Friend to Friend

Racial and ethnic differences exist in breast cancer survival rates. The prevalence of late stage disease may be attributable to poverty. Low-income women often face such barriers to access as cost, lack of regular health care, inadequate health insurance, and they may seek health care for acute conditions rather than prevention. Higher levels of routine mammography should substantially improve breast cancer survival among groups where screening utilization is relatively low.

Friend to Friend (FTF) is a multidimensional community-based intervention to increase mammography utilization among low-income women living in public housing high rise apartment complexes. The intervention is intended to promote awareness about the benefits of mammography and address individual knowledge, attitudes, and beliefs concerning breast cancer and mammography. FTF uses the social dynamics within each housing unit to change assumptions about breast cancer screening and to provide an immediate opportunity for women to make a screening commitment.

Social networks in the buildings were intended to provide opportunities for observational learning, reinforcement, and emotional support to help overcome perceived barriers associated with mammography.

The intervention was designed to work through local community organizations and peer volunteers to optimize the generalizability of the approach and to increase the likelihood that the program would be sustained after the study period.

The main intervention consists of a one-hour event conducted in the housing unit. The intervention is conducted once a year in each intervention building during each of the two years of the intervention period. Continued outreach by women who attended is recommended.

Participants were low-income, underserved women living in public high-rise apartments, aged 40 years and older. About half the participants had not had a mammogram within the past 15 months.

The intervention is suitable for implementation in community settings and public housing developments.

Required resources include the FTF educational manual concerning facts about breast cancer and mammography and the FTF volunteer handbook. A physician or nurse is required to give an oral presentation to participants about the benefits of early detection and mammography. Costs associated with the program's implementation are not provided.

For the intervention, 41 high rise buildings were randomized to either the treatment (FTF) or a delayed treatment (control group). Intervention consisted of building-wide recruitment activities, an hour-long event in each building, and outreach by participants to non-participants. Recruitment activities consisted of general building-wide publicity such as flyers, posters, and presentations at resident council meetings. The core of FTF was the hour-long event promoted as a party to building residents. The party consisted of three main components:

1. presentation by a physician or nurse about the benefits of early breast cancer detection through mammography,
2. facilitator-led small group discussion, and
3. a session in which facilitators offered to help women prompt their physicians to offer them mammograms.

Women who attended these parties were encouraged to invite neighbors and friends who had not attended a party and to request a mammogram or a mammogram reminder from an FTF volunteer.

Results indicated:

• At follow-up, 64% of the women in the treatment group compared to 52% in the control group reported having had a mammogram in the past 15 months.