The Delta project: increasing breast cancer screening among rural minority and older women by targeting rural healthcare providers.

PURPOSE/OBJECTIVES To test a multimethod approach designed for rural healthcare providers to increase breast cancer screening among low-income, African American, and older women. DESIGN Two-year experimental pretest/post-test with random assignment by group. SETTING Primary healthcare providers' offices. SAMPLE 224 nurses, physicians, and mammography technicians. METHODS Standardized patients to observe and record healthcare providers' performances, followed by direct feedback, newsletters, posters, pocket reminder cards, and lay literature about screening to use in clinics. MAIN RESEARCH VARIABLES Healthcare providers' knowledge and attitudes as measured by survey responses, skills as measured by a checklist, and the provision of breast cancer screening as measured by mammography facilities' data. FINDINGS Healthcare providers significantly improved in demonstration of breast cancer screening practice after the intervention. Nurses performed significantly better than physicians on the breast examination during the post-test. More women older than 50 received mammograms in the experimental counties than in the comparison counties. Culturally sensitive lay literature is needed for African American women with low literacy. CONCLUSIONS Successful interventions included use of standardized patients to teach healthcare providers in their office settings, prompts such as posters and pocket reminder cards, and easy-to-read newsletters. IMPLICATIONS FOR NURSING Physicians and nurses play a powerful role in motivating women to have mammograms and clinical breast examinations and to practice breast self-examination. Interventions that help these providers fulfill that role should be implemented.