Cancer Control Research3R01CA076330-05S2
Vernon, Sally W.
WOMEN VETERANS AND BREAST CANCER SCREENING
Very little research has been conducted on how to disseminate effective cancer screening interventions in health care settings. We propose to implement, through the Veterans Affairs (VA) health system, a targeted mammography intervention (Project HOME) aimed at women veterans age 40 and over who are currently non-compliant with breast cancer screening guidelines. This theory-based intervention was tested by a 5year prospective randomized trial in a national population-based sample of women veterans, including users and non-users of the VA health system. Preliminary results show that the intervention was effective overall, and particularly effective in motivating VA users to adhere to guidelines (RO1 CA76330-05, 1999-2004). The Department of Veterans Affairs (VA) has sought to improve health care services for women veterans by creating the Women Veterans Health Program and assigning Women Veterans Program Managers (WVPMs) to all VA Regional Offices. Women veterans are at increased lifetime risk of cancer relative to the general adult female population and the VA is committed to preventive health measures that prevent or lead to the early detection of cancer. The VA has set an 85% compliance standard for women veterans to have had a mammogram in the past 2 years and WVPMs are very interested in educational efforts to promote compliance. We plan to build on the VA's existing infrastructure by partnering with WVPMs to understand adopter and setting characteristics, customizing the Project HOME intervention for use in 6 VA clinics, implementing a theory-based strategy to maximize program adoption, implementation, and maintenance, and evaluating the effectiveness of the dissemination strategy and potential for institutionalization among all VA clinics. We will conduct a cost-effectiveness analysis of implementing Project HOME in the VA clinics. Theories of diffusion and dissemination will guide plans for program adoption, implementation, and maintenance. Quantitative and qualitative tools will be created to conduct a process evaluation of the dissemination plan. Outcomes will include interest in adopting Project HOME, quality of implementation, number of women veterans reached, and mammography compliance. If successful, we will extend this dissemination project to all VA clinics, thus potentially reaching an estimated 166,000 women veterans over 40 years of age who are currently using VA outpatient health services.