Development of cultural belief scales for mammography screening

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.

The sociocultural effects on orthopedic surgeries in Taiwan

Various sociocultural factors affect healthcare-seeking behaviors. In Taiwanese society, superstitions and lunar festivals play important roles in people’s lives. We investigated the impact of “Ghost Month” (the 7^th lunar month) and Chinese New Year (the 12^th lunar month and the 1^st lunar month of the following year) on the number of elective surgeries and emergent surgeries in Taiwan. The number of total knee replacement (TKR) surgeries and proximal femur fracture (PFF) surgeries in each lunar month from 2000 to 2011 were extracted from the Taiwan National Health Insurance Database, a computerized and population-based database. Patients were then sorted by location of residence or gender. The average number of TKR surgeries performed was significantly lower during the 1^st, 7^th, and 12^th lunar months in urban areas, whereas in rural areas this trend was only evident in the 7^th and 12^th lunar months. There was however, no significant difference in the average number of PFF surgeries in each lunar month except for an increase seen in the 1^st lunar month in rural patients (p<0.05). When sorted by gender, the average number of TKR surgeries was significantly decreased in the 7^th and 12^th lunar months in male patients, and decreased in the 1^st, 7^th, and 12^th lunar months in female patients. In contrast, there was no difference in the average numbers of PFF surgeries in the 7^th and 12^th lunar months either in male or female patients. We proposed that the timing of elective surgeries such as TKR might be influenced by Ghost Month and Chinese New Year; however, emergent PFF surgeries were not significantly influenced by sociocultural beliefs and taboos in Taiwan.

African American patients' intent to screen for colorectal cancer: Do cultural factors, health literacy, knowledge, age and gender matter?

African Americans have higher colorectal cancer (CRC) mortality rates. Research suggests that CRC screening interventions targeting African Americans be based upon cultural dimensions. Secondary analysis of data from African-Americans who were not up-to-date with CRC screening (n=817) was conducted to examine: 1) relationships among cultural factors (i.e., provider trust, cancer fatalism, health temporal orientation (HTO)), health literacy, and CRC knowledge; 2) age and gender differences; and 3) relationships among the variables and CRC screening intention. Provider trust, fatalism, HTO, health literacy and CRC knowledge had significant relationships among study variables. The FOBT intention model explained 43% of the variance with age and gender being significant predictors. The colonoscopy intention model explained 41% of the variance with gender being a significant predictor. Results suggest that when developing CRC interventions for African Americans, addressing cultural factors remain important, but particular attention should be given to the age and gender of the patient.

The impact of breast cancer knowledge and attitudes on screening and early detection among an immigrant Iranian population in southern California

Few studies explored factors influencing breast cancer screening and early detection behaviors among immigrant Iranian women residing in the USA. Using a cross-sectional survey, a convenience sample of 319 Iranian American women was selected to investigate the impact of breast cancer knowledge and attitude on screening. A self-administered questionnaire assessed breast cancer screening knowledge, attitude, and mammography use (ever, previous year, and future intention). 79 % of the women in the study reported ever receiving at least one mammogram and 74 % received a mammogram in the past year. Personal attitude had an independent significant effect on: mammography use in the last year, ever use of mammography, and future intention to screen. Knowledge and morality-induced attitude influenced screening behavior but not significantly. Interventions targeting breast cancer screening among immigrant Iranian women in the USA should focus on enhancing personal attitudes in order to influence actual screening behavior.

Development of the Thai breast cancer belief scale for Thai immigrants in the United States

Asian American women have not benefited from the decline in breast cancer mortality and have lower rates of mammography use. Understanding mammography behaviors among these Asian American women requires culturally specific measures. Champion's belief scale was translated into Thai and cultural items were added. The Thai breast cancer belief scale (TBCBS), the Suinn-Lew self-identification acculturation, and the Asian values scale-revised were administered to 250 Thai immigrants. The TBCBS was tested for face validity, construct validity, and internal consistency. Factor analysis reflected the 4 constructs of the health belief model and accounted for 45.8% of the variance. Cronbach's alpha ranged from .77 to .90. Modest correlations were observed between TBCBS subscales and acculturation scales. Results indicate that the TBCBS measures breast cancer beliefs among Thai immigrant population.

Obesity, gynecological factors, and abnormal mammography follow-up in minority and medically underserved women

BACKGROUND

The relationship between obesity and screening mammography adherence has been examined previously, yet few studies have investigated obesity as a potential mediator of timely follow-up of abnormal (Breast Imaging Reporting and Data System [BIRADS-0]) mammography results in minority and medically underserved patients.

METHODS

We conducted a retrospective cohort study of 35 women who did not return for follow-up >6 months from index abnormal mammography and 41 who returned for follow-up < or =6 months in Nashville, Tennessee. Patients with a BIRADS-0 mammography event in 2003-2004 were identified by chart review. Breast cancer risk factors were collected by telephone interview. Multivariate logistic regression was performed on selected factors with return for diagnostic follow-up.

RESULTS

Obesity and gynecological history were significant predictors of abnormal mammography resolution. A significantly higher frequency of obese women delayed return for mammography resolution compared with nonobese women (64.7% vs. 35.3%). A greater number of hysterectomized women returned for diagnostic follow-up compared with their counterparts without a hysterectomy (77.8% vs. 22.2%). Obese patients were more likely to delay follow-up >6 months (adjusted OR 4.09, p = 0.02). Conversely, hysterectomized women were significantly more likely to return for timely mammography follow-up < or =6 months (adjusted OR 7.95, p = 0.007).

CONCLUSIONS

Study results suggest that weight status and gynecological history influence patients' decisions to participate in mammography follow-up studies. Strategies are necessary to reduce weight-related barriers to mammography follow-up in the healthcare system including provider training related to mammography screening of obese women.

Beliefs related to breast cancer and breast cancer screening among Lebanese Armenian women

Our purpose of this article was to investigate women's beliefs about breast cancer, breast cancer screening, and intervention programs. We designed the study using a cross-sectional/descriptive correlation. The participants were drawn from a convenience sample (N=94). The instrument included Champion's Revised Health Belief Model Scale (CHBMS). Analysis was performed using SPSS (2005), 15.0. More than sixty-four percent (64.8%) of women surveyed were over 41. Results showed that 80.9% of women surveyed had heard of breast self-exams (BSEs), while 76.6% had heard of mammography. However, 53.2% never practiced breast self-examinations, and 79.6% never underwent mammography. Mean belief scores follow: low susceptibility (14.32), barriers to BSE (15.24), barriers to mammography (14.85), high seriousness (23.42), benefits to breast self-examination (22.7), confidence (36.45), health motivation (27.27), and benefits to mammography (24.28). Significant relationships included the relationship between barriers to breast self-examination and whether women had heard about breast self-examinations (p=.02); the relationship between susceptibility and whether women had heard of or underwent mammography (p=.027); the relationship between confidence and whether women had heard of mammography (p=.056); the relationship between confidence and perceived financial status (p=.05); and benefits of mammography (p=.05). Appropriate interventions are developed.

Mammography adherence: a qualitative study

BACKGROUND

Regular mammography accounts for half of the recent declines in breast cancer mortality. Mammography use declined significantly in 2008. Given the success of regular breast cancer screening, understanding why mammography use decreased is important. We undertook a focus group study to explore reasons women who were previously adherent with regular mammography no longer were screened.

METHODS

We conducted 20 focus groups with white non-Hispanic, black non-Hispanic, Hispanic, Japanese American, and American Indian/Alaska Native women, and segmented the groups by age, race/ethnicity, and health insurance status. A conceptual framework, based on existing research, informed the development of the focus group guide. Discussion topics included previous mammography experiences, perceptions of personal breast cancer risk, barriers to mammography, and risks and benefits associated with undergoing mammography. Atlas.ti was used to facilitate data analysis.

RESULTS

All focus groups (n=128 women) were completed in 2009 in five cities across the United States. Half of the groups were held with white non-Hispanic women and the remainder with other racial/ethnic groups. Major barriers to routine mammography included (1) concerns about test efficacy, (2) personal concerns about the procedure, (3) access to screening services, (4) psychosocial issues, and (5) cultural factors. For uninsured women, lack of health insurance was the primary barrier to mammography.

CONCLUSIONS

Multilevel interventions at the health-care provider and system levels are needed to address barriers women experience to undergoing regular mammography screening. Ultimately, breast cancer screening with mammography is an individual behavior; therefore, individual behavioral change strategies will continue to be needed.

Closing the gap in mammogram screening: an experimental intervention among low-income Hispanic women in community health clinics

A low rate of mammogram screening exists among low-income Hispanic women. To address this disparity, an experimental intervention containing audiovisual and written media was conducted using the health belief model as a framework. The purpose of this study was to determine if low-income Hispanic women, more than 40 years of age, who received targeted cancer prevention education (n = 105) had a significantly greater perceived threat of breast cancer, greater benefits and lower barriers to screening, and stronger intentions to obtain mammograms compared to a control group (n = 105). Intervention participants reported significantly greater perceived benefits, self-efficacy, and mammogram screening intentions than the control group. Predictors of mammogram screening intentions, when controlling for covariates, included receiving the intervention, and having greater perceived benefits, self-efficacy, and lower barriers. Results demonstrate the effectiveness of a low-cost, theory-based intervention aimed at increasing mammogram screening to assist in the monitoring of Healthy People 2020 objectives.

The impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States: a pilot study

OBJECTIVES

Studies on colorectal cancer screening among specific Asian American groups are limited despite the fact that Asians are comprised of culturally distinct subgroups. The purpose of this study was to investigate the impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States.

METHODS

One hundred and seventeen Filipino men and women aged 50 years or older participated in the cross-section research design. Lifetime proportion of immigration, language preference and cultural beliefs of personal control regarding health outcomes measured cultural characteristics. Demographic and healthcare variables were also measured to describe the study sample. Participant recruitment employed culturally responsive sampling methods.

RESULTS

There was no significant association between language preference and screening. Likewise, perceived personal internal control of health outcome was not related to screening. However, personal external control revealed a marginally significant association. The percent of lifetime residence in the United States was significantly greater among those who were adherent to screening than those who were not adherent. After adjusting for demographic and healthcare variables, the relationship between length of immigration and screening adherence was no longer significant. Finally, age and doctor's recommendation showed significant impact on colorectal cancer screening adherence.

DISCUSSION

This pilot study adds to the knowledge regarding cultural factors associated with colorectal cancer screening behaviors among Filipino Americans. Future research is needed to confirm findings that will be useful in developing culturally appropriate strategies to increase screening adherence.

Psychosocial determinants of mammography follow-up after receipt of abnormal mammography results in medically underserved women

This article targets the relationship between psychosocial determinants and abnormal screening mammography follow-up in a medically underserved population. Health belief scales were modified to refer to diagnostic follow-up versus annual screening. A retrospective cohort study design was used. Statistical analyses were performed examining relationships among sociodemographic factors, psychosocial determinants, and abnormal mammography follow-up. Women with lower mean internal health locus of control scores (3.14) were two times more likely than women with higher mean internal health locus of control scores (3.98) to have inadequate follow-up (OR=2.53, 95% CI=1.12-5.36). Women with less than a high school education had lower cancer fatalism scores than women who had completed high school (47.5 vs. 55.2, p-value=.02) and lower mean external health locus of control scores (3.0 vs. 5.3) (p-value<.01). These constructs have implications for understanding mammography follow-up among minority and medically underserved women. Further comprehensive study of these concepts is warranted.

Psychosocial Correlates of Mammography Screening in Older African American Women

PURPOSE/OBJECTIVES

To explore psychosocial correlates of older African American women's adherence to annual mammography screening, including cancer fatalism, dispositional optimism, social support, knowledge of breast cancer screening guidelines, perceptions of general health, and components of the Health Belief Model (HBM), and to examine factors associated with annual mammography screening.

DESIGN

Cross-sectional survey.

SETTING

Central North Carolina.

SAMPLE

198 African American women aged 50-98 years living in low-income housing.

METHODS

Women attended group sessions at low-income housing complexes and completed questionnaires. Differences between women who had or did not have a mammogram in the previous year were explored using correlate variables associated with the HBM. Stepwise multivariable regression models were fit to explore factors associated with social support and significant components of the HBM.

MAIN RESEARCH VARIABLES

Demographics, cancer fatalism, dispositional optimism, social support, perceptions of general health, components of the HBM, and mammography in the past year.

FINDINGS

The groups did not differ by age, education, marital status, having a friend or family member with breast cancer, ever having had a clinical breast examination, self-rated health, cancer fatalism, dispositional optimism, or feelings about the seriousness of and their susceptibility to breast cancer. The groups differed significantly on mammogram-related variables, how often women should have clinical breast examinations, benefits and barriers to mammography screening, and social support. Stepwise multivariable regression analyses showed that dispositional optimism and social support were related significantly to perception of benefits; education, dispositional optimism, and cancer fatalism were related to barriers; and dispositional optimism was related to social support.

CONCLUSIONS

Older, low-income, African American women have perceived barriers to cancer screening, educational and cancer knowledge detriments, and a lack of health-related social support that may decrease adherence to mammography screening.

IMPLICATIONS FOR NURSING

The next step is to develop culturally appropriate educational interventions that increase knowledge about breast cancer and screening guidelines, enhance health-related social support, and address barriers and perhaps cancer fatalism in older, low-income, African American women.

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

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

Sociocultural context of mammography screening use

PURPOSE/OBJECTIVES

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

DESIGN

Descriptive, retrospective, cross-sectional study.

SETTING

Community-based organizations and public housing.

SAMPLE

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

METHODS

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

MAIN RESEARCH VARIABLES

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

FINDINGS

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

CONCLUSIONS

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

IMPLICATIONS FOR NURSING

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

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

PURPOSE/OBJECTIVES

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

DESIGN

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

SETTING

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

SAMPLE

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

METHODS

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

MAIN RESEARCH VARIABLES

Knowledge and beliefs about breast cancer.

FINDINGS

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

CONCLUSIONS

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

IMPLICATIONS FOR NURSING

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

Predictors of perceived breast cancer risk and the relation between perceived risk and breast cancer screening: a meta-analytic review

BACKGROUND

Perceived risk is a principal variable in theoretical models that attempt to predict the adoption of health-protective behaviors.

METHODS

This meta-analysis synthesizes findings from 42 studies, identified in PubMed and PsycInfo from 1985 onward. Studies examined demographic and psychological variables as predictors of perceived breast cancer risk and the relationship between perceived risk and breast cancer screening. Statistical relationships, weighted for sample size, were transformed to effect sizes and 95% CIs.

RESULTS

Women do not have accurate perceptions of their breast cancer risk (N = 5561, g = 1.10). Overall, they have an optimistic bias about their personal risk (g = 0.99). However, having a positive family history (N = 70660, g = 0.88), recruitment site, and measurement error confounded these results. Perceived risk is weakly influenced by age (N = 38000, g = 0.13) and education (N = 1979, g = 0.16), and is moderately affected by race/culture (N = 2192, g = 0.38) and worry (N = 6090, g = 0.49). There is an association between perceived risk and mammography screening (N = 52766, g = 0.19). It is not clear whether perceived risk influences adherence to breast self-examination. Women who perceived a higher breast cancer risk were more likely to pursue genetic testing or undergo prophylactic mastectomy.

CONCLUSION

Perceived breast cancer risk depends on psychological and cognitive variables and influences adherence to mammography screening guidelines.