Do Community Health Worker Interventions Improve Rates of Screening Mammography in the United States? A Systematic Review

Background—Community health workers (CHWs) are lay individuals who are trained to serve as liaisons between members of their communities and healthcare providers and services. Methods—A systematic review was conducted to synthesize evidence from all prospective controlled studies on effectiveness of CHW programs in improving screening mammography rates. Studies reported in English and conducted in the United States were included if they: (1) evaluated a CHW intervention designed to increase screening mammography rates in women 40 years of age or older without a history of breast cancer; (2) were a randomized controlled trial (RCT), case-controlled study, or quasi-experimental study; and (3) evaluated a CHW intervention outside of a hospital setting. Results—Participation in a CHW intervention was associated with a statistically significant increase in receipt of screening mammography [Risk Ratio (RR):1.06 (favoring intervention); 95% Confidence Interval (CI:1.02, 1.11),p=0.003]. The effect remained when pooled data from only RCTs were included in meta-analysis (RR:1.07,95 % CI:1.03,1.12,p=0.0005), but was not present using pooled data from only quasi-experimental studies (RR:1.03,95 % CI:0.89,1.18,p=0.71). I