Using an integrated social-behavioral text message approach to improve screening mammography in African American women.

Abstract

240 Background: The rate of breast cancer among Black and White women is nearly equivalent but the death rate is 40% higher for Blacks. This disparity is often attributed to lower screening mammography rates in Black women. The effectiveness of text messages on increasing screening mammography among Black women is not well known. Importantly, the themes that are most effective at promoting behavioral changes in Black women’s breast cancer screening practices through text message interventions have not been explored. An integrated social-behavioral approach was used to identify themes associated with Black women’s response to two types of text messaging: reminder and educational texts. Methods: A qualitative study was conducted in Metropolitan Baltimore with two focus groups among Black breast cancer survivors. Participants completed a demographic survey and indicated text messaging practices and preferences for future breast screening texts via survey. Participants provided feedback on a series of 17 educational and reminder text messages. Focus groups were digitally recorded and transcribed for analysis. Text message preferences were analyzed using a content analysis approach. Multiple themes were identified, discussed and recorded. Results: 17 participants had an average age of 60. All participants reported cell phone ownership and 82% of participants reported texting. 46% reported an interest in reminder text messages and 54% reported an interest in educational text messages. Four main themes were derived from participants’ responses the text message series: 1) access to cancer care surveillance, 2) social network support, 3) patient-centered approach, and 4) self-advocacy. Text messages that included themes of self-advocacy, social network support, and patient-centered approach generated positive responses and the text messages that included access to cancer care surveillance were perceived as demotivating. Educational text messages were perceived to be more motivating than reminder text messages. Conclusions: Breast cancer screening behaviors are affected by various demographic, social-behavioral, and socioeconomic factors. The findings from this study suggest that developing an educational text message content that incorporates social and behavioral themes focusing on the patient may be more beneficial to improve breast cancer screening rates in this population.

Behavioral Interventions to Improve Breast Cancer Screening Outreach

“…Our findings are consistent with other text messaging studies for preventive health activities . We did not find an increase in obtaining a mammogram from text messaging among Black women, which is surprising as qualitative studies have shown acceptability and potential in the use of text messaging in this population …”

“…21,[27][28][29][30] We did not find an increase in obtaining a mammogram from text messaging among Black women, which is surprising as qualitative studies have shown acceptability and potential in the use of text messaging in this population. 31,32 In trial B, there was a 1.1-percentage point higher response to the clinician endorsement letter that was not statistically significant. There are a few reasons that might explain this finding.…”