Community attitudes and mammography use: does it really matter what other people think?

Barriers to mammography screening among racial and ethnic minority women

RATIONALE

Breast cancer is the second leading cause of cancer death among women. Disparities in breast cancer mortality rates adversely affect racial/ethnic minority women. Mammography screening is the most effective early detection method and means of reducing mortality rates. Yet, barriers prevent racial/ethnic minority women from participating in regular screening.

OBJECTIVE

This review aimed to summarize self-reported barriers to mammography screening in racial/ethnic minority women in studies using open-ended assessments and closed-ended assessments.

METHOD

Literature searches were conducted in two databases, PsycINFO and PubMed. Barriers were detailed in full by barrier type (psychological/knowledge-related, logistical, cultural/immigration-related, and social/interpersonal) and summarized briefly by race/ethnicity (African American/Black, Asian/Pacific Islander, Hispanic, American Indian/Native American, and Middle Eastern).

RESULTS

Twenty-two open-ended and six closed-ended studies were identified as eligible for this review. Overall, racial/ethnic minority women identified common logistical and psychological/knowledge-related barriers. Additionally, women reported cultural/immigration-related and social/interpersonal barriers that were closely tied to their racial/ethnic identities.

CONCLUSIONS

It was concluded that cultural/immigration-related barriers may be the only barrier type that is unique to racial/ethnic minority women. Thus, designing studies of barriers around race and ethnicity is not always appropriate, and other demographic factors are sometimes a more important focus. The variability in 'barrier' definitions, how data were collected and reported, and the appropriateness of closed-ended measures were also examined. This literature may benefit from detailed and strategically designed studies that allow more clear-cut conclusions and better comparison across studies as well as improving closed-ended measures by incorporating insights from investigations using open-ended inquiry.

Family/friend recommendations and mammography intentions: the roles of perceived mammography norms and support

Identifying factors that increase mammography use among Latinas is an important public health priority. Latinas are more likely to report mammography intentions and use, if a family member or friend recommends that they get a mammogram. Little is known about the mechanisms underlying the relationship between social interactions and mammography intentions. Theory suggests that family/friend recommendations increase perceived mammography norms (others believe a woman should obtain a mammogram) and support (others will help her obtain a mammogram), which in turn increase mammography intentions and use. We tested these hypotheses with data from the ¡Fortaleza Latina! study, a randomized controlled trial including 539 Latinas in Washington State. Women whose family/friend recommended they get a mammogram within the last year were more likely to report mammography intentions, norms and support. Perceived mammography norms mediated the relationship between family/friend recommendations and intentions, Mediated Effect = 0.38, 95%CI [0.20, 0.61], but not support, Mediated Effect = 0.002, 95%CI [-0.07, 0.07]. Our findings suggest perceived mammography norms are a potential mechanism underlying the effect of family/friend recommendations on mammography use among Latinas. Our findings make an important contribution to theory about the associations of social interactions, perceptions and health behaviors.

Presence of medical schools may contribute to reducing breast cancer mortality and disparities

Understanding differences among counties more or less successful in addressing breast cancer (BC) mortality disparities is important. Medical resources may be more available in counties with BC mortality rates (BCMR) low and similar for White and Black women. Based on Black and White BCMR we classified selected counties in four types from failing (high BCMR for both groups of women) to successful (low BCMR for both). Medical resource data were from Area Resource Files. In multivariate analyses, number of physicians or hospitals, HMO penetration, and proportion of hospitals with mammography centers did not predict county type. The proportion of hospitals with medical schools predicted counties being with Black:White disparities vs. with reverse disparities (OR 0.96, CI 0.94-0.99), or being successful vs. failing (OR 1.03, CI 1.00-1.06) or vs. with disparities (OR 1.04, CI 1.01-1.07). Medical resources did not explain county type differences, but type of care available may be important.

Initial and repeat mammography screening: different behaviors/different predictors

Despite evidence of the efficacy of mammography in early detection of breast cancer, many women choose not to have a mammogram. Some women who have an initial mammogram do not return for a second one. Many others, especially minority women, and those who live in rural areas or in a low socioeconomic class, are not being screened according to recommended guidelines. The full benefits of early detection are available only if women receive regular screening. This study of 830 randomly selected women over age 50 from rural, eastern North Carolina included women who had never had a mammogram (213), women who had had a mammogram but not in the prior 2 years (89), and women who reported having had a mammogram in the previous 2 years (528). Logistic regression was used to identify significant mammography predictor variables. The results support the robust role that provider recommendation plays in encouraging mammography behavior; they also demonstrate that past behavior is also a strong predictor of future screening participation. Only 13% of the women who had never had a mammogram reported obtaining a referral from their provider compared with 79% of the women who had a mammogram in the previous 2 years. Likewise, 75% of the women who had engaged in mammography behavior in the prior 2 years expressed a positive intention to be screened in the next year compared with only 14% of those women who had never had a mammogram. Initial and repeat mammography screenings are different behaviors and are influenced by different factors. For provider counseling to be effective, the strategies employed need to consider past behavior as well as current recommendations, and they must incorporate a discussion of beliefs as well as reinforcement of regular screening behavior.

Taking charge of self: breast health practices of older rural women

The purpose of this grounded theory study was to explore breast health practices of older Vermont women residing in rural communities. Although the three components of breast health-mammography, clinical breast exam, and self-breast exam-are recommended for women 40 years and over, minimal research has empirically analyzed the breast health practices of healthy women to ascertain if, in fact, these procedures are followed, and if so, what the motivation is for doing so. Twelve women, 50-64 years, participated in face-to-face, audiotaped interviews. Data analysis, including line-by-line and constant comparative approaches, occurred concurrently with data collection. Taking Charge of Self, the generated theory, describes participants' engagement in a process of learning how to take charge of their lives. The analysis indicates that health care providers have a powerful role in the lives of women in this age group. With an increasing emphasis on health promotion and disease prevention, health care providers are positioned to cultivate and support women's development of the personal or internal motivation for health and well-being.

Predictors of breast cancer screening in a panel study of African American women

PURPOSE

This study examines the predictors of breast cancer screening participation in a panel study of African American women over age 40. We examine the effect of depression, age, beliefs and concerns about breast cancer and its risk, communication with social networks regarding screening, marital status, participation in religious organizations, breast cancer family history, and participation in a breast cancer education program.

METHODS

Participants were recruited from 30 African American churches, two low-income housing projects, and from a health fair at a historically African American University (N = 364). Participants were interviewed upon recruitment, and three months later. Multinomial logistic regression models are estimated to assess the relative impact of covariates on the odds of getting a mammogram while controlling for other factors. We also assess predicted probabilities of screening at specific levels of covariates.

RESULTS

We find that age, marriage, an educational intervention, talking with friends, and believing that early detection can lead to cure had a positive impact on getting a mammogram between T1 and T2. In contrast, depression significantly reduces the odds of getting a mammogram. Family histories of breast cancer and church participation have no effect on rates of mammography net of other factors.