Training community health workers: factors that influence mammography use

The purpose of this study was to assess factors that influence mammography use among volunteer community health workers (CHWs). Data trends indicate lower mammography rates among minority and low-income women. Although CHW interventions have been shown to promote mammography use among this population, training strategies and the use of a comprehensive needs assessment are lacking. Using a cross-sectional study design, data were collected via a mailed survey. The dependent variable was mammography use within the past 2 years. The independent variables were categorized according to the factors in the PRECEDE-PROCEED model. Predisposing factors included susceptibility, barriers, benefits, health motivation, self-efficacy, education, and age. Enabling factors included income, health insurance, and regular source of care. Reinforcing factors included physician recommendation to get a mammogram, social norms, and family history of breast cancer. Self-reported data from a mailed survey were obtained from a convenience sample of urban CHWS (N = 109) ages 40-73 with a mean age of 55 (SD = 9.43). The sample included 90% African American and 8% White women. Logistic regression results showed barriers to be predictive of mammography use among CHWs controlling for age, self-efficacy, health motivation, and social norms. The findings suggest CHW training focus on how to identify and address barriers to increase the likelihood of mammography use among CHWs. Future research is needed to identify cultural differences in barriers for minority CHWs.