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Backgroundhe Peace of Mind Program – an adapted evidence-based intervention to improve mammography appointment adherence in underserved women – was expanded to safety net clinics. This study assessed effectiveness of the intervention in improving mammography appointment adherence and implementation of the intervention. MethodsThe intervention was implemented through a non-randomized stepped wedge cluster design with 19 Federally Qualified Health Centers and charity care clinics in the Greater Houston area. Clinics were their own control during the baseline period and conducted at least three mammography drives during the baseline and intervention period. A multivariable generalized estimating equation logistic regression was conducted to examine mammography appointment adherence. To examine adoption and implementation of the intervention, two surveys assessing Consolidated Framework for Implementation Research constructs were conducted with clinic leadership and staff. One-sided t-tests were conducted to analyze mean score changes between the adoption and implementation survey. Results total of 4402 women (baseline period = 2078; intervention period = 2324) were included in the final analysis. Women in the intervention period were more likely to attend or reschedule their mammography appointment (OR = 1.30; p < 0.01). Similarly, for those in the intervention period, women who completed the intervention were more likely to attend or reschedule their mammography appointment than those who did not complete the intervention (OR = 1.62; p < 0.01). The mammography appointment no-show rates for those in the baseline period, in the intervention period, and who completed the intervention were, respectively, 22%, 19%, and 15%. In terms of the adoption and implementation survey, a statistically significant mean score decrease was observed in Inner Setting overall and in two Inner Setting constructs, Culture – Effort and Implementation Climate. Conclusions This study provided a pragmatic approach to translating an evidence-based mammography intervention into practice in safety net clinics. While the intervention improved mammography appointment adherence, there our opportunities to further integrate Consolidated Framework for Implementation Research constructs in future implementation of the intervention. Future research on the effects of implementation moderators particularly Inner Setting constructs would be of value to implementation practitioners.