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Biomedical subjects

L Irwig

Publications and source records attributed to L Irwig.

15 recordsLinked to original sources
PubMed1992

The impact of a screening mammography program on Sydney general practitioners.

The aim of this study was to determine changes in Sydney general practitioners' (GPs) knowledge about, attitude towards and intention to recommend screening mammography over the two years since a screening mammography program was first implemented in the Central Sydney Health Service (CSHS) area. 123 GPs from the CSHS area were selected from a list maintained by the Breast X-ray Programme, while 127 GPs from the rest of Sydney were selected from the Yellow Pages telephone directory. The overall response rate was 84 per cent. Outcomes were assessed by a self-administered questionnaire covering knowledge, attitudes and beliefs, self-report of recent referral practice, intention to recommend, and sources of information about mammography screening. Demographic data were also collected. Results showed that overall knowledge has increased both inside and outside the CSHS area, but important deficiencies in knowledge remain in both areas. Attitudes to screening mammography have improved in the CSHS area, especially regarding the efficacy of screening mammography and patient compliance. Importantly, positive views of screening mammography have declined outside the CSHS area, especially about whether screening mammography can save women's lives. GPs in both areas remain concerned about costs. The presence and strategies of the Breast X-ray Programme have had some positive effect on the attitudes of GPs towards, but not knowledge of, screening mammography.

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PubMed1992

Evaluating the impact of a promotional campaign for screening mammography: who attends?

The Breast X-ray Programme of the Central Sydney Health Service is one of 11 pilot programs in Australia assessing the best methods of delivering population-based mammographic screening. The aim of this study was to determine the attendance rate and to describe sociodemographic predictors of attendance in an area serviced by the program. A well-defined population of approximately 4500 women aged 45 to 70 was identified within the Central Sydney area for intensive testing of recruitment strategies. After four visits (spanning two years) to the area by a mobile screening van, 48% of the women were screened. Women from non-English-speaking backgrounds were just as likely to attend as women from English-speaking backgrounds, probably because special attention was given to recruiting these women. Older women from English-speaking backgrounds were less likely to attend, whereas no age trend existed for women of non-English-speaking backgrounds. Sampled attendance data of women from English-speaking backgrounds showed that women with more education were more likely to attend screening. Women who were employed were just as likely to attend as those who were not. In order to screen 70% of the targeted population as set forth for a national mammography screening program, it appears that community recruitment efforts alone will not be sufficient. With special attention to recruitment coverage, older women and women from non-English-speaking backgrounds can be successfully recruited. Special attention will also need to be focused on encouraging attendance in women who have less formal education.

Age Factors↗
PubMed1992

Evaluating the impact of a promotional campaign for screening mammography: women's knowledge and sources of awareness.

The Breast X-Ray Programme of the Central Sydney Health Service was advertised by generalised strategies aimed at the total community, including poster and pamphlet distribution, and strategies aimed at general practitioners, supplemented by written invitations and recommendation from the general practitioner, invitations for friends, and invitations from the service using the electoral listing. In order to evaluate the reach or impact of the promotional campaign in the Drummoyne local government area, telephone interviews were conducted with women aged 45 to 70 randomly selected from the community. Women's knowledge about breast cancer, screening and the Breast X-Ray Programme, plus sociodemographic characteristics, were obtained before screening (n = 628), 10 months (n = 93) and 2 years after screening started (n = 206). While knowledge about risk did not change, significant increases were found in the proportion of women who had heard of mammography, screening mammography specifically and the screening van. In addition there were significant increases in the proportion of women exposed to information about screening mammograms. The campaign generally had an equal effect on different sociodemographic but managed to achieve greater effects in women of non-English-speaking backgrounds and lower occupational status. A random sample of program attenders aged 45 to 70 (n = 763) were asked how they found out about the van. 'Seeing the van' was the most consistently reported source of awareness. Others included 'GPs' 'newspapers', 'other print media' and 'personal networks'. Women with additional qualifications since leaving school were more likely to state 'newspaper' and 'other print media' as a source.

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PubMed1992

Ineffective recruitment strategies for screening mammography: letterbox drops and invitations for friends.

To test the effectiveness of two interventions to encourage women to attend for mammographic screening, four randomised trials of letterbox drops were conducted. Leaflets about the screening service (n = 3984) were distributed to households within defined areas. Attendance from the 79 streets where a drop was made was compared with attendance from 78 control streets before and after the drop. No major effects were found either within each trial or across trials. In the second intervention, 69 women who attended the service were offered invitations for two friends. An additional 21 attenders were approached with the offer of an incentive to recruit friends. Invitations included an explanatory letter with an appointment time, a pamphlet and a contact phone number. The final response rate was only 7% and an incentive of an instant scratch lottery ticket for the original attender did not improve the response. Thus we identified two interventions with no major effect in recruiting women to mammographic screening.

Australia↗
PubMed1991

Estimating an individual's true cholesterol level and response to intervention.

An individual's blood cholesterol measurement may differ from the true level because of short-term biological and technical measurement variability. Using data on the within-individual and population variance of serum cholesterol, we addressed the following clinical concerns: Given a cholesterol measurement, what is the individual's likely true level? The confidence interval for the true level is wide and asymmetrical around extreme measurements because of regression to the mean. Of particular concern is the misclassification of people with a screening measurement below 5.2 mmol/L who may be advised that their cholesterol level is "desirable" when their true level warrants further action To what extent does blood cholesterol change in response to an intervention? In general, confidence intervals are too wide to allow decision making and patient feedback about an individual's cholesterol response to a dietary intervention, even with multiple measurements. If no change is observed in an individual's cholesterol value based on three measurements before and three after dietary intervention, the 80% confidence interval ranges from a true increase of 4% to a true decrease of 9%.

Adult↗
PubMed1991

Development and validation of an instrument to measure satisfaction of participants at breast screening programmes.

A reliable and valid questionnaire has been developed to measure the satisfaction of participants with service offered at mammography screening programmes. The questionnaire measures five specific aspects: convenience and accessibility, staffs' interpersonal skills, information transfer between staff and client, physical surroundings and perceived technical competence of staff. A general satisfaction dimension was also included. Systematic procedures were followed to ensure that the initial pool of items met the criteria for satisfactory content validity. These procedures included extensive literature review and interviews with participants and service providers. Discriminant validity was assessed by a modified Q-sort procedure, where eight expert judges sorted items into relevant dimensions. The sample for other validity and reliability testing consisted of 584 women who were participants at a breast X-ray programme in Melbourne, Australia. Concurrent validity was demonstrated by considering the correlation of the sum of the subscale scores for each respondent with their score on the general subscale (r = 0.76; P less than 0.001). Multiple regression was used to provide further evidence for the discriminant validity of the proposed subscales and support for the multidimensional conceptualism of satisfaction. Scores on the general satisfaction subscale were used as an outcome variable and other subscale scores were predictor variables. All subscale scores significantly contributed to the prediction of satisfaction, over and above that of other subscales (R2 = 0.59). This indicates that these subscales are measuring distinct dimensions of satisfaction. Cronbach's alpha of each subscale was over 0.50, indicating that the subscales are reliable. The instrument is a potentially useful tool for assessing the quality of care at mammographic screening services and could be used routinely by such services to monitor satisfaction.

Australia↗
PubMed1991

Women's perceptions of screening mammography.

A random sample of women in Sydney were interviewed by telephone to determine their knowledge about and attitudes to mammography. A response rate of 56 per cent (628 women) was obtained. While the majority of women had had some experience with breast cancer, knowledge about which age groups were most at risk and treatment alternatives was limited. Only about half of the sample had heard about screening mammography before the survey. However, when a simple explanation was given, 79 per cent expressed a favourable attitude toward it. Only 22 per cent of women thought of themselves as being personally susceptible to breast cancer; the proportion was lower in women over 60 than in those in their 40s. Morbid concern about breast cancer was rare. About a quarter of the sample expressed concern about mammographically induced exposure to radiation. Attitudes and perceptions of personal susceptibility were not associated with knowledge about risks of breast cancer. However, having a favourable attitude and a lack of concern about radiation were associated with previously having heard about screening mammography. Women speaking a language other than English at home and from households where the main income earner was in an unskilled occupation were least likely to have heard of screening mammography. Suggestions for data-based recruitment strategies are discussed.

Attitude to Health↗
PubMed1991

A randomised trial of invitations to attend for screening mammography.

The aim of this study was to evaluate the effectiveness of invitations for mammographic screening. Women aged 45 to 69 who had not attended for screening at the mobile Breast X-Ray Programme of the Central Sydney Area Health Service were randomly selected from the 1989 electoral listing. In the geographical area in which the study was conducted (Drummoyne local government area), 36 per cent of women had attended for screening before the intervention, indicating that the invitations were aimed at the reluctant participant. Women were randomly allocated to a control group who did not receive invitations (n = 80), and an intervention group who received letters from the Program inviting them to attend at a specified time (n = 163). Overall 33 per cent of women (53 of 163) who were sent invitations attended for screening compared to 9 per cent of those not invited (7 of 80) (P less than 0.001). Older women responded at least as well as younger women. In addition, the distribution of language spoken at home was similar for electoral listing attenders and the community as a whole, suggesting that this intervention works as well for women of English- and non-English-speaking backgrounds. The results suggest that the response to an invitation for screening from a source not personally known to women achieves comparable attendance to an invitation from their general practitioner, as assessed in a previous study.

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PubMed1990

A randomised trial of general practitioner-written invitations to encourage attendance at screening mammography.

The aim of this study was to examine the effectiveness of general practitioner-written invitations to the Breast X-Ray Programme of the Central Sydney Area Health Service. Five out of six randomly selected general practices in Drummoyne participated. Within each practice, women aged 45 to 70 were individually randomised to receive or not receive a letter from their general practitioner (GP). Thirty-two per cent of women attended if invited compared to 7 per cent if they were not sent an invitation. An attendance of 38 per cent was obtained for women whose GP chose to send a letter with an appointment compared to 24 per cent for women whose GP chose to send a general invitation without an appointment. Combining all practices, women who consulted their GP within the previous 6 months were more likely to attend in response to the invitation (38 per cent) than women whose last consultation was more remote, dropping to 15 per cent in those who last attended that GP over 2 years earlier. Women aged 65 to 70 years old were at least as likely to respond to the invitation as women aged 45 to 64. Reminder letters were subsequently sent to a random half of nonrespondents who had attended the practice in the previous 12 months. A further 18 per cent of women attended after the reminder letter was sent (8/45), compared with 2 per cent in the control group (1/48). Twenty-seven per cent of women in Drummoyne had already attended for screening mammography before the trial.(ABSTRACT TRUNCATED AT 250 WORDS)

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