Purpose Though mammography screening can decrease breast cancer mortality, actual mammography screening remains low. Health literacy may be a barrier to obtaining a mammogram. There is conflicting evidence as to which method is the most effective in educating low-literate women and increase mammography screening. The objective of this research was to evaluate the effectiveness of a multimedia breast cancer education program compared to a standard breast cancer brochure among women with low health literacy.
Methods Minority women between the ages of 50 and 69 who were patients of the urgent care clinic of a large urban hospital and who had not received a mammogram within the previous year were recruited by a research assistant from August 2003-2004. Baseline questionnaires and health literacy assessments were administered. Information on income, education level, general health, and mammography status were collected. Health literacy levels were assessed using the 66-item Rapid Estimate of Adult Literacy in Medicine (REALM) screening instrument. Participants were randomized into the brochure or multimedia CD group. Post-test questionnaires were administered immediately after completing the intervention.
Results 56 women participated in the study, with 21 in the multimedia group and 35 in the brochure group. Groups did not differ significantly by race/ethnicity, marital status, income, education, health literacy level, or past mammography history. There were no significant differences at baseline between the groups for breast cancer/screening knowledge, likelihood of obtaining a mammogram, cancer beliefs, perceived cancer risk, perceived treatment response efficacy, and barriers to obtaining a mammogram. There were no significant differences between groups at post-test for knowledge, beliefs, response efficacy, and barrier scores. Those in the multimedia group had higher likelihood mean scores (18.29) than those in the brochure group (17.09) (p = .058), indicating greater intention to obtain a mammogram. No significant differences were found between groups in the number of women who obtained mammograms within 9 months of receiving the intervention, however.
Conclusions Future research is needed to replicate the study with a larger sample size. Lower-cost health education materials, such as brochures and videos, may be more appropriate educational tools until the efficacy of multimedia interventions in low-literacy populations have been proven.
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