Date of Award

Winter 2005

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Laurel Garzon

Committee Member

Karen Karlowicz

Committee Member

John Lombard


Community health worker (CHW) interventions promote early detection of breast cancer and mammography use to help eliminate health disparities for minority and low-income women. Data trends show lower mammography use among this population although CHW interventions have been shown to promote mammography use. However, CHW interventions have not been tested sufficiently to examine the factors that influence mammography use of CHWs.

This cross-sectional study examined the factors that influence mammography use of CHWs and the relationship of self-efficacy, social norms, and mammography use of CHWs. The PRECEDE model served as the framework combining social factors, beliefs, attitudes, behaviors, and accessibility of resources for this mixed methods study.

Self-reported data from mailed surveys were obtained from a convenience sample of volunteer CHWs (n = 109) from two urban areas in Virginia. Perceived susceptibility, barriers, benefits, and health motivation were measured using Champion's Health Belief Model Scale (1999). Perceived self-efficacy and social norms were measured using Egbert and Parrott's Social Cognitive Scale for Female Cancer Screening (2001). Qualitative data from two in-depth CHW interviews and a CHW focus group were examined to explore how the factors influence mammography use of CHWs and social settings that define health behaviors.

The logistic regression analysis revealed barriers to be predictive of mammography use of CHWs controlling for self-efficacy, social norms, health motivation, and age. Qualitative results showed additional barriers of cost, insurance, and transportation as factors that hindered mammography use and family support as a factor that facilitated mammography use.

Findings from this study provide a clear direction for planning effective CHW interventions using a needs assessment based on PRECEDE. Results suggest identifying and addressing specific barriers to increase the likelihood of mammography use and teaching strategies to increase self-efficacy of CHWs. Further research is needed to confirm the findings of this study and identify cultural differences for the factors that influence mammography use of CHWs.