The methods for the meta-analysis are described more fully elsewhere (see Meissner et al., 1998, and Legler et al., 2002). Briefly, using accepted meta-analytic methods, the authors conducted extensive searches of the literature, then constructed a database of the 51 studies that focused on breast cancer screening. Articles that were retained in the analysis were those that met the following criteria:
Objectives were to increase use of mammography among asymptomatic women in diverse populations;
Reports of intervention outcomes were based on actual receipt of mammograms, either by self-report or verified report in a clinical database or medical record; and
Studies used experimental or quasi-experimental designs.
Ultimately, 38 controlled, experimental, and quasi-experimental interventions that specifically focused on or reported separate mammography outcomes for diverse populations were included in the meta-analyses.
Interventions were categorized according to Rimer’s (Rimer, 1994; Meissner et al., 1998; Rimer et al., 2000a) typology: access enhancing (e.g., transportation to appointments, mobile vans, vouchers, and reduced-cost mammograms), system directed (e.g., provider prompts), individual directed (e.g., one-on-one counseling, tailored and untailored letters and reminders, telephone counseling), community education, social network (e.g., peer leaders, lay health advisors), mass media, and multistrategy interventions (see Table 4-1).
The outcomes were study-specific adherence rates. The definition of adherence was provided by each study author. This allowed for the inclusion of a wider range of studies both with respect to followup time and study type. Because the field has been evolving, definitions have changed over time. Generally, study outcomes typically were described as obtaining a mammogram within a specified number of months; the time period varied from study to study.