The Robeson County Outreach Screening and Education (ROSE) Project

Highlights
Program Title The Robeson County Outreach Screening and Education (ROSE) Project
Purpose Designed to increase mammography screening by addressing barriers to obtaining a mammogram among low-income, rural women. (2006)
Program Focus Awareness building and Motivation
Population Focus Medically Underserved
Topic Breast Cancer Screening
Age Adults (40-65 years), Older Adults (65+ years)
Gender Female
Race/Ethnicity American Indian, Black, not of Hispanic or Latino origin, White, not of Hispanic or Latino origin
Setting Home-based, Rural
Origination United States
Funded by NCI (Grant number(s): R01CA72022-04)
RTIPs Scores
This program has been rated by external peer reviewers. Learn more about RTIPs program review ratings.
Research Integrity
4.1
Intervention Impact
3.0
Dissemination Capability
3.0
(1.0 = low    5.0 = high)
RE-AIM Scores
Beginning in 2012, new programs are scored on RE-AIM criteria. This program was posted prior to the inclusion of RE-AIM scores and does not have these scores included. Click on the information icon next to "RE-AIM Scores" above to learn more about RE-AIM.

The Need

Several large studies conducted worldwide show that breast cancer screening with mammograms reduces the number of breast cancer-related deaths in women aged 40 to 69, particularly in women over the age of 50 years. The National Cancer Institute recommends that women aged 40 and older have a screening mammogram (X-ray of the breasts) every 1 to 2 years.
Back to Top

The Program

Description

The Robeson County Outreach, Screening and Education (ROSE) Project offers education on breast care, breast cancer, and breast cancer screening to women over the age of 40 and provides assistance to low-income, rural women overcoming barriers to obtaining a mammogram. The goal of the ROSE Project is to use lay health advisors (LHAs) to deliver an individualized, home-based health education intervention to improve rates of mammography screening in a population of women who are traditionally underserved by cancer control efforts-specifically, low-income Caucasian, African American, and Native American women living in rural areas.  LHAs are minority residents in the community with a background in health care or the social sciences who have received training to deliver the program.

The ROSE Project consists of three in-person home visits 30 to 90 minutes in duration with two follow-up phone calls to assist in making a mammography appointment and discuss any remaining barriers to obtaining a mammogram, and two postcard reminders that address the woman's stage of change in relation to obtaining a mammogram and offer assistance in setting up a mammogram appointment. The intervention is delivered over a 10- to 14-month period.

Implementation Guide

The Implementation Guide is a resource for implementing this program. It provides important information about the staffing and functions necessary for administering this program in the user's setting. Additionally, the steps needed to carry out the research-tested program, relevant program materials, and information for evaluating the program are included. The Implementation Guide can be viewed and downloaded in the Products page.

Back to Top

Community Preventive Services Task Force Finding

Guide to Community Preventive Services This program is an example of one-on-one education interventions (Breast Cancer Screening) and small media interventions (Breast Cancer Screening), which are recommended by the Community Preventive Services Task Force, as found in the Guide to Community Preventive Services.
Back to Top

Time Required

Training: LHAs must successfully complete one week of intensive training, participate in follow-up weekly phone or in-person meetings with an LHA supervisor, and attend additional follow-up training sessions during the program.

Program Implementation: Implementation occurs over a 10- to 14-month period and involves:
-- First home visit: up to 60 minutes
-- Second home visit: up to 90 minutes
-- Two follow-up phone calls (during months 2 and 6): no duration specified
-- Two follow-up postcard reminders (during months 4 and 8)
-- Third and final home visit (during months 10 through 14): up to 90 minutes

Back to Top

Intended Audience

The intervention targets minority and low-income women living in rural areas who are over 40 years old.
Back to Top

Suitable Settings

The intervention is delivered in the home of each individual and includes follow-up phone calls and mailings.
Back to Top

Required Resources

Interventionists are lay health advisors, primarily minority women residents in the community with a background in health care or the social sciences (for example, a nurse, social worker or teacher). LHAs should possess good social and organizational skills, a professional demeanor, and the ability to work flexible hours. Successful completion of LHA training is verified though a comprehensive written examination, conducting practice intervention sessions, and performing a breast self-examination on breast models.
 
The following materials are required:
-- CHE (Community Health Education) Manual
-- Visit 1 materials
-- Visit 2 materials
-- Visit 3 materials
-- Phone call follow-up materials (month 2) (includes a mailed Staging Card)
-- Phone call follow-up materials (month 6) (includes a mailed Staging Card)

For inquiries related to staff training, please contact the Principal Investigator (P.I.) for this program.  The P.I.'s contact information can be viewed on the Products page.

Back to Top

About the Study

A randomized clinical study evaluated the effects of the ROSE Project intervention versus a comparison condition, in which participants received a physician letter and a National Cancer Institute brochure on cervical cancer. The primary outcome of interest was the rate of mammography utilization among study participants. Additional outcomes of interest included perceived barriers, beliefs, and knowledge related to mammography screening.

Eight hundred ninety-seven women over 40 years of age at 4 federally funded community health centers who had no record-verified mammography in the past 12 months and no pending mammography scheduled were randomly assigned to either the intervention group (453 women) or the comparison group (444 women). Study participants were 33% African American, 42% Native American, and 25% White, with an average age of 55 years. Overall, 83% of study participants were defined by one or more of the following criteria: a household income of less than $20,000 per year, no private health insurance, and/or no high school/GED diploma. The most frequent reported barriers to obtaining a mammogram reported at baseline were cost (54%) and lack of encouragement from a doctor (45%). The most commonly reported negative beliefs about mammography were that radiation from the procedure can cause cancer (41%), that it hurts - i.e., is painful (41%), and "I feel okay, so why bother getting a mammogram" (31%). In terms of baseline knowledge, 44% of the women believed that "the only good treatment for breast cancer is an operation to remove the breast", only 32% were aware of the recommendation to begin getting mammograms at age 40, and 90% had no knowledge of the Breast and Cervical Cancer Detection Program (BCCDP) in Robeson County that provides free mammograms to low-income women.

Data were collected at baseline and follow-up (12 to 14 months after random assignment) with a survey containing 12 items related to barriers, 4 items related to beliefs, 12 items related to knowledge, and 4 items related to health care access. Composite scores were calculated separately for barriers, for beliefs, and for knowledge.  A high composite score on barriers indicated many barriers to obtaining a mammogram, whereas a high composite score on beliefs indicated more positive beliefs about mammography, and a high composite score on knowledge indicated more accurate knowledge about mammography and breast cancer.  Analyses of the primary outcome, receipt of a mammogram in the past 12 months, were carried out on 95% of the original randomized sample. Pre-post analyses of the interview survey data were carried out on 91% of the original randomized sample.

Back to Top

Key Findings


  • Among women assigned to the intervention group, 42.5% had medical record-verified mammography in the 12 months prior to follow-up, compared with 27.3% of women assigned to the comparison group (p<.001). By racial group, more African American intervention group women than African American comparison group women (p=.008), more Native American intervention group women than Native American comparison group women (p=.002), and more Caucasian intervention group women than Caucasian comparison group women (p=.024) obtained a record-verified mammogram in the 12 months prior to follow-up assessment. 

    Graph of Study Results


  • Women assigned to the intervention group had a lower average barrier score at follow-up than women assigned to the comparison group (p<.001).
  • Women assigned to the intervention group had a higher (i.e., improved) average belief score at follow-up than women assigned to the comparison group (p=.004).
  • Knowledge scores increased significantly from baseline to follow-up for both intervention group women (p=.002) and comparison group women (p<.001). However, knowledge scores at follow-up were not significantly different between the two groups after adjusting for baseline.
Back to Top

Publications

Primary

For Review

Additional

Back to Top
Last Modified: 05/12/2012
  • View Notes

Use this area to take notes about how this program might work for you. Read More about RE-AIM.

Reach

Absolute number, proportion and representativeness of individuals who participate in the program.


(Max. 8 characters)

(Max. 8 characters)
(No max # of characters)
(No max # of characters)

Effectiveness

Impact on important outcomes, including potential negative effects, quality of life and economic factors.

(No max # of characters)
(No max # of characters)
(No max # of characters)

Adoption

Absolute number, proportion and representativeness of settings and intervention agents willing and able to initiate the program.

(No max # of characters)

Implementation

At the setting level- refers to the fidelity to the various elements of an intervention's protocol, including consistency of delivery as intended and the time and cost of the intervention. At the individual level- refers to clients' use of the intervention strategies.

(No max # of characters)

Maintenance

Please note that RE-AIM stands for Reach, Effectiveness, Adoption, Implementation and Maintenance. However, since “Maintenance” occurs after a program has been implemented, a notes section for this is not included as a part of this tool.