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Intervention by community health workers improved rates of screening mammography
Wells KJ. Cancer Epidemiol Biomarkers Prev. 2011;doi:10.1158/1055-9965.EPI-11-0276.
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Results from a systematic review of prospective controlled studies evaluating the effectiveness of interventions by community health workers showed that those interventions lead to increased rates of screening mammography.
The effect was even more pronounced when the race and ethnicity of the health workers matched that of the community they served.
“The findings have significant implications for public health practice by indicating community health worker interventions are associated with improvements in rate of one-time screening mammography, especially in medical settings, urban settings and in participants who are racially or ethnically concordant with the community health worker,” the researchers said. “However, as mammography is a behavior that must be repeated multiple times, there is still much that is unknown regarding efficacy of community health worker interventions in increasing repeated breast cancer screening.”
Researchers reviewed 24 randomized controlled trials, case-control studies and/or quasi-experimental studies published from 1980 to Jan. 31, 2008. Eligible studies evaluated interventions by community health workers designed to increase screening mammography rates in women aged at least 40 years who did not have a history of breast cancer in which intervention was delivered outside of a hospital.
Of 18 studies with sufficient data to evaluate rate of screening mammography in the meta-analysis, 10 (56%) were randomized trials and eight were quasi-experimental. Researchers determined that there were 9,342 mammograms after intervention and 19,494 in the control groups. The pooled RR for obtaining screening mammography was 1.06 (95% CI, 1.02-1.11), indicating a statistically significant effect of interventions on improving rate of screening mammography.
The quasi-experimental studies were excluded from further sensitivity analysis because results varied in magnitude and direction of effect. The pooled RR for obtaining mammography in the randomized trials was 1.07 (95% CI, 1.03-1.12), based on 2,235 in the experimental group and 12,442 in the control group.
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