Native American recruitment into breast cancer screening: The NAWWA project

Background. American Indian women's historically low breast cancer incidenc e and mortality rates have gradually increased such that in many parts of t he United Stares they equal "U.S. All Races" rates. Thus, American Indian w omen need screening to maintain their low rates. Methods. In an outreach pr ogram, local American Indian women were trained as lay health advisers, "Na tive Sisters," to Locate and contact American Indian women in the Denver me tropolitan area and provide education and encouragement to increase partici pation in mammography screening. Participation was monitored and interviews collected descriptive information and information about risk factors for b reast cancer. An interrupted-time-series design was used to assess changes in mammography participation. Results. The NAWWA program increased recruitm ent of American Indian women (p < 0.05). Women recruited by the Native Sist ers were more likely to be currently on hormone replacement therapy and to be menopausal. Conclusions. The lay health adviser program was effective in recruiting American Indian women to have screening mammography. Barriers t o participation were complex and often involved cultural values and beliefs .