Greenberg, Grant M, M.D., M.H.S.A., M.A.

Johnson, Melanie B, MPA

Rangoola, Jasmine

Shaak, Kyle, BS

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationA MIXED METHODS APPROACH TOEXPLORING BARRIERS TOMAMMOGRAPHY COMPLETION.Jasmine RangoolaEast Stroudsburg University of PennsylvaniaGrant M. Greenberg M.D., M.H.S.A., M.A.Lehigh Valley Health Network, grant.greenberg@lvhn.orgMelanie B. Johnson MPALehigh Valley Health Network, Melanie_B.Johnson@lvhn.orgKyle Shaak BSLehigh Valley Health Network, Kyle.Shaak@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtRangoola, J., Greenebrg, G., Johnson, M., Shaak, K., (2017, July, 31) A Mixed Methods Approach To Exploring Barriers ToMammography Completion. Poster presented at: LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network,Allentown, PA.© 2017 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaA MIXED METHODS APPROACH TO EXPLORING BARRIERS TO MAMMOGRAPHY COMPLETION• Breast cancer (BC) is one of the most common cancer among women in United States (1).• Mammograms are the best way to find breast cancer early(2).• Department of Family Medicine at Lehigh Valley Health Network (LVHN) has a mammography rate of 67%. • Healthy People 2020 has a target of 81.1% for women aged 50-74 years who had a mammogram in the past 2 years (3).• The purpose of the study was to identify individual and systemic barriers for mammography screening and propose measures or interventions for addressing those barriers. REFERENCES1.Centers for Disease Control and Prevention. (2016). Breast cancer statistics. Retrieved from https://www.cdc.gov/cancer/breast/statistics/index.htm2. Centers for Disease Control and Prevention. (2016b). What is a mammogram. Retrieved from   https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm3. Office of Disease Prevention and Health Promotion. (2017). Cancer. In Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Cancer/objectives#40554. Champion, V.L., & Skinner, C.S. (2008). The Health Belief Model. In K. Glanz, B.K. Rimer, & K. Vishwanath (Eds.) Health behavior and health education: Theory, research, and practice (4th ed) (pp. 45 - 65).San Francisco, CA: Jossey BassJasmine Rangoola, MPH Candidate, Grant Greenberg, MD, MHSA, MA, Melanie Johnson, MPA & Kyle Shaak, MPHBACKGROUND / INTRODUCTIONMETHODSRESULTS RESULTSRECOMMENDATIONS• Conducted at 4 Practices and 1 Breast Health Services (BHS) site• Based on Health Belief Model (4)• 260 patients were called, 24  completed Interviews• Baseline screening rates• Identification of practice samples• Demographic variables• Background and significance, Known barriers and Previous ResearchLiterature SearchBaseline Data AnalysisStaff Interviews & ProcessObservationPatientTelephonic Interviews• Four Lehigh Valley Physician Group (LVPG) Family Medicine Practices  and 1 Breast Health Services (BHS) Location were identified for the Mixed Methods approach, including patient sampling,  staff interviews and workflow mapping.• Informal patient interviews were conducted with women meeting criteria: aged 50-74, active patient at one of the 4 identified practices, English-speaking, with no documented breast cancer screening in the last 24 months. Patient Participant Demographics:Medicare (41.7%), Private insurance (50%) & Medicaid (8.3%)Not Hispanic (83.3%), Hispanic (12.5%) & Unknown (4.2%) Average Age of Participants: 61.1 yearsPatient Interviews Data: HEALTH BELIEF MODEL• Only 25% said that they were at risk of developing BCPerceived Susceptibility • 70.8% considered BC as seriousPerceived Severity• 62.5% said mammography screening has some benefitsPerceived Benefits• 66.7% were very likely/likely to go for mammography in future. Self -EfficacyThrough both the patient and staff interviews, systematic barriers were identified and coded according to the following themes: process, communication gap, technology, access and resources.   Process• No scheduling on same day• Script/Order for self-referrals• No follow up of overdue patientsCommunication Gap• Location, Timings, Insurance• Coordination with BHS• No standard guideline is followed• Gap between perceived barriers by patients and staffTechnology• 79.2% of the participants had missing EPIC mammography records• No caller ID display of LVHNAccess• Need more morning and evening hours according to staffResources• Outdated location handouts• No Breast Cancer Screening Brochures at some practices• Implementation of Caller ID displaying hospital name.• Educate patients on importance & value of screening, & risk for BC.• Educate patients & staff on near universal coverage for mammography screening. • Add information on mammography locations in EPIC After Visit Summary or provide a map of locations & hours of the BHS sites.• Streamlining processes for self-referred & overdue patients.• Assessment of screening rates through web-portal scheduling, once active• Determinate and disseminate Breast Health Imaging Guide & standard guidelines• Improve capturing of internal & external data for mammograms in EPIC to avoid measurement errors.• Convenience scheduling pilot (in office scheduling)• Compare and learn from processes of colon cancer screening at LVHN.• Further research on need for resources, marketing, availability of hours and preference of timings by the patients is required.• Friends/ Relatives advise: 54.2%• Physician Recommendation: 45.8%• Reminders: 45.8%• Talking to someone who has had one: 37.5%• Web-Portal Scheduling: 33.3%• Advertisement: 25%• If there is a concern: 16.7%• Family History of Cancer: 4.2%• Proper Follow up after screening: 4.2%Cues to Action41.7%25.0% 25.0%20.8% 20.8%16.7% 16.7%12.5% 12.5% 12.5% 12.5%16.7%0%5%10%15%20%25%30%35%40%45%Perceived Barriers for Mammography

A MIXED METHODS APPROACH TO EXPLORING BARRIERS TO MAMMOGRAPHY COMPLETION.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1530&context=research-scholars-posters

A MIXED METHODS APPROACH TO EXPLORING BARRIERS TO MAMMOGRAPHY COMPLETION.

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