County-level outcomes of a rural breast cancer screening outreach strategy: a decentralized hub-and-spoke model (BSPAN2)

Simon J.Craddock Lee, Robin T. Higashi, Stephen J. Inrig, Joanne M. Sanders, Hong Zhu, Keith E. Argenbright, Jasmin A. Tiro

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Rural mammography screening remains suboptimal despite reimbursement programs for uninsured women. Networks linking non-clinical community organizations and clinical providers may overcome limited delivery infrastructure in rural areas. Little is known about how networks expand their service area. To evaluate a hub-and-spoke model to expand mammography services to 17 rural counties by assessing county-level delivery and local stakeholder conduct of outreach activities. We conducted a mixed-method evaluation using EMR data, systematic site visits (73 interviews, 51 organizations), 92 patient surveys, and 30 patient interviews. A two-sample t test compared the weighted monthly average of women served between hub- and spoke-led counties; nonparametric trend test evaluated time trend over the study period; Pearson chi-square compared sociodemographic data between hub- and spoke-led counties. From 2013 to 2014, the program screened 4603 underinsured women. Counties where local “spoke” organizations led outreach activities achieved comparable screening rates to hub-led counties (9.2 and 8.7, respectively, p = 0.984) and did not vary over time (p = 0.866). Qualitative analyses revealed influence of program champions, participant language preference, and stakeholders’ concerns about uncompensated care. A program that leverages local organizations’ ability to identify and reach rural underserved populations is a feasible approach for expanding preventive services delivery.

Original languageEnglish (US)
Pages (from-to)349-357
Number of pages9
JournalTranslational Behavioral Medicine
Issue number2
StatePublished - Jun 1 2017


  • Breast cancer
  • Health disparities
  • Health services delivery
  • Mixed methods
  • Program implementation
  • Rural

ASJC Scopus subject areas

  • Applied Psychology
  • Behavioral Neuroscience


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