Increasing Breast Health Access for Women With Disabilities

Institution: Alta Bates Summit Medical Foundation
Investigator(s): Carol D'Onofrio, DrPH - Ann Cupolo Freeman,  -
Award Cycle: 1998 (Cycle IV) Grant #: 4BB-2400 Award: $502,616
Award Type: CRC Full Research Award
Research Priorities
Detection, Prognosis and Treatment>Imaging, Biomarkers, and Molecular Pathology: improving detection and diagnosis



Initial Award Abstract (1998)
Women with disabilities have been neglected in breast cancer statistics; national, state, and local screening initiatives; screening services; and education. To address these gaps, this project pursued 5 questions: (1) What is the prevalence of barriers to breast screening among women with physical disabilities? (2) Are these barriers, differences in types and seventy of functional limitation, and age and ethnicity associated with differences in screening utilization? (3) To what extent do the outreach, education, and service delivery strategies employed to date by the Breast Health Access for Women with Disabilities (BHAWD) coalition reduce barriers to screening? (4) What changes are needed in BHAWD strategies and in health policy to increase access to breast screening for women with disabilities? (5) What are the prospects for disseminating the BHAWD program to other California communities?

Secondary analysis of the 1994 National Health Interview Survey and its Disability Followback found that over 19% of U.S. women age 20 and older have at least one physical limitation and that over 15 million have disabilities that complicate taking the actions involved in breast screening: mobility limitations that make it difficult to keep medical appointments are most common. Regardless of how disability was defined (Activities of Daily Living, Instrumental Activities of Daily Living, Functional Limitations, or having a mobility problem), the likelihood that women had had a clinical breast exam (CBE) and a mammogram (age 40+ only) within the last 2 years decreased as the number of their disabilities increased (p<.0001). The likelihood that women had these exams within the past two years also was greater for African Americans than whites, married than unmarried women, and women who had at least a high school education,'health insurance, and a recent physical exam. Being age 75 and older (compared to ages 40-49), living in a rural compared to a suburban area, and having difficulty lifting decreased the likelihood of being up-to-date with each type of exam.

A local survey of 312 women with disabilities provided more detailed information about ways in which specific limitations impede access to breast screening and showed that screening utilization also is associated with attitudes, perceptions, and access issues related to screening rates in the general population. Despite these obstacles, within the past year 73% of the sample had had a CBE; 60% of women age 40+ had a mammogram, as had a surprising 53% of younger women. However, in both age groups, about 18% said that their last mammogram had been done because of a breast problem rather than as part of a routine check-up. Only 22% of the local women surveyed had heard of BHAWD and of these, just 43% had visited the BHAWD clinic: on average, these women had more disabilities than those who had never heard of BHAWD.

These and other data, including a collaborative assessment of lessons learned from the program's experience to date, informed BHAWD's strategic planning, leading to new initiatives and grant support. A survey of 45 disability and screening providers revealed few other activities to increase access to breast screening for women with disabilities in other California regions and considerable interest in the BHAWD program. Dissemination activities have been successfully initiated and further collaborative research is being planned.


Final Report (2001)
Women with disabilities have been neglected in breast cancer statistics, national, state, and local screening initiatives, screening services, and education. To address these gaps, this project is studying 5 key research questions: (1) What is the prevalence of barriers to breast screening among women with physical disabilities? (2) Are these barriers, and the differences in types and severity of functional limitation, and age and ethnicity associated with differences in screening utilization? (3) To what extent do the outreach, education, and service delivery strategies employed to date by the Breast Health Access for Women with Disabilities (BHAWD) coalition reduce barriers to screening? (4) What changes are needed in BHAWD strategies and in health policy to increase access to breast screening for women with disabilities? (5) What are the prospects for disseminating the BHAWD program to other California communities?

Objectives 1-2 are being studied through secondary analysis of the 1994 National Health Interview Survey (NHIS), its Health Promotion and Medical Access supplements, and its Disability Followback. Results show that regardless of how disability is defined (Activities of Daily Living, Instrumental Activities of Daily Living, Functional Limitations, or having a mobility problem), the odds of being up­-to-date with mammograms decrease with the number of physical limitations (p<.0001). In all models, the Odds Ratio is better for African Americans than for whites and for women ages 50-64 than 40-49. Being age 75 or older (compared to ages 40-49) decreased the OR. Variables on barriers to screening constructed from the NHIS data are currently being refined after which final models will be run.

Because analysis of the NHIS data set is subject to several constraints, a survey of 320 local women with disabilities was conducted to address objectives 1-3. Analysis of these data is in progress. To address objective 4, the BHAWD Coalition is collaboratively developing a manual that critically reviews BHAWD's experience in increasing breast health access and makes related program and policy recommendations. This manual is in advanced draft form, and when completed will be used in a statewide survey of agencies to address objective 5.

Next steps are to complete (1) analysis and reporting of the NHIS data, (2) analysis and reporting of the local survey, (3) the final draft of the BHAWD manual, and (4) the dissemination study. Project findings will reduce the human and economic impact of breast cancer for women with disabilities by filling an information void and by informing further research, policy initiatives, and the development of breast screening and education programs.

Increasing Breast Health Access for Women With Disabilities
Periodical:Highlights: A Publication of the Northern California Cancer Center
Index Medicus:
Authors:
Yr: 1999 Vol: 10(2) Nbr: 4, Winter Abs: Pg: