The Delta project: increasing breast cancer screening among rural minority and older women by targeting rural healthcare providers

Oncol Nurs Forum. 2003 Jul-Aug;30(4):669-77. doi: 10.1188/03.ONF.669-677.


Purpose/objectives: To test a multimethod approach designed for rural healthcare providers to increase breast cancer screening among low-income, African American, and older women.

Design: Two-year experimental pretest/post-test with random assignment by group.

Setting: Primary healthcare providers' offices.

Sample: 224 nurses, physicians, and mammography technicians.

Methods: 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.

Main research variables: 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.

Findings: Healthcare providers significantly improved in demonstration of breast cancer screening practice after the intervention. Nurses performed significantly better than physicians on the breast examination during the post-test. More women older than 50 received mammograms in the experimental counties than in the comparison counties. Culturally sensitive lay literature is needed for African American women with low literacy.

Conclusions: Successful interventions included use of standardized patients to teach healthcare providers in their office settings, prompts such as posters and pocket reminder cards, and easy-to-read newsletters.

Implications for nursing: Physicians and nurses play a powerful role in motivating women to have mammograms and clinical breast examinations and to practice breast self-examination. Interventions that help these providers fulfill that role should be implemented.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Distribution
  • Arkansas
  • Black or African American / statistics & numerical data
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / ethnology
  • Breast Neoplasms / nursing*
  • Clinical Competence / standards
  • Ethnicity / statistics & numerical data
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Mammography / nursing
  • Mammography / statistics & numerical data
  • Mass Screening / nursing*
  • Mass Screening / statistics & numerical data
  • Minority Groups / statistics & numerical data
  • Nursing Methodology Research / methods
  • Nursing Methodology Research / statistics & numerical data
  • Oncology Nursing / statistics & numerical data
  • Physicians / statistics & numerical data
  • Primary Health Care / statistics & numerical data*
  • Rural Health / statistics & numerical data*
  • Rural Health Services / statistics & numerical data
  • Workforce