Relation between intervention exposures, changes in attitudes, and mammography use in the North Carolina Breast Cancer Screening Program

Abstract

Objective: Many past interventions have been based on the assumption that improving attitudes about mammography can increase mammography use. We studied changes in breast cancer and mammography attitudes over time in mediating the effect of intervention exposures on mammography use in the North Carolina Breast Cancer Screening Program. Data came from interviews with a cohort of 331 black women who said they had heard of mammography at baseline interview. Methods: We created scores and score changes for mammography (7 items) and breast cancer (11 items) attitudes at baseline (1993-1994) and follow-up interviews (1996-1997). We modeled intervention exposures, attitude changes, and mammography use in linear risk and logistic regression. Intervention exposures were defined for mammography discussion with a project lay health advisor ("LHA advice"), mammography discussion with anyone besides a doctor or nurse, and project awareness. Results: Positive change in mammography attitudes was associated with intervention exposures and mammography use and appeared to account for a large percentage (34-98%) of the effect of mammography discussion variables on increased mammography use. Greatest effect of attitude improvement was found for women without a recent mammogram at baseline and with the least positive baseline attitude scores. Conclusion: Using cohort data enabled us to examine the role of attitude change over time on mammography use. Breast cancer screening programs should target women with the most negative mammography attitudes and the least mammography use to start with and concentrate their messages on improving attitudes specific to mammography rather than improving attitudes about breast cancer risk.