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Watts T, Orshak J, Ondoma C, Lauver D. Research Guided by the Theory of Care-Seeking Behavior: A Scoping Review. West J Nurs Res 2024; 46:468-477. [PMID: 38682743 DOI: 10.1177/01939459241247688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND A particular Theory of Care-Seeking Behavior was developed to explain care-seeking behavior with psychosocial concepts, external conditions, and clinical and demographic factors. Having a careful review of studies based on this theory could guide future research on care-seeking behaviors. OBJECTIVES With a scoping review: describe characteristics of studies guided by a Theory of Care-Seeking Behavior, summarize support for the relationships of proposed, explanatory variables with care-seeking behaviors, and examine support for propositions in the theory. METHOD Searching 5 electronic databases, we sought studies that were: full-text, peer-reviewed, in English, data-based, guided by the theory, and published from January 1, 1992, to January 1, 2022. RESULTS Across 18 identified articles, the behaviors studied included: symptomatic screening (n = 8), asymptomatic screening (n = 7), and care-seeking behaviors for either screening or symptoms (n = 3). A total of 3328 adults participated in the studies. In 16 studies, all participants were female. In 60% to 83% of studies, researchers had reported findings that supported the relationships of explanatory concepts with care-seeking behavior. Among the 7 studies that tested the 2 propositions of theory, all 7 tests failed to support the proposition that clinical and demographic factors influence care-seeking behavior indirectly through psychosocial variables. Six tests supported the proposition that psychosocial variables influence behavior conditionally, on external conditions. CONCLUSIONS Relationships of these explanatory variables with care-seeking behaviors were supported, as was 1 of 2 propositions. The Theory of Care-Seeking Behavior can be applied to new clinical situations to continue to build knowledge of the theory and understanding of care-seeking behaviors.
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Affiliation(s)
- Theresa Watts
- Orvis School of Nursing, University of Nevada, Reno, NV, USA
| | - Jennifer Orshak
- School of Nursing, University of Wisconsin-Madison, WI, USA
- Department of Veterans Affairs, William S. Middleton Memorial Veterans Hospital, Madison Wisconsin, USA
| | - Cissy Ondoma
- School of Nursing, University of Wisconsin-Madison, WI, USA
| | - Diane Lauver
- School of Nursing, University of Wisconsin-Madison, WI, USA
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Savage LC, Minardi F, Miller SJ, Jandorf LH, Erblich J, Margolies LR, Konte H, Sly JR. Identifying Frequently Endorsed Benefits and Barriers to Breast Cancer Screening for African-Born Women in the NYC Metropolitan Area: a Pilot Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01865-2. [PMID: 38082068 DOI: 10.1007/s40615-023-01865-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 03/01/2024]
Abstract
Most cancer screening data report on Black participants without distinguishing nativity, limiting our understanding of the needs of distinct groups within the African diaspora. The purpose of this pilot study was to assess demographic characteristics and perceptions of the benefits of and barriers to mammography among African immigrant women in New York City (NYC). Forty-two women who were 40 years or older, born in Africa, and English and/or French-speaking were recruited from African immigrant communities in NYC to complete a survey. Eighty percent of our sample aged 50 to 73 was adherent to the 2016 USPSTF mammography screening guideline. The most frequently endorsed benefits were that mammography will help find breast cancer early, could help find a breast lump before it is big enough to feel, and that if found early, breast cancer could be successfully treated. The most endorsed barriers were that having a mammogram is painful and that lack of insurance or being treated rudely at the mammogram center would keep participants from having a mammogram. Chi-square analyses assessed relationships between demographic characteristics and perceptions about mammography and revealed that endorsement of barriers to screening (e.g., health issues, transportation problems, pain, and time associated with mammography) varied by educational attainment. Findings suggest that future interventions should be multi-level and (1) support patients in accessing screening via resource sharing, (2) address other commonly cited barriers such as fear of pain during the procedure, and (3) support anti-racist healthcare environments especially in terms of treatment by providers.
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Affiliation(s)
- Leah C Savage
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Francesca Minardi
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah J Miller
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lina H Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joel Erblich
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Hunter College, New York, NY, USA
| | - Laurie R Margolies
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jamilia R Sly
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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3
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Record SM, Thomas SM, Chanenchuk T, Baker JA, Grimm LJ, Plichta JK. Breast Cancer Risk Assessment and Screening Practices Reported Via an Online Survey. Ann Surg Oncol 2023; 30:6219-6229. [PMID: 37460738 PMCID: PMC10528282 DOI: 10.1245/s10434-023-13903-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Breast cancer screening guidelines differ between organizations, and significant variations in practice patterns exist. Previous evidence suggests that provider-level factors are the greatest contributors to risk assessment and screening practice variability. This study aimed to characterize provider factors associated with breast cancer risk assessment and screening practice patterns, and to assess perceived barriers to providing risk assessment. METHODS An online survey was distributed to providers at a single academic institution and to providers publicly via social media (January to August 2022). Respondents in the United States who care for adult women at risk for the development of breast cancer were included. RESULTS Most of the respondents in the 143 completed surveys were white/Caucasian (79%) females (90%) age 50 years or younger (79%), and whereas 97% discuss breast cancer screening with their patients, only 90% order screening mammograms. Risk factor assessment was common (93%), typically performed at the first visit (51%). Additional training in genetics or risk assessment was uncommon (17%), although the majority were interested but did not have the time or resources (55%). Although most (64%) did not perceive barriers to providing risk assessment or appropriate screening, the most common barriers were time (77%) and education (55%). Barriers were more common among family practice or obstetrics and gynecology (OB/GYN) providers and those who worked in an academic setting (all p < 0.05). CONCLUSIONS Breast cancer risk assessment and screening practices are highly variable. Although time is the major barrier to providing risk assessment, providers also need education. Primary care organizations could partner with breast cancer-focused societies for additional resources.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Tori Chanenchuk
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay A Baker
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Lars J Grimm
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Holcomb J, Rajan SS, Ferguson GM, Sun J, Walton GH, Highfield L. Implementation of an Evidence-Based Intervention with Safety Net Clinics to Improve Mammography Appointment Adherence Among Underserved Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:309-318. [PMID: 34822118 PMCID: PMC9852109 DOI: 10.1007/s13187-021-02116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Abstract
The Peace of Mind Program is an evidence-based intervention to improve mammography appointment adherence in underserved women. The aim of this study was to assess effectiveness of the intervention and implementation of the intervention in safety net clinics. The intervention was implemented through a non-randomized stepped wedge cluster hybrid study design with 19 Federally Qualified Health Centers and charity care clinics within the Greater Houston area. A multivariable generalized estimating equation logistic regression was conducted to examine mammography appointment adherence. A survey assessing Consolidated Framework for Implementation Research constructs was also conducted with clinic staff prior to adoption and eight weeks post implementation. One-sided t-tests were conducted to analyze mean score changes between the surveys. A total of 4402 women (baseline period = 2078; intervention period = 2324) were included in the final regression analysis. Women in the intervention period were more likely to attend or reschedule their mammography appointment (OR = 1.30; p < 0.01) than those in the baseline period receiving usual care. 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%. A total of 15 clinics prior to adoption and eight clinics completed the survey at 8 weeks post implementation A statistically significant mean score decrease was observed in Inner Setting and in two Inner Setting CFIR constructs, Culture-Effort, and Implementation Climate. While the intervention improved mammography appointment adherence, there are opportunities to further integrate Consolidated Framework for Implementation Research constructs. Trial registration: Clinical trials registration number: NCT02296177.
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Affiliation(s)
- Jennifer Holcomb
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA.
- Sinai Urban Health Institute, 1500 South Fairfield Avenue, Chicago, IL, 60608, USA.
| | - Suja S Rajan
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA
| | - Gayla M Ferguson
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA
| | - Jiali Sun
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA
- Houston Hospice, 1905 Holcombe Blvd, Houston, TX, 77030, USA
| | - Gretchen H Walton
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA
| | - Linda Highfield
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA.
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA.
- Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P and Katherine G McGovern Medical School, 6431 Fannin St, Houston, TX, 77030, USA.
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Pett L, Hollenberg B, Mahoney J, Paz J, Siu N, Sun A, Zhang R, von Euler-Chelpin M. Participation and adherence to mammography screening in the Capital Region of Denmark: The importance of age over time. PLoS One 2023; 18:e0280790. [PMID: 36689434 PMCID: PMC9870097 DOI: 10.1371/journal.pone.0280790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/05/2022] [Indexed: 01/24/2023] Open
Abstract
Mammography screening's effectiveness depends on high participation levels. Understanding adherence patterns over time is important for more accurately predicting future effectiveness. This study analyzed longitudinal adherence to the biennial invitations in the Capital Region of Denmark from 2008-2017. We analyzed participation rates for five-year age groups along with their percent changes in each invitation round using linear regressions. Participation in the mammography screening program increased from 73.1% to 83.1% from 2008-2017. The participation rate among all age groups increased from the first to the fifth round, with the oldest age group having the largest increase (average percent change = 3.66; p-value = 0.03).
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Affiliation(s)
- Lindsay Pett
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Becky Hollenberg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Mahoney
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jake Paz
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nathan Siu
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Sun
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rachel Zhang
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Makhnoon S, Chen M, Levin B, Ensinger M, Mattie KD, Grana G, Shete S, Arun BK, Peterson SK. Use of breast surveillance between women with pathogenic variants and variants of uncertain significance in breast cancer susceptibility genes. Cancer 2022; 128:3709-3717. [PMID: 35996941 PMCID: PMC11160485 DOI: 10.1002/cncr.34429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Use of surveillance mammography and magnetic resonance imaging (MRI) has been understudied among women with variant of uncertain significance (VUS) compared to pathogenic and likely pathogenic variants (P/LP). METHODS Using data from two cancer settings, we calculated use of risk-reducing mastectomy (RRM) and surveillance during each 13-month span after genetic testing up to 6 years afterwards for a cohort of genetically elevated risk women. RESULTS Of 889 women, VUS carriers were less likely to undergo RRM compared to those with P/LP (hazard ratio [HR], 0.17; p = <.001) and high-risk women were more likely to undergo RRM than average-risk women (HR, 3.91; p = .005). Longitudinally, surveillance use among unaffected women decreased from 49.8% in the first year to 31.2% in the sixth year after genetic testing. In comparison, a greater proportion of women with a personal history of breast cancer underwent surveillance, which increased from 59.3% in the first year to 63.6% in the sixth year after genetic testing. Mammography rates did not differ between women with P/LP and VUS within the first 13 months after genetic testing and up to 4 years afterward. Over the first 4 years after genetic testing, women with VUS were less likely to undergo annual MRIs compared to P/LP. CONCLUSION The authors found that VUS, whether in high or moderate penetrance breast cancer susceptibility genes, was associated with lower use of annual breast MRI compared to P/LP variants and equivalent use of annual mammography. These results add important evidence regarding VUS-related breast surveillance.
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Affiliation(s)
- Sukh Makhnoon
- Department of Behavioral Science, UT MD Anderson Cancer Center, Houston, TX
| | - Minxing Chen
- Department of Biostatistics, UT MD Anderson Cancer Center, Houston TX
| | - Brooke Levin
- William G. Rohrer Cancer Genetics Program, Division of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ
| | - Megan Ensinger
- OhioHealth Cancer Genetics Program, OhioHealth, Columbus, OH
| | - Kristin D Mattie
- William G. Rohrer Cancer Genetics Program, Division of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ
| | - Generosa Grana
- William G. Rohrer Cancer Genetics Program, Division of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ
| | - Sanjay Shete
- Division of Cancer Prevention and Population Sciences, UT MD Anderson Cancer Center, Houston TX
| | - Banu K Arun
- Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, TX
| | - Susan K Peterson
- Department of Behavioral Science, UT MD Anderson Cancer Center, Houston, TX
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Champion VL, Monahan PO, Stump TE, Biederman EB, Vachon E, Katz ML, Rawl SM, Baltic RD, Kettler CD, Zaborski NL, Paskett ED. The Effect of Two Interventions to Increase Breast Cancer Screening in Rural Women. Cancers (Basel) 2022; 14:4354. [PMID: 36139515 PMCID: PMC9496655 DOI: 10.3390/cancers14184354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Guideline-based mammography screening is essential to lowering breast cancer mortality, yet women residing in rural areas have lower rates of up to date (UTD) breast cancer screening compared to women in urban areas. We tested the comparative effectiveness of a tailored DVD, and the DVD plus patient navigation (PN) intervention vs. Usual Care (UC) for increasing the percentage of rural women (aged 50 to 74) UTD for breast cancer screening, as part of a larger study. Four hundred and two women who were not UTD for breast cancer screening, eligible, and between the ages of 50 to 74 were recruited from rural counties in Indiana and Ohio. Consented women were randomly assigned to one of three groups after baseline assessment of sociodemographic variables, health status, beliefs related to cancer screening tests, and history of receipt of guideline-based screening. The mean age of participants was 58.2 years with 97% reporting White race. After adjusting for covariates, 54% of women in the combined intervention (DVD + PN) had a mammogram within the 12-month window, over 5 times the rate of becoming UTD compared to UC (OR = 5.11; 95% CI = 2.57, 10.860; p < 0.001). Interactions of the intervention with other variables were not significant. Significant predictors of being UTD included: being in contemplation stage (intending to have a mammogram in the next 6 months), being UTD with other cancer screenings, having more disposable income and receiving a reminder for breast screening. Women who lived in areas with greater Area Deprivation Index scores (a measure of poverty) were less likely to become UTD with breast cancer screening. For rural women who were not UTD with mammography screening, the addition of PN to a tailored DVD significantly improved the uptake of mammography. Attention should be paid to certain groups of women most at risk for not receiving UTD breast screening to improve breast cancer outcomes in rural women.
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Affiliation(s)
- Victoria L. Champion
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Patrick O. Monahan
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Timothy E. Stump
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Erika B. Biederman
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Eric Vachon
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Mira L. Katz
- Division of Health Behavior and Health Promotion, The Ohio State University, Columbus, OH 43210, USA
| | - Susan M. Rawl
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Ryan D. Baltic
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Carla D. Kettler
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Natalie L. Zaborski
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Electra D. Paskett
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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8
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Miles RC, Flores EJ, Carlos RC, Boakye-Ansa NK, Brown C, Sohn YJ, Narayan AK. Impact of Health Care-Associated Cost Concerns on Mammography Utilization: Cross-Sectional Survey Results From the National Health Interview Survey. J Am Coll Radiol 2022; 19:1081-1087. [PMID: 35879187 DOI: 10.1016/j.jacr.2022.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Health care-related cost concerns and financial toxicity are increasingly recognized barriers along the breast cancer care continuum. The purpose of this study was to evaluate the association between patient-reported cost concerns and screening mammography utilization. METHODS Survey participants aged 40 to 74 years from the 2018 National Health Interview Survey without personal history of breast cancer were included (response rate: 64%). Respondents were queried if they had experienced specific access-related health care barriers. Multiple variable logistic regression analyses were performed to evaluate the association between barriers to care and patient-reported screening mammography utilization. RESULTS Of survey respondents, 7,511 women were included. Of this group, 68.9% reported receiving a screening mammogram within the last 2 years and 52.2% reported receiving a screening mammogram within the last year. Of all survey respondents, 48.4% reported worry paying medical bills. Patients who reported worry about paying medical bills (odds ratio [OR] 0.86; 95% confidence interval [CI]: 0.76-0.97; P = .01), challenges affording dental care (OR 0.65; 95% CI: 0.54-0.77; P < .01), and challenges affording eyeglasses (OR 0.67; 95% CI: 0.54-0.84; P < .01) were less likely to report screening mammography use than their respective counterparts. Patients who skipped medication doses (OR 0.69; 95% CI: 0.52-0.91; P < .01), took less medication, (OR 0.63; 95% CI: 0.48-0.82; P < .01), and delayed filling prescriptions (OR 0.71; 95% CI: 0.56-0.90; P < .01) to save money were also less likely to report receiving mammography screening. CONCLUSION Patient-reported cost-related barriers are associated with decreased utilization of routine mammography.
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Affiliation(s)
- Randy C Miles
- Chief, Breast Imaging and Associate Director, Research in Radiology, Denver Health, University of Colorado, Denver, Colorado.
| | - Efren J Flores
- Associate Chair, Equity, Inclusion and Community Health, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ruth C Carlos
- Assistant Chair, Clinical Research, Department of Radiology, University of Michigan, Ann Arbor, Michigan; and Editor-in-Chief, JACR
| | | | - Corey Brown
- Meharry Medical College, Nashville, Tennessee
| | - Young-Jin Sohn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Vice Chair, Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
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9
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Robinson JK, Brown Z, Spring B. Melanoma Skin Self-Examination Education During Mammography: Health Burden of Women Impairs Implementation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:858-864. [PMID: 32090289 PMCID: PMC7483150 DOI: 10.1007/s13187-020-01714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Identification of barriers to seeking health care for a concerning mole found during skin self-examination (SSE) by women educated during screening mammography. In this sequential mixed methods research, interviews with women who found a concerning mole and did not have health-care follow-up were analyzed and a survey was created. One year after SSE education, barriers to having health care for a self-identified concerning mole were assessed. The electronic medical records for all participants, who received education, were reviewed to ascertain who received health care related to a concerning mole or a screening mammogram. Among the 280 women who performed SSE, 85 found a concerning mole. Nine months later 51 women did not receive health care for the mole. Barriers were the burden of other medical concerns, fear of what the doctor will find, feeling like nothing is wrong, and being too busy. A positive screening mammogram (Fisher's two-sided exact test, p < 0.001) and a history of indoor tanning (Fisher's two-sided exact test, p = 0.011) were significantly associated with lack of follow-up for a concerning mole. Targeted melanoma self-identification with SSE relies upon participants initiating performance and seeking medical care for a concerning mole. The burden of a positive screening mammogram reported to women at about the same time as they identified the concerning mole was associated with failing to seek care for their concerning mole. Reminders to check moles for change 4 months after identifying a concerning mole may benefit women. Clinicaltrials.gov NCT03512457.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 1050, Chicago, IL, 60611, USA.
| | - Zoe Brown
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 1050, Chicago, IL, 60611, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Hsieh HM, Chang WC, Shen CT, Liu Y, Chen FM, Kang YT. Mediation Effect of Health Beliefs in the Relationship Between Health Knowledge and Uptake of Mammography in a National Breast Cancer Screening Program in Taiwan. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:832-843. [PMID: 32103458 DOI: 10.1007/s13187-020-01711-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Despite evidence that breast cancer screening effectively diagnoses and treats cancer through early detection, mammography use remains low in Taiwan. We applied the health belief model (HBM) and the knowledge-attitude-behavior (KAB) model as theoretical frameworks to examine factors associated with mammography uptake among women aged 45-69 years in Taiwan. A cross-sectional survey January-July 2018 was conducted of women aged 45-69 years in five southern Taiwan health institutions. Survey questionnaires included demographics, HBM constructs, and health knowledge regarding breast cancer and screening. Multivariable logistic regression models explored the mediation effects of HBM constructs between health knowledge and mammography use. The final analytical sample included 621 women; 67 did not receive mammography and 554 received mammography. When the regression model was adjusted only for demographic factors, women with adequate health knowledge were more likely to undergo mammography (AOR = 2.321, 95%CI = 1.141-3.809); in regression models including health knowledge and HBM constructs, the likelihood effect of health knowledge declined and became insignificant (AOR = 1.711, 95%CI = 0.985-2.972), indicating potential mediation effects between health knowledge and up-to-date mammography use. Overall, based on the HBM and the KAB theoretical framework, our data support that health belief played a substantial mediating role in the association between health knowledge and mammography uptake, in particular perceived barriers and cues to action in the HBM, which were modifying factors of health beliefs. Therefore, to improve mammography uptake, it may be helpful to design educational model-based interventions through tackling those modifiable perceived barriers and enhancing the intensity of external cues to action.
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Affiliation(s)
- Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, 100 Shih-Chung 1st Road, San-Ming Dist, Kaohsiung, 807, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Wei-Chieh Chang
- Department of Neurological Surgery, National Cheng Kung University Hospital, Kaohsiung, Taiwan
| | - Cheng-Ting Shen
- Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Yi Liu
- Department of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Ming Chen
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Ting Kang
- Department of Management, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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Satoh M, Sato N. Relationship of attitudes toward uncertainty and preventive health behaviors with breast cancer screening participation. BMC WOMENS HEALTH 2021; 21:171. [PMID: 33882923 PMCID: PMC8061057 DOI: 10.1186/s12905-021-01317-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Abstract
Backgroundcxs Early detection of breast cancer is effective for prolonging survival, but the participation rate in breast cancer screening among target Japanese women remains low. This study examined the relationships between tendencies in decision-making under conditions of uncertainty, health behaviors, demographics, and breast cancer screening participation in Japanese women. Methods Secondary analysis was performed using data from the 2017 Keio Household Panel Survey (KHPS). The study population consisted of 2945 households. Data were obtained from the KHPS for women aged 40 years or older. Breast cancer screening participation in the past year, risk aversion, time preference, health behaviors (e.g., smoking, alcohol consumption, and medical treatment received in the past year), and demographic variables were analyzed. Results Data from 708 women were analyzed. Among the respondents, 28.8% had attended breast cancer screening in the past year. Factors found to significantly contribute to breast cancer screening participation included higher risk aversion (odds ratio [OR], 2.34; 95% confidence interval [CI] = 1.03–5.32; p = 0.043), medical treatment received in the past year (OR, 1.56; 95% CI = 1.06–2.30; p = 0.026), higher self-rated health (OR, 1.47; 95% CI = 1.18–1.83; p = 0.001), living above the poverty line (OR, 2.31; 95% CI = 1.13–4.72; p = 0.022), and having children (OR, 1.57; 95% CI = 1.02–2.42; p = 0.042). Factors significantly associated with non-participation in breast cancer screening were smoking (OR, 0.20; 95% CI = 0.10–0.42; p < 0.000), alcohol consumption (OR, 0.56; 95% CI = 0.37–0.86; p = 0.007), being self-employed (OR, 0.22; 95% CI = 0.10–0.46; p < 0.000), and being unemployed (OR, 0.48; 95% CI = 0.26–0.90; p = 0.022). No significant relationship was observed between time preference and screening participation. Conclusions The results indicate that women who recognize the actual risk of developing breast cancer or have high awareness of breast cancer prevention tend to participate in breast cancer screening. Barriers to screening participation are not working for an organization that encourages screening and low income.
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Affiliation(s)
- Miho Satoh
- Department of Fundamental Nursing, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Naoko Sato
- Department of Clinical Nursing, Fukushima Medical University, Fukushima, Fukushima, Japan
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Tiensoli SD, Felisbino-Mendes MS, Velasquez-Melendez G. Health Iniquity, Unhealthy Behavior, and Coverage of Mammography in Brazil. Rev Bras Enferm 2020; 73:e20200011. [PMID: 33338162 DOI: 10.1590/0034-7167-2020-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/26/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of mammography screening and the association among socio-demographic, behavior factors and non-adherence to mammography screening among women between 50 and 69 years old, using data from Vigitel 2016. METHOD Cross-sectional, population-based study with data from Vigitel including 12,740 women in the 50-69 age group. The variables were analyzed using logistic regression. RESULTS Among the women studied, 21.8% had not had a mammography in the past 2 years. The characteristics associated with non-adherence to the test were having less than 12 years of education (p<0.001), having no partner (p=0.001), being underweight (p=0.002), having a negative self-perceived health status (p<0.001) and having at least one negative health behavior (p<0.001). CONCLUSION There is a subgroup of women with markers of social vulnerability, which reflect the inequality in mammography screening.
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Kosog K, Earle M, Stellon E, Nolan C, Wainwright MK, Webb T, Canar WJ. Identifying an association between socio-demographic factors and breast cancer screening adherence in a federally qualified health centre sample in the United States. A retrospective, cross-sectional study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1772-1779. [PMID: 32304270 DOI: 10.1111/hsc.13002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
Federally Qualified Health Centres (FQHC) are community-based centres in the United States, intended to fill a gap in care for underserved populations, including Medicaid patients and the homeless. Because of the Affordable Care Act, passed into law in 2010, there was a 29% increase in Medicaid enrolees nationally. One service offered at FQHCs is breast cancer screening. Breast cancer screening has been shown to have the lowest adherence levels among low-income women and homeless women. As they serve patients with socio-economic barriers, FQHCs are a vital resource in ensuring access to such screening. This study aimed to identity an association between socio-demographic factors and breast cancer screening adherence in FQHC patients that included the homeless. This exploratory, cross-sectional, retrospective study looked at encounter level data from a FQHC in a major metropolitan (Chicago, IL) area from January 1st, 2017 through December 31st, 2018. Data were collected in January of 2019. This was a convenience sample. Association was tested through bivariate chi-square tests and multivariate logistic regression analysis, investigating the association between socio-demographic characteristics and compliance (Yes/No) for breast cancer screening. Results showed age (55-59; 65-69) and homeless status (doubling-up, transitional) showed a positive association with breast cancer screening, while insurance status (self-pay) had a negative association. Age, homeless status and insurance type were significantly associated with adherence. Demographic characteristics in the homeless population can be used to identify nonadherence.
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Affiliation(s)
- Kari Kosog
- Dept. of Health Systems Management, Rush University, ECG Management Consultants, Chicago, IL, USA
| | - Melinda Earle
- College of Nursing and College of Health Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ed Stellon
- Heartland Alliance Health, Chicago, IL, USA
| | | | | | - Thomas Webb
- Center for Quality, Safety and Value Analytics, Rush University Medical Center, Chicago, IL, USA
| | - William J Canar
- Dept. of Health Systems Management, Rush University, ECG Management Consultants, Chicago, IL, USA
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Effect of a national population-based breast cancer screening policy on participation in mammography and stage at breast cancer diagnosis in Taiwan. Health Policy 2020; 124:478-485. [DOI: 10.1016/j.healthpol.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
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Ghanbari A, Rahmatpour P, Hosseini N, Khalili M. Social Determinants of Breast Cancer Screening among Married Women: A Cross-Sectional Study. J Res Health Sci 2020; 20:e00467. [PMID: 32814688 PMCID: PMC7585759 DOI: 10.34172/jrhs.2020.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Regular cancer screening is the best way for early detection of breast cancer, but studies showed the low participation rates of screening in Iran. We aimed to determine breast cancer screening among married women and related factors in North of Iran. STUDY DESIGN A cross-sectional study. METHODS This cross-sectional study was carried out from Jan to Mar 2017 among 1472 married women in an urban population in Rasht City, North of Iran. Data were collected using a questionnaire included socio-demographic information and breast cancer screening behaviors. Descriptive statistics, chi-square and logistic regression were used for data analyzing with SPSS. RESULTS The mean age of women was 35.1 ±6.5 years. Majority of women never performed clinical breast examination (70.7%) and regular monthly breast self-examination (52.2%). Only women over 40 yr performed mammography. Mammography performance was associated with health insurance (OR=4.99; 95% CI: 1.10, 22.53) and family history (OR=1.60; 95% CI: 1.19, 2.19), clinical breast examination was associated with age of women (OR=2.87; 95% CI: 1.90, 4.32) and breast self-examination was associated with age and occupation of women [OR=1.67; 95 % CI: 1.16, 2.39, OR=1.65; 95% CI: 1.19, 2.29) respectively]. CONCLUSION The rate of breast cancer screening was low among married women. Therefore considering the structural and cultural barriers, effective health education is essential to reduce inequality and increase the efficiency of screening programs.
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Affiliation(s)
- Atefeh Ghanbari
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Pardis Rahmatpour
- PhD Candidate in Nursing, Iran University of Medical Sciences, Tehran,
| | - Narges Hosseini
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Malahat Khalili
- Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
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Stephens SE, Foley KL, Miller D, Bellinger CR. The Effects of Health Disparities on Perceptions About Lung Cancer Screening (LCS): Survey Results of a Patient Sample. Lung 2019; 197:735-740. [DOI: 10.1007/s00408-019-00281-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022]
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