Increasing Mammography Among Latinas with Disabilities

Institution: University of California, San Francisco
Investigator(s): H. Stephen Kaye, Ph.D. - Elsa Quezada,  -
Award Cycle: 2006 (Cycle 12) Grant #: 12AB-2700 Award: $50,000
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Disparities: eliminating the unequal burden of breast cancer

This is a collaboration with: 12AB-2701 -

Initial Award Abstract (2006)
Introduction to the research topics: Women with disabilities and Latinas make up two groups who have not received the attention needed for breast cancer screening. Although the recommended guideline for women over 40 is to have an annual mammogram, research shows that fewer women with major physical disabilities follow that guideline, compared to women without disabilities. Similarly, research shows that many fewer Latinas follow the mammography guidelines than non-Hispanic women. Even worse, many Latinas never get mammograms—twice as many as women who are not Latina.

In 2004–05, Community Resources for Independent Living, a non-profit organization serving people with disabilities in suburban Alameda County, conducted a Healthy Women Project which successfully showed that health education could motivate women with physical disabilities to obtain mammograms. The participants included mostly white or African American women. In the proposed project, we plan to apply lessons learned from the Healthy Women Project to a different and particularly vulnerable population—Latinas with disabilities, who are mostly poor, often speak only Spanish, and live in an agricultural area with few accessible health facilities. We propose to (1) expand the project to include improving accessibility of health facilities and training in self-advocacy for the participants, (2) build in the cultural and communication supports needed to serve Latinas with physical or sensory disabilities, and (3) work toward systems change through community education and dissemination of project findings.

The question(s) or central hypotheses of the research:
1. If Latinas with disabilities receive support from other Latinas, education about the importance of breast cancer screening, skills to speak up for themselves in healthcare settings to meet their own healthcare needs, and access to places to go to get their mammography needs met in a culturally appropriate way, will they be more motivated to comply with mammography guidelines?
2. Even with limited resources, can community clinics, other health care providers, and disability organizations work together to break down communication, physical, and attitudinal barriers and increase access to mammography services and programs for Latinas with disabilities?
3. If this community removes the barriers, and provides support, education, skills, and resources to Latinas with disabilities, will more such women get their mammograms as recommended?

The general methodology: This project will use a peer health education approach that includes support, information, and skill building. Also, the project will work with health clinics to change the way they do business to improve the clinic’s ability to serve Latina women with disabilities. To determine whether the project made a difference, the women will participate in a survey before and at the end of the project to determine if they understand more about the issues and have changed their attitudes towards mammography. The project will also follow-up the women to see if they went for their mammograms and what experiences they had with the screening.

Innovative elements of the project: In this project, we are reaching out to Latinas with disabilities, using lessons learned in another community, and finding out whether providing education and changing the environment to meet the specific needs of these women will change people’s attitudes and their health behaviors, and potentially save lives.

Community involvement: This project involves the disability community, the Latino/a community, the women’s health advocacy community and people providing community-based medical and public health services to the underserved residents of Monterey, San Benito, and Santa Cruz counties. People from all these groups will participate in all phases of the project, both as project partners and as members of the Advisory Committee. Participating organizations include local disability organizations serving people with hearing or visual impairments, Clinica de Salud del Valle de Salinas, the Monterey County Health Consortium, and Every Woman Counts.

Final Report (2008)

Both women with disabilities and Latinas are less likely to obtain mammograms than their non-minority counterparts. The principal aim of the project was to to develop and evaluate an intervention to increase mammography rates among Latinas with disabilities, using peer education about breast cancer and the importance and availability of mammography, as well as training in healthcare self-advocacy. The project was successfully completed: 350 women from the Central Coast area of California attended one of the 32 classes that were offered between August 2007 and April 2008. Ninety-five of those women met the study criteria by virtue of having a physical or sensory disability, being 40 years of age or older, identifying as Latina, and being out of compliance with recommended mammography guidelines. Project participants typically lived in or near poverty and had low literacy skills; many were monolingual in Spanish and a substantial minority were uninsured. A comparison of pre- and post-tests indicates that participants increased their awareness of breast cancer and mammography and gained greater confidence in their ability to obtain a mammogram. During the two months following the class, a majority of participants either obtained a mammogram or attempted to do so.

Despite strong partnerships established with other community organizations, the principal challenges involved recruitment of project participants and effective utilization of community health workers (promotoras) in conducting the intervention. Multiple layers of stigma related to the subjects of cancer, breasts, and disability made women reluctant either to participate at all or to declare themselves as having a disability; this barrier to recruitment was ultimately overcome through dedicated effort and flexible strategies that took advantage of existing social networks and living arrangements. Although the use of promotoras to encourage mammography among the target population remains a promising strategy, the project was largely unable to successfully utilize volunteer staff from other organizations in the intervention.

Major accomplishments of the project include increased interest in and awareness of issues related to both disability and breast cancer among partner organizations in the community, development of an innovative curriculum to educate Latinas with disabilities about breast cancer and mammography, an intervention that was largely sucessful despite challenges, and successful training of two groups of promotoras on disability and breast health issues. Future plans include developing more broadly focussed health promotion strategies, with breast cancer and mammography as one component, and using a promotora model to bring these strategies directly to the target population.