In 1995–1996, Linda Burhansstipanov, M.S.P.H., Dr.P.H. at AMC Cancer Research Center in Denver, Colo., implemented and evaluated the effectiveness of Native American Women's Wellness through Awareness (NAWWA).

NAWWA is a culturally competent recruitment model aimed at increasing the number of underserved urban American Indian women participating in an early detection breast cancer screening program. The target population, Native American women 40 years of age and older, lived in the Denver metropolitan area or in the greater Los Angeles/Orange County area.

Key Findings:

• "High"-level recruitment strategies involving steps and elements specific to Native Americans were much more effective than the typical "culturally sensitive" strategies used by most government programs.
  • Not only did program participation more than double when high-level recruitment strategies were used, but there was a significant drop in the number of women who canceled their scheduled appointments, and an increase in the number of women who called with questions or dropped into the clinic.
  • When low-level strategies were used, the percentage of "no shows" was between 50 and 80 percent.
  • During high-level interventions, this figure dropped to less than 20 percent.
• Among the high-level strategies tested, the Native Sisters Program, a "navigator program," was the most effective. Unlike other programs that provide a health care "navigator" only once breast cancer is discovered, this project used the Native Sisters throughout the recruitment and screening process.

Dissemination about the project has been widespread through presentations to over 10,000 people at various meetings and conferences, an article in Cancer (October 15, 1998), and varied press coverage.