MADRE (Mammograms Available Due to Research and Education)

There are populations at risk for late stage breast cancer (BC) diagnoses and worse post-diagnosis quality of life, including Latinas, in part due to non-adherence to guideline-concordant screening. Education+navigation (educate) approaches offer community education to address psychosocial barriers (e.g., fear) and navigate individuals to free/low-cost breast cancer care. Our transdisciplinary team has developed a promising empowerment+navigation (empower) approach that may lead to greater BC screening. In the empower approach, individuals who are non-adherent to US Preventive Services Task Force (USPSTF) guidelines learn about BC; are navigated to free/low cost breast cancer care; and gain communication skills to promote BC screening throughout their networks. Our premise is that empowering non-adherent individuals as breast health agents may lead to greater BC screening among non-adherent individuals and their networks than treating non-adherent individuals as passive recipients of education. The current proposal tests our premise and identifies “active ingredients” of the empower approach. In Aim 1, we will conduct an individual randomized controlled trial (RCT). Among non-adherent individuals, we will compare the effects of empower and educate approaches on initial and repeat BC screening, in line with USPSTF guidelines. In Aim 2, we conduct an observational social network study. We will recruit network members through nonadherent individuals enrolled in our RCT. Among network members, we will compare the effects of empower and educate approaches on initial and repeat BC screening across four years. In Aim 3, we will explore theoretical mechanisms of change that could contribute to intervention differences in BC screening. For non-adherent individuals’ BC screening, we will examine the mediating roles of greater BC knowledge and motivation to be healthy role model. For network members’ BC screening, we will examine the mediating role of non-adherent individuals’ enhanced capacity to promote BC screening. Specifically, we will test the independent effects of volunteerism in community BC initiatives, potential to “bridge” network members with formal change agents (e.g., community health workers, navigators), acceptability to promote BC, feasibility to promote BC, and BC promotion to network members. Our innovative, robust approach has direct implications for expediting the translation of promising community interventions into practice.