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Decreasing Disparities in Breast Cancer Screening in Refugee Women Using Culturally Tailored Patient Navigation

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A Capsule Commentary to this article was published on 25 June 2013

ABSTRACT

BACKGROUND

Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective.

OBJECTIVE

Evaluate whether a PN program for refugee women decreases disparities in breast cancer screening.

DESIGN

Retrospective program evaluation of an implemented intervention.

PARTICIPANTS

Women who self-identified as speaking Somali, Arabic, or Serbo-Croatian (Bosnian) and were eligible for breast cancer screening at an urban community health center (HC). Comparison groups were English-speaking and Spanish-speaking women eligible for breast cancer screening in the same HC.

INTERVENTION

Patient navigators educated women about breast cancer screening, explored barriers to screening, and tailored interventions individually to help complete screening.

MAIN MEASURES

Adjusted 2-year mammography rates from logistic regression models for each calendar year accounting for clustering by primary care physician. Rates in refugee women were compared to English-speaking and Spanish-speaking women in the year before implementation of the PN program and over its first 3 years.

RESULTS

There were 188 refugee (36 Somali, 48 Arabic, 104 Serbo-Croatian speaking), 2,072 English-speaking, and 2,014 Spanish-speaking women eligible for breast cancer screening over the 4-year study period. In the year prior to implementation of the program, adjusted mammography rates were lower among refugee women (64.1 %, 95 % CI: 49–77 %) compared to English-speaking (76.5 %, 95 % CI: 69 %–83 %) and Spanish-speaking (85.2 %, 95 % CI: 79 %–90 %) women. By the end of 2011, screening rates increased in refugee women (81.2 %, 95 % CI: 72 %–88 %), and were similar to the rates in English-speaking (80.0 %, 95 % CI: 73 %–86 %) and Spanish-speaking (87.6 %, 95 % CI: 82 %–91 %) women. PN increased screening rates in both younger and older refugee women.

CONCLUSION

Linguistically and culturally tailored PN decreased disparities over time in breast cancer screening among female refugees from Somalia, the Middle East and Bosnia.

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Acknowledgements

The authors would like to thank the patient navigators and the Community Health Team at the MGH Chelsea HealthCare Center for their work on the program.

This program was funded by Susan G. Komen for Cure Massachusetts Affiliate Foundation. Drs. Percac-Lima and Atlas are supported in part from a grant from the Agency for Health Care Research and Quality (R18 HS018161).

The study was presented at the New England Meeting of the Society of General Medicine in Portland ME on March 23 2012, and at the Annual Meeting of the Society of General Medicine in Orlando, FL on May 10 2012.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Massachusetts General Hospital Chelsea HealthCare Center, 151 Everett Avenue, Chelsea, MA, 02150, USA

    Sanja Percac-Lima MD, PHD & Sarah A. Oo MSW

  2. Department of Medicine, Massachusetts General Hospital General Medicine Division, Boston, MA, USA

    Sanja Percac-Lima MD, PHD, Jeffrey M. Ashburner MPH & Steven J. Atlas MD, MPH

  3. Massachusetts General Hospital Cancer Center, Boston, MA, USA

    Barbara Bond LICSW, EdD

  4. Bridgewater State University, Bridgewater, MA, USA

    Barbara Bond LICSW, EdD

  5. Massachusetts General Hospital Center for Community Health Improvement, Boston, MA, USA

    Sanja Percac-Lima MD, PHD & Sarah A. Oo MSW

Authors
  1. Sanja Percac-Lima MD, PHD
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  2. Jeffrey M. Ashburner MPH
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  3. Barbara Bond LICSW, EdD
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  4. Sarah A. Oo MSW
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  5. Steven J. Atlas MD, MPH
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Correspondence to Sanja Percac-Lima MD, PHD.

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Percac-Lima, S., Ashburner, J.M., Bond, B. et al. Decreasing Disparities in Breast Cancer Screening in Refugee Women Using Culturally Tailored Patient Navigation. J GEN INTERN MED 28, 1463–1468 (2013). https://doi.org/10.1007/s11606-013-2491-4

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  • DOI: https://doi.org/10.1007/s11606-013-2491-4

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