The presentation identifies vulnerable populations in rural areas and their health disparities. Rural areas are defined as having low population density and distance from urban centers with few economic activities. Approximately 19% of Americans live in rural areas and are more likely to be uninsured compared to urban residents. Rural residents experience higher rates of chronic diseases, injuries, cancer deaths and less access to preventive healthcare services. The presentation proposes a plan to address mammography compliance among uninsured rural women using a mobile mammography unit on a quarterly basis. Key elements of the plan include qualifying patients, an interdisciplinary team and addressing challenges of cost, participation and evaluating effectiveness.

1. Vulnerable Populations
Presentation
LaToya Gipson

2. Identification of
Vulnerable
Population
• 19.3% of U. S. Population resides in rural
areas (AHRQ, 2013)
• Rural is defined in terms of:
• Low population size and density
• Distance from urban areas
• Low degree of urbanization
• Few types of economic activity
(Cogan, 2012)
• Any area not categorized as
urbanized areas or clusters (HRSA,
2012)

3. Identification of
Vulnerable
Population
• In 2009, approximately 50 million
Americans without health insurance (Sabik
& Dahman, 2012)
• Individuals living in rural areas are more
likely to be uninsured
• In 2004-2005, rate of rural uninsured
23% as compared to 19% urban
uninsured (Ziller, Lenardson, & Coburn,
2012)

4. Health Disparities
• Premature mortality (death before age 75)
• Unintentional injuries
• Suicide
• Chronic Obstructive Pulmonary Disease
(COPD)
• Cigarette smoking
• Cardiovascular disease
• Chronic health conditions (Arthritis,
Diabetes, Hypertension)
• Higher death rates from cancer
(Eberhardt & Pamuk, 2004; Hartley, 2004)

5. Health Disparities
• Less likely to participate in preventive
health services
• Lack of health insurance
• Barriers to access of care (Ziller et al., 2012)
• Special health concern for uninsured
women in rural areas - lack of utilization of
screening mammography
• Between 1993 and 2005, mammography rates
found to be the lowest among uninsured at 38.3%
• Contributes to being diagnosed at a later stage
of disease, thereby increasing mortality rates
from breast cancer (Sabatino, Coates, Uhler,
Breen, Tangka, & Shaw, 2008)

6. Clinical Question
“Will the quarterly addition of a mobile
mammography unit to an existing breast
health program improve compliance
rates in uninsured women residing in
rural areas?

7. Interdisciplinary
Plan
Mobile mammography
(Atkins, Madhaven, LeMasters, Vyas, Gainor,
& Remick, 2013: Vyas, Madhavan, Kelly,
Metzger, Schreiman, & Remick, 2013)

8. Interdisciplinary
Plan
• Qualifying patients
• Women residing in designated rural
areas or surrounding areas serviced by
breast health program
• Uninsured
• Has received a normal clinical breast
exam (CBE) within the last 3 months or
found to have a normal CBE on the day
of program
• Must not have any pre-existing breast
concerns
• Those who have not had screening
mammography within the last year
• At least 40 years of age

9. Interdisciplinary
Plan
• Team will consist of
• Advanced Practice Registered Nurse
(APRN)
• Radiologic technician
• Radiologist
• Driver of mobile unit

10. Interdisciplinary
Plan
• Patient services include
• CBE if not current
• Education regarding breast health
• Mammography screening
(Fontenoy, Langlois, Chang, Daigle,
Pelletier, Guertin, Theberge, &
Brisson, 2013)

11. Stakeholders
• Residents and future residents of rural
communities served
• Participants in the program
• APRN, Driver, Radiologic Technician,
Radiologist
• St. Luke’s Episcopal Medical Mobile Ministry
• Susan G. Komen of Shreveport
• Local media
• Sponsors
• State and local officials

12. Challenges to
Program
Implementation
• Cost
• Grant writing – Healthy People 2020
• Public campaigns, grass roots
fundraising
• Utilizing volunteers instead of paid
staff
• Establishing small teams
• Rental of mobile units
• Use of digital technology
(HealthyPeople.gov, 2014; Bongiorno & de
Chesnay, 2012; Naeim, Keeler, Bassett,
Parikh, Bastani, & Reuben, 2009)

13. Challenges to
Program
Implementation
• Resident Participation
• Early and persistent advertising
• Providing education regarding the
importance of screening in breast
health
• Being culturally sensitive
• Demonstration of a non-judgmental
attitude
• Use of incentives

14. Quality and
Effectiveness of Plan
• Based on client participation
• Use of questionnaires to evaluate
service and recommendations for
future events
• Comparison of compliance rates for
mammography referrals the previous
year using the breast health program
to the rates of mammography
performed with the use of mobile
mammography

15. Use of Technology
• More than 200 million people (77%) in
North America have Internet access
(Curley, 2012)
• Nearly 80% of Americans own a cell phone
• 73% participate in text messaging
(Kratzke, Wilson, & Vilchis, 2012)

16. Use of Technology
• Patients should be informed of
reputable Internet sites for finding
information regarding breast cancer
and screening recommendations
(Fayed, 2010)

17. Use of Technology
• Text message reminders
• Notification of mammography
• Breast cancer prevention
messages
(Kratzke et al., 2012)

18. References
 Agency for Healthcare Research and Quality [AHRQ], (2013). Residents of rural areas. Retrieved from
http://www.ahrq.gov/research/findings/nhqrdr/nhdr13/chap11.html
 Atkins, E., Madhavan, S., LeMasters, T., Vyas, A., Gainor, S. J., & Remick, S. (2012). Are obese women
more likely to participate in a mobile mammography program? Journal of Community Health, 38, 338-
348. doi: 10.1007/s10900-012-9619-z
 Bongiorno, A. W., & de Chesnay, M. (2012). Developing population-based programs for the vulnerable.
In M. de Chesnay & B. A. Anderson (Eds.), Caring for the vulnerable: Perspectives in nursing theory,
practice, and research (pp. 395-404). Burlington, MA: Jones & Bartlett Learning.
 Cogan, C. (2012). Barriers to healthcare access for Latino service workers in a resort community. In M. de
Chesnay & B. A. Anderson (Eds.), Caring for the vulnerable: Perspectives in nursing theory, practice, and
research (pp. 339-356). Burlington, MA: Jones & Bartlett Learning.
 Curley, A. L. C. (2012). Using information systems to improve population outcomes. In A. L. C. Curley &
P. A. Vitale (Eds.), Population based nursing: Concepts and competencies for advanced practice (pp.
133-154). New York, NY: Springer Publishing Company.
 Eberhardt, M. S., & Pamuk, E. R. (2004). The importance of place of residence: Examining health in
rural and nonrural areas. American Journal of Public Health, 94(10), 1682-1686. doi:
http://dx.doi.org.ezproxy.nsula.edu

19. References
 Fayed, L. (2010). Top 7 Breast Cancer sites. Retrieved from:
http://cancer.about.com/od/breastcancer/tp/cancersites.htm
 Fontenoy, A., Langlois, A., Chang, S., Daigle, J., Pelletier, E., Guertin, M., Theberge, I., &
Brisson, J. (2013). Contribution and performance of mobile units in an organized
mammography screening program. Canadian Journal of Public Health, 104(3), 193e-199.
Retrieved from
http://eds.a.ebscohost.com.ezproxy.nsula.edu/eds/pdfviewer/pdfviewer?vid=1&sid=c43b72f8-
068e-4380-a544-6a2f21921053%40sessionmgr4003&hid=4102
 Hartley, D. (2004). Rural health disparities, population health, and rural culture. American Journal of Public Health,
94(10), 1675-1677.
 Health Resources and Services Administration [HRSA], (2012). Defining the rural population. Retrieved from
http://www.hrsa.gov/ruralhealth/policy/definition_of_rural.html
 HealthyPeople.gov (2014). Access to health services. Retrieved from
httpwww.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
 Kratzke, C., Wilson, S., & Vilchis, H. (2013). Researching rural women: Breast cancer
prevention information seeking behaviors and interest in internet, cell phone, and text use. J
Community Health, 38(1), 54-61. doi:10.1007/s10900-012-9579-3

20. References
 Naeim, A., Keeler, E., Bassett, L. W., Parikh, J., Bastani, R., & Reuben, D. B. (2009). Cost- effectiveness of
increasing access to mammography through mobile mammography for older women. Journal of the American
Geriatrics Society, 57(2), 285-290. doi: 10.111/j.1532-5415.2008.02105.
 Sabatino, S. A., Coates, R. J., Uhler, R. J., Breen, N., Tangka, F., & Shaw, K. M. (2008). Disparities in
mammography use among US women aged 40-64 years, by race, ethnicity, income, and health insurance
status,1993 and 2005. Medical Care, 46(12), 692-700. Retrieved from http:/www.jstor.org/stable/40221724
 Sabik, L. M., & Dahman, B. A. (2011). Trends in care for uninsured adults and disparities in care by insurance status.
Medical Care Research and Review, 69(2), 215-230. doi: 10.1177/1077558711418519
 Vyas, A., Madhavan, S., Kelly, K., Metzger, A., Schreiman, J., & Remick, S. (2013). Do Appalachian women
attending a mobile mammography program differ from those visiting a stationary mammography facility? Journal
of Community Health, 38, 698-706. doi: 10.1007/s10900-013-9667-z
 Ziller, E. C., Lenardson, J. D., & Coburn, A. F. (2012). Health care access and use among the rural uninsured.
Journal of Health Care for the Poor and Underserved, 23, 1327-1345. Retrieved from
http://search.proquest.com.ezproxy.nsula.edu/docview/1033504367?accountid=26272