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Nursing

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1. Davis et al – Descriptive correlational design
Dependent variable-received a mammography within last 12 months
Independent variable-knowledge and attitudes as measured by face to face interviews with closed end questions, reasons for non adherence (Doctor didn’t recommend it), belief statements about breast cancer, depressive symptoms as measured by the Center for Epidemiological Studies Depression Scale
No Intervention/ questionnaire only 2. Farmer et al: Cross-sectional survey
Dependent variable-increasing mammography adherence to screening within last 12 months
Independent variable-Questionnaires, questions designed to elucidate perceptions of beliefs and barriers to screening, susceptibility and seriousness of breast cancer, knowledge of screening guidelines.
Social support, cancer fatalism, dispositional optimism, perceptions of general health, screening guidelines. No Intervention/ questionnaire only

3. Levy-Storms: Cross-sectional survey
Dependent variable- three levels of nonadherence; Never had a mammogram (never), more than 2 years ago (lapsed), in the last 1-2 years (due)
Independent variable- based on self report; demographics, knowledge (of risk factors and screening guidelines), beliefs (perceived norms, perceived severity, perceived susceptibility, and perceived efficacy of early detection and mammography), psychological (concern about pain and about finding breast cancer) and access barriers (not in a health maintenance organization (HMO), regular checkup, transportation difficulties, cost, and difficulty making an appointment), referral from a provider, and behavioral intention No Intervention/ questionnaire only 4. Earp et al : cohort design
Dependent variable- The primary outcome was self-reported mammography use in the previous 2 years.
Independent variable-knowledge and attitudes related to breast cancer, social support, attitudes to the health care system
Intervention
Studies conducted with disadvantaged urban populations have shown that lay health advisor interventions increase mammography use among women recruited from the community.
Lay health advisors are community members trained to act as links between the professional health care system and their communities.

After training, lay health advisors worked individually and collaboratively with each other to promote awareness and use of breast cancer screening among African American women in their communities.
Community outreach specialists supported lay health advisors through monthly meetings and assistance in organizing activities. These specialists also worked with staff and community leaders to establish local advisory committees. Community activities (approximately 2 per month) included presentations made to local community groups (at beauty parlors, nutrition sites, churches, and other places where women gathered) and community events (such as health fairs, parades, and mobile mammography van days).
At the individual level, advisors engaged in one-to-one conversations (approximately 2 per week per advisor) with women they knew and used culturally sensitive materials informed by the focus group data.
Approximately 11,772 informational/motivational items were distributed, including brochures and posters with photos of local residents and mammography information tailored to each county and church fans and holiday cards (Mother's Day, Valentine's Day, and Christmas) with messages about mammography screening.
Project staff member’s expert in breast imaging met briefly with several of the local radiology practices to ensure compliance with the Mammography Quality Standards Act and to raise awareness of African American women's barriers in regard to mammography,
Finally, lay health advisors and community outreach specialists worked with providers and community organizations to increase access to mammography by providing transportation and promoting lower charges. 5. Champion et al: prospective randomized

Dependent variable- improve adherence to mammography screening who had not had a mammogram within one year
Independent variable- variables used in this study were perceived susceptibility, perceived benefits, and perceived barriers tailored interventions; telephone counseling, in-person counseling, physician letter, combination of telephone with letter, and in-person with letter all emphasized susceptibility and benefits and barriers, and were specific to the women’s response
Intervention
Message content was as follows: If a woman was in the precontemplation stage, her counseling emphasized susceptibility and benefits. Messages related to perceived susceptibility or benefits were specific to the woman’s responses. For instance, if a woman was 60 but did not perceive herself at risk because her mother had not developed breast cancer, the counselor stressed that 75% of women who develop breast cancer have no risk-discernible factors. (Examples are listed in Fig. 1.) For women in the contemplation stage, barriers specifically listed by the individual were discussed and strategies to lessen barriers addressed. Prior research has indicated that precontemplators may need information on perceived risk and benefits whereas addressing barriers may be more important for contemplators [27]. For example, if a woman was afraid to have a mammogram because of past pain caused by the test, counselors suggested taking Tylenol before the procedure. Printed, nontailored materials were developed specifically for the study and contained general messages related to susceptibility, benefits, and barriers. Both telephone and in-person counseling used the same protocol for tailoring messages to promote mammography screening. 6. Coleman et al: pretest/post-test design
Dependent variable- increase breast cancer screening, (CBE and mammography)., among low-income, African American and older women.
Outcome measures were (a) knowledge of the American Cancer Society’s screening guidelines as measured by surveys; (b) attitudes toward the use of the recommended screening guidelines as measured by surveys; (c) ability to do a focused breast health interview, perform CBE, and give appropriate advice regarding breast cancer screening and teaching BSE, as measured by performance scores; (d) number of mammography referrals according to self-report in surveys; and (e) number of women obtaining screening mammograms according to mammography facilities’ records.
Independent variable- Healthcare providers’ knowledge and attitudes as measured by survey responses, skills as measured by a checklist,( and the provision of breast cancer screening as measured by mammography facilities’ data.) to increase breast cancer screening, (CBE and mammography)., among low-income, African American and older women.

Standardized patients to observe and record healthcare providers’ performances, followed by direct feedback, newsletters, posters, pocket reminder cards, and lay literature about screening to use in clinics.

Intervention
Standardized patients who traveled to the primary care clinics with the research assistant gave the performance examinations. At the University of Arkansas for Medical Sciences (UAMS), standardized patients have high school or advanced degrees and include homemakers, nurses, secretaries, and teachers. They are dedicated and motivated to the task and have shown their abilities to teach. During a two-week training program, the women watched videotapes about breast examination and studied a breast education manual developed by UAMS faculty. They memorized a clinical scenario in which a woman who is concerned about breast cancer presents to a clinic for breast examination. The women learned their own breast anatomy and physical findings by attending a one-hour didactic session on breast anatomy and abnormalities and having a thorough breast examination and explanations by a surgical breast specialist. Finally, they practiced teaching as a group and rehearsed the clinical scenario with a mock student.

In the Breast Cancer Screening Performance Checklist the Standardized patient filled in the bubble if the healthcare professional completed the task.
There are five categories assessed:
Risk Factor/Symptoms- Were they addressed?
Screening Recommendations addressed?
Communication-style
Preparation for Physical Examination- yes or no
Breast Proficiency Score- details of actual performed exam on standardized patient Note: Numbers in parentheses before each item are for the benefit of the reader to see the weighting and did not appear on the form; rather, the form had a bubble beside each item to be filled in if that task was completed by the healthcare provider.
Coleman,et al.

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