Empower + Logistic Assistance

According to 2024 estimates, there are more than 300,000 new cases of breast cancer and over 40,000 breast cancer deaths per year. The U.S. Preventive Services Task Force recommends biennial screening mammography for women aged 40 to 74 years. Screening can detect breast cancer at an early stage to maximize the potential for treatment to be effective. 

Multicomponent interventions such as patient navigation, group education, and engagement with community health workers (CHW) are recommended strategies to increase mammography screening rates. Programs that include multiple approaches are more likely to see screening uptake, and this can be particularly important for Latina women, who have a lower rate of mammography screening compared with White and Black women. Evidence demonstrates a need for CHW-led interventions to engage Latina women and encourage timely mammography screening.

Empower + Logistic Assistance is a culturally tailored intervention designed to increase mammography among Latina women aged 50 to 74 years. Based on the health belief model, social cognitive theory, cognitive dissonance theory, and volunteerism models, the intervention aims to educate participants about breast cancer screening and empower them to become breast cancer health promotion advocates among their social networks and in their communities. Empower + Logistic Assistance consists of three weekly 2-hour group sessions followed by five monthly phone calls. 

Led by CHWs, each of the three group sessions includes a presentation of empirical information, CHW testimonials about their personal experiences or family’s experiences with breast cancer, group discussions about the topic and how to take action, and development of individual action plans and checklists. The three sessions cover the following information:

-- Session 1, Personal Breast Cancer Screening. This session provides information on breast cancer screening, screening guidelines, and the benefits of early detection. 
-- Session 2, Family and Friends’ Breast Cancer Risks and Needs in Networks. This session provides information on screening in relation to immediate networks of participants, with the focus on information diffusion to family and friends. It includes a role-playing component.
-- Session 3, Community’s Breast Cancer Risks and Needs. This session provides information on screening in relation to the communities at large, with a focus on cancer health volunteerism in community-based breast cancer initiatives. Opportunities are presented for participants to sign up for local community volunteer events. 

After women participate in the sessions, they receive logistic assistance during five monthly booster phone calls with field assistants (FAs). During the calls, FAs share their own experience with screening and discuss screening barriers, such as those related to costs and transportation. FAs also offer to help overcome barriers, refer women to low-cost screening, and provide assistance to women for their appointments.

-- 40 hours for CHW orientation training (on how to identify eligible women and lead the group sessions) and ongoing booster trainings 
-- 40 hours for field assistant orientation training (on how to schedule group sessions and lead booster calls) and ongoing booster trainings 
-- 6 hours for three 2-hour group sessions
-- 1 hour for five monthly booster calls for each participant

The intended audience for the program is Latina women aged 50 to 74 years.

The program is suitable for implementation in community settings.

Required resources to implement the program include the following:
-- Empower + Logistic Assistance PowerPoint presentations for group sessions (English and Spanish)

To access these resources, click on view Program Materials.

This quasi-experimental pilot study involved two community-based organizations in Chicago. One in West Chicago (n=76 participants) implemented the Empower + Logistic Assistance intervention, and one in South Chicago (n=69 participants) implemented a comparison program, Educate + Logistic Assistance. Both communities were largely Latino (at least 65%), with 30% of the population between 100% and 199% of the federal poverty level. The intervention and comparison conditions were identical in format and duration, and both included logistic assistance, but the Educate + Logistic Assistance comparison condition provided information and activities to encourage participants’ self-efficacy and behavior change, specifically in the areas of breast cancer screening, diet, and physical activity, while the Empower + Logistic Assistance intervention addressed participants’ skills in becoming breast cancer health promotion advocates within their social networks. 

Recruitment was done by CHWs, who distributed fliers and interacted with women at in-person events and online, and by participants, who could recruit peers. Participants were eligible if they were Latina women aged 50 to 74 years old, resided in one of the two designated neighborhoods, did not have a breast cancer history, had not obtained a mammogram within the past 2 years, and had no history of volunteering in health-related activity. 

Most participants were 52 to 64 years old (68%) with others being 65 to 74 years old (32%). Most participants identified Mexico as their country of birth (83%). 

The primary outcome was mammography attainment within 6 months of the intervention. This outcome was assessed using medical record data.

• At 6-month follow-up, a higher percentage of intervention than comparison group participants had attained mammography screening (p<.0001).