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A Meta-Analysis of Interventions to Promote Mammography Among Ethnic Minority Women

Han, Hae-Ra; Lee, Jong-Eun; Kim, Jiyun; Hedlin, Haley K.; Song, Heejung; Kim, Miyong T.

doi: 10.1097/NNR.0b013e3181ac0f7f

Background: Although many studies have been focused on interventions designed to promote mammography screening among ethnic minority women, few summaries of the effectiveness of the interventions are available.

Objective: The aim of this study was to determine the effectiveness of the interventions for improving mammography screening among asymptomatic ethnic minority women.

Methods: A meta-analysis was performed on intervention studies designed to promote mammography use in samples of ethnic minority women. Random-effects estimates were calculated for interventions by measuring differences in intervention and control group screening rates postintervention.

Results: The overall mean weighted effect size for the 23 studies was 0.078 (Z = 4.414, p < .001), indicating that the interventions were effective in improving mammography use among ethnic minority women. For mammography intervention types, access-enhancing strategies had the biggest mean weighted effect size of 0.155 (Z = 4.488, p < .001), followed by 0.099 (Z = 6.552, p < .001) for individually directed approaches such as individual counseling or education. Tailored, theory-based interventions resulted in a bigger effect size compared with nontailored interventions (effect sizes = 0.101 vs. 0.076, respectively; p < .05 for all models). Of cultural strategies, ethnically matched intervention deliveries and offering culturally matched intervention materials had effect sizes of 0.067 (Z = 2.516, p = .012) and 0.051 (Z = 2.365, p = .018), respectively.

Discussion: Uniform improvement in mammography screening is a goal to address breast cancer disparities in ethnic minority communities in this country. The results of this meta-analysis suggest a need for increased use of a theory-based, tailored approach with enhancement of access.

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Hae-Ra Han, PhD, RN, is Associate Professor, School of Nursing; Jong-Eun Lee, PhD, RN, is Postdoctoral Fellow, School of Nursing; Jiyun Kim, PhD, RN, is Postdoctoral Fellow, School of Nursing; Haley K. Hedlin, BA, is Doctoral Student, Bloomberg School of Public Health; Heejung Song, PhD, is Research Associate, Bloomberg School of Public Health; and Miyong T. Kim, PhD, RN, FAAN, is Professor, School of Nursing, Bloomberg School of Public Health, and School of Medicine, The Johns Hopkins University, Baltimore, Maryland.

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Accepted for publication March 12, 2009.

This study was supported by a grant from the National Cancer Institute (R01 CA129060). Editorial support was provided by the Johns Hopkins University School of Nursing Center for Collaborative Intervention Research. Funding for the Center is provided by the National Institute of Nursing Research (P30 NRO 8995). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.

Corresponding author: Hae-Ra Han, PhD, RN, School of Nursing, The Johns Hopkins University, 525 North Wolfe Street, Room 448, Baltimore, MD 21205-2110 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.