Abstract
SETTING: In France, participation rates in breast cancer screening have been decreasing, along with socio-territorial inequalities. To enhance women's access to breast cancer screening, an interventional research project was implemented to assess the effectiveness, efficiency, and optimal modalities of a mobile mammography unit for women living remotely in Normandy. INTERVENTION: The randomized cluster trial was directed towards rural women. Before deploying the mobile unit, an intervention theory was developed. The principles of action to reduce inequalities, the definition and standardization of interventions, and the link to behavior change theories to establish causal mechanisms were integrated into a single model. We aimed to produce new knowledge on these mechanisms and develop intervention evaluations. OUTCOMES: Using the key function/implementation/context model, the key functions of the expected intervention were listed, linked to the behavior change technique and theoretical domain framework, and finally to the capability, opportunity, motivation-behavior model components. The mechanisms and levers that can improve access to breast cancer screening are also described. This approach also allowed the standardization of stakeholders' implications and their corresponding actions. Concrete interventions implemented included scheduling appointments at the mobile unit and implementing a suite of measures to improve the information provided to women regarding breast cancer screening. IMPLICATIONS: This theoretical framework should be compared with interventions carried out during the deployment of mobile units. Various elements interact dynamically with and alter originally planned interventions. This experiential feedback may inform decisions on the transferability of mobile mammography units to other contexts. TRIAL REGISTRATION : This study was registered at ClinicalTrials.gov (registration date: December 21, 2021; registration number: NCT05164874).