The global role, impact, and limitations of Community Health Workers (CHWs) in breast cancer screening: a scoping review and recommendations to promote health equity for all

Figures & data

Figure 1. PRISMA flowchart of the included and excluded publications

Figure 2. Themes were extracted and compiled from included publications to allow for examination of CHW deployment to address breast cancer screening. Fisher’s Exact Test was used for statistical analysis of the incidence of these themes in HIC and LMIC

Appendix A. Specific search strings for the six electronic databases (PubMed, Scopus, Web of Science, Global Health, Cochrane Breast Cancer, and ProQuest) included in this review

PubMed	((((“Allied health personnel” OR “Auxiliary health worker*” OR “Barefoot doctor*” OR “Basic health worker*” OR “Community assistant*” OR “Community drug distributor*” OR “Community health representative*” OR “Community health advocate*” OR “Community health agent*” OR “Community health aide*” OR “Community health promoter*” OR “Community health volunteer*” OR “Community health worker*” OR “Community mobilizer*” OR “Community nutrition worker*” OR “Community resource person” OR “Community reproductive health worker*” OR “Community support worker*” OR “Community volunteer*” OR “Community-based worker*” OR “Female community health volunteer*” OR “Female multipurpose health worker*” OR “Health and nutrition worker*” OR “Health service assistant*” OR “Health surveillance assistant*” OR “Health promoter*” OR “Home health aide*” OR “Lady health worker*” OR “Lay health visitor*” OR “Lay health worker*” OR “Link worker*” OR “Maternal and child health promotion worker*” OR “Maternal and child health worker*” OR “Mental health worker*” OR “Mother coordinator*” OR “Nutrition volunteer*” OR “Nutrition worker*” OR “Outreach educator*” OR “Paramedical worker*” OR “Peer volunteer*” OR “Postnatal support worker*” OR “Rural health motivator*” OR “Rural health worker*” OR “Village drug-kit manager*” OR “Village Health Guide” OR “Village health helper*” OR “Village health worker*” OR “Village health team*” OR “Voluntary worker*” OR “Women group leader*”)) AND (“Breast cancer“[Mesh] OR “breast cancer” OR “breast lump” OR “breast exam”))
Scopus	((TITLE-ABS-KEY (“Allied health personnel” OR “Auxiliary health worker*” OR “Barefoot doctor*” OR “Basic health worker*” OR “Community assistant*” OR “Community drug distributor*” OR “Community health representative*” OR “Community health advocate*” OR “Community health agent*” OR “Community health aide*” OR “Community health promoter*” OR “Community health volunteer*” OR “Community health worker*” OR “Community mobilizer*”) OR TITLE-ABS-KEY (“Community nutrition worker*” OR “Community resource person” OR “Community reproductive health worker*” OR “Community support worker*” OR “Community volunteer*” OR “Community-based worker*” OR “Female community health volunteer*”) OR TITLE-ABS-KEY (“Female multipurpose health worker*” OR “Health and nutrition worker*” OR “Health service assistant*” OR “Health surveillance assistant*” OR “Health promoter*” OR “Home health aide*” OR “Lady health worker*” OR “Lay health visitor*”) OR TITLE-ABS-KEY (“Lay health worker*” OR “Link worker*” OR “Maternal and child health promotion worker*” OR “Maternal and child health worker*” OR “Mental health worker*” OR “Mother coordinator*”) OR TITLE-ABS-KEY (“Nutrition volunteer*” OR “Nutrition worker*” OR “Outreach educator*” OR “Paramedical worker*” OR “Peer volunteer*” OR “Postnatal support worker*” OR “Rural health motivator*”) OR TITLE-ABS-KEY (“Rural health worker*” OR “Village drug-kit manager*” OR “Village Health Guide” OR “Village health helper*” OR “Village health worker*” OR “Village health team*” OR “Voluntary worker*” OR “Women group leader*”)) AND PUBYEAR > 1977) AND (TITLE-ABS-KEY (“breast cancer” OR “breast carcinoma” OR “breast lump” OR “breast exam”) AND PUBYEAR > 1977)
Web of Science	(TS=(“Allied health personnel”) OR TS=(“Auxiliary health worker*”) OR TS=(“barefoot doctor*”) OR TS=(“Basic health worker*”) OR TS=(“Community assistant*”) OR TS=(“Community drug distributor*”) OR TS=(“Community health representative*”)OR TS=(“Community health advocate*”) OR TS=(“Community health agent*”) OR TS=(“Community health aide*”) OR TS=(“Community health promoter*”) OR TS=(“Community health volunteer*”) OR TS=(“Community health worker*”) OR TS=(“Community mobilizer*”) OR TS=(“Community nutrition worker*”) OR TS=(“Community resource person*”) OR TS=(“Community reproductive health worker*”) OR TS=(“Community support worker*”) OR TS=(“community volunteer*”) OR TS=(“Community-based worker*”) OR TS=(“Female community health volunteer*”) OR TS=(“Female multipurpose health worker*”) OR TS=(“Health and nutrition worker*”) OR TS=(“Health service assistant*”) OR TS=(“Health surveillance assistant*”) OR TS=(“health promoter*”) OR TS=(“Home health aide*”) OR TS=(“Lady health worker*”) OR TS=(“Lay health visitor*”) OR TS=(“Lay health worker*”) OR TS=(“Link worker*”) OR TS=(“Maternal and child health promotion worker*”) OR TS=(“Maternal and child health worker*”) OR TS=(“Mental health worker*”) OR TS=(“Mother coordinator*”) OR TS=(“Nutrition volunteer*”) OR TS=(“Nutrition worker*”) OR TS=(“Outreach educator*”) OR TS=(“Paramedical worker*”) OR TS=(“Peer volunteer*”) OR TS=(“Postnatal support worker*”) OR TS=(“Rural health motivator*”) OR TS=(“Rural health worker*”) OR TS=(“Village drug-kit manager*”) OR TS=(“Village Health Guide”) OR TS=(“Village health helper*”) OR TS=(“Village health worker*”) OR TS=(“Village health team*”) OR TS=(“voluntary worker*”) OR TS=(“Women group leader*”)) AND (TS=(“breast cancer*”) OR TS=(“breast carcinoma*”) OR TS=(“breast lump*”) OR TS=(“breast exam*”))
Global Health	1. (allied health personnel or Auxiliary health worker* or barefoot doctor* or basic health worker* or community assistant* or community drug distributor* or community health representative* or community health advocate* or community health agent* or Community health aide* or Community health promoter* or Community health volunteer* or Community health worker* or Community mobilizer* or Community nutrition worker* or Community resource person or Community reproductive health worker* or Community support worker* or Community volunteer* or Community-based worker* or Female community health volunteer* or Female multipurpose health worker* or (Health and nutrition worker*) or Health service assistant* or Health surveillance assistant* or Health promoter* or Home health aide* or Lady health worker* or Lay health visitor* or Lay health worker* or Link worker* or (Maternal and child health promotion worker*) or (Maternal and child health worker*) or Mental health worker* or Mother coordinator* or Nutrition volunteer or Nutrition worker* or Outreach educator* or Paramedical worker* or Peer volunteer* or Postnatal support worker* or Rural health motivator* or Rural health worker* or Village drug-kit manager* or Village Health Guide or Village health helper* or Village health worker* or village health team* or Voluntary worker* or Women group leader*).af. 2. (breast cancer or breast carcinoma or breast lump or breast exam).af. 3. 1 AND 2
Cochrane Breast Cancer	#1 MeSH descriptor: [Community Health Workers] explode all trees #2 MeSH descriptor: [Health Personnel] explode all trees #3 MeSH descriptor: (health worker* or health care worker* or health professional or health personnel or doctor* or nurse* or physician*) #4 MeSH descriptor: #1 or #2 or #3 #5 MeSH descriptor: [Health Education] explode all trees #6 MeSH descriptor: [Education, Continuing] explode all trees #7 MeSH descriptor: [Education, Medical] explode all trees #8 MeSH descriptor: [Education, Nursing] explode all trees #9 MeSH descriptor: (train* or training or education or curriculum or teaching or learning or staff development or medicine) #10 MeSH descriptor: #5 or #6 or #7 or #8 or #9 #11 MeSH descriptor: #4 and #10 #12 MeSH descriptor: [Health Knowledge, Attitudes, Practice] explode all trees #13 MeSH descriptor: #11 or #12 #14 MeSH descriptor: [Physical Examination] explode all trees #15 MeSH descriptor: ((physical or clinical breast or clinical or breast) adj1 exam*) #16 MeSH descriptor: clinical breast examination #17 MeSH descriptor: [Mass Screening] explode all trees #18 MeSH descriptor: #14 or #15 or #16 or #17 #19 MeSH descriptor: [Breast Neoplasms] explode all trees #20 MeSH descriptor: breast near neoplasm* #21 MeSH descriptor: breast near carcinom* #22 MeSH descriptor: breast near cancer* #23 MeSH descriptor: breast near tumour* #24 MeSH descriptor: breast near tumor* #25 MeSH descriptor: breast near malignan* #26 MeSH descriptor: #19 or #20 or #21 or #22 or #23 or #24 or #25 #27 MeSH descriptor: #13 and #18 and #26 Search string based on Sayed et al. (2017)^a
ProQuest	Included databases: Health & Medical Collection, Nursing & Allied Health Database, Public Health Database, Social Science Database, Sociology Database Document type included: Article, Dissertation/Thesis, Evidence Based Healthcare (“Allied health personnel” OR “Auxiliary health worker*” OR (“barefoot doctor” OR “barefoot doctors”) OR “Basic health worker*” OR “Community assistant*” OR “Community drug distributor*” OR “Community health representative*” OR “Community health advocate*” OR “Community health agent*” OR “Community health aide*” OR “Community health promoter*” OR “Community health volunteer*” OR “Community health worker*” OR “Community mobilizer*” OR “Community nutrition worker*” OR “Community resource person” OR “Community reproductive health worker*” OR “Community support worker*” OR (“community volunteer” OR “community volunteering” OR “community volunteerism” OR “community volunteers”) OR “Community-based worker*” OR “Female community health volunteer*” OR “Female multipurpose health worker*” OR “Health and nutrition worker*” OR “Health service assistant*” OR “Health surveillance assistant*” OR (“health promoters”) OR “Home health aide*” OR “Lady health worker*” OR “Lay health visitor*” OR “Lay health worker*” OR “Link worker*” OR “Maternal and child health promotion worker*” OR “Maternal and child health worker*” OR “Mental health worker*” OR “Mother coordinator*” OR “Nutrition volunteer*” OR “Nutrition worker*” OR “Outreach educator*” OR “Paramedical worker*” OR “Peer volunteer*” OR “Postnatal support worker*” OR “Rural health motivator*” OR “Rural health worker*” OR “Village drug-kit manager*” OR “Village Health Guide” OR “Village health helper*” OR “Village health worker*” OR “Village health team*” OR (“voluntary worker” OR “voluntary workers”) OR “Women group leader*”) AND (“breast cancer*” OR “breast carcinoma*” OR “breast lump*” OR “breast exam*”) AND pd(1977–2019)

^aSayed S, Ngugi A, Ochieng P, Mwenda AS, Salam RA. Training health workers in clinical breast examination for early detection of breast cancer in low‐ and middle‐income countries. Cochrane Database Syst Rev. 2017;2017[1]. doi:10.1002/14651858.CD012515

Appendix B. Specific data extracted from each individual paper included in this review to be used for analysis, including but not limited to summaries, methods, outcomes, and limitations

Author	Title of Paper	Publication Year	Journal	Volume	Issue	Country	Location (including Region/District)	Primary Aim of the Paper
Ahmed, N.U.; Haber, G.; Semenya, K.A.; Hargreaves, M.K.	Randomized controlled trial of mammography intervention in insured very low-income women	2010	Cancer Epidemiol. Biomarkers Prev.	19	7	United States	Tennessee	To determine if intervention with letter vs. letter with follow up by lay health workers will improve compliance with mammography screening
Bird, J.A.; McPhee, S.J.; Ha, N.-T.; Le, B.; Davis, T.; Jenkins, C.N.H.	Opening pathways to cancer screening for Vietnamese-American women: Lay health workers hold a key	1998	Prev. Med.	27	6	United States	San Francisco, California	To address breast and cervical cancer in the Vietnamese population in California by implementing preventive measures and education with lay health workers who speak the same language and are able to reach the population on a culterally relevant level.
Brandford, A.; Adegboyega, A.; Combs, B.; Hatcher, J.	Training Community Health Workers in motivational interviewing to promote cancer screening	2019	Health Promot. Pract.	20	2	United States	Kentucky	To describe the feasibility of training CHWs to deliver an Motivational Interviewing (MI) intervention to promote cancer screening in underserved populations.
Chowdhury, T.I.; Love, R.R.; Chowdhury, M.T.I.; Artif, A.S.; Ahsan, H.; Mamun, A.; Khanam, T.; Woods, J.; Salim, R.	Feasibility study of case-finding for breast cancer by community health workers in rural Bangladesh	2015	Asian Pac. J. Cancer Preven.	16	17	Bangladesh	A sub-district of the Khulna Division (eight villages)	Two primary aims: to determine the feasibility of using CHWs to identify serious breast problems and record patient data with and without cell-phone technology. Also, to determine if CHWs can increase access to medical care for patients with serious breast problems.
Duggan, C.; Dvaladze, A.L.; Tsu, V.; Jeronimo, J.; Constant, T.K.H.; Romanoff, A.; Scheel, J.R.; Patel, S.; Gralow, J.R.; Anderson, B.O.	Resource-stratified implementation of a community-based breast cancer management programme in Peru	2017	Lancet Oncol.	18	10	Peru	La Libertad	To implement a community-based program for breast health in order to improve breast healthcare delivery in Peru.
Earp, J.A.L.; Viadro, C.I.; Vincus, A.A.; Altpeter, M.; Flax, V.; Mayne, L.; Eng, E.	Lay Health Advisors: A strategy for getting the word out about breast cancer	1997	Health Educ. Behav.	24	4	United States	North Carolina	To use North Carolina Breast Cancer Screening Program’s (NC-BCSP) as a case study to describe the steps involved in developing, implementing, and evaluating a Lay Health Advisor (LHA) intervention aimed at transforming natural helpers into lay health advisors. The authors review five phases of implementation and how such an intervention bridges gaps between health care providers, agencies, and local communities.
Elder, J.P.; Haughton, J.; Perez, L.G.; Martínez, M.E.; De La Torre, C.L.; Slymen, D.J.; Arredondo, E.M.	Promoting cancer screening among churchgoing Latinas: Fe en Acción/Faith in Action	2017	Health Educ. Res.	32	2	United States	San Diego County, California	To evaluate self-reported cancer screening of a two-group randomized trial promoting breast, cervical, and colorectal cancer screening among churchgoing Latinas through promotoras. The article examines how screenings are affected by the community intervention Fe en acción/Faith in Action which was led by the promotoras.
English, K.C.; Fairbanks, J.; Finster, C.E.; Rafelito, A.; Luna, J.; Kennedy, M.	A socioecological approach to improving mammography rates in a tribal community	2008	Health Educ. Behav.	35	3	United States	New Mexico	To highlight the processes and intermediate outcomes of a pilot community-based intervention to increase mammography rates of women in an American Indian tribe in New Mexico.
Fernández, M.E.; Gonzales, A.; Tortolero-Luna, G.; Williams, J.; Saavedra-Embesi, M.; Chan, W.; Vernon, S.W.	Effectiveness of Cultivando la Salud: A breast and cervical cancer screening promotion program for low-income hispanic women	2009	Am. J. Public Health	99	5	United States	Anthony, NM; Eagle Pass, TX; Merced, California; Watsonville, California.	To increase breast and cervical cancer screening through an educational intervention for low-income Hispanic farmworker women who do not follow suggested guidelines for screening, and thereby reduce breast and cervical cancer incidence and mortality rates for Hispanic women.
Flax, V.L.; Earp, J.L.	Counseled women’s perspectives on their interactions with lay health advisors: A feasibility study	1999	Health Educ. Res.	14	1	United States	North Carolina (five Eastern rural counties)	To assess the feasibility of conducting semi-structured, in-depth interviews with black women of older age and to gather reports on women’s perceptions of the interactions with their Lay Health Advisors (LHAs).
Ford, S.; Meghea, C.; Estes, T.; Hamade, H.; Lockett, M.; Williams, K.P.	Assessing the fidelity of the Kin KeeperSM prevention intervention in African American, Latina and Arab women	2014	Health Educ. Res.	29	1	United States	Detroit, Michigan; Dearborn, Michigan	To examine fidelity and consistency of treatment delivery and see qualititatively the impact of the intervention.
Giarratano, G.; Bustamante-Forest, R.; Carter, C.	A multicultural and multilingual outreach program for cervical and breast cancer screening	2005	J. Obstet. Gynecol. Neonatal Nurs.	34	3	United States	New Orleans, Louisiana	To improve access to early detection screening of breast and cervical cancer amongst underserved, multicultural communities in New Orleans.
Gu, J.; Maxwell, A.E.; Ma, G.X.; Qian, X.; Tan, Y.; Hsieh, H.-C.; Tu, S.-P.; Wang, J.H.-Y.	Evaluating the training of Chinese-speaking Community Health Workers to implement a small-group intervention promoting mammography	2019	J. Cancer Educ.	34	4	United States	Washington, District of Columbia; Southern California; New York City, New York	To evaluate the effectiveness of the training curriculum and the fidelity of intervention implementions by Chinese-American CHWs on mammography rates among Chinese-American women in the community.
Gutnik, L.; Lee, C.; Msosa, V.; Moses, A.; Stanley, C.; Mzumara, S.; Liomba, N.G.; Gopal, S.	Clinical breast examination screening by trained laywomen in Malawi integrated with other health services	2016	J. Surg. Res.	204	1	Malawi	Lilongwe	To assess feasibility and performance of clinical breast exams by laywomen in urban health clinics in Malawi.
Han, H.-R.; Lee, H.; Kim, M.T.; Kim, K.B.	Tailored lay health worker intervention improves breast cancer screening outcomes in non-adherent Korean-American women	2009	Health Educ. Res.	24	2	United States	Los Angeles, California	To evaluate a model for training lay health workers to increase screening and education to detect breast cancer among in Korean-American (KA) women.
Han, H.-R.; Song, Y.; Kim, M.; Hedlin, H.K.; Kim, K.; Lee, H.B.; Roter, D.	Breast and cervical cancer screening literacy among Korean American women: A Community Health Worker-led intervention	2017	Am. J. Public Health	107	1	United States	Baltimore, Maryland and Washington, District of Columbia	To test a community health worker (CHW)-led health literacy intervention on mammogram and Pap test screening among Korean American women.
Huerta, E.E.; Weeks-Coulthurst, P.; Williams, C.; Swain, S.M.	Take care of your neighborhood	2018	Breast Cancer Res. Treat.	167	1	United States	Washington, District of Columbia	Assess the role of CHWs in countering the disparity of urban women who have insurance but do not seek care until have symptoms of advanced breast cancer.
Hunt, B.R.; Allgood, K.L.; Kanoon, J.M.; Benjamins, M.R.	Keys to the successful implementation of community-based outreach and navigation: Lessons from a breast health navigation program	2017	J. Cancer Educ.	32	1	United States	Chicago, Illinois	Assess effectiveness of CHW-led intervention in Chicago encouraging at-risk women to get mammograms and follow-up care as needed.
Kiger, H.	Outreach to multiethnic, multicultural, and multilingual women for breast cancer and cervical cancer education and screening: a model using professional and volunteer staffing.	2003	Fam. Community Health	26	4	United States	Santa Monica, California	To increase the number of women receiving breast cancer screening and to improve community education of breast health and awareness of screening services.
Kohler, R.E.; Miller, A.R.; Gutnik, L.; Lee, C.N.; Gopal, S.	Experiences and perceptions regarding clinical breast exam screening by trained laywomen in Malawi	2017	Cancer Causes Control	28	2	Malawi	Lilongwe	To explore participant perceptions of clinical breast exams as an intervention and to assess integrity of interventions in order to inform future program designs.
Larkey, L.K.; Herman, P.M.; Roe, D.J.; Garcia, F.; Lopez, A.M.; Gonzalez, J.; Perera, P.N.; Saboda, K.	A cancer screening intervention for underserved Latina women by lay educators	2012	J. Women’s Health	21	5	United States	Phoenix, Arizona	To test two methods of delivering a cancer screening and prevention curriculum taught by promotoras: individually or within a social support group.
Livaudais, J.C.; Coronado, G.D.; Espinoza, N.; Islas, I.; Ibarra, G.; Thompson, B.	Educating hispanic women about breast cancer prevention: Evaluation of a home-based promotora-led intervention	2010	J. Women’s Health	19	11	United States	Lower Yakima Valley, Washington State	To measure the impact of a home-based group educational intervention that addresses general cancer and breast cancer-specific awareness and screening.
Mayfield-Johnson, S.; Fastring, D.; Fortune, M.; White-Johnson, F.	Addressing breast cancer health disparities in the Mississippi Delta through an innovative partnership for education, detection, and screening	2016	J. Community Health	41	3	United States	Mississippi Delta	To increase breast cancer screening rates for African American women in the Mississippi Delta.
Nuño, T.; Martinez, M.E.; Harris, R.; Garcia, F.	A Promotora-administered group education intervention to promote breast and cervical cancer screening in a rural community along the U.S.-Mexico border: a randomized controlled trial	2010	Cancer Causes Control	22	3	United States	Yuma County, Arizona	To analyze the effectiveness of using lay community health workers (promotoras) to promote the utilization of breast and cervical cancer screening processes among post-menopausal Hispanic women.
Pace, L.E.; Dusengimana, J.-M.V.; Keating, N.L.; Hategekimana, V.; Rugema, V.; Bigirimana, J.B.; Costas-Chavarri, A.; Umwizera, A.; Park, P.H.; Shulman, L.N.; Mpunga, T.	Impact of breast cancer early detection training on Rwandan health workers’ knowledge and skills	2018	J. Glob. Oncol.	4	1	Rwanda	Burera District	To address the delays women experience between the onset of breast symptoms and first presentation at a health facility, as well as delays between symptom onset and receiving a breast cancer diagnosis.
Riehman, K.S.; Fisher-Borne, M.; Martinez, J.M.; Daven, M.; Thompson, L.; Fouad, M.N.; Partridge, E.E.	A Community Health Advisor program to reduce cancer screening disparities in the deep south and Appalachia: The American Cancer Society’s CHA collaborative	2017	Health Promot. Pract.	18	5	United States	Alabama, Arkansas, Kentucky, Louisiana, Mississippi, North Carolina, Tennessee, Virginia, and West Virginia	To reduce breast cancer screening disparities and increase community engagement, particularly in rural Appalachian and American-Indian populations. In addition, to train volunteers to deliver cancer prevention messages and accompany women to their screenings.
Scheel, J.R.; Molina, Y.; Briant, K.J.; Ibarra, G.; Lehman, C.D.; Thompson, B.	Latinas’ mammography intention following a home-based Promotores-led intervention	2015	J. Community Health	40	6	United States	Lower Yakima Valley, Washington State	To examine how knowledge and social engagement changed as a result of the home visits, and to determine if post-intervention knowledge and social engagement aligned with subsequent changes in mammography intention.
Schuster, A.L.R.; Frick, K.D.; Huh, B.-Y.; Kim, K.B.; Kim, M.; Han, M.-R.	Economic evaluation of a Community Health Worker-led health literacy intervention to promote cancer screening among Korean American women	2015	J. Health Care Poor Underserved	26	2	United States	Baltimore, Maryland; Washington, District of Columbia	To determine the cost-effectiveness of CHWs implementing interventions that aim to improve breast and cervical cancer screening rates.
Simon, M.A.; O’Brian, C.A.; Kanoon, J.M.; Venegas, A.; Ignoffo, S.; Picard, C.; Allgood, K.L.; Tom, L.; Margellos-Anast, H.	Leveraging an implementation science framework to adapt and scale a Patient Navigator Intervention to improve mammography screening outreach in a new community	2019	J. Cancer Educ.	N/A	N/A	United States	Chicago, Illinois	To evaluate the Helping Her Live (HHL) CHW-led model in the Southwest of Chicago (SW) and assess implementation of the program based on an already established program in the West side of Chicago (W)
Tum, S.J.; Maree, J.E.; Clarke, M.	Creating awareness and facilitating cervical and breast cancer screening uptake through the use of a Community Health Worker: A pilot intervention study	2013	Eur. J. Cancer Care	22	1	South Africa	Tshwane, South Africa	To increase rates of breast and cervical cancer screening, to increase community awareness of breast and cervical disease, and to evaluate the effectiveness of CHWs.
Welsh, A.L.; Sauaia, A.; Jacobellis, J.; Min, S.J.; Byers, T.	The effect of two church-based interventions on breast cancer screening rates among Medicaid-insured Latinas	2005	Prev. Chronic Dis.	2	4	United States	Denver, Colorado	To increase breast cancer screenings for Latinas in Colorado, using the church as a site of intervention due to its large impact in the social networks of the population.
Williams, K.P.; Mabiso, A.; Todem, D.; Hammad, A.; Hill-Ashford, Y.; Hamade, H.; Palamisono, G.; Robinson-Lockett, M.; Zambrana, R.E.	Differences in knowledge of breast cancer screening among African American, Arab American, and Latina women	2011	Prev. Chronic Dis.	8	1	United States	Detroit, Michigan; Dearborn, Michigan	To evaluate differences in breast cancer knowledge and socioeconomic status between the populations studied in association with multiple forms of breast cancer screening.
Williams, K.P.; Mullan, P.B.; Todem, D.	Moving from theory to practice: Implementing the Kin KeeperSM Cancer prevention model	2009	Health Educ. Res.	24	2	United States	Michigan	To evaluate if breast cancer education of individual women would lead to increased education among their families.