Using Lay Health Workers to Promote Mammography Screening with African-American Women in the Emergency Department: An RCT

Background:Although the majority of U.S. women currently obtain mammograms African American women continue to face challenges to adherence to breast cancer screening guidelines. These challenges have contributed to stunning disparities in breast cancer mortality rates for African American women versus other U.S. women. These disparities call for researchers to focus on innovative venues and approaches to encourage screening in this vulnerable population.  The Emergency Room is one such venue where underserved populations may go to seek treatment. The use of lay health workers in this setting is an innovative approach to elimination of health disparities in this vulnerable group.  

Purpose: The purpose of this study was to test the efficacy of a pilot intervention featuring a lay health worker to increase mammography utilization among African American women recruited from those waiting in the Emergency Department.

Methods: This study was a three armed pilot of a randomized controlled trial (n=96)comparing the effects of a brief motivational interview delivered by a lay health worker with those of a targeted brochure and a usual care control group, all given by a lay health worker in the ED while women were in the waiting room.

Results: The average age of the participants was 51.9, most women were not married (79.2%) and had an annual household income of $40,000 or less (84.1%). Thirty four percent of the women did not have health insurance or a primary care provider. All women enrolled in the study had not had a mammogram in the last year and were out of compliance with ACS guidelines. One quarter (23%) of the sample reported having never had a mammogram. More than a quarter of the sample received a mammogram during the study (27.4%). There was no group difference by mammography status at the 3 month follow up.

Conclusions: Using innovative venues and approaches are necessary to eliminating health disparities for African American women and other vulnerable populations. One such innovative venue is the Emergency Department where more than a quarter of the women surveyed had never had a mammogram. The use of lay health workers in this setting was effective in all groups that were contacted in this setting. This increase in mammograms in this hard to reach group is evidence of the efficacy of these innovations.