Mammography maintenance: A longitudinal, population-based study of insured women

by Gierisch, Jennifer Marie, Ph.D., THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL, 2008, 138 pages; 3331014


Early detection through mammography screening is an effective way to control breast cancer. Rates of mammography screening have increased dramatically over the last decade although recent data suggest that rates may now be declining. To reduce their risk of breast cancer morbidity and mortality, women should maintain regular on-schedule mammography use (i.e., mammography maintenance). Repeat use is a necessary step towards that goal. Many variables have been examined as predictors or correlates of repeat mammography use. However, few studies of mammography maintenance exist.

The data for these secondary analyses come from PRISM (Personally Relevant Information on Screening Mammography), a five-year health communication intervention trial. Participants in this study come from PRISM control group (n=1522). Predictors of interest were informed by behavioral theory and previous research on maintenance of health behaviors. Descriptive statistics and survival analysis were used to assess study aims. Mammography use was calculated at the end of each follow-up period (12, 24 and 36 months). Unsustained maintenance was defined as not having consecutive mammograms on schedule (10 to 14 months apart).

Only 38% of women sustained mammography maintenance over three years. We observed differences in the proportion of women endorsing attitudes and beliefs when trends were plotted according to on-schedule mammography use over time. When variables were examined in longitudinal models, women who reported less satisfaction with their past mammography experience, expressed lower self-efficacy, reported poor/fair health and reported barriers to getting a mammogram were more likely to be non-adherent to mammography maintenance over three years. Additionally, behavioral intentions were significant predictors of unsustained maintenance and mediated the effects of self-efficacy and barriers.

This study provides evidence that we have not yet achieved high levels of compliance with mammography maintenance. Even in a previously adherent, insured population, there still may be important cognitive variables that predict regular mammography use. Continuing to search for additional factors not tested in this study that affect long-term maintenance of episodic behavior remains important. At the same time, we should look at the modifiable factors confirmed as significant variables in this study in order to promote regular mammography use.

AdviserJo Anne Earp
Source TypeDissertation
SubjectsWomen's studies; Public health
Publication Number3331014

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