Barriers to Breast Cancer Screening In a Managed Care Population

Sharp Health Plan wanted to increase mammography screening for its at-risk female population. Thirty percent of at-risk members were non-adherent. Members’ reasons for avoiding screening were examined.

Sandra R. Parkington, MPH, RN
Quality Improvement Coordinator, Sharp Health Plan
Nora Faine, MD, MPH
Chief Medical Officer, Sharp Health Plan
Marcia C. Nguyen
Senior Data Analyst, Sharp Health Plan
Michelle T. Lowry, MPH
Quality Assistant, Sharp Health Plan
Poorva A. Virginkar
MHSA candidate 2009


PURPOSE: In 2006, Sharp Health Plan (SHP) conducted a campaign to increase mammography screening for at-risk female members that consisted of mailing each eligible member an informational mammography postcard with an appointment tracker. Then came an automated phone call reminder. After the mammography campaign, 70 percent of SHP members sought mammography screening while 30 percent remained nonadherent. SHP decided to conduct a survey to better understand members’ barriers to breast cancer screening.

DESIGN: A survey based on Prochaska and Velicier’s Transtheoretical Model of Change was designed to assess members’ behavioral stage and barriers to breast cancer screening.

METHODOLOGY: The survey was administered to all nonadherent members via personal phone calls with nearly 50 percent of the nonadherent completing the interview. All quantitative data were examined, and a code book was created to assess additional qualitative data. Findings were further analyzed by stage of change, ethnicity/race, and region of San Diego.

PRINCIPAL FINDINGS: The top three barriers identified were: Mammogram not a priority, Knowledge deficit, and Had a bad experience in the past.

CONCLUSION: A common set of mammography barriers was found in the SHP member population. However, when segmented into ethnic, racial, geographic, and behavioral stage groups, various barriers were identified. SHP providers can use this information to develop more tailored interventions and to increase the rate of breast cancer screening for their member population.


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