Date of Graduation

Summer 8-2014

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Behavioral Health (MSBH)


School of Nursing and Health Professions


This paper explores the efforts of the San Francisco Department of Public Health (SFDPH) and San Francisco General Hospital (SFGH) to increase their overall mammogram screening rate to 76.7% by June 2015 in order to receive funding from the federal government. The target population is women within SF DPH’s primary care program, 50-74 years old, and overdue for a mammogram.

The literature reports there are health disparities among women who receive mammograms and how breast cancer affects them. African American women have the highest mortality rates and women of color are more likely to be diagnosed at a later stage, when treatment options are limited (National Cancer Institute, 2014). There were disparities found within the mammogram rates at SFDPH which varied by ethnicity, insurance type, and socioeconomic status. The literature also supports this finding with The National Cancer Institute (2014) stating that lower screening rates are associated with lower education levels and incomes, the uninsured, and women of color.

A pilot study was conducted at the SFGH Avon Breast Center, which included extending evening hours and opening a Saturday clinic for mammograms, from February to June 2014, to increase appointment accessibility for patients. The overall mammogram rate was calculated using data from just over 13,000 eligible women in the SFDPH system. After the pilot study ended, the mammogram rate for every ethnicity group had increased and the overall rate had increased by 5%. Using a chi-square test, this increase was shown to be statistically significant. The appoinment show rate also increased by 16% during the pilot study, as compared to the regular hour appointments, and this increase was shown to be statistically significant as well. Patient and staff surveys were distributed to obtain quantitative and qualitative feedback directly from involved stakeholders. It was noted that women enjoyed the pilot study hours and were especially interested in having other services offered on Saturdays as well.

By offering evening and Saturday hours, the mammogram and show rates experienced a significant increase, and the patients awarded high satisfaction scores for their experience during the pilot study. SFDPH and SFGH are collaborating together to address this issue in addition to discovering other methods to educate women on the importance of getting screened for breast cancer and to make mammograms more accessible to women from diverse backgrounds.