In this particular instance the place to start would be to launch an education program aimed at both patients and providers as to the importance of early detection screening for breast cancer. The goal would be to implement outreach strategies to improve access to screening for women who have rarely or never been screened. A second thing that would need to be done would be that of developing a transportation and child care program that could be utilized by these women in order to help them to seek services. The hope would be that by raising awareness about the importance of early detection and providing access to screening services that a larger percentage of rural women would obtain screening procedures. Another barrier that would need to be addressed would be that of insurance availability. For those women who have access to insurance the reason for not seeking screening may be one of the aforementioned reasons of lack of transportation and child care, but for some women their reasons include either no insurance or insurance that still leaves them with a high out of pocket cost. For this group there would need to be put into place some sort of reduced cost programs at which these women could seek care at a reasonable rate that they could afford.

A third barrier that would need to be addressed in the intervention program would be that of the fact that there are some women who just live too far away from any providers in order to seek screenings. A solution to this would be to hold mobile mammography clinics every month in order to provide service access to those women who have no other choices. These could target both those women who have insurance and those who don't. The ultimate goal of this program is increase the number of overall rural women who seeking screening services.

Assessment of any health promotion program is critical for a variety of reasons, most notably to measure the process of implementing the program, the impact of the program, and the overall outcome of the program. An advantage to using the Precede-Proceed Model is that it has evaluation built systematically into the planning process. This allows for adjustments in the plan to be made...

Pre-evaluation of the amount of services being utilized at local screening facilities would need to be obtained so that these could be compared with post utilization rates of these same services. Services within the mobile mammography clinics would be tracked on a monthly basis to ensure that utilization was being seen. The amount of services that are being used within the transportation and child care programs could also be tracked on monthly basis. If it is determined that any of the newly developed programs are not being used then it would be beneficial to look at the marketing and education piece to make sure that the work is getting out about these services.
Research need to continue in order to develop innovative strategies to ensure timely and high quality clinical services and access to treatment for women with a cancer or pre-cancer diagnosis. The ultimate goal is to save lives which can not be done without early prevention screenings being done for all women, regardless of education, income or location of where they live.