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Ganguly AP, Baker KK, Redman MW, McClintock AH, Yung RL. Racial disparities in the screening mammography continuum within a heterogeneous health care system. Cancer 2023; 129:3171-3181. [PMID: 37691529 DOI: 10.1002/cncr.34632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 09/12/2023]
Abstract
BACKGROUND Decreased mammography drives breast cancer disparities. Black women have lower rates of mammography completion than White women, and this contributes to disparities in outcomes. Points of disparity along the continuum for screening mammography remain underresearched. METHODS The authors compared mammography referrals for Black and White women aged 40-74 years at a heterogeneous academic medical center. Completion of steps of the screening mammography continuum was compared between Black and White women within two age cohorts: 40-49 and 50-74 years. Multivariable logistic regression was used to evaluate the association between race and mammogram completion. RESULTS Among 26,476 women, 3090 (12%) were Black, and 23,386 (88%) were White. Among Black women aged 50-74 years who were due for mammography, 40% had referrals, 39% were scheduled, and 21% completed mammography; the corresponding values for White women were 42%, 41%, and 27%, respectively. Similar differences in referral outcomes were noted for women aged 40-49 years, although Black women had lower rates of provider-initiated referrals (9% vs. 13%). Adjusted analyses for those aged 40-49 and 50-74 years demonstrated an association between Black race and lower rates of mammography completion (odds ratio [OR] for 40-49 years, 0.74; 95% CI, 0.57-0.95; p = .02; OR for 50-74 years, 0.85; 95% CI, 0.74-0.98; p = .02). In multivariable analyses, noncommercial insurance and higher comorbidity were associated with lower rates of mammography. Provider-initiated referral was positively correlated to mammogram completion. CONCLUSIONS Black race was associated with 15%-26% lower mammography completion (adjusted). Both groups experienced the highest attrition after scheduling mammograms, although attrition was more precipitous for Black women. These findings have implications for future interventions, including increasing provider-initiated referrals and decreasing barriers to attending scheduled mammograms.
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Affiliation(s)
- Anisha P Ganguly
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
- Division of General Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kelsey K Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Mary W Redman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Adelaide H McClintock
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rachel L Yung
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington, USA
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Urrutia MT, Padilla O. Validity of a questionnaire on self-efficacy for Pap test adherence screening. Front Oncol 2022; 12:979799. [DOI: 10.3389/fonc.2022.979799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionSelf-efficacy has been related to different health preventive behaviors, included adherence to the Papanicolaou test—also called Pap smear or Pap test. The aim of this study is to test construct and criterion validity and reliability of a questionnaire on self-efficacy and the Pap test in Chilean women.MethodThis study was carried out on a sample of 969 women of ages from 25 to 64, who are users of the public health care system in Santiago, Chile. The validity of the Self-Efficacy Scale for the Pap Smear Screening Participation (SES-PSSP) questionnaire was done by confirmatory factor analysis, external criteria by t-test, and reliability by Cronbach’s alpha.ResultsThree models were tested, obtaining a questionnaire with 20 items and 2 dimensions. The criteria validity was confirmed by adherence to the Pap test. The final questionnaire has a reliability of 0.95, measured by Cronbach´s alpha.ConclusionA valid and reliable questionnaire to measure self-efficacy in relation to the Pap test is a relevant contribution in cervical cancer prevention, especially related to interventions focused on increasing adherence.
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Lee MH, Hong S, Merighi JR. The Association Between Fatalism and Mammography Use in Korean American Immigrant Women. HEALTH EDUCATION & BEHAVIOR 2021; 49:740-749. [PMID: 34396786 DOI: 10.1177/10901981211029253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatalism is reported as a salient cultural belief that influences cancer screening disparities in racial and ethnic minority groups. Previous studies provide a range of measures and descriptions of cancer fatalism, but no studies to our knowledge have analyzed how fatalistic views cluster together within subgroups to form distinct profiles, and how these profiles can be predicted. This study identified subgroups of Korean American immigrants with similar fatalistic beliefs toward cancer and examined the influence of fatalism, health belief variables, and health literacy on mammography use. A cross-sectional survey design was used to obtain a convenience sample of 240 Korean American immigrant women in Los Angeles, California. Latent class analysis was used to identify unobserved subgroups of fatalism. Hierarchical logistic regression models were used to identify predisposing, enabling, and need factors associated with recent mammography use. The latent class analysis model identified three cancer fatalism subgroups: high fatalism (17.8%), moderate fatalism (36.7%), and low fatalism (45.5%). Women in the high fatalism subgroup were more likely to have had a mammogram within the past 2 years than women in the low fatalism subgroup. Regression analysis revealed three facilitators of recent mammogram use: level of fatalism, perceived barriers to mammogram, and family history of cancer. Although cultural beliefs can have a powerful influence on health-seeking behavior, it is important to weigh individual and contextual factors that may weaken or mediate the relationship between fatalism and engaging in preventive care such as having a mammogram.
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Affiliation(s)
- Mi Hwa Lee
- East Carolina University, Greenville, NC, USA
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Mammography Self-efficacy Scale and Breast Cancer Fear Scale: Psychometric Properties of the Arabic Versions Among Saudi Women. Cancer Nurs 2021; 44:163-170. [PMID: 31652134 DOI: 10.1097/ncc.0000000000000767] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early screening for breast cancer (BC) is critical for improving health outcomes and reducing mortality. Research has shown that self-efficacy and fear of BC can influence patients' screening behaviors. Validated measures to assess these constructs among Saudi women are lacking. OBJECTIVE The aim of this study was to assess the psychometric properties of the Arabic versions of the Champion Mammography Self-efficacy Scale (CMSES) and Champion Breast Cancer Fear Scale (CBCFS) in a sample of Saudi women. METHODS The CMSES and CBCFS were back-translated into Arabic using an established translation protocol. Reliability was assessed using Cronbach's α coefficients. Construct validity was evaluated using exploratory and confirmatory factor analytical procedures. RESULTS The findings from the factor analysis confirmed the unidimensional structure of both scales as reported by the original authors. Additionally, both scales exhibited high internal consistency (Cronbach's α coefficients) of .91 for the modified CMSES-Arabic and .94 for the CBCFS-Arabic. CONCLUSIONS This article provided initial evidence of reliability and construct validity for the modified CMSES-Arabic and the CBCFS-Arabic. IMPLICATIONS FOR PRACTICE Nurses and other allied health professionals can now use these measures to better understand how self-efficacy and fear of BC are related to compliance with cancer screening among Saudi women and in other Arabic-speaking contexts. The scales could also be useful for developing and testing the effectiveness of interventions aimed at improving mammography testing rates.
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Flores-Luevano S, Shokar NK, Dwivedi AK, Shokar GS, Defeu SN. Breast Cancer Fear Among Mexican American Women in the United States. Breast Cancer (Auckl) 2020; 14:1178223420952745. [PMID: 32922022 PMCID: PMC7453449 DOI: 10.1177/1178223420952745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Fear has been described as potentially important in affecting breast cancer screening completion. Limited information is available on the prevalence and determinants of fear among Mexican American women. This study describes perceived breast cancer fear and its association with personal characteristics and screening behavior among Mexican American women. METHODS This is a secondary analysis of data collected during the implementation of the Breast Cancer Education, Screening and NavigaTion program among eligible uninsured women in two Texas border counties. Participants completed a 26-item survey to assess eligibility, risk status, prior screening, and breast cancer fear. Descriptive statistics and multivariable analyses were used to determine associations between the fear score, personal characteristics, and mammography screening. RESULTS In all, 1916 of 2012 eligible women completed the study. The mean age was 57.3 years, 99.2% were Hispanic, and 88% were born in Mexico; 15% had a family history of breast cancer and 14% had never had a mammogram. The mean breast cancer fear score was 25.5 (standard deviation: 10.52; range: 8-40); 54.0 % (95% confidence interval: 52.1%-56.7%) had a high fear level. In multivariable analyses, better health status (P < .001), older age (P = .039), birth in the United States (P = .020), and having a regular doctor (P = .056) were associated with lower fear scores. There was no association between breast cancer fear and mammography screening. CONCLUSION Breast cancer fear is high and varies by personal characteristics and health status among uninsured Mexican American border-residing women due for screening, but is not associated with screening behavior. Further research is needed to clarify the effect of interventions designed to help reduce breast cancer fear among these women, including educational interventions to reduce breast cancer fear.
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Affiliation(s)
- Silvia Flores-Luevano
- Department of Molecular and Translational Medicine, and Department of Family and Community Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Navkiran K Shokar
- Department of Family and Community Medicine, and Department of Molecular and Translational Medicine, Cancer Prevention and Control, Center of Emphasis for Cancer, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Alok Kumar Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Biostatistics and Epidemiology Consulting Lab (BECL), Texas Tech University Health Sciences Center El Paso (TTUHSC EP), El Paso, TX, USA
| | - Gurjeet S Shokar
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Sandrine N Defeu
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
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Davis CM. Health Beliefs and Breast Cancer Screening Practices Among African American Women in California. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 41:259-266. [DOI: 10.1177/0272684x20942084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background African American women continue to have higher mortality rates of breast cancer when compared to other women, and evidence suggests that early detection of breast cancer can lead to favorable outcomes, yet there remains a paucity of literature about health beliefs and the utilization of three screening practices, namely breast self-examination, clinical breast examination and mammography in California, a state that currently has one of the highest breast cancer mortality rates among African American women. Purpose To investigate the relationship between health beliefs and three breast cancer detection practices, e.g. breast self-examination, clinical breast examination, and mammography in a cohort of African American women. Methods Using a descriptive correlational design, a convenience sample of two hundred and eighty-two (n = 282) self-identified women from six regional chapters of a national Black women’s political organization in California, completed a Demographic Data Questionnaire and Champion’s Health Belief Model Scale which assessed the hypothesized relationships of health beliefs and breast cancer detection practices. Results Among this culturally diverse group of women (49.8% American, 28.8% African, 21.4% West Indian), health motivation was positively related to the practice of BSE and annual physician visitation for clinical breast examinations. Health locus of control was positively related to the practice of BSE. Having relatives and friends who were diagnosed with breast cancer was strongly associated with having a mammogram and annual physician visitation for clinical breast examinations. Conclusion These findings may be used to target and develop interventions that are tailored to the unique characteristics of these diverse women.
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Affiliation(s)
- Claudia M. Davis
- Department of Nursing, Center for Promotion of Health Disparities Research and Training, California State University San Bernardino
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Al-Zalabani AH. Adaptation and validation of the Arabic version of self-efficacy scale for mammography. A report on psychometric properties. Saudi Med J 2020; 40:707-713. [PMID: 31287132 PMCID: PMC6757206 DOI: 10.15537/smj.2019.7.23938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objectives: To culturally adapt and validate a mammography-specific self-efficacy (MSSE) scale into Arabic for the Saudi Arabian context. Methods: A methodological study aimed at tool translation and adaptation conducted in primary healthcare centers in As Madinah, Saudi Arabia between March 2016 and May 2016. The MSSE scale was translated and adapted into Arabic using standard procedures. Content and face validity were investigated. Confirmatory factor analysis and reliability analysis were used to determine the scale’s psychometric properties. Results: The scale showed a good internal consistency (Cronbach’s alpha=0.88). The confirmatory factor analysis supported the scale’s single-factor structure and the goodness-of-fit indices confirmed the model’s good fit (comparative fit index=0.961, Tucker-Lewis index=0.943, root-mean-square error of approximation=0.076, and standardized root-mean-square residual=0.045). Women who had a mammogram in the last 2 years scored significantly higher on the scale (39±6.2) than women who had never received a mammogram (35.88±7.2; p=0.009). Conclusion: The study confirmed that the scale’s Arabic version has good psychometric properties, using reliability analysis, confirmatory factor analysis, and extreme groups validation. The scale is likely to be useful for evaluating interventional studies aimed at improving mammography screening participation rates.
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Affiliation(s)
- Abdulmohsen Hamdan Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia. E-mail.
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Breast Cancer Stage at Diagnosis in a New Jersey Cancer Education and Early Detection Site. Am J Clin Oncol 2018; 41:1043-1048. [DOI: 10.1097/coc.0000000000000425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim SJ, Glassgow AE, Watson KS, Molina Y, Calhoun EA. Gendered and racialized social expectations, barriers, and delayed breast cancer diagnosis. Cancer 2018; 124:4350-4357. [PMID: 30246241 DOI: 10.1002/cncr.31636] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/07/2018] [Accepted: 06/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Black women are more likely to be diagnosed at a later stage of breast cancer in part due to barriers to timely screening mammography, resulting in poorer mortality and survival outcomes. Patient navigation that helps to overcome barriers to the early detection of breast cancer is an effective intervention for reducing breast cancer disparity. However, the ability to recognize and seek help to overcome barriers may be affected by gendered and racialized social expectations of women. METHODS Data from a randomized controlled trial, the Patient Navigation in Medically Underserved Areas study, were used. The likelihood of obtaining a follow-up screening mammogram was compared between women who identified ≥1 barriers and those who did not. RESULTS Of the 3754 women who received the Patient Navigation in Medically Underserved Areas navigation intervention, approximately 14% identified ≥ 1 barriers, which led to additional navigator contacts. Consequently, those women who reported barriers were more likely to obtain a subsequent screening mammogram. Black women, women living in poverty, and women with a higher level of distrust were less likely to report barriers. CONCLUSIONS Minority women living in poverty have always been the source of social support for others. However, gendered and racialized social expectations may affect the ways in which women seek help for their own health needs. A way to improve the effectiveness of navigation would be to recognize how minority women's gender images and expectations could shape how they seek help and support. A report of no barriers does not always translate into no problems. Proactive approaches to identify potential barriers may be beneficial.
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Affiliation(s)
- Sage J Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Anne Elizabeth Glassgow
- College of Medicine, Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | | | - Yamile Molina
- Division of Community Health Science, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Elizabeth A Calhoun
- Center for Population Science and Discovery, University of Arizona Health Sciences, Tucson, Arizona
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Scheel JR, Molina Y, Coronado G, Bishop S, Doty S, Jimenez R, Thompson B, Lehman CD, Beresford SAA. Healthcare Factors for Obtaining a Mammogram in Latinas With a Variable Mammography History. Oncol Nurs Forum 2017; 44:66-76. [PMID: 27991613 DOI: 10.1188/17.onf.66-76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Borrayo EA, Rosales M, Gonzalez P. Entertainment-Education Narrative Versus Nonnarrative Interventions to Educate and Motivate Latinas to Engage in Mammography Screening. HEALTH EDUCATION & BEHAVIOR 2016; 44:394-402. [PMID: 27553361 DOI: 10.1177/1090198116665624] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The evidence is limited comparing the effects of entertainment-education (E-E) narrative versus nonnarrative interventions to educate and motivate Latinas to engage in mammography screening. AIMS This study compared an E-E narrative intervention to two nonnarrative interventions' effects among Latinas on breast cancer knowledge and motivation, as measured by changes in self-efficacy, behavioral norms, and behavioral intentions to engage in mammography screening. METHOD A sample of 141 Spanish-speaking Latinas was randomly assigned to one of three arms: an E-E narrative video, a nonnarrative educational video, and printed educational materials. Using a repeated measures design, the influence of the E-E narrative on pretest to posttest measures was assessed and compared to the influence of the other two interventions. RESULTS The E-E narrative and nonnarrative interventions significantly increased Latinas' breast cancer knowledge, mammography self-efficacy, and behavioral norms from pretest to posttest. However, the E-E narrative participants' pretest to posttest difference in mammography self-efficacy was significantly higher when compared to the difference of the other two interventions. The effect of the E-E narrative intervention on self-efficacy and behavioral norms was moderated by the participants' absorption in the story and identification with the story characters. CONCLUSION E-E narrative and nonnarrative interventions significantly educated and motivated Latinas to engage in mammography screening. The effects on mammography self-efficacy, an important precursor to behavior change, can be more strongly influenced by E-E narratives. DISCUSSION Although E-E narrative and nonnarrative interventions were effective, the need still exists to assess if they can ultimately influence lifesaving breast cancer screening behaviors.
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Affiliation(s)
| | - Monica Rosales
- 2 Los Angeles County Department of Public Health, Los Angeles, CA, USA
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Jerome-D’Emilia B, Suplee P, Akincigil A. Validation of the Spanish Version
of the Mammography-Specific Self-Efficacy Scale. Oncol Nurs Forum 2015; 42:E279-86. [DOI: 10.1188/15.onf.e279-e286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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