Women who volunteered to dispense health information in local communities without pay succeeded in boosting the number of older black women in eastern North Carolina who underwent mammography by 6 percent, a new study concludes. Such volunteers, known as lay health advisers, increased the number of lowest-income black women who took the sometimes life-saving test by 11 percent.

Researchers at the University of North Carolina at Chapel Hill schools of public health and medicine and the UNC Lineberger Comprehensive Cancer Center conducted the study. Their goal was to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a UNC-based network of advisers intended to boost screening among rural black women over age 50.

"Even though African-Americans are less likely than whites to develop breast cancer, as a group they are more likely to die from it," said Dr. Jo Anne L. Earp, the study's leader. "Among the reasons are that they are screened less often, and their breast cancers are detected at later, more advanced stages."

Earp and her colleagues first established the intervention and network in 1992. The latest research is based on 801 black women who completed both a baseline survey and a follow-up three years later.

"Our new study demonstrates that although intensive, a lay health adviser network intervention, supplemented by efforts to increase access and quality, appears effective and may be the best community-based approach for increasing mammography use among these women," said Earp.

A report on the work appeared in the American Journal of Public Health. The research involved detecting changes in mammography use in five "intervention" counties relative to comparison counties, where no special mammography promotion efforts took place.

"After we trained them, our 140 or so lay health advisers-all middle-class women-went to work talking to their neighbors, their relatives and anyone they could reach in churches, senior centers, health fairs and nutrition sites," Earp said. "Besides boosting breast cancer screening rates among low-income black women, they also broke the silence-the stigma that used to be attached to breast cancer in their communities."

Preliminary analyses of data from a second follow-up done in 2000 suggest the screening gains have remained, even though the formal part of the program ended, she said.

"To me the fascinating thing is that once a lay health adviser, always a lay health adviser," Earp said. "Well over 100 of these women are still active and just won't quit. They say, 'Teach us more-about diabetes, hypertension, arthritis and other topics.' They are hungry for learning, and they love making a difference."

SOURCES:
American Journal of Public Health, April 2002; 92(4):646-654
University of North Carolina at Chapel Hill (http://www.unc.edu)