Decreasing disparities in breast cancer screening in refugee women using culturally tailored patient navigation

Abstract

Background: Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective.

Objective: Evaluate whether a PN program for refugee women decreases disparities in breast cancer screening.

Design: Retrospective program evaluation of an implemented intervention.

Participants: Women who self-identified as speaking Somali, Arabic, or Serbo-Croatian (Bosnian) and were eligible for breast cancer screening at an urban community health center (HC). Comparison groups were English-speaking and Spanish-speaking women eligible for breast cancer screening in the same HC.

Intervention: Patient navigators educated women about breast cancer screening, explored barriers to screening, and tailored interventions individually to help complete screening.

Main measures: Adjusted 2-year mammography rates from logistic regression models for each calendar year accounting for clustering by primary care physician. Rates in refugee women were compared to English-speaking and Spanish-speaking women in the year before implementation of the PN program and over its first 3 years.

Results: There were 188 refugee (36 Somali, 48 Arabic, 104 Serbo-Croatian speaking), 2,072 English-speaking, and 2,014 Spanish-speaking women eligible for breast cancer screening over the 4-year study period. In the year prior to implementation of the program, adjusted mammography rates were lower among refugee women (64.1 %, 95 % CI: 49-77 %) compared to English-speaking (76.5 %, 95 % CI: 69 %-83 %) and Spanish-speaking (85.2 %, 95 % CI: 79 %-90 %) women. By the end of 2011, screening rates increased in refugee women (81.2 %, 95 % CI: 72 %-88 %), and were similar to the rates in English-speaking (80.0 %, 95 % CI: 73 %-86 %) and Spanish-speaking (87.6 %, 95 % CI: 82 %-91 %) women. PN increased screening rates in both younger and older refugee women.

Conclusion: Linguistically and culturally tailored PN decreased disparities over time in breast cancer screening among female refugees from Somalia, the Middle East and Bosnia.

Figure 1.

Adjusted mammography screening completion rates within the prior 2 years, p values, and 95 % confidence intervals in the refugee group compared to English-speaking and Spanish-speaking groups over a 4-year period.

Figure 2.

Unadjusted mammography screening completion rates within the prior 2 years in Arabic, Serbo-Croatian and Somali refugee groups over a 4-year period.