Evaluating educational interventions to increase breast density awareness among Latinas: A randomized trial in a Federally Qualified Health Center

Abstract

Background: The objective of this randomized trial was to evaluate the short-term effect of bilingual written and interpersonal education regarding mammographic breast density (MBD).

Methods: Latinas aged 40 to 74 years who were presenting for screening mammography were recruited and randomized 1:1:1 to receive a letter with their mammogram and MBD results (usual care [UC]), a letter plus a brochure (enhanced care [ENH]), or a letter plus a brochure and telephonic promotora education (interpersonal care [INT]). Surveys were administered at enrollment (T0 ) and 2 weeks to 6 months after intervention delivery (T1 ). Differences were assessed with χ2 , Kruskal-Wallis, and McNemar tests and pairwise comparisons as appropriate. INT metrics and audio recordings were analyzed with descriptive statistics and qualitative content analysis.

Results: Between October 2016 and October 2019, 943 of 1108 Latina participants (85%) completed both surveys. At T1 , INT participants were more likely (P < .001) to report seeing their MBD results in the letter (70.2%) than UC (53.1%) or ENH participants (55.1%). The percentage of INT women who reported speaking with a provider about MBD (29.0%) was significantly greater (P < .001) than the percentage of UC (14.7%) or ENH participants (15.6%). All groups saw significant (P < .001) but nondifferential improvements in their knowledge of MBD as a masking and risk factor. In the INT group, the promotora delivered education to 77.1% of the 446 participants randomized to INT and answered questions at 28.3% of the encounters for an average of $4.70 per participant.

Conclusions: Among Latinas in a low-resource setting, MBD knowledge may increase with written or interpersonal education, but with modest investment, interpersonal education may better improve MBD awareness and prompt patient-provider discussions.

Trial registration: ClinicalTrials.gov NCT02910986.

Keywords: breast screening; health disparities; mammographic breast density (MBD); mammography; randomized clinical trial.

Conflict of interest statement

Conflict of Interest: BKP reports grants from Hologic, Inc. and GRAIL, Inc. outside the submitted work. The other authors did not declare conflicts of interest.

© 2021 American Cancer Society.

Figures

Figure 1. CONSORT study flow diagram

*Education date was the date of results letter mailing for the usual care group; date of results letter and brochure mailing for enhanced group and for those in the interpersonal group who failed to complete the promotora’s call; and the date of the promotora’s intervention delivery for those in the interpersonal group who did complete it.

Figure 2. Knowledge of MBD masking (A, “What impact do dense breasts have on the ability of a mammogram to correctly detect cancer?”) and risk knowledge (B, “Women who have dense breasts are at greater risk for getting breast cancer”) at T0 and T1 by group