Breast and Cervical Cancer Screening: Reaching Women with Disabilities in Alaska

INTRODUCTION: Health disparities in cancer morbidity and mortality are important public health problems. The National Cancer Institute reports that lower rates of cancer screening contribute to more advanced disease at diagnosis and higher cancer death rates.  Approximately one in five women in the U.S. experience disabilities and often lack access to health services. Access to cancer screening services may be very limited, especially among low-income women. In Alaska, the influence of climate, geography and public transportation intensify problems with access to cancer screening services. The purpose of this study was to learn if low-income women with disabilities living in the community have reduced access to and participation in cancer screening services for breast and cervical cancer. The goal was to identify and understand barriers in order to improve access to services. METHODS: Using a community-based, mixed methods approach, a structural barriers framework guided the retrospective cohort study. Specific aims: explore how socioeconomic status, ethnicity, living situation, location of health care providers, insurance status, disability type and severity affect access to services; and assess how external factors, i.e., informational, attitudinal and environmental barriers, influence access to services. Criterion-based, purposive sampling was used to conduct face-to-face interviews with an investigator-initiated instrument and a standardized Quality of Life tool. Recruitment strategies included enlisting community partners to distribute materials, implementing a Healthy Women Alaska curriculum, and providing incentives. RESULTS: Despite active recruitment, enrollment was inadequate to meet the target. A sample of 40 women was recruited with formal and informal activities: grocery/discount stores/malls (9); Healthy Women Alaska (10); study groups, clinics, snowball (10); community partners (12). CONCLUSION: Low-income women with disabilities, living in the community may be hidden from traditional recruitment activities. No single recruitment method will be successful for hard-to-reach women. Creative, flexible strategies are needed to recruit participants from this important group of women.