African American women's experiences with breast cancer screening

Psychometric properties of the Persian version of the Cancer attitude inventory

BACKGROUND

The Cancer Attitude inventory (CAI) was developed to measure attitudes toward cancer. The aim of the present study was to describe the development of the Persian version of the CAI and to evaluate its psychometric properties in an Iranian sample.

METHODS

The forward-backward method was used to translate the CAI scale from English into Persian. After linguistic validation and a pilot check, a cross-sectional study was performed and psychometric properties of the Iranian version of the questionnaire were assessed. The scale validation was conducted with a convenience sample of 820 laypeople. Construct validity was assessed through both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was assessed through Cronbach's alpha analysis and test-retest analysis.

RESULTS

Five factors were identified in CAI: isolation, helplessness, fear of consequence, belief of control and independence, and fear of death. The results achieved from the CFA displayed that the data fit the model: the relative chi-square (× 2/df) = 2.98 (p < .001), and the root mean square error of approximation (RMSEA) = .07 (90% CI = .06-.07). All comparative indices of the model had scores greater than .80, demonstrating a good fit to the data. Cronbach's Alpha and the intra-class correlation coefficient (ICC) were .97, which is well above the acceptable threshold.

CONCLUSIONS

The results indicate that the Persian version of the CAI is practical, reliable and valid. Consequently, the instrument could be used in plans to create positive attitudes about cancer control and treatment among Persian people.

Effectiveness of Interventions for Breast Cancer Screening in African American Women: A Meta-Analysis

OBJECTIVE

The purpose of this study was to report the results of a meta-analysis conducted on the effects of clinical trials in breast cancer screening for African American women between 1997 and 2017.

DATA SOURCES

Articles published in English and in the United States, between January 1997 and March 2017, were eligible for inclusion if they (1) conducted psychosocial, behavioral, or educational interventions designed to increase screening mammography rates in predominantly African American women of all ages; (2) utilized a randomized, controlled trial (RCT) design; and (3) reported quantitative screening rates following the intervention.

STUDY DESIGN

Randomized clinical trials on breast cancer screening in African American women, published between January 1997 and March 2017, were selected from database searches.

DATA COLLECTION METHODS

Data collected included effect size of screening versus comparison interventions, intervention characteristics, and a number of study characteristics to explore potential moderators. Search results yielded 327 articles, of which 14 met inclusion criteria and were included in analyses.

PRINCIPAL FINDINGS

Findings indicated that screening interventions for African American women were significantly more likely to result in mammography than control (OR = 1.56 [95 percent CI = 1.27-1.93], p < .0001). Although no patient or study characteristics significantly moderated screening efficacy, the most effective interventions were those specifically tailored to meet the perceived risk of African American women.

CONCLUSIONS

Screening interventions are at least minimally effective for promoting mammography among African American women, but research in this area is limited to a small number of studies. More research is needed to enhance the efficacy of existing interventions and reduce the high morbidity and mortality rate of this underserved population.

Inner Resources as Predictors of Psychological Well-Being in Middle-Income African American Breast Cancer Survivors

Although African American women are exposed to major life stressors such as breast cancer, many have high levels of psychological well-being (PWB). However, there are no current studies that describe the psychological effects of applying sense of coherence, hope, and spiritual perspective by African American breast cancer survivors. These three inner resources have each been positively associated with PWB or coping. This correlational study tested the Gibson Model of Inner Resources in 162 African American breast cancer survivors who completed the Abbreviated Herth Hope Index, Spiritual Perspective Scale, Sense of Coherence Scale (13-item) and the Quality of Life/Breast Cancer (PWB Subscale). Statistical analyses included correlation, multiple regression, and path analysis. Study findings supported the model. Sense of coherence significantly accounted for 37.5% and hope for 5.3% of PWB. Spiritual perspective did not significantly account for any of the variance, but there was an indirect path from spiritual perspective through hope to PWB. Sense of coherence and hope were direct predictors; however, spiritual perspective and hope together were predictors of PWB. Health professionals should consider strategies to enhance sense of coherence and hope when caring for African American breast cancer survivors. Qualitative research is indicated to further explore spirituality in this population.

Disparities in radiation therapy delivery: current evidence and future directions in head and neck cancer

Background

Though treatments for head and neck cancer have improved in recent years, significant variation persists in the delivery of surgery, radiation therapy, and systemic therapy to patients throughout the United States.

Body

In this review, we explore the current evidence regarding radiation therapy utilization inequities across the spectra of race, socioeconomic status, and age. We also discuss hypothesized mechanisms for how non-clinical factors may influence shared clinical decisions between patients and providers. Finally, we suggest future directions for research in treatment disparities.

Conclusions

Radiation therapy continues to be delivered inequitably among certain subpopulations with head and neck cancer and other cancers. More research into the drivers of these disparities and interventions designed to address them are necessary.

The spiritual framework of coping through the voices of cancer survivor narratives

Gall et al. (2005) developed a framework for spirituality by adapting and applying the transactional model of stress and coping, which is an interactive and fluid process spurred by a stressor involving spiritual appraisal, person factors, spiritual connections, spiritual coping behavior, and meaning-making impacting well-being. The components of the framework are examined through five cancer survivor narratives. The results showed that the components of the framework were experienced by the survivors, for example, various spiritual problem-solving styles were used, indication of spiritual connections to nature, others, and the transcendent. Meaning-making was common as they faced the life-threatening disease which often altered their worldview. The spirituality of the participants is reflected in the spiritual framework and the framework embraces these survivor experiences. This study has limitations due to its qualitative nature and small sample size.

The meaning of breast cancer risk for African American women

PURPOSE

To describe African American women's experience of being at high risk for breast cancer.

DESIGN

A hermeneutic phenomenological approach was used to guide in-depth interviews and analysis. Methods to ensure trustworthiness and rigor were included.

METHODS

Open interviews were conducted with 20 African American women who were at high risk for breast cancer (family history, personal history, genetic mutation). They were recruited from a cancer risk clinic and community-based settings. Data were transcribed verbatim, and themes were labeled among and between all interviews.

FINDINGS

Five themes were identified: (a) life-changing experience; (b) relationships: fears, support, and concerns; (c) the healthcare experience; (d) raising awareness; and (e) strong faith.

CONCLUSIONS

Young women at high risk for breast cancer have unique emotional and support needs that are shaped by stage in life, relationships with significant others, their faith, and interactions with the healthcare delivery system.

CLINICAL RELEVANCE

Breast cancer does occur in young women. This highlights the need for timely and sensitive approaches to care when young women present with breast health concerns or abnormal breast findings.

Do recently diagnosed black breast cancer patients find questions about cancer fatalism acceptable? A preliminary report

Socio-cultural factors such as cancer fatalism have been understudied in cancer patients. Women from two cancer centers completed a structured phone survey and an open-ended cognitive interview. Socio-cultural variables of fatalism, hope, and spiritual coping were measured using standardized scales. Older women had significantly higher fatalism scores compared to younger women (p < 0.01). Fatalism rates were low. Ratings of hope and collaborative religious coping were high (m = 20, m = 35, respectively). Qualitative comments confirmed the overall low acceptability of the fatalism measures. Further research is needed to identify measures that are acceptable to newly diagnosed patients.

Cancer perceptions of South African mothers and daughters: implications for health promotion programs

Cancer is one of the leading causes of death worldwide. A major reason why women do not obtain cancer screening procedures relates to the high levels of fear associated with cancer. In this study, we explored South African mothers' and daughters' reaction to the word "cancer" specifically. The study sample included 157 randomly selected mother and adolescent daughter pairs from an urban community in Cape Town, South Africa. Mothers and their adolescent daughters had very similar responses to the term "cancer." We found that most South African mothers and daughters had a fear-based attitude toward the illness. When we asked mothers what they immediately thought of upon hearing "cancer," a majority of women (69%) thought of death, and another 43% thought of suffering and the detrimental consequences of the illness. Similarly, 50% of the daughters also thought of death, and 42% thought of the detrimental aspects of cancer. Fatalistic attitudes and negative emotional reactions have important implications in cancer prevention and need to be addressed within a public health context.

Effects of personal characteristics on African-American women's beliefs about breast cancer

PURPOSE

This study measured the effect of demographic and clinical characteristics on health and cultural beliefs related to mammography.

DESIGN

Cross-sectional study.

SETTING

Interviews were conducted during 2003 and 2004 in a Midwestern urban area.

SUBJECTS

Subjects were 344 low-income African-American women 40 years and older who had not had mammography within the previous 18 months.

MEASURES

The instrument measured personal characteristics, belief and knowledge scales, and participants' mammography experience and plans.

ANALYSIS

Multiple regression analysis assessed the effect of specific demographic and clinical characteristics on each of the scale values and on subjects' stages of readiness to change.

RESULTS

The subjects' levels of education significantly affected six of the 12 belief and knowledge scales. Higher-educated women felt less susceptible to breast cancer, had higher self-efficacy, had less fear, had lower fatalism scores, were less likely to be present-time oriented, and were more knowledgeable about breast cancer. Older women felt they were less susceptible to breast cancer, had higher fatalism scores, were more present-time oriented, and were less knowledgeable about breast cancer.

CONCLUSIONS

The findings suggest that mammography promotion programs for African-Americans should consider the education levels and ages of the target women to be most effective.

Black women and breast health: a review of the literature

AIM

In the UK, it is known that screening inequalities exist involving ethnic minority groups such as Black women (Patnick, 2009). To date, there is limited UK data on Black British women and breast health awareness. Black British women appear to be an underrepresented group in breast cancer studies (Breast Cancer Care, 2004, 2005). This literature review aimed to explore Black women's perceptions of breast health and factors that influence breast cancer screening practices.

METHODS

A literature search for the period 1994 to September 2009 was undertaken using BNI, CINAHL, PubMed, OSH-ROM, PsyInfo, Google scholar, and Scopus databases. Key words used included: breast cancer, breast health, African American women, Black British women, black women, breast cancer screening, qualitative studies. Hand-searching was also done, and reference lists of papers were examined for relevant studies.

RESULTS

Black women hold a variety of views and perceptions on the risk that breast cancer poses. These perceptions are strongly related to existing knowledge, related stigmatization, spiritual and religious beliefs, all of which can adversely influence motivation to engage in self-breast examination and breast cancer screening.

CONCLUSION

US based studies identified several influential factors: religion, educational awareness of breast cancer screening, breast health awareness. Breast health interventions and research are needed to increase breast health awareness in Black British women.

One more hurdle to increasing mammography screening: pubescent, adolescent, and prior mammography screening experiences

BACKGROUND

Approximately $8.1 billion dollars is spent each year in the United States alone on the treatment of breast cancer. Survival rates are dependent on access to, and utilization of, early detection services. The primary reason for disparity in breast cancer mortality is the delay in time to diagnosis, resulting in poor prognosis. Despite ongoing research to understand barriers to mammography screening, recent studies report a decrease in mammography screening among all racial groups.

METHODS

A qualitative approach was used to elicit information from 36 White non- Hispanic, African-American, Hispanic, and Native American women without a history of breast cancer. Women were invited to share written or audiotape-recorded narratives about experiences pertaining to their breasts and their mammography screening experiences.

FINDINGS

Major categories identified were: teasing, family norms and values, media/societal influence, body image, and mammography screening experiences. The resulting effects of these experiences left these women with feelings of shame and "conflict" regarding their breasts. The major theme identified was breast conflict. Findings suggest that breast conflict may persist throughout the lifespan and can have a negative influence on a woman's decision to participate in mammography screening.

CONCLUSION

The authors hypothesize that experiences that occur during adolescence pertaining to young girls' breasts can influence a women's body image, which in turn can later in life affect health-seeking behaviors related to mammography screening. These findings have implications for public health practice in planning for breast cancer screening, education, and interventions for women from diverse racial/ethnics groups.

Social determinants of Black-White disparities in breast cancer mortality: a review

Despite the recent decline in breast cancer mortality, African American women continue to die from breast cancer at higher rates than do White women. Beyond the fact that breast cancer tends to be a more biologically aggressive disease in African American than in White women, this disparity in breast cancer mortality also reflects social barriers that disproportionately affect African American women. These barriers hinder cancer prevention and control efforts and modify the biological expression of disease. The present review focuses on delineating social, economic, and cultural factors that are potentially responsible for Black-White disparities in breast cancer mortality. This review was guided by the social determinants of health disparities model, a model that identifies barriers associated with poverty, culture, and social injustice as major causes of health disparities. These barriers, in concert with genetic, biological, and environmental factors, can promote differential outcomes for African American and White women along the entire breast cancer continuum, from screening and early detection to treatment and survival. Barriers related to poverty include lack of a primary care physician, inadequate health insurance, and poor access to health care. Barriers related to culture include perceived invulnerability, folk beliefs, and a general mistrust of the health care system. Barriers related to social injustice include racial profiling and discrimination. Many of these barriers are potentially modifiable. Thus, in addition to biomedical advancements, future efforts to reduce disparities in breast cancer mortality should address social barriers that perpetuate disparities among African American and White women in the United States.

Family matters in mammography screening among African-American women age > 40

PURPOSE

To examine how family history of cancer influences the mammography screening behaviors of asymptomatic African-American women.

METHODS

Using the National Health Interview Survey's 2000 Cancer Control Module, the authors performed bivariate analyses and multivariate logistic regressions with SAS/SUDAAN due to the complex sampling design.

RESULTS

Of the 1,531 African-American women in the final sample, 38% had a family history of cancer. Women with a family history of cancer were 39% more likely to have a recent mammogram compared to women with no family history of cancer (OR = 1.39; 95% CI: 1.06-1.81; p < 0.05). Eighty-five percent of African-American women aged > 40 with a family history of cancer indicated having a mammogram in the past compared to nearly 70% of African-American women without a family history of cancer.

CONCLUSION

Family history of any cancer independently and positively predicted mammography screening behaviors among asymptomatic African-American women. This suggests that African-American women with a history of cancer in their family are more likely (and perhaps more motivated) to engage in early cancer detection practices.

"I've been through something": poetic explorations of African American women's cancer survivorship

This article describes common experiences of African American women breast cancer survivors through poetic analysis. Group-as-a-whole theory and empirical and interpretive phenomenology guided analysis of transcripts from three focus groups (n = 21) of African American breast cancer survivors. Familiarity with transcripts and themes led to awareness of poetic ways in which African American women described experiences. Black feminist literature and African American historical references contextualized survivors' experiences. Poetic interpretations of African American women's breast cancer experiences, from diagnosis to survivorship, were created from transcript dialogues. Verbatim words were used to construct the poems, as often as possible. Eleven poems describe the journey from diagnosis to survivorship as experienced by African American women. The poetry may raise levels of awareness of African American women's breast cancer survivorship experiences. Attention to subtleties that underpin culture within the context of health care environments may help health care providers to improve cultural competence.

Breast cancer knowledge, attitudes, and screening behaviors among African American women: the Black cosmetologists promoting health program

Background

African American women have higher rates of breast cancer mortality than their white counterparts. Studies have suggested that this is partly caused by discovery of cancer at a later stage, highlighting the importance of encouraging early detection of breast cancer in this population. To guide the creation of a breast cancer education intervention and help focus other health educators' and clinicians' health promotion efforts, this study explored whether a cohort of African American women living in San Diego would demonstrate the possession of adequate baseline knowledge about breast cancer screening and adherence to widely recommended screening guidelines.

Methods

African American women (N = 1,055) from San Diego, California participated in a beauty salon-based survey about breast cancer knowledge, attitudes, and screening practices. Women's ages ranged from 20 to 94 years, with average age of 42.20 (SD = 13.53) years. Thirty-four percent reported completing college and/or some graduate school training, and 52% reported having some college or post high school formal training. Seventy-five percent of the sample reported working outside their home. Participating cosmetologists and their salons were recruited to the study through word-of-mouth referral by highly respected African American community leaders.

Results

Salon clients reported low rates of adherence to recommended breast cancer screening guidelines. Of the 1,055 participants, 31% reporting performing breast self-exam every month. Of those participants 40 and older, 57% reported having had a clinical breast exam and 43% reported having had a mammogram in the past year. Knowledge of breast cancer was associated with adherence to screening guidelines. While women recognized the serious health threat that breast cancer poses and that early detection of breast cancer is important, only 30% of women reported feeling well informed about the disease. Many participants demonstrated a lack of basic knowledge about breast cancer. The Health Belief Model postulates that access to such information is an essential element in the progression toward engaging in screening behaviors.

Conclusion

Data from this study reflect a continuing need for increased breast cancer education for African American women. In light of the considerable mainstream information available related to breast cancer, these data reinforce the need for more breast cancer education programs that are clearly intended to attract the attention of African American women.

Collaborative Breast Health Intervention for African American Women of Lower Socioeconomic Status

PURPOSE/OBJECTIVES

To describe all phases of a collaborative breast health intervention delivered by paraprofessionals or specially trained community health advisors (CHAs) for African American women designed to increase mammography screening.

DESIGN

Collaborative pretest, post-test breast health intervention.

SETTING

Large city in Ohio.

SAMPLE

68 African American women with a median age of 57.8 (SD = 5.28) obtained mammography screening and participated in the breast health intervention.

METHODS

Specially trained CHAs used aggressive recruitment strategies to increase mammography screening and knowledge of breast health and mammography screening in African American women aged 50 and older.

MAIN RESEARCH VARIABLES

Knowledge scores of breast health and mammography screening.

FINDINGS

Ninety women (81%) met the inclusion criteria and were recruited into the intervention, but only 68 (76%) obtained mammography screening. The women demonstrated increased knowledge by change in pre- to post-test scores. Several questions were statistically significant.

CONCLUSIONS

Collaborative breast health interventions delivered by trained CHAs are effective in increasing screenings as well as knowledge of breast health and mammography screening in African American women. The unique role of the CHA is especially important in recruitment of hard-to-reach women and was vital to the success of the educational intervention. Most importantly, the women valued the individualized attention to their breast health and agreed to share the information with significant others. Further collaborative interventions designed to increase screenings and increase knowledge of breast health and mammography screening are needed to reduce the health disparities of later-stage detection and poorer survival of breast cancer in African American women.

IMPLICATIONS FOR NURSING

Oncology nurses should build on the findings and deliver further outreach programs to increase mammography screening and knowledge of breast health in a larger number of women of lower socioeconomic status. Future research is needed to determine the influence of reminder phone calls for mammography screening. Oncology nurses should incorporate evaluation strategies at baseline and periodically throughout an intervention to provide more comprehensive data and enhance the credibility of findings. To maximize success, oncology nurses should work collaboratively with other healthcare professionals such as certified x-ray technicians and influential people in the community to increase knowledge of breast health and mammography screening.

Knowledge, barriers, and facilitators of Korean women and their spouses in the contemplation stage of breast self-examination

The aim of this study was to identify the knowledge, barriers, and facilitators of breast self-examination (BSE) in Korean couples in the contemplation stage. The study design was based on assumptions from the Health Belief Model and Transtheoretical Model that contemplators perceiving benefits as greater than barriers are likely to move to the next stage. Participant couples, with wives having never practiced BSE but with an intention to do so, were drawn from churches. Qualitative research was conducted with focus group methodology including both husbands and wives in the groups. Data transcribed from audiotapes were analyzed to identify common themes. Knowledge of breast cancer and BSE included "perceiving risks of getting breast cancer," "behaviors used to stay healthy and detect breast cancer," and "skills in BSE"; barriers to BSE included "lack of sensitivity to breast cancer," "fear of getting bad news," "lack of information," and "shortage of time"; and facilitators of BSE included "making BSE a monthly routine," "continuous systematic interaction from healthcare professionals reaching out to the community," and "encouragement and help from husbands." To improve compliance with BSE, women in the contemplation stage need specific and correct knowledge delivered by diverse materials, reminders, and the inclusion of husbands as facilitators.

Differences in health and cultural beliefs by stage of mammography screening adoption in African American women

Behavioral studies show that women's stage of readiness to adopt mammography screening affects their screening rates and that beliefs about breast cancer and screening affect stages of screening. The purposes of this study were to determine, first, the relationship between particular health and cultural beliefs and stage of mammography screening adoption in urban African American women, and second, whether demographic and experiential characteristics differed by stage. Data were analyzed from 344 low-income African American women nonadherent to mammography screening who participated in a 21-month trial to increase screening. At baseline, these women were randomized into 1 of 3 groups: tailored interactive computer instruction, targeted video, or usual care. Participants were categorized by stage of mammography screening adoption at 6 months as precontemplators (not planning to have a mammogram), contemplators (planning to have a mammogram), or actors (had received a mammogram). Although demographic and experiential variables did not differentiate stages of screening adoption at 6 months postintervention, some health and cultural beliefs were significantly different among groups. Actors were more preventive-health-oriented than precontemplators and had fewer barriers to screening than did contemplators. Precontemplators had more barriers, less self-efficacy, and greater discomfort with the mammography screening environment than did contemplators or actors. These results will be useful, not to change cultural beliefs, but to guide the design of health education messages appropriate to an individual's culture and health belief system. Cancer 2007. (c) 2006 American Cancer Society.

Research institute for nurse scientists responds to the challenge to expand and strengthen research focused on breast cancer in African American women

In an era where scientifically derived 'evidence' is used as a basis for nursing practice, it is imperative that nurses have a breadth of knowledge relative to the fundamentals of nursing science; knowledge of the current standards of nursing and medical practice; and knowledge of the characteristics, needs, concerns, and challenges of diverse consumer and patient population groups. Yet, while a significant body of 'evidence' that describes the experiences and needs of African American women across the breast care continuum has been generated, research suggests that there is a need to expand and strengthen this body of science. This report presents an overview of a decade of research focused on breast cancer among African American women and describes an initiative funded by the Susan G. Komen Breast Cancer Foundation to expand and strengthen nursing science that aims to reduce and/or eliminate excess breast cancer morbidity and mortality among African American women. Cancer 2007. (c) 2006 American Cancer Society.

Social processes used by African American women in making decisions about mammography screening

PURPOSE

To describe the social processes used by African American (AA) women ages > or = 50 years in making decisions about mammography screening.

DESIGN

Grounded theory methodology.

METHODS

Tape-recorded interviews with a researcher-designed, semi-structured interview guide with an initial and theoretical sample of 30 AA women ages 52 to 71 of diverse socioeconomic status. Interviews occurred in various settings such as the church rectory, women's homes, and work settings. Extensive written field notes and tapes were transcribed verbatim immediately after the interviews by an experienced transcriptionist.

FINDINGS

The women's decisions about mammography screening were associated with five social processes: (a) acknowledging prior experiences with healthcare providers and systems; (b) reporting fears and fatalistic beliefs of breast cancer and related treatment; (c) valuing the opinions of significant others; (d) relying on religious beliefs and supports; and (e) caregiving responsibilities of significant others. The processes were further differentiated by three distinct decision-making styles: taking charge, enduring, and protesting.

CONCLUSIONS

Each of the social processes was reported equally and emphasized by the diverse sample of AA women in decisions related to mammography screening. Mammography screening decisions were heavily influenced by caregiving responsibilities. Further research is needed to explain and understand this social process on the health and well-being of AA women over time.

Claiming health: mammography screening decision making of African American women

PURPOSE/OBJECTIVES

To develop a substantive theory that explains how African American women aged 50 years and older of different socioeconomic status (SES) make decisions about mammography screening.

DESIGN

Qualitative, grounded theory.

SETTING

Churches, places of employment, or women's homes in a large city in Ohio.

SAMPLE

30 women aged 52-72 years; 16 in the initial sample and 14 in the theoretical sample.

METHODS

Audiotaped interviews and extensive written field notes; interviews were transcribed verbatim and analyzed using the constant comparison method, resulting in saturation of data.

MAIN RESEARCH VARIABLES

Decision-making processes explaining mammography screening.

FINDINGS

"Claiming health" emerged as the substantive theory explaining decisions that affect mammography screening and was embedded in the social contexts of cultural heritage and learned kinship values, religious beliefs and supports, and prior negative experiences with healthcare professionals and the healthcare system. Claiming health involved sisterhood and fellowship relationships fostered in the church. Claiming health was differentiated by age and SES, with older women of lower SES reporting greater reliance on cultural heritage and negative recollections of the healthcare system when making decisions regarding mammography. Each subconcept of claiming health was equally important and influenced decision making.

CONCLUSIONS

Oncology nurses can benefit from the information presented by assisting older women of lower SES who may have encountered negative experiences in the healthcare system to develop effective assertiveness and communication skills when interacting with healthcare professionals.

IMPLICATIONS FOR NURSING

Further research is needed to determine whether claiming health is a way of thinking about health generally or is used solely to explain experiences with mammography screening.

Sociocultural context of mammography screening use

PURPOSE/OBJECTIVES

To examine variations in cultural and health beliefs about mammography screening among a socioeconomically diverse sample of African American and Caucasian women and to identify which set of beliefs predicted mammography screening adherence.

DESIGN

Descriptive, retrospective, cross-sectional study.

SETTING

Community-based organizations and public housing.

SAMPLE

111 African American women and 64 Caucasian women, aged 40 years or older, with no history of breast cancer.

METHODS

Telephone and in-person structured interviews were conducted. Items used previously validated scales based on the Cultural Assessment Model for Health and the Health Belief Model.

MAIN RESEARCH VARIABLES

Race or ethnicity, education, income, personal space, health temporal orientation, personal control, fatalism, susceptibility, benefits, barriers, self-efficacy, and mammography screening adherence.

FINDINGS

African American women were more fatalistic about breast cancer and perceived fewer benefits to screening. Mammography screening-adherent women were more future oriented, believed that they had less control over finding health problems early, had fewer barriers to screening, and experienced more physical spatial discomfort during the screening procedure than nonadherent women.

CONCLUSIONS

Several of the cultural beliefs were not significantly different by race or ethnicity. However, cultural and health beliefs were significant predictors of mammography screening.

IMPLICATIONS FOR NURSING

Theoretically based cultural beliefs are important to consider for behavioral interventions to increase mammography screening in African American and Caucasian women.

Teaching breast cancer screening to African American women in the Arkansas Mississippi river delta

PURPOSE/OBJECTIVES

To determine the effectiveness of a multifaceted, culturally sensitive breast cancer education program for African American women in the Arkansas Mississippi River Delta.

DESIGN

Experimental (i.e., posttest only, control group design).

SETTING

African American churches and a county Extension Homemakers Club sponsored through the Arkansas Extension Homemakers council.

SAMPLE

53 African American women. The experimental group included 30 participants who had a mean age of 56 years, and the control group consisted of 23 participants with a mean age of 51 years.

METHODS

After the presentation of a multifaceted, culturally sensitive breast cancer education program, a variety of instruments were administered to participants in the experimental group that measured dependent variables. Subjects in the control group completed the same instruments in the absence of a viable intervention. Data were analyzed using t tests.

MAIN RESEARCH VARIABLES

Knowledge and beliefs about breast cancer.

FINDINGS

The experimental group's mean scores were significantly higher than the control group's on the Breast Cancer Knowledge Test and the susceptibility scale of the Breast Cancer Screening Belief Scales. The experimental group also scored significantly higher than the control group on the confidence scale of the Breast Cancer Screening Belief Scales.

CONCLUSIONS

The multifaceted, culturally sensitive breast cancer education program appeared to be responsible for the differences in scores between the experimental and control groups.

IMPLICATIONS FOR NURSING

Culturally sensitive group educational programs aimed at helping African American women in the rural South become more knowledgeable about breast cancer and early detection clearly are needed. Such efforts also must focus on increasing women's confidence in effectively performing regular breast self-examination as well as their understanding of personal risk. Healthcare professionals play a major role in the development and implementation of these programs.

Differences in Breast Self-Examination Techniques between Caucasian and African American Elderly Women

BACKGROUND

The efficacy of breast self-examination (BSE) is controversial, recommendations to women are mixed, and reported differences by race in BSE are contrary to what is expected. We attribute this, in part, to measurement error in studies assessing the effectiveness of BSE. We assess differences by race in self-reported BSE while controlling selected sociodemographic indicators, BSE training, embarrassment, and perceived competence.

METHODS

Data are from personal interviews with 1011 women ages 50 and older, with approximately equal numbers of African Americans and Caucasians reporting that they examine their own breasts.

RESULTS

African American women are more likely than Caucasians to report examining their breasts visually, whereas Caucasian women are more likely than African Americans to report tactile examination of breast tissue, consistent with recommended BSE procedure.

CONCLUSIONS

BSE measures must be multidimensional to detect differences by race to guide interventions promoting self-detection of breast lumps, early presentation, and mortality reduction.

Depressive symptoms among women with an abnormal mammogram

An abnormal mammography finding constitutes a stressful event that may increase vulnerability by developing or intensifying pre-existing psychological morbidity. We evaluated depressive symptoms using the Composite International Diagnostic Interview among women of four ethnic groups who had an abnormal mammography result controlling for the effect of demographic, psychosocial and medical factors on recent onset of depressive symptoms. Telephone surveys were conducted among women aged 40-80 years recruited from four clinical sites in the San Francisco Bay Area after receiving a screening mammography result that was classified as abnormal but probably benign, suspicious or highly suspicious, or indeterminate using standard criteria. Among the 910 women who completed the interview, mean age was 56 (S.D.=10), 42% were White, 19% Latina, 25% African American, and 14% Asian. Prevalence of lifetime depressive symptoms was 44%, and 11% of women had symptoms in the previous month. Multivariate logistic regression models showed that Asian ethnicity, annual income >$10 000 and weekly attendance at religious services were significantly associated with decreased depressive symptoms. Having an indeterminate result on mammography and being on disability were significantly associated with more depressive symptoms. Reporting a first episode of depression more than a year before the interview was associated with significant increase in depressive symptoms in the month prior to the interview regardless of mammography result. Women with an indeterminate interpretation on mammography were at greater risk of depressive episode in the month prior to the interview compared to women with probably benign results (odds ratio=2.41; 95% CI=1.09-5.31) or with a suspicious finding. Clinicians need to consider depression as a possible consequence after an abnormal mammography result.

Breast health information needs of women from minority ethnic groups

BACKGROUND

For women from minority ethnic groups to make informed decisions about their health, and particularly about whether to participate in breast cancer screening programmes, access to a range of appropriately designed high quality, culturally-specific and sensitive health information is needed.

AIMS

Through a critical review of the literature, this paper aims to determine the breast health and breast cancer screening information needs of women from minority ethnic groups and to discuss the implications of cultural difference for nurses in relation to the development and dissemination of health information.

METHODS

A critical review of the research literature published in English between 1996 and 2002 was conducted. Electronic and the relevant Cochrane Collaboration databases were searched using a range of search terms to retrieve literature specifically relevant to the aims of the review. The use of personal contacts and posting a request for information on the mailing list at minority-ethnic-health@jiscmail.ac.uk facilitated the retrieval of grey literature. All references retrieved were entered on a bibliographic database. The title and abstract of each was examined to assess it for inclusion in the review.

FINDINGS

There was little published information about specific breast cancer screening information needs from the perspective of women from minority ethnic groups. In comparison with the indigenous population, the information needs of people from minority ethnic groups differ in relation to their cultural beliefs and values and the effects of these on health care practices. Inadequate knowledge about breast health and breast cancer screening may be a consequence of the provision of insufficient or culturally inappropriate information.

CONCLUSIONS

There is a dearth of research highlighting breast health and breast cancer screening information needs of women from minority ethnic groups. In providing information, their needs appear to have been an 'add on'. Health care professionals' lack of understanding about cultural beliefs, values and knowledge, together with racial stereotyping and misconceptions about cancer in minority ethnic groups, pose challenges to information dissemination. Health care professionals need to work collaboratively with women from minority ethnic groups, identifying culturally-specific beliefs and values about breast cancer, breast cancer risk and screening, in order to develop appropriate and acceptable information and dissemination strategies.

African American women's breast memories, cancer beliefs, and screening behaviors

African American women experience higher breast cancer mortality and lower survival rates compared with white women of comparable age and cancer stage. The literature is lacking in studies that address the influence of past events on current health behaviors among women of diverse cultural groups. This qualitative exploratory study used participant narratives to examine associations between women's memories and feelings concerning their breasts and current breast cancer screening behaviors. Twelve professional African American women, aged 42 to 64 years, shared stories about memories and feelings regarding their breasts. Codes grouped together with related patterns and recurrences revealed categories that encompassed the language and culture of the participants. The categories identified were Seasons of Breast Awareness, Womanhood, Self-Portraits, Breast Cancer and Cancer Beliefs, Breast Cancer Screening Experiences, and Participants' Advice for Change. These categories provide direction for further exploration of barriers to health promotion practices among African American women and women in general.

It's all sacred: African American women's perspectives on spirituality

In this study, we examined the meaning and function of spirituality for a group of African American women. Participants had been recruited for a focus group study exploring the significance of mother-daughter-sister relationships to the well being and health behavior choices of women. Women developed individually defined concepts of spirituality by combining Judeo-Christian traditions and African cosmology. Spirituality was a cornerstone of many participants' daily lives. It influenced women's decision-making and behavior across many realms. For example, many women came to the conclusion that domestic violence was not part of God's plan for their lives. Spiritual-based strategies may provide a rich foundation for innovative and efficacious health promotion interventions targeting African American women. Clinicians can assist in the co-creation of sacred spaces where women can connect with themselves and each other.

Developing and testing lay literature about breast cancer screening for African American women

Written materials about breast cancer screening for African American women with low literacy skills are needed. Available materials were not at or below third-grade reading levels, were not culturally sensitive, and were not accurate in illustrating correct breast self-examination (BSE) techniques. Focus groups representing the target population helped the authors design a pamphlet describing how to perform BSE and a motivational picture book to help women overcome barriers to screening. The authors chose a food theme for the cover of the pamphlet written at a third-grade level and suggested a photographic version. In the motivational book, two women address barriers to screening and replace myths and fears with facts and actions. Data from 162 women showed that they learned from both the photographic and illustrated versions. Women in the photographic group found significantly more lumps in the silicone models, so the authors chose that version to use in final testing. Finally, nurses pretested a group of patients before they reviewed the materials and post-tested another group after they reviewed them. The group who had reviewed the materials had greater knowledge of and intent to follow the guidelines and received higher scores on BSE techniques.

Korean women's breast cancer experience

The purpose of this study was to explore cultural meanings of breast cancer among Korean women in South Korea. A descriptive longitudinal study using methodological triangulation was conducted, and only qualitative findings are presented in this article. Ten Korean women who were newly diagnosed with a plan of surgery and subsequent chemotherapy, who did have severe fatigue at the time of recruitment, were recruited through Seoul National University Hospital. Data were collected using in-depth, 2-hour interviews and analyzed using thematic analysis. The themes emerged through the analysis process included: (a) "I did wrong," (b) "I cannot ask male physicians." (c) "I don't want to show the operation site to my husband." and (d) "I do household tasks by myself." The overriding theme was marginalization of the women within the context of their patriarchal culture. The findings suggest that culture is an important context circumscribing women's health/illness experience.

African Americans with cancer: the relationships among self-esteem, locus of control, and health perception

The purpose of this study was to describe and examine the relationships among self-esteem, locus of control, and perceived health status in African Americans with cancer and to identify predictors of perceived health status. A convenience sample of 95 oncology outpatients at two large medical facilities completed the Tennessee Self-Concept Scale, the Multidimensional Health Locus of Control Scale, and the Cantril Ladder, a measurement of perceived health. In an audiotaped interview two open-ended questions were used to clarify participants' Cantril Ladder scores. A significant positive relationship was discovered between self-esteem and powerful others health locus of control (p <.05). Participants tended to view God as the Powerful Other capable of influencing their health and well-being. Self-esteem and an internal health locus of control were found to account for 23% of the perceived variance in health status. In addition, interview data indicated that participants with normal to high levels of self-esteem and an internal health locus of control perceived their state of health and well-being positively.

Development of scholars interested in community-based health promotion research

Culturally consistent community-based health promotion interventions have been identified as integral components of strategies to decrease health disparities. The limited number of culturally competent scholars impedes the development of appropriate interventions. This article examines issues relevant to the development of scholars interested in community-based health promotion research. It is the outcome of a series of discussions by the authors held over a 3-month period. Specific topics include classroom and communal educational opportunities to enhance cultural competence and creation of supportive environments for aspiring community-based scholars. Particular attention is given to the importance of ongoing opportunities for interaction between students and lay community scholars.

Qualitative research with diverse populations

OBJECTIVES

To describe the benefits of conducting qualitative research with members of diverse cultures.

DATA SOURCES

Research studies, articles and books on philosophy of science.

CONCLUSIONS

Qualitative research with diverse populations is useful when little research exists on a topic, when there are no reliable and valid instruments for the groups, and when the appropriate language to use or the appropriate concepts and questions to ask are unclear. Participating in research that includes discussing your experiences has also been found to be valuable to those participating.

IMPLICATIONS FOR NURSING PRACTICE

Qualitative studies with diverse groups are needed to understand the concepts that are important to members of these groups, and to guide us in asking the correct questions using correct language.