A systematic review of mammography educational interventions for low-income women

Objective. We conducted a systematic review to examine the effectiveness of educational interventions in increasing mammography screening among low-income women. Data Sources. Bibliographic databases, including MEDLINE, The Cochrane Central Register of Controlled Dials, The Cochrane Database of Systematic Reviews, and the ISI Web of Science, were searched for relevant articles. Study Inclusion and Exclusion Criteria. Randomized, community-based trials targeting low-income women and published between January 1980 and March 2003 were included. Data Extraction. The search yielded 242 studies; 24 met all inclusion criteria. Data Synthesis. Three studies used mammography vans, three used low-cost vouchers or provided free mammograms, three used home visits, one used community education alone, one provided referrals, five incorporated multiple intervention strategies, two used phone calls, one used videos and print material, and five used primarily print material. Results. Of nine studies that reduced barriers to care via mammography vans, cost vouchers, or home visits, eight showed statistically significant increases in mammography screening. Seven of the eight studies that used peer educators had significant increases in screening, as did four of the five studies that used multiple (intervention) components. Conclusions. Interventions that used peer educators, incorporated multiple intervention strategies, or provided easy access via vans, cost vouchers, or home visits were effective in increasing screenings. Mailed letter or telephone reminders were not effective in trials involving low-income women, which is contrary to findings from middle upper-income studies.