Mammography adherence: a qualitative study

Breast cancer screening and immigrant women-A scoping review of attendance, knowledge, barriers and facilitators

AIM

The aim of this study was to summarize the latest research reports about immigrant women and attendance in breast cancer screening.

DESIGN

Scoping review.

METHODS

Literature searches were made in CINAHL, PubMed, Web of Science, Google Scholar, Oatd and Oalster. Twenty-three articles were included in the study. Data were analysed with inductive content analysis.

RESULTS

Out of data four main categories were formed: attendance rates, incidence, barriers and facilitators, and knowledge and perception. The results show that attendance rates, barriers and facilitators for attendance, knowledge and experience of breast cancer and breast cancer screening differ between several factors such as the woman's migrant background, country of origin, religion, length of stay in the new home country and sociodemographic factors.

Food security status and breast cancer screening among women in the United States: Evidence from the Health and Retirement Study and Health Care and Nutrition Study

PURPOSE

To assess the impact of food insecurity on biennial breast cancer screenings (i.e., mammography or breast X-ray) among older women in the United States (US).

METHODS

Data from the 2014 and 2016 waves of the Health and Retirement Study and the 2013 Health Care and Nutrition Study were used. The analyses were limited to a nationally representative sample of 2,861 women between 50 and 74 years of age, residing in the US. We employed a propensity score weighting method to balance observed confounders between food-secure and food-insecure women and fit a binary logistic regression to investigate population-level estimates for the association between food security and breast cancer screening.

RESULTS

Food insecurity was significantly associated with failure to obtain a mammogram or breast X-ray within the past two years. Food-insecure women had 54% lower odds of reporting breast cancer screening in the past 2 years (adjusted OR = 0.46; 95% CI 0.30-0.70, p-value < 0.001) as compared to food-secure women. Additional factors associated with a higher likelihood of receiving breast cancer screenings included greater educational attainment, higher household income, regular access to health care/advice, not smoking, and not being physically disabled or experiencing depressive symptoms.

CONCLUSION

Results demonstrate a socioeconomic gradient existing in regard to the utilization of regular breast cancer screenings among women. Those who tend to have lower education, lower income, and lack of reliable healthcare access are more likely to be food insecure. Thus, more likely to face the financial, logistical, or environmental barriers in obtaining screening services that accompany food insecurity.

Development and validation of the psychometric properties of the perceived barriers of mammography scale

We aimed to develop and test the psychometric properties of the Perceived Barriers of Mammography Scale (PBMS-23). Based on a mixed method design researchers generated item pool through qualitative data and literature review and next, 500 women ages 40 to 69 years completed the questionnaire. Based on exploratory and confirmatory Factor Analysis, 23 items, researchers revealed eight domains of fate and destiny, breast conflict, defense avoidance, inconveniences/difficulties of mammography screening, contrasting/competing priorities, fear, distrust of mammography, and lack of knowledge with appropriate fitness for the data. PBMS-23 is valid and reliable instrument for assessing perceived barriers of mammography.

Balancing risks: Qualitative study of attitudes, motivations and intentions about attending for mammography during the COVID-19 pandemic

AIMS

To explore attitudes, motivations and intentions about attending for mammography among women who cancelled or postponed breast cancer screening, which had remained open in Denmark during the COVID-19 pandemic.

METHODS

A telephone interview study was conducted at the end of April 2020. A qualitative, phenomenological approach was chosen to identify themes and concepts and a semi-structured interview guide was developed. The analysis was structured according to constructs from the theory of planned behaviour, including attitudes to breast cancer screening, norms and motivations to comply with breast cancer screening, perceived control and anticipated regret.

RESULTS

Interviews were carried out with 33 women aged 50-69 (mean 62) years. The women felt that screening was of secondary importance during the height of the pandemic and they felt low perceived control over transportation to the screening clinic and over the screening situation itself, where social distancing was impossible. They perceived messages from the authorities as conflicting regarding the request for social distancing and a lack of recommendations about using face masks at the screening clinic.

CONCLUSIONS

Women who postponed or cancelled breast cancer screening during the COVID-19 pandemic felt that public recommendations appeared contradictory. Uncertainty about the 'new norm(al)' of COVID-19 made them stay at home, although the screening clinics remained open. The findings point to the importance of addressing perceived inconsistency between recommendations from the World Health Organization and the national management of these recommendations, and to secure univocal information from the authorities about the recommended use of healthcare services in a time of crisis.

Quantification of Potential Inequities in Breast Cancer Incidence in New Mexico Through Bayesian Disease Mapping

INTRODUCTION

The incidence of breast cancer among non-Hispanic American Indian and Alaska Native (AI/AN) women varies across the United States. We applied county-level Bayesian disease mapping to quantify potential inequities in 10-year breast cancer incidence in New Mexico to better inform health equity initiatives among its non-Hispanic at-risk AI/AN population.

METHODS

We used data from the Surveillance, Epidemiology, and End Results (SEER) program from 2005 through 2014 to identify new cases of breast cancer in New Mexico's 33 counties. To account for spatial variation, a county-level Area Deprivation Index, and the small area estimation problem inherent in these data, we borrowed strength globally and locally by applying Bayesian disease mapping to the counts of age-adjusted county-level breast cancer incidence. We quantified the disparity effect, as measured by the age-adjusted rate ratio, comparing the incidence of breast cancer between at-risk non-Hispanic AI/AN and non-Hispanic White women and assessed whether the ratio differed among counties.

RESULTS

Accounting for over-dispersion and spatial correlation among the 33 counties and a county-level Area Deprivation Index, the posterior mean of the overall age-adjusted rate ratio was 0.384 (95% credible interval, 0.253--0.546). The age-adjusted rate of breast cancer in non-Hispanic AI/AN women was 0.38 times the corresponding age-adjusted rate for non-Hispanic White women; however, a significant reduction in breast cancer incidence was observed in 16 of the 33 counties.

CONCLUSION

The application of Bayesian disease mapping to these data provided substantial evidence of an overall disparity in breast cancer incidence between at-risk non-Hispanic AI/AN and non-Hispanic White women in New Mexico, which was more marked than previously reported and limited to certain counties. Targeted statewide and county-level health-equity initiatives may lead to a reduction in these disparities.

Health outcomes and experiences of direct-to-consumer high-intensity screening using both whole-body magnetic resonance imaging and cardiological examination

Background

Alongside a clinical and research setting, whole body magnetic resonance imaging (WB-MRI) is increasingly offered as a direct-to-consumer screening service. Data is needed on the clinical relevance of findings and associated psychological impact of such screening. Therefore, we conducted a prospective follow-up study to provide insight in the effectiveness and psychological impact of direct-to-consumer screening using both WB-MRI and cardiological examination.

Methods and findings

The study population consisted of 3603 voluntary, primarily middle-aged participants who underwent commercial WB-MRI and cardiological screening at one of 6 study clinics in Germany or the Netherlands between July 2014 and March 2016. MRI investigation consisted of directed scans of the brain, neck, abdomen and pelvis. Cardiovascular examination included pulmonary function, resting electrocardiogram, transthoracic echocardiogram and a bicycle exercise stress test. Findings were assessed by experienced radiologists and cardiologists. In addition, participants were inquired about several (psychological) domains, including the expectations and consequences of the screening procedure. Out of 3603 individuals, 402 (11.2%) demonstrated abnormal MRI (n = 381) and/or cardiological findings (n = 79) for which they were advised to undergo further consultation <3 months in regular healthcare. In 59.1% of cases of abnormal MRI findings which were consulted, fully completed consultations were available in 87.1%. After consultation, 77.6% of initial MRI outcomes were adopted. In 40.9% of cases of abnormal MRI findings, recommendations for consultation were not adhered to during the study period. 71.1% of adopted MRI-findings required treatment or monitoring, including 19 malignancies. For abnormal cardiological findings, 70.9% of cases were consulted in regular healthcare. Of these, 91.1% had a completed follow-up procedure of which 72.5% of initial findings were adopted and 83.8% of these findings required treatment or monitoring. The most frequently reported psychological consequences of the screening procedure were getting reassurance (72.0%) and insight into one’s own health status (83.0%). 5.0% reported to feel insecure about their health and 6.2% worried more about their health as a consequence of screening. Main limitations of the study were considered the telephonic follow-up of referred clients and the heterogeneity of screening equipment and assessment of radiologists and cardiologists.

Conclusions

Direct-to-consumer screening using whole-body MRI and cardiological testing is feasible and effective for the detection of clinically relevant and treatable abnormalities. Psychological harm was not frequently reported in study participants.

Older Women’s Perspectives Driving Mammography Screening Use and Overuse: a Narrative Review of Mixed-Methods Studies

Purpose of Review

Examining what older women know and perceive about mammography screening is critical for understanding patterns of under- and overuse, and concordance with screening mammography guidelines in the USA. This narrative review synthesizes qualitative and quantitative evidence around older women’s perspectives toward mammography screening.

Recent Findings

The majority of 43 identified studies focused on promoting mammography screening in women of different ages, with only four studies focusing on the overuse of mammography in women ≥ 70 years old. Older women hold positive attitudes around screening, perceive breast cancer as serious, believe the benefits outweigh the barriers, and are worried about undergoing treatment if diagnosed. Older women have limited knowledge of screening guidelines and potential harms of screening.

Summary

Efforts to address inequities in mammography access and underuse need to be supplemented by epidemiologic and interventional studies using mixed-methods approaches to improve awareness of benefits and harms of mammography screening in older racially and ethnically diverse women. As uncertainty around how best to approach mammography screening in older women remains, understanding women’s perspectives along with healthcare provider and system-level factors is critical for ensuring appropriate and equitable mammography screening use in older women.

Psychosocial predictors of mammography history among Chinese American women without a recent mammogram

Chinese American women have lower rates of mammography screening compared with non-Hispanic White women. Although the extent of perceived barriers, as conceptualized by the Health Belief Model, have been shown to distinguish between currently non-adherent Chinese American women who have ever and never had a mammogram, it is less clear which types of perceived barriers differentiate them. One hundred twenty-eight Chinese American women in the New York metropolitan area who had not had a mammogram in the past year completed baseline assessments for a mammography framing intervention study. Demographics, medical access variables, and perceived barriers to mammography (lack of access, lack of need for screening, and modesty) were used to predict mammography history (ever versus never screened). Fifty-five women (43%) reported having been screened at least once. A sequential logistic regression showed that English speaking ability and having health insurance significantly predicted mammography history. However, these control variables became non-significant when the three barrier factors were included in the final model. Women who reported a greater lack of access (OR = 0.36, p < .05) and greater lack of need (OR = 0.27, p < .01) were less likely to be ever screeners. Unexpectedly, women who reported greater modesty were more likely to be ever screeners (OR = 4.78, p < .001). The results suggest that interventions for Chinese American women should identify and target specific perceived barriers with consideration of previous adherence.

Mapping mammography in Arkansas: Locating areas with poor spatial access to breast cancer screening using optimization models and geographic information systems

Introduction:

Arkansans have some of the worst breast cancer mortality to incidence ratios in the United States (5th for Blacks, 4th for Whites, 7th overall). Screening mammography allows for early detection and significant reductions in mortality, yet not all women have access to these life-saving services. Utilization in Arkansas is well below the national average, and the number of FDA-approved screening facilities has decreased by 38% since 2001. Spatial accessibility plays an important role in whether women receive screenings.

Methods:

We use constrained optimization models within a geographic information system (GIS) to probabilistically allocate women to nearby screening facilities, accounting for facility capacity and patient travel time. We examine accessibility results by rurality derived from rural–urban commuting area (RUCA) codes.

Results:

Under most models, screening capacity is insufficient to meet theoretical demand given travel constraints. Approximately 80% of Arkansan women live within 30 minutes of a screening facility, most of which are located in urban and suburban areas. The majority of unallocated demand was in Small towns and Rural areas.

Conclusions:

Geographic disparities in screening mammography accessibility exist across Arkansas, but women living in Rural areas have particularly poor spatial access. Mobile mammography clinics can remove patient travel time constraints to help meet rural demand. More broadly, optimization models and GIS can be applied to many studies of healthcare accessibility in rural populations.

Non-participation in mammographic screening - experiences of women from a region in Sweden

Background

Understanding women’s life conditions regarding their non-participation in different health-promoting and disease-preventing activities is important as it may draw attention to potential areas for improvement in the healthcare sector. Mammographic screening, a disease-preventing service, facilitates early detection of any potential malignancies and consequently prompts initiation of treatment. The reasons for non-participation in mammographic screening can be understood from different perspectives, such as socioeconomic and lifestyle-related determinants of health. This study aims to gain a deeper understanding of women’s experiences and perceptions about non-participation in mammographic screening in a Swedish region with a single mammographic facility.

Methods

Data from individual semi-structured interviews, conducted in 2018 with eleven women between the ages of 48 and 73, were analysed by a qualitative content analysis.

Results

The findings reveal three main categories: 1) doubts regarding mammographic screening and its organisation, 2) sense and sensibility in the decision to refrain from mammographic screening, and 3) dependency and options. These three categories indicate aspects, such as the individual’s life situation, accessibility to the offered service, and the flexibility of the healthcare system, that need to be considered to improve the organisation of mammographic screening.

Conclusion

Listening to the women’s voices regarding their experiences and perceptions about mammographic screening is important as individual characteristics and social circumstances interact with healthcare and affect the degree of participation.

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.

Optimism may moderate screening mammogram frequency in Medicare: A longitudinal study

Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.

Inconsistent Mammography Perceptions and Practice among Women of Over 40 Years in Iran

Objective: This paper aims to report the relationship between perceptions of mammography and screening practices. Methods: This cross-sectional study was conducted between May and September 2017, involving 400 women of over 40 years old, who was referred to as urban health centers in Tehran, Iran. The subjects were selected by multi-stage cluster sampling. Women with inconsistent mammography perceptions and practices were identified the Pros and Cons of mammography behavior for perceptions and Transtheoretical model (TTM) stage of adoption for prior and intended screening practices. The research instrument included a self-administered questionnaire and data were analyzed using descriptive statistics and measures of central tendency, and the chi-square, T-tests, and correlation regression analysis. Results: The average age participant was 45.6±5.4. Consistent with the TTM and pros and cons of mammography, women in action tended to have more positive perceptions of mammography than women in pre-contemplation or contemplation (mean decisional balance: action= 16.8; SD, 1.4; contemplation=1.8; SD, 0.48; precontemplation= SD, 1.4;0.56; p<0.001). Conclusion: results of the current study indicate there are inconsistent mammography perceptions and practice among women in Iran, then we recommend that future intervention, consider setting factors in addition to standard perceptions focused counseling.

Breast Screening Utilization and Cost Sharing Among Employed Insured Women After the Affordable Care Act

OBJECTIVE

To assess changes in screening mammography cost sharing and utilization before and after the Affordable Care Act (ACA) and the revised US Preventive Services Task Force (USPSTF) guidelines. To compare mammography cost sharing between women aged 40 to 49 and those 50 to 74.

METHODS

We used patient-level analytic files between 2004 and 2014 from Clinformatics Data Mart (OptumInsight, Eden Prairie, Minnesota). We included women 40 to 74 years without a history of breast cancer or mastectomy. We conducted an interrupted time series analyses assessing cost sharing and utilization trends before and after the ACA implementation and USPSTF revised guidelines.

RESULTS

We identified 1,763,959 commercially insured women aged 40 to 74 years. Between 2004 and 2014, the proportion of women with zero cost share for screening mammography increased from 81.9% in 2004 to 98.2% in 2014, reaching 93.1% with the 2010 ACA implementation. The adjusted median cost share remained $0 over time. Initially at 36.0% in 2004, screening utilization peaked at 42.2% in 2009 with the USPSTF guidelines change, dropping to 40.0% in 2014. Comparing women aged 40 to 49, 50 to 64, and 65 to 74, the proportion exposed to cost sharing declined over time in all groups.

CONCLUSIONS

A substantial majority of commercially insured women had first-dollar coverage for mammography before the ACA. After ACA, nearly all women had access to zero cost-share mammography. The lack of an increase in mammography use post-ACA can be partially attributed to a USPSTF guideline change, the high proportion of women without cost sharing before the ACA, and the relatively low levels of cost sharing before the policy implementation.

Perceived Barriers to Mammography Adoption among Women in Iran: A Qualitative Study

Background

Breast cancer is the most commonly diagnosed tumorous cancer and the second leading cause of cancer-related deaths among women worldwide. This study aimed to qualitatively explore the barriers to mammography adoption among Iranian women.

Methods

This study is a qualitative component of a large research project on exploratory sequential mixed method design, utilizing conventional content analysis. In total, 24 participants were selected from among women who had participated in the first phase of the study. Data were collected through in-depth, semi-structured interviews.

Results

Five main themes were extracted, consisting of unawareness of mammography, fear control, priority of mammography needs, inadequate competency of mammography centers, and a sense of losing family support.

Conclusion

Different perceived barriers within various levels (individual, intrapersonal, health systems, and community) play influential roles in women’s decisions to participate in breast cancer screening program, which indicates the cultural aspect of perceived barriers in different communities and countries. The study provides the basis for intervention planning in this regard.

Experiences and perceptions about undergoing mammographic screening: a qualitative study involving women from a county in Sweden

PURPOSE

 An organized population-based mammographic screening programme aims for an early detection of potential breast abnormalities so that treatment can commence. Continuous participation and a high attendance rate are vital for an effective programme. It is important to understand the underlying reasons for participation in mammographic screening, should there be factors that are amendable within reason and could be adjusted. Therefore, the invited women are valuable sources of information. This study aimed at describing the experiences and perceptions about mammographic screening of women from three municipalities in a Swedish county.

METHOD

 Six semi-structured focus-group discussions, each with four to five participants, were held. Content analysis was then conducted.

RESULTS

 The screening procedure, such as staff professionalism, was covered. Other people's opinions and the woman's own understanding affected the women's decisions on whether or not to undergo the procedure. Structural conditions, such as travel time and financial issues, were sources of concern. However, the offer to perform mammographic screening was perceived with gratitude.

CONCLUSIONS

 Structural conditions, risk and time perceptions, the screening procedure, attitudes towards undergoing it and appreciation of its benefit may influence the women's continuous willingness to be screened, which in turn may affect public and individual health.

A Systematic Review of Barriers and Facilitators to Mammography in American Indian/Alaska Native Women

Introduction: The purpose of this systematic review was to synthesize the current knowledge of factors that enable or impede American Indian and Alaska Native (AI/AN) women from accessing breast cancer screening. Methodology: A systematic search of MEDLINE and CINAHL databases identified relevant research studies published from 2007 to 2017. Results: Consistent with other low-income populations, socioeconomic factors were related to lower rates of screening in AI/AN women. However, some factors, such as reliance on the Indian Health Service, cultural issues, and traditionality were unique to this population. Discussion: AI/AN women appear to face many of the difficulties that other low-income minority women face in accessing preventive care; however, they may face unique challenges and circumstances in accessing care. Efforts to work with tribes in the development of interventions framed by community-based participatory research are needed to tackle the disparities in the AI/AN community.

Healthcare Factors for Obtaining a Mammogram in Latinas With a Variable Mammography History

PURPOSE/OBJECTIVES

To understand the relationship between mammography history and current thoughts about obtaining a mammogram among Latinas and examine the mediation effects of several healthcare factors.
.

DESIGN

Cross-sectional survey.
.

SETTING

Federally qualified health centers (Sea Mar Community Health Centers) in western Washington.
.

SAMPLE

641 Latinas nonadherent and adherent with screening mammography.
.

METHODS

Baseline survey data from Latinas with a mammography history of never, not recent (more than two years), or recent (less than two years) were analyzed. Preacher and Hayes methods were used to estimate the mediation effect of healthcare factors.
.

MAIN RESEARCH VARIABLES

The survey assessed mammography history, sociodemographic and healthcare factors, and current thoughts about obtaining a mammogram.
.

FINDINGS

Latinas' thoughts about obtaining a mammogram were associated with mammography history. Having had a clinical breast examination mediated 70% of differences between Latinas with a never and recent mammography history. Receipt of a provider recommendation mediated 54% of differences between Latinas with and without a recent mammography history.
.

CONCLUSIONS

These findings emphasize the importance of the patient-provider relationship during a clinic visit and help inform how nurses may be incorporated into subsequent screening mammography interventions tailored to Latinas.
.

IMPLICATIONS FOR NURSING

As providers, health educators, and researchers, nurses have critical roles in encouraging adherence to screening mammography guidelines among Latinas.

Hearing the Silenced Voices of Underserved Women: The Role of Qualitative Research in Gynecologic and Reproductive Care

In order to provide effective evidence-based health care to women, rigorous research that examines women's lived experiences in their own voices is needed. However, clinical health research has often excluded the experiences of women and minority patient populations. Further, clinical research has often relied on quantitative research strategies; this provides an interesting but limited understanding of women's health experiences and hinders the provision of effective patient-centered care. This article defines qualitative research and its unique contributions to research, and provides examples of how qualitative research has given insights into the reproductive health perspectives and behaviors of underserved women.

The Association of English Functional Health Literacy and the Receipt of Mammography among Hispanic Women Compared to Non-Hispanic U.S.-Born White Women

BACKGROUND

Breast cancer is a leading cause of cancer death among Hispanic women in the U.S., and mammography is the recommended screening for early diagnosing and preventing breast cancer. Several barriers exist to influence mammography utilization including poor health literacy. However, it is unclear whether the effect of health literacy on mammography utilization is consistent between Hispanic women and non-Hispanic White women. The main objective of this study was to examine association between functional health literacy and the receipt of mammography among Hispanic women compared to non-Hispanic White women in the U.S.

METHODS

A cross-sectional design using participants engaged in the National Assessment of Adult Literacy. Study sample comprised of 4,249 Hispanic and non-Hispanic U.S.-born White women ≥ 40 years of age who completed the functional health literacy assessment. Regression analyses were performed to test the association between health literacy and receipt of mammography. Among Hispanic women, analyses considered the influence of language-preference acculturation.

RESULTS

Equal percentages of Hispanic (59.3%) and non-Hispanic White (60.6%) women received mammography. After adjusting for covariates, health literacy was positively associated with receiving mammography among U.S.-born White women (β = 0.14, p<0.001), but negatively associated with mammography among Hispanic women (β = -0.13, p<0.001). Analyses stratified by acculturation status revealed that higher health literacy was associated with lower mammography among language-preference acculturated Hispanic women (β = -0.48, p<0.001), yet an opposite result among less acculturated Hispanic women (β = 0.08, p<0.001).

CONCLUSION

Functional health literacy has different associations with mammography depending upon ethnicity. Language-preference acculturation may explain the differing association.

Multilevel Intervention Raises Latina Participation in Mammography Screening: Findings from ¡Fortaleza Latina!

BACKGROUND

Breast cancer is the most commonly diagnosed cancer in women in the United States, and Latinas have relatively low rates of screening participation. The Multilevel Intervention to Increase Latina Participation in Mammography Screening study (¡Fortaleza Latina!) sought to assess the efficacy of a clinic- and patient-level program to increase breast cancer screening among Latinas in Western Washington who seek care at a safety net health center.

METHODS

The study enrolled 536 Latinas ages 42 to 74 who had a primary care clinic visit in the previous 5 years and had not obtained a mammogram in the previous 2 years. Participants were block-randomized within clinic to either (i) a control arm (usual care) or (ii) a promotora-led, motivational interviewing intervention that included a home visit and telephone follow-up. At the clinic level, two of four participating clinics were provided additional mammography services delivered by a mobile mammography unit.

RESULTS

Rates of screening mammography 1 year post-randomization were 19.6% in the intervention group and 11.0% in the usual care group (P < 0.01), based on medical record data. No significant differences in participants' mammography screening were observed in clinics randomized to additional mammography services versus usual care (15.8% vs. 14.4%; P = 0.68).

CONCLUSION

This multilevel intervention of promotora-delivered motivational interviewing and free mammography services modestly raised rates of participation in breast cancer screening among Latinas.

IMPACT

Our findings can inform future efforts to boost mammography participation in safety net practices. Cancer Epidemiol Biomarkers Prev; 25(4); 584-92. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".

Delays in Cancer Care Among Low-Income Minorities Despite Access

INTRODUCTION

Narrowing the racial/ethnic and socioeconomic disparities in breast and cervical cancer requires an in-depth understanding of motivation for adherence to cancer screening and follow-up care. To inform patient-centered interventions, this study aimed to identify reasons why low-income women adhered to or delayed breast or cervical cancer screening, follow-up and treatment despite access to cancer care-related services.

METHODS

Semistructured qualitative interviews were conducted among women with access to cancer care-related services receiving care at an academic cancer center, federally qualified health centers, or free clinics in the Chicago metropolitan area. Transcripts were coded and analyzed for themes related to rationales for adherence.

RESULTS

Among 138 participants, most were African American (46%) or Hispanic (36%), English speaking (70%), and between ages 41 and 65 years (64%). Primary drivers of nonadherence included lack of knowledge of resources, denial or fear, competing obligations, and embarrassment. Facilitators included abnormality identification, patient activation, provider-initiated actions, and motivation from family or friends.

CONCLUSIONS

Interventions targeting increased adherence to care among low-income and ethnic minority women should direct efforts to proactive, culturally and patient-informed education that enables patients to access resources and use the health care system, address misconceptions about cancer, ensure health care providers' communication of screening guidelines, and leverage the patient's social support network.

A pilot randomized controlled trial of telephone intervention to increase Breast Cancer Screening uptake in socially deprived areas in Scotland (TELBRECS)

OBJECTIVES

To determine whether a brief telephone support intervention could increase breast cancer screening uptake among lower socio-demographic women in Scotland, via eliciting and addressing barriers to screening attendance.

METHODS

In a pilot randomized controlled trial, participants receiving a reminder letter for a missed screening appointment (February-June 2014) were randomized to four arms: No telephone call (control), Simple telephone reminder (TEL), Telephone support (TEL-SUPP), or Telephone support plus anticipated regret (TEL-SUPP-AR). Primary outcomes were making an appointment and attending breast screening.

RESULTS

Of 856 women randomized and analysed on intention-to-treat basis, compared with controls, more women in the telephone intervention groups made an appointment (control: 8.8%, TEL: 20.3%, TEL-SUPP: 14.1%; TEL-SUPP-AR: 16.8%, χ(2)(3) = 12.0, p = .007) and attended breast screening (control: 6.9%, TEL: 16.5%, TEL-SUPP: 11.3%; TEL-SUPP-AR: 13.1%, χ(2)(3) = 9.8, p = .020). Of 559 women randomized to the three telephone groups, 404 were successfully contacted and 247 participated in the intervention. Intervention participants (ie. per protocol analysis) were more likely to make (17% versus 10%, χ(2)(1) = 7.0, p = .008) and attend (13% versus 7%, χ(2)(1) = 5.5, p = .019) an appointment than non-participants, but there were no differences in attendance between the three telephone groups.

CONCLUSIONS

A simple telephone reminder doubled attendance at breast screening in women from lower socio-demographic areas who had not attended their initial appointment, compared with a reminder letter only (odds ratio 2.12, 95% CI (1.2, 3.8)). However, contacting women proved problematic and there was no additional effect of telephone support or anticipated regret.

Perceptions of One's Neighborhood and Mammogram Use among a Sample of Low-Income Women at Risk for Human Immunodeficiency Virus and Sexually Transmitted Infections

BACKGROUND

Neighborhood disorder, signs of physical and social disorganization, has been related to a range of poor mental and physical health outcomes. Although individual factors have been widely associated with getting a mammogram, little is known about the impact of the neighborhood environment on a woman's decision to get a mammogram.

METHODS

In a sample of women at risk for human immunodeficiency virus and sexually transmitted infections, we explored the role of perceptions of one's neighborhood on getting a mammogram. The study included two samples: women 40 to 49 years (n = 233) and women 50 years and older (n = 83). Data were collected from May 2006 through June 2008.

RESULTS

Women age 50 years and older who lived in a neighborhood with disorder were 72% less likely to get a mammogram compared with women who lived in neighborhoods without disorder. There was no relationship for women age 40 to 49 years.

CONCLUSIONS

Interventions are needed to increase awareness and encourage women living in neighborhoods with disorder to get a mammogram. In addition to interventions to increase mammography, programs are needed to decrease neighborhood disorder. Increasing neighborhood cohesion, social control, and empowerment could integrate health promotion programs to both reduce disorder and increase health behaviors.

Breast cancer knowledge, attitudes and screening behaviors among Indian-Australian women

PURPOSE OF RESEARCH

The aims of the study were to report breast cancer screening practices among Indian-Australian women and to examine the relationship between demographic characteristics, cultural beliefs and women's breast cancer screening (BCS) behaviors.

METHOD

A descriptive and cross-sectional method was used. Two hundred and forty two Indian-Australian women were recruited from several Indian organizations. English versions of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ) were administered. The main research variables are BCS practices, demographic characteristics and total scores on each of the BCSBQ subscales.

RESULT

The majority of participants (72.7%-81.4%) had heard of breast awareness, clinical breast examination (CBE) and mammograms. Only 28.9% performed a BSE monthly and although 60% had practiced CBE, only 27.3% of women within the targeted age group had annual CBE. Only 23.6% of women within the targeted age group reported they had a mammogram biennial. Marital status and length of stay in Australia were positively associated with women's screening behaviors. In terms of BCSBQ score, women who had the three screening practices regularly as recommended obtained significantly higher scores on the "attitude towards general health check-ups" and "barriers to mammographic screening" subscales. There was a significant difference in the mean score of the "knowledge and perceptions about breast cancer" between women who did and who did not engage in breast awareness.

CONCLUSIONS

Our study reveals that attitudes toward health check-ups and perceived barriers to mammographic screening were influential in determining compliance with breast cancer screening practices among Indian-Australian women.

An educational strategy for improving knowledge about breast and cervical cancer prevention among Mexican middle school students

INTRODUCTION

Prevention programs have not achieved the expected results in preventing mortality from breast and cervical cancer in Mexico. Therefore, we propose a complementary strategy.

METHODOLOGY

An educational strategy for high school students in Mexico (2011-2013) was designed (longitudinal design, two measurements and a single intervention). The postintervention assessment included: 1) knowledge acquired by students about cancer prevention and 2) The performance of the student as a health promoter in their household. The strategy was based on analysis of cases and developed in three sessions. An assessment tool was designed and validated (Test-Retest). The levels of knowledge according to the qualifications expected by chance were determined. Wilcoxon test compared results before and after intervention.

RESULTS

An assessment instrument with 0.80 reliability was obtained. 831 high school students were analyzed. Wilcoxon rank-sum test showed a significant learning after the intervention (Z = - 2.64, p = 0.008) with improvement of levels of knowledge in a 154.5%. 49% of students had a good performance as health promoters.

CONCLUSIONS

The learning in preventive measures is important to sensitize individuals to prevention campaigns against cancer. This strategy proved to improve the level of knowledge of students in an easy and affordable way.

Translation of interviews from a source language to a target language: examining issues in cross-cultural health care research

AIMS AND OBJECTIVES

To illuminate translation practice in cross-language interview in health care research and its impact on the construction of the data.

BACKGROUND

Globalisation and changing patterns of migration have created changes to the world's demography; this has presented challenges for overarching social domains, specifically, in the health sector. Providing ethno-cultural health services is a timely and central facet in an ever-increasingly diverse world. Nursing and other health sectors employ cross-language research to provide knowledge and understanding of the needs of minority groups, which underpins cultural-sensitive care services. However, when cultural and linguistic differences exist, they pose unique complexities for cross-cultural health care research; particularly in qualitative research where narrative data are central for communication as most participants prefer to tell their story in their native language. Consequently, translation is often unavoidable in order to make a respondent's narrative vivid and comprehensible, yet, there is no consensus about how researchers should address this vital issue.

DESIGN

An integrative literature review.

METHODS

PubMed and CINAHL databases were searched for relevant studies published before January 2014, and hand searched reference lists of studies were selected.

RESULTS

This review of cross-language health care studies highlighted three major themes, which identify factors often reported to affect the translation and production of data in cross-language research: (1) translation style; (2) translators; and (3) trustworthiness of the data.

CONCLUSION

A plan detailing the translation process and analysis of health care data must be determined from the study outset to ensure credibility is maintained. A transparent and systematic approach in reporting the translation process not only enhances the integrity of the findings but also provides overall rigour and auditability.

RELEVANCE TO CLINICAL PRACTICE

It is important that minority groups have a voice in health care research which, if accurately translated, will enable nurses to improve culturally relevant care.

A pilot telephone intervention to increase uptake of breast cancer screening in socially deprived areas in Scotland (TELBRECS): study protocol for a randomised controlled trial

Background

Breast cancer accounts for almost 30% of all cancers and is the second leading cause of cancer deaths in women in Scotland. Screening is key to early detection. The Scottish Breast Screening Programme is a nationwide, free at point of delivery screening service, to which all women aged between 50 and 70 years are invited to attend every 3 years. Currently over three-quarters of invited women regularly attend screening. However, women from more deprived areas are much less likely to attend: for example in the 3 years from 2010–2012 only 63% of women in the most deprived area attended the East of Scotland Breast Screening programme versus 81% in the least deprived. Research has suggested that reminders (telephone or letter) and brief, personalised interventions addressing barriers to attendance may be helpful in increasing uptake in low-income women.

Methods/Design

We will employ a brief telephone reminder and support intervention, whose purpose is to elicit and address any mistaken beliefs women have about breast screening, with the aim that the perceived benefits of screening come to outweigh any perceived barriers for individuals. We will test whether this intervention, plus a simple anticipated regret manipulation, will lead to an increase in the uptake of breast cancer screening amongst low-income women who have failed to attend a first appointment, in a randomised controlled trial with 600 women. Participants will be randomly allocated to one of four treatment arms i.e. 1) Letter reminder (i.e. Treatment as usual: CONTROL); 2) Telephone reminder (TEL), 3) Telephone reminder plus telephone support (TEL-SUPP) and 4) Telephone reminder plus support plus AR (TEL-SUPP-AR). The primary outcome will be attendance at breast screening within 3 months of the reminder letter.

Discussion

If this simple telephone support intervention (with or without AR intervention) leads to a significant increase in breast screening attendance, this would represent a rare example of a theoretically-driven, relatively simple psychological intervention that could result in earlier detection of breast cancer amongst an under-served group of lower socio-economic women.

Trial registration

Current Controlled trials: ISRCTN06039270. Registered 16^th January 2014.

Assessment of mammography experiences and satisfaction among American Indian/Alaska Native women

BACKGROUND

American Indian/Alaska Native (AI/AN) women have lower breast cancer (BCA) screening and 5-year survival rates than non-Hispanic Whites. Understanding reasons for low screening rates is important to combatting later stage diagnoses. The purpose of this study was to assess mammography experiences and satisfaction among AI/AN women.

METHODS

Nine focus groups were held with rural (N = 15) and urban (N = 38) AI/AN women 40 years and older in Kansas and Kansas City, Missouri, living both near and far from Indian Health Service (IHS) and tribal facilities, to examine experiences and satisfaction with mammography. Transcripts were coded and themes identified using a community-based participatory research approach.

FINDINGS

Themes were classified under knowledge, communication, and awareness of BCA; barriers to mammography; mammogram facility size; impressions of mammogram technologist; motivations for getting a mammogram; and how to improve the mammogram experience. Participants had knowledge of prevention, but described cultural reasons for not discussing it and described better experiences in smaller facilities. Participants indicated having a mammogram technologist who was friendly, knowledgeable, respectful, competent, and explained the test was a determining factor in satisfaction. Other factors included family history, physician recommendation, and financial incentives. Barriers included transportation, cost, perceptions of prejudice, and time constraints. Participants on reservations or near IHS facilities preferred IHS over mainstream providers. Suggestions for improvement included caring technologists, better machines with less discomfort, and education.

CONCLUSIONS

Interventions to enhance the professionalism, empathy, and cultural awareness of mammogram technologists; reduce barriers; and provide positive expectations and incentives could improve satisfaction and compliance with screening mammography.

The National Prevention Strategy and breast cancer screening: scientific evidence for public health action

Mammography screening rates in the United States have remained fairly stable over the past decade, and screening rates remain low for some groups. We examined insights from recent public health research on breast cancer screening to identify promising new approaches to improve screening rates and address persistent health disparities in mammography use. We considered this research in the context of the four strategic directions of the National Prevention Strategy: elimination of health disparities, empowered people, healthy and safe community environments, and clinical and community preventive services. This research points to the value of direct outreach and case management services, interventions to support more patient-centered models of care, and more organized, population-based approaches to identify women who are eligible to be screened, encourage participation, and monitor results.

Barriers to screening mammography

Breast cancer (BRCA) is the second most commonly diagnosed cancer among women in the USA, and mammography is an effective means for the early detection of BRCA. Identifying the barriers to screening mammography can inform research, policy and practice aiming to increase mammography adherence. A literature review was conducted to determine common barriers to screening mammography adherence. PsycINFO and PubMed databases were searched to identify studies published between 2000 and 2012 that examined barriers associated with reduced mammography adherence. Three thematic groups of barriers, based on social ecology, were identified from the literature: healthcare system-level, social and individual-level barriers. Researchers must consider screening behaviour in context and, therefore, should simultaneously consider each level of barriers when attempting to understand screening behaviour and create interventions to increase mammography adherence.

Women's responses to information about overdiagnosis in the UK breast cancer screening programme: a qualitative study

OBJECTIVES

To explore the influence of overdiagnosis information on women's decisions about mammography.

DESIGN

A qualitative focus group study with purposive sampling and thematic analysis, in which overdiagnosis information was presented.

SETTING

Community and university settings in London.

PARTICIPANTS

40 women within the breast screening age range (50-71 years) including attenders and non-attenders were recruited using a recruitment agency as well as convenience sampling methods.

RESULTS

Women expressed surprise at the possible extent of overdiagnosis and recognised the information as important, although many struggled to interpret the numerical data. Overdiagnosis was viewed as less-personally relevant than the possibility of 'under diagnosis' (false negatives), and often considered to be an issue for follow-up care decisions rather than screening participation. Women also expressed concern that information on overdiagnosis could deter others from attending screening, although they rarely saw it as a deterrent. After discussing overdiagnosis, few women felt that they would make different decisions about breast screening in the future.

CONCLUSIONS

Women regard it as important to be informed about overdiagnosis to get a complete picture of the risks and benefits of mammography, but the results of this study indicate that understanding overdiagnosis may not always influence women's attitudes towards participation in breast screening. The results also highlight the challenge of communicating the individual significance of information derived from population-level modelling.