BACKGROUND
The goal of the Mammography Access Project is to increase the rates of mammography screening among women with mobility disabilities. The project involves two phases: (1) training of mammography technicians to better serve the needs of women with disabilities and perform an effective mammogram, and (2) accessibility assessment of every mammography facility in the state using the Mammography Facility Assessment for Disability Access. When accessibility assessments are complete, project staff provides technical assistance and recommendations for modifications that can improve access for women with disabilities.
NAME THE ISSUE/PROBLEM/ GOAL TO BE ADDRESSED
JUSTIFY THE PRIORITY ISSUE(S)/PROBLEM(S)/ GOAL(S) TO BE ADDRESSED.
Women with disabilities, an estimated 27 million population, have the same need for preventive health screenings as women without disabilities. Yet many women with disabilities do not receive these screenings; according to the Behavioral Risk Factors Surveillance Systems (BRFSS) for 2008, only 72.2 percent of women aged 40 and older with mobility impairments had a mammogram within the past year, compared to 77.8 percent of women without disabilities. Part of the problem is that there are numerous barriers to receiving mammograms for women with disabilities, including inaccessible mammography machines, physical barriers within medical facilities, and lack of knowledge and understanding by staff regarding how to help with positioning and transfers. Early detection is an important factor in breast cancer survival rates, and a lack of access to routine, properly administered screenings puts women with disabilities at higher risk for poor outcomes.
STATE THE ISSUE/PROBLEM/GOAL TO BE ADDRESSED
Too few women with disabilities receive mammograms.
ANALYZE THE ISSUE OR PROBLEM
Ask questions about the issue/ problem/ goal to identify key behaviors and actors and their consequences
The behaviors of women with disabilities; health care professionals; health care providers; and public health professionals need to change to address the problem.
The specific behaviors that need to change include the following:
- Women with disabilities need to gain appropriate knowledge regarding cancer screening and the importance of mammograms, and need to access mammograms for their preventive health.
- Health care professionals should be trained on how to accommodate women with disabilities, such as positioning needs when performing a mammogram.
- Health care providers should provide mammography sites that are easily accessible to women with disabilities and comply with the Americans with Disabilities Act Accessibility Guidelines.
- Public health professionals should advocate for accessible mammography sites and include women with disabilities in public awareness campaigns about breast cancer.
Women with disabilities are affected by this problem because a lack of screening can lead to greater risk of not finding cancer until it is in an advanced stage, leading to a poor prognosis. The families of these women can be affected financially or emotionally or both, especially if cancer is found at a later stage. In a broader sense, the community as a whole may be affected because of cost of care if extensive medical bills are incurred.
Analyze "root" causes or problem to identify the conditions/behaviors, and related interventions, that might contribute to improvement (but, why? analysis)
"Root"cause #1
The problem is that too few women with disabilities are receiving mammograms.
- "But, why?" Because they are unaware of cancer screening importance.
- "But, why?" Because women are not encouraged to receive screenings by their health care providers.
- "But, why?" Because preventive health screenings, such as mammography, are not viewed as a top priority for women with disabilities.
Based on the analysis of "root" causes to the problem, these specific conditions and possible interventions can be identified:
- Too little information about breast cancer screening is made available to women with disabilities (Provide information to the disability community)
- Health care providers are not providing screenings or encouraging patients with disabilities to receive mammograms. (Educate providers and provide information on accommodating women with disabilities)
"Root" cause #2
The problem is that too few women with disabilities are receiving mammograms.
- "But, why?" Because they are unable to access the mammography site or mammography equipment.
- "But, why?" Because health care providers do not know how to make facilities and mammography equipment accessible to women with disabilities.
- "But, why?" Because the access needs of women with disabilities are often overlooked.
Based on the analysis of "root" causes to the problem, these specific conditions and possible interventions can be identified:
- Mammography sites are not accessible to women with disabilities. (Assess the accessibility of sites and provide recommendations to improve access.)
- Mammography equipment is not accessible to women with disabilities who cannot stand or position themselves and technicians are not trained to position women with limited mobility. (Obtain accessible equipment and train providers to position and accommodate women with disabilities.)
IDENTIFY RESTRAINING AND DRIVING FORCES THAT AFFECT THE ISSUE OR PROBLEM
A lack of mammography awareness and accessibility rights keeps women with disabilities in the same situation: they're not obtaining breast cancer screenings. However, the public health community and the disability community are working to raise awareness of the issue. These forces can bring about change and affect the problem when directed at the two audiences vital to the cause: health care providers and women with disabilities.
A restraining force is the possible cost of retrofitting health care facilities that were not initially designed to be accessible.
FIND RELATIONSHIP AMONG THE ISSUES/ PROBLEMS /GOALS
The priority issue is breast cancer screening among women with disabilities. Women with disabilities are also likely to experience similar barriers to other health care services; if women with disabilities are not receiving mammograms, it is likely that they are not receiving other screenings such as pap smears. A comprehensive approach to health care for women with disabilities that looks beyond specific screenings provides an overall focus on health and wellness.