among Latinas, the indegent, and the ones with reduced quantities of education (1-3). Individual thinking and techniques, usage of health care bills, low income, and language issues (4-6) are normal obstacles if you have low utilization of cancer assessment solutions. Studies carried out particularly with Latinas have actually identified social obstacles to getting these types of services, such as for example “fatalismo,” difficulties with acculturation, fear, and embarrassment (7-9). Barriers found to be connected with not enough cancer of the breast testing among low-income ladies consist of older age, low degree of training, not enough medical insurance, work-related responsibilities, transport dilemmas, and not enough present doctor visits (10). Interventions found in the population that is general at increasing the prices of mammogram testing, such as for instance news promotions and chart reminders, have indicated small effectiveness among Latinas (11,12). Church-based interventions therefore the utilization of peer counselors are a couple of current promising methods to reaching the Latina community (12-14).

This research defines a pilot task geared towards increasing cancer of the breast testing among Latinas in Colorado through two interventions that are church-based. The Colorado Foundation for health care bills (CFMC) carried out the scholarly research with capital through the Centers for Medicare & Medicaid solutions (CMS), previously the healthcare Financing management. The analysis goal would be to compare the end result of this two interventions regarding the mammogram prices of Latinas and non-Latina whites (NLWs) enrolled in the Medicaid fee-for-service system.

To make sure that the interventions in this pilot research had been culturally appropriate, the participation associated with the community was wanted in most stages regarding the task. The task ended up being called Tepeyac due to the value to Latinos because the web site in Mexico where Our Lady of Guadalupe seemed to Saint Juan Diego. The interventions incorporated themes identified by town, like the significance of household, and had been delivered through the Catholic church, a fundamental piece of the Latino network that is social.

This report may be the second in a string that examines the effect regarding the Tepeyac interventions in the mammogram assessment rates among Latinas and NLWs signed up for Medicare, Medicaid, and wellness maintenance businesses (HMOs). The Tepeyac task has formerly demonstrated success in decreasing the disparity between older Latinas and NLWs signed up for the Medicare fee-for-service program (15). This analysis targets the consequence of those interventions on younger ladies included in the Medicaid fee-for-service program, an optimal automobile for assessing education initiatives in this high-risk, low-income team.