dictor of screening than language and ethnic factors—indicators of acculturation. Like all women, Hispanic women with access to health care are more likely to be screened than are women without access to health care. A disproportionate percentage of Hispanic women, however, are low income; Hispanics are also more likely to report health insurance inadequacies and poorer quality of life, factors that are likely to interfere with maintenance of screening behaviors (Fox and Roetzheim, 1994; Zambrana et al., 1999). Nonetheless, whereas financial costs and inadequate reimbursement are barriers to screening, interventions directed only at screening costs have not been particularly effective in the absence of patient education. Indeed, even when the poor have adequate health insurance, they encounter more barriers to screening than upper income groups (Fox, Roetzheim, and Kington, 1997).
It is important to consider the assets and resources on which women of diverse groups may draw. As noted in the following sections, interventions can be designed to build environmental supports for screening. System-directed, access-enhancing, and policy-directed interventions provide important means of building these supports; indeed, access-enhancing strategies, including the provision of transportation or free mammograms, play a particularly crucial role in increasing screening rates.
This section provides a brief overview of the major findings on interventions designed to facilitate use of mammography screening. In 1994, Rimer reviewed the trends in interventions in the United States in the following areas: mass media campaigns (e.g., A Sa Salud project), individual directed (e.g., letters from physicians, mailed reminders, telephone counseling, posters), system directed (e.g., systemwide prompts, computer-generated reminders), access enhancing (e.g., mobile vans, special programs with cost subsidies), social networks (e.g., community-based programs such as Save Our Sisters), policy directed (e.g., changes in regula-