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Results of a Randomized Trial to Increase Mammogram Usage among Samoan Women

Departments of ¹ Family and Community Medicine and ² Medicine, the Office of Policy and Planning, and the Program in Oncology and the University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland; Departments of ³ Health Services and ⁴ Biostatistics, School of Public Health, and ⁵ The Jonsson Comprehensive Cancer Center at the University of California, Los Angeles, California; and ⁶ National Office of Samoan Affairs, Carson, California

Requests for reprints: Shiraz I. Mishra, University of Maryland School of Medicine, University of Maryland Statewide Health Network, 401 W. Redwood Street, Suite 100, Baltimore, MD 21201. Phone: 410-706-8887; Fax: 410-706-8891. E-mail: smishra{at}som.umaryland.edu

Background: There are no effective breast cancer education programs targeting Samoan women. We tested the effectiveness of a theory-guided, culturally appropriate breast cancer education program (the intervention) designed to increase mammography use among Samoan women.

Methods: This community-based participatory cluster-randomized controlled intervention trial used a parallel two-group design. The sample consisted of 776 women aged 42 and older who had not had a mammogram in the preceding 2 years. The primary outcome was self-reported mammogram use between pretest and posttest.

Results: Overall, there was no statistically significant intervention effect, although the odds of self-reported mammogram use were higher in the intervention than the control group (odds ratio (OR), 1.26; 95% confidence interval (95% CI), 0.74, 2.14; P = 0.39). Exploratory subgroup analyses found that the intervention was effective only among women who were aware of mammograms but had never previously obtained one (OR, 1.99; 95% CI, 1.03, 3.85; P = 0.04). Low need for social support and lack of endorsement of culture-specific beliefs about breast cancer were associated with mammogram use in this group. In women unaware of mammography at pretest, high perceived susceptibility to breast cancer and endorsement of culture-specific beliefs were associated with mammogram use. For women who had previously obtained a mammogram, lower self-efficacy was associated with mammogram use. Intervention compared with control group women had significantly higher levels of knowledge of risk factors and lower endorsement of culture-specific beliefs at posttest.

Conclusions: Results suggest that a multifaceted education intervention may improve mammogram usage for certain subgroups of Samoan women. (Cancer Epidemiol Biomarkers Prev 2007;16(12):2594–604)