Purpose: The purpose of this study was to test an intervention (the Screening Adherence Follow-up Program [SAFe]) that was designed to reduce the number of known barriers to diagnostic follow-up adherence and initiation of treatment among women with low incomes who had abnormal mammogram findings.
Description of program: The investigators developed and implemented a highly structured, theory- and evidence-based intervention that combined health education, counseling, and systems navigation, which was delivered by a team consisting of a peer counselor and a social worker who held a masters degree. A scripted baseline telephone interview identified potential barriers to follow-up adherence and provided counseling interventions for each patient. Patients were assigned to different service intensities based on the level of risk for nonadherence. Patients with significant mental health symptoms, psychosocial stressors, or who had received a diagnosis of cancer were referred to the team social worker for further assessment and intervention. Patients also received reinforcing telephone follow-up calls at 6 and 12 months.
Results: An observational pilot study of SAFe (N = 605) in two large urban diagnostic centers showed that 71% of women receiving SAFe were Hispanic, 18% were Black, and 11% were from other ethnic backgrounds. Adherence rates through diagnostic resolution and the initiation of treatment for women who had received a diagnosis of cancer were 93% and 90%, respectively, at the two study sites. Rates of adherence among women who could not be located or who refused study consent were significantly lower (72% and 69%, respectively). The rate of timely adherence was also higher among the women served. Patient satisfaction with SAFe was generally high.
Clinical implications: Study results support the combining of interventions and the practical utility of a clinical decision-making algorithm to determine individualized nonadherence risk and to assign service intensity based on individual need. Problems in locating women for enrollment were experienced.