A cross-cultural consumer-based decision aid for screening mammography

Background. "Women should have mammograms" is the usual perspective of educ ational interventions about screening. The perspective that ''women should be informed'' about potential risks and benefits so they can make value- an d evidence-integrated personal decisions has recently been advocated. Howev er, this perspective has not previously been operationalized. we developed an evidence-based cross-cultural mammography decision aid (MDA), for Europe an American and Mexican American women who are 50-70 years old at average r isk of breast cancer, of varying educational levels, and English- or Spanis h-speaking. Methods. MDA development included: (1) content development by a multidiscip linary team and lay women and (2) testing for validity and reliability, Fou r parts include: (1) introduction; (2) information about logistics (cost, t ime, discomfort) and risks (sequelae of false-positive or negative results; (3) probability of developing breast cancer; and (4) benefit of mammograph y regarding breast cancer outcomes (e.g., death and recurrence). We assesse d reliability (stability of decisions with the same information) after 1-2 weeks. We assessed validity (comprehension of information) quantitatively ( probabilities were changed to see whether preferences changed predictably) and qualitatively (focus groups, standardized probes for comprehension). Su bjects were a convenience sample of 49 European American (50-81 years old) and 54 Mexican American (49-89 years old) women from administrative staff a t a medical school, the waiting room of an indigent primary care clinic, an d a community center. Results. Reliability was 100%. In quantitative validity testing, 22 of 28 w omen (89%) changed preference as predicted with changed probabilities, Comp rehension was confirmed qualitatively in all phases of testing with both Sp anish and English versions. Conclusion, The decision aid is valid and reliable in English and Spanish f or southwestern Mexican American and European American women at average ris k of breast cancer, including those of low educational levels. (C) 2000 Ame rican Health Foundation and Academic Press.