Improving female preventive health care delivery through practice change: An every woman matters study

Elisabeth L. Backer, Jenenne A. Geske, Helen E. McIlvain, Diane M. Dodendorf, William C. Minier

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: The levels of breast and cervical cancer screening in Nebraska primary care remain sub-optimal despite awareness of their importance, and despite implementation of the Every Woman Matters program to assist low-income women. The GAPS model was used to develop a practice-based intervention to identify and reduce barriers to delivery of breast and cervical cancer screening services. Methods: Seven primary care practices actively participated in this multimethod case study. A research nurse collected data and facilitated the intervention process at each site. Qualitative data from field notes, patient encounters, and in-depth interviews of physicians and key informants were collected to describe the process of Papanicolaou and mammogram service delivery, and to identify barriers/facilitators to screening, and potential change areas. Chart reviews provided information regarding the preintervention and postintervention identification/execution of Papanicolaou smears and mammograms. Qualitative and quantitative analyses led to individual practice case studies. Cross case comparisons identified common themes. Results: The individual practice plans for change had many commonalities, ie, developing screening databases and reminder systems. The biggest differences involved practice contexts. Despite use of the GAPS model and a financial incentive to obtain "buy in" from providers and staff, change was difficult for all but 2 of the practices. Conclusion: The complexity of practice context and its effect on change cannot be underestimated. Individual practice providers and staff are often unaware of the potential challenges, and unable/unwilling to overcome them.

Original languageEnglish (US)
Pages (from-to)401-408
Number of pages8
JournalJournal of the American Board of Family Practice
Issue number5
StatePublished - 2005

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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