Sociocultural context of mammography screening use

The Association Between Fatalism and Mammography Use in Korean American Immigrant Women

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.

The relationship between cancer fatalism and education

PURPOSE

Fatalism is defined by feelings of pessimism, hopelessness, and powerlessness regarding cancer outcomes. Early researchers reported associations between race and cancer fatalism. Yet current evidence suggests that social determinants of health are better predictors of cancer fatalism than race. Therefore, the aim of this study was to examine the association between age, race, education, and cancer fatalism.

METHODS

Three hundred ninety (n = 390) women who attended a screening mammogram at the Joanne Knight Breast Health Center at Siteman Cancer Center at Washington University School of Medicine (St. Louis, MO) completed the Powe Fatalism Inventory (PFI), a 15-item self-report instrument used to operationalize cancer fatalism. We used Pearson's correlation, independent samples t-tests, one-way ANOVA with post hoc tests, and linear regression to analyze the relationships between PFI total scores and age, race, and education.

RESULTS

There were no differences between the mean PFI scores for Non-Hispanic Whites (1.89, SD 0.55) and African Americans (2.02, SD 0.76, p = 0.092, 95% CI 0.27 to 0.02). We found significant differences between the mean PFI scores across levels of education. Women who attained a high school degree or less (n = 72) reported higher PFI scores (2.24, SD 0.77) than women who attended some college or post-high school vocational training (n = 111; 1.95, SD 0.61) and women with a college or postgraduate degree (n = 206; 1.83, SD 0.57). When PFI score was regressed onto age, race, and education, only education significantly explained fatalism (B = -0.19, p < 0.001).

CONCLUSIONS

In this study, cancer fatalism did not differ between Non-Hispanic White and African American women attending a screening mammogram. However, lower educational levels were associated with higher cancer fatalism. The previously observed associations between race and cancer fatalism may be explained by racial disparities in social determinants of health, such as education. Importantly, study findings indicate that the people with the greatest need for cancer fatalism interventions are those with lower educational levels.

The health belief model and theory of planned behavior applied to mammography screening: A systematic review and meta-analysis

BACKGROUND

The Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) are used to explain screening behavior. Although reviews of each model have been conducted independently, none have compared the application of both to mammography screening.

METHODS

A systematic review of literature published in five databases from 1974 to 2020 was performed. Meta-analysis of the explanatory value of the HBM and TPB and effect sizes of their cognitive variables was conducted.

RESULTS

Altogether, 673 papers reporting HBM studies and 577 reporting TPB studies were recovered, of which 43 HBM studies and 15 TPB studies met the eligibility criteria. Twelve studies reported on the explanatory value of either model. The explained variance for HBM ranged from 25% to 89% (mean R²  = .55), while the explained variance for TPB ranged from 16% to 81% (mean R²  = .24 [screening behavior as outcome] and 0.46 [intention as outcome]). The component of "cue to action" had the greatest effect size (mean OR 1.80 [95% CI: 1.58-2.04]).

CONCLUSIONS

While the HBM and TPB both demonstrated positive explanatory value, most studies examined the individual constructs of each model and failed to report consistently on the effectiveness of the models.

'Our culture prohibits some things': qualitative inquiry into how sociocultural context influences the scale-up of community-based injectable contraceptives in Nigeria

OBJECTIVES

To explore how sociocultural factors may support or impede the adoption of community-based distribution of injectable contraceptives in Nigeria.

DESIGN

A qualitative study based on inductive thematic analysis was conducted through in-depth interviews and focus group discussions.

SETTING

Most participants lived in Gombe State, North-East Nigeria. Other participants were from Ibadan (South-West) and Abuja (Federal Capital Territory).

PARTICIPANTS

Through seven key informant interviews, 15 in-depth interviews and 10 focus group discussions, 102 participants were involved in the study.

METHODS

This study conducted in 2016 was part of a larger study on scale-up of community-based distribution of injectable contraceptives. Qualitative data were collected from traditional and religious leaders, health workers and community members. The data were audio recorded, transcribed and analysed using a thematic framework method.

RESULTS

Sociocultural challenges to scale-up included patriarchy and men's fear of losing control over their spouses, traditional and religious beliefs about fertility, and myths about contraceptives and family planning. As a result of deep-rooted beliefs that children are 'divine blessings' and that procreation should not be regulated, participants described a subtle resistance to uptake of injectable contraceptives. Since Gombe is largely a patriarchal society, male involvement emerged as important to the success of meaningful innovation uptake. Community leaders largely described their participation in the scale-up process as active, although they also identified the scope for further involvement and recognition.

CONCLUSION

Scale-up is more than setting up health sector implementing structures, training health workers and getting innovation supplies, but also requires preparedness which includes paying attention to complex contextual issues. Policy implementers should also see scale-up as a learning process and be willing to move at the speed of the community.

Factor structure and internal reliability of cultural belief scales about colorectal cancer screening among Koreans in the Republic of Korea

BACKGROUND

Culturally sensitive, reliable and valid cultural belief scales for colorectal cancer (CRC) screening in Koreans in the Republic of Korea are not available in the literature. The purpose of this study was to adapt and validate existing cultural belief scales for CRC screening in Koreans.

METHODS

Individual interviews, expert reviews, and a pilot test were conducted for instrument adaptation, and a cross-sectional survey with 884 Koreans was conducted for instrument validation. Construct validity using exploratory and confirmatory factor analyses and reliability of the Korean version of the instruments were examined.

RESULTS

Exploratory factor analysis using c four factors that accounted for 48.12% of the variance. The validity and reliability of the cultural belief scales were supported by confirmatory factor analysis and Cronbach's alpha.

CONCLUSIONS

The results of the present study showed that the four-factor cultural belief scales were culturally sensitive, reliable and valid in Koreans. The final cultural belief scales could be used to identify cultural beliefs more accurately and specifically, as well as to develop effective interventions to increase CRC screening in Koreans in the Republic of Korea.

Can Health Belief Model Predict Breast Cancer Screening Behaviors?

BACKGROUND:

Breast cancer is the second cause of cancer-related death among women. Prevention programs insist on the early diagnosis and screening to reduce the mortality rate.

AIM:

The study was conducted to determine the predictors of breast cancer screening behaviours based on the health belief model.

MATERIAL AND METHODS:

The present cross-sectional study was conducted by involving 304 women ranging from 20 to 65 years of age, living in East Guilan cities, the North of Iran, in 2015 using two-stage cluster sampling. The research instrument was Champion’s Health Belief Model Scale. The data were analysed based on Regression test by using SPSS software version 18.

RESULTS:

The results showed perceived benefits (ExpB = 1.118, p = 0.009), self-efficacy (ExpB = 1.122, p = 0.001) and the perceived barriers (ExpB = 0.851, p = 0.001) as the predictors of breast self-examination. In addition, the study revealed that the two components of perceived benefits (ExpB = 1.202), and the perceived barriers were the predictors of mammography (ExpB = 0.864) (p = 0.001). None of the health belief model components showed a role to predict clinical breast examination (P > 0.05).

CONCLUSION:

The present study highlights the need for educational programs, which should focus on increasing breast self-exam skills and understanding the benefits of healthy behaviours and eliminating their barriers.

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.
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DESIGN

Cross-sectional survey.
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SETTING

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

641 Latinas nonadherent and adherent with screening mammography.
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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.
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MAIN RESEARCH VARIABLES

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

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

Fatalism Revisited: Further Psychometric Testing Across Two Studies

Cancer fatalism may impact outcomes, particularly for African American (AA) women with breast cancer (BrCa). We examined the psychometrics of the modified Powe Fatalism Inventory in sample of AA women with BrCa from two studies. Only the predetermination and God's will items satisfy the conditions to be classified as a strong subscale. Our analysis identified that five items had strong psychometric properties for measuring fatalism for AA women with BrCa. However, these items do not include all the defining attributes of fatalism. A strong measure of fatalism strengthens our understanding of how this concept influences AA patient outcomes.

Practice of Breast Cancer Early Diagnosis Methods among Women Living in Samsun, and Factors Associated with This Practice

OBJECTIVE

The purpose of this study was to assess practice of breast cancer early diagnosis methods among women and the factors associated with this practice.

MATERIALS AND METHODS

The population of this cross-sectional study consisted of 410,377 women over the age of 20, living within the administrative borders of Samsun province. Stratified systematic sampling was used in the selection of the 800-member sample. The Health Belief Model Scale, a questionnaire consisting of open and closed-ended questions, was used to elicit women's demographic data and determine their awareness on early diagnostic techniques. The questionnaires were administered face-to-face by visiting individuals' addresses.

RESULTS

80.5% of women had knowledge on breast self-examination (BSE). 12.6% of the women who were aware of BSE stated that they regularly performed BSE. 30.4% of women had clinical breast examination (CBE) by health personnel at least once, while 36.8% of women over 40 years of age obtained mammography at least once. Factors associated with women's performance of BSE were age, having received education about breast health, perception of severity, barriers for BSE and self-efficacy. Factors affecting CBE included age, presence of history of breast cancer in a relative or friend, having received education about breast health; while factors associated with women's undergoing mammography were identified as age, a family member with a history of breast cancer and barriers for mammography.

CONCLUSION

Determination of the factors associated with practice of breast cancer early diagnosis methods, and implementation of planned training programs based on these results is important in increasing compliance with these methods.

What Black Women Know and Want to Know About Counseling and Testing for BRCA1/2

Black women are just as likely to have hereditary breast cancer mutations as White women, yet their participation in genetic counseling and testing is substantially lower. This study sought to describe Black women's awareness and perceptions of BRCA1/2 testing and to identify barriers and motivators to seeking BRCA1/2 services. Fifty intercept interviews were conducted with Black women in public places (a professional women's basketball game, a grocery store, a faith-based community event, and the waiting area at a breast care clinic) in Washington, DC. More than half of the women (54%) were aware that genetic tests to determine risk for certain breast and ovarian cancers exist, but the majority (88%) had never heard of BRCA1/2, specifically. After hearing a description of BRCA1/2 genetic markers, 82% stated that they would agree to BRCA1/2 testing if it was offered to them. Perceived advantages of testing included cancer prevention and the ability to share information with family members. Perceived disadvantages included emotional distress associated with identification of the mutation and the potential misuse of results to deny healthcare or employment. Physician recommendation, self-care, and known family history were among the motivators for testing. Women listed possible media and venues for intervention. In spite of low rates of BRCA1/2 testing in the Black community, women in this sample were open to the idea. Interventions that address barriers and include cultural tailoring are necessary.

Compliance with regimens of existing vaccines in Orumba North local government area of Anambra state, Nigeria

The factors associated with third dose of diphtheria, pertussis and tetanus (DPT3) uptake, a true indicator of compliance with required regimen of vaccines, in Anambra state, Nigeria, were investigated in a cross-sectional survey of 600 mothers (15-49). Being an older mother showed a positive association with compliance. Compliance was more among those who used the government health facilities for their health needs (χ(2 )= 12.286, p < .001). Satisfactory experiences with health service influenced compliance (χ(2 )= 8.542, p = .002). Those with good perception (30.1%) complied more (χ(2 )= 42.572, p < .001). Those who were aware that immunization protects the children against vaccine preventable diseases complied more (χ(2 )= 8.735, p = .002). In conclusion, the action-hesitancy model strengthens the Health Belief Model in explaining parents' attitude to childhood immunization, as experience and perception of the health service influenced uptake more. Health education and campaigns should be directed at factors that would encourage mothers to adopt required behaviours.

Farsi Version of the Mammography Self-efficacy Scale for Iranian Women

BACKGROUND

Self-efficacy is a crucial factor in adopting mammography behavior. A reliable and valid instrument is necessary to measure self-efficacy among Iranian women.

OBJECTIVE

The aim of this study is to translate the original version of Champion's Mammography Self-efficacy Scale into Farsi and then to estimate the Farsi version's reliability and validity.

METHODS

In a cross-sectional study, 200 women 40 years or older who were referred to health centers in Iran were invited to complete the related questionnaires during an interview. Cronbach's α coefficients and item-total correlations were measured to evaluate the reliability of the scales. Content and face validities were evaluated using the opinions of a panel of experts, and construct validity was estimated through applying confirmatory factor analysis. Logistic regression and χ tests were used to estimate theoretical relationships.

RESULTS

In terms of reliability, the internal consistency α was .904 and the test-retest reliability correlation over a 4-week period was 0.624. With regard to the confirmatory factor analysis, the proportion of χ to degrees of freedom was 0.394, giving a P value of .852 and a root-mean-square error of approximation less than 0.001 with confidence intervals of less than 0.001 and 0.018, with a comparative fit index of 1, normed fit index of 0.999, relative fit index of 0.993, and incremental fit index of 1.

CONCLUSION

The items that form the self-efficacy measurement scale in the Farsi version are highly reliable and valid.

IMPLICATIONS FOR PRACTICE

Healthcare professionals and nursing health communities may apply the instrument to determine women's self-efficacy and to plan appropriate educational interventions, aiming at promoting women's mammography behavior.

Compliance With Regimens of Existing Vaccines in Orumba North Local Government Area of Anambra State, Nigeria

The factors associated with third dose of diphtheria, pertussis and tetanus (DPT3) uptake, a true indicator of compliance with required regimen of vaccines, in Anambra state, Nigeria, were investigated in a cross-sectional survey of 600 mothers (15–49). Being an older mother showed a positive association with compliance. Compliance was more among those who used the government health facilities for their health needs (χ2 = 12.286, p < .001). Satisfactory experiences with health service influenced compliance (χ2 = 8.542, p = .002). Those with good perception (30.1%) complied more (χ2 = 42.572, p < .001). Those who were aware that immunization protects the children against vaccine preventable diseases complied more (χ2 = 8.735, p = .002). In conclusion, the action-hesitancy model strengthens the Health Belief Model in explaining parents’ attitude to childhood immunization, as experience and perception of the health service influenced uptake more. Health education and campaigns should be directed at factors that would encourage mothers to adopt required behaviours.

Fatalistic Beliefs and Cervical Cancer Screening Among Mexican Women

Fatalistic beliefs about cervical cancer were studied in 464 Mexican women, and how such beliefs relate to participation in cervical cancer screening was evaluated. Rural women were less likely than urban women to have had a Pap test and more likely to believe that the illness is due to bad luck or fate. These were also the beliefs most associated with nonscreening among rural women, whereas for urban women the belief most associated with nonscreening was "there is not much I can do to prevent cervical cancer."

Simultaneous Development of a Multidimensional Fatalism Measure in English and Spanish

Fatalism has been shown to predict several health behaviors, but researchers often find inconsistent results for the same behaviors across studies. This may be partially attributable to the diversity of fatalism measures that have been used in previous studies. A review of the literature revealed 51 different scales, all purported to measure fatalism, but often with heterogeneous content (Esparza 2005). A study done by Esparza (2005) retrieved 29 scales, including the most frequently used scales, and performed an exploratory factor analysis, obtaining as a result five factors: fatalism, helplessness, internality, luck, and divine control. The purpose of this study was to develop a multidimensional fatalism scale based on the previous findings by Esparza (2005). This scale was developed simultaneously in English and Spanish in order to linguistically “decenter” item content. The factor structure was cross-validated and measurement invariance was assessed across language versions. According to the measurement invariance analysis, this test is invariant across English and Spanish in its factor structure, loadings, variances, and covariances. This study results suggest that this scale may be used interchangeably in both English and Spanish.

Breast cancer threat appraisal: design and psychometric analysis of a new scale for older women

BACKGROUND

The prospect of being diagnosed with breast cancer generates emotional responses associated with a high degree of health threat. When considering screening, older women are faced with physical and psychological consequences inherent in considering the threat of disease.

AIMS AND OBJECTIVES

To describe the development and evaluate initial reliability and validity of the Breast Cancer Threat Appraisal Scale (BCTAS), a self-report instrument measuring psychosocial and situational factors related to breast cancer threat appraisal in older women.

DESIGN AND METHODS

Preliminary survey items for the Breast Cancer Threat Appraisal Scale (BCTAS) were designed using content experts and focus groups and subsequently tested by a sample of older women. Two hundred forty-three (n = 243) complete data sets were submitted to principal components analysis (PCA). Internal consistency reliability and construct validity of resulting factors were measured.

RESULTS

PCA with orthogonal rotation resulted in four components defined by 34 items with loadings of ≥0.40. Internal consistency reliability was evident in all four components (Component # 1 = 0.87, Component # 2 = 0.81, Component # 3 = 0.70 and Component # 4 = 0.72). Correlations between Breast Cancer Fear and total BCTAS (r = 0.29, P < 0.001) and Component # 3 (r = 0.39, P < 0.001) provided partial construct validity.

CONCLUSIONS

Psychometric analysis provided initial evidence of reliability for four conceptually meaningful scales and partial construct validity for total score and one factor.

IMPLICATIONS FOR PRACTICE

Using these empirically derived scales may clarify for health providers how older women perceive personal threat of breast cancer and inform collaborative decision-making to foster screening.

Acceptance of a community-based navigator program for cancer control among urban African Americans

Patient navigation is now a standard component of cancer care in many oncology facilities, but a fundamental question for navigator programs, especially in medically underserved populations, is whether or not individuals will use this service. In this study, we evaluated acceptance of a community-based navigator program for cancer control and identified factors having significant independent associations with navigation acceptance in an urban sample of African Americans. Participants were African American men and women ages 50-75 who were residents in an urban metropolitan city who were referred for navigation. Of 240 participants, 76% completed navigation. Age and perceived risk of developing cancer had a significant independent association with navigation acceptance. Participants who believed that they were at high risk for developing cancer had a lower likelihood of completing navigation compared with those who believed that they had a low risk for developing this disease. The likelihood of completing navigation increased with increases in age. None of the socioeconomic factors or health care variables had a significant association with navigation acceptance. There are few barriers to using community-based navigation for cancer control among urban African Americans. Continued efforts are needed to develop and implement community-based programs for cancer control that are easy to use and address the needs of medically underserved populations.

Factors influencing participation in breast cancer screening

Despite the efficacy of mammography and the widespread promotion of screening programmes, a significant number of eligible women still do not attend for regular breast screening. An integrative review methodology was considered the most appropriate means to critically analyse the available literature pertaining to factors which influence participation in breast cancer screening. From the extensive literature search, 12 selected core research papers met the inclusion criteria and were incorporated in the literature review. Four themes emerged from the literature which impact on participation in mammography screening: psychological and practical issues, ethnicity issues, influence of socioeconomic status and issues related to screening programmes. The recent Independent Review Panel on Breast Cancer Screening endorsed the importance of access to information which clearly communicates the harms and benefits of breast screening to enable women to make informed decisions about their health. The recommendations from the panel and others have been included in this review.

Impact of Psychological Distress on Prostate Cancer Screening in U.S. Military Veterans

The benefit of routine prostate cancer screening is currently under debate; however, many experts recommend that men with elevated risk for the disease discuss the potential risks and benefits of screening with their health care team. Psychological factors have been negatively associated with preventive health behaviors such as cancer screenings. The purpose of this study was to investigate the impact of depressive and trauma-related symptoms on prostate cancer screening behaviors and relevant health care perceptions among a sample of U.S. military veterans, as veterans are at higher risk for prostate cancer, depression, and posttraumatic stress disorder than the general population. Participants (n = 350) were a national sample of predominantly Caucasian (84.6%) male U.S. military veterans (60.5 years ± 8.9) who completed an online questionnaire regarding past prostate cancer screening engagement, as well as validated measures of depression, posttraumatic stress disorder, and perceived barriers and benefits to prostate cancer screening. Results indicate that greater depressive symptoms, trauma-related symptoms, and perceived barriers were associated with lower rates of past prostate cancer screening among this veteran sample and that greater depressive and trauma-related symptoms were associated with greater perceived barriers to prostate cancer screening. As prostate cancer screening recommendations continue to evolve, it is important for health care providers not only to discuss pros and cons of screening with high risk men but also to consider the impact of psychological distress on the decision-making process.

An integrated view of cultural perceptions of cancer among Arab people in Israel

The aim of this study was to review published studies on the cultural aspects of screening and care of Arab cancer patients living in Israel. The literature published from the beginning of recording, available up to December 2012, was systematically reviewed. Fifteen studies on perceptions of cancer screening and five studies on different aspects of coping with cancer were identified. Non-attendance of screening for early detection of breast or colorectal cancer was reported to be associated with higher personal barriers (the health belief model) and higher cultural and social barriers. Perceptions of cancer risk, causes, outcomes and personal responsibility were widespread from traditional to more modern biomedical views, and sometimes integrated. Among breast cancer patients, effects of a collective and family centred way of life and strong support by one's spouse were evident, followed by a change towards closer spousal relations. Religious coping strategies were the most prevalent among breast cancer patients and were related to better well-being. An integration of traditional and modern perceptions of cancer, attitudes towards screening and coping with cancer were evident. More research is needed in order to advance a culturally competent care of cancer patients and of interventions that encourage screening for the early detection of cancer.

Family Support and Colorectal Cancer Screening among Urban African Americans

Colorectal cancer (CRC) is the third leading cause of cancer death among African Americans. Less than 50% of African Americans have had CRC screening. This study examined the relationships between family support and influence, cultural identity, CRC beliefs, and a screening informed decision among 129 urban African Americans. Family support (p < .01) significantly predicted CRC beliefs and CRC beliefs significantly predicted informed decision (p < .01). Based on study results, practitioners should routinely assess family support and CRC beliefs with African Americans patients. This may improve patient-provider shared decision-making satisfaction and CRC screening adherence among African American patients.

Characteristics of persons who complied with and failed to comply with annual ivermectin treatment

OBJECTIVE

To assess individual compliance with annual ivermectin treatment in onchocerciasis-endemic villages.

METHODS

Multi-site study in eight APOC-sponsored projects in Cameroon, Nigeria and Uganda to identify the socio-demographic correlates of compliance with ivermectin treatment. A structured questionnaire was administered on 2305 persons aged 10 years and above. Two categories of respondents were purposively selected to obtain both high and low compliers: people who took ivermectin 6-8 times and 0-2 times previously. Simple descriptive statistics were employed in characterizing the respondents into high and low compliers, while some socio-demographic and key perceptual factors were employed in regression models constructed to explain levels of compliance among the respondents.

RESULTS

Some demographic and perceptual factors associated with compliance were identified. Compliance was more common among men (54.4%) (P < 0.001). Adults (54.6%) had greater rates of high compliance (P < 0.001. The mean age of high compliers (41.5 years) was significantly older (35.8 years) (t = 8.46, P < 0.001). Perception of onchocerciasis and effectiveness of ivermectin influenced compliance. 81.4% of respondents saw benefits in annual ivermectin treatment, high compliance among those who saw benefits was 59.3% compared to 13.3% of those who did not (P < 0.001).

CONCLUSION

Efforts to increase compliance with ivermectin treatment should focus on providing health education to youth and women. Health education should also highlight the benefits of taking ivermectin.

The interaction of perceived risk and benefits and the relationship to predicting mammography adherence in African American women

PURPOSE/OBJECTIVES

To test the interaction of perceived risk and benefits and how they impact stage of mammography readiness and adherence.

DESIGN

Cross-sectional study.

SETTING

Community gathering centers and healthcare clinics across Indiana.

SAMPLE

299 African American women who had not had a mammogram in more than 18 months.

METHODS

In-person interviews were used to collect data on sociodemographics, health belief variables, and stage of readiness to undertake mammography screening. Four categories were created to measure the combined magnitude of high or low levels of perceived risk and benefit, with health belief variables linked to modified mammography screening behavior.

MAIN RESEARCH VARIABLES

Perceived risks and benefits, stage of readiness, and mammography adherence.

FINDINGS

The lowest rate of mammography adherence was in women with a high perceived risk and low perceived benefit toward mammography adherence (26%). The highest rate of adherence was in women with a high perceived benefit and low perceived risk (46%). Differences in mammography adherence were statistically significant between the groups (p = 0.009).

CONCLUSIONS

The interaction of high perceived risk and low perceived benefits impacted readiness to undergo screening mammography.

IMPLICATIONS FOR NURSING

Reducing disparities in breast cancer diagnosis and survival requires timely and efficient mammography adherence. African American medically underserved women with high perceived risk and low perceived benefits exhibited a reluctance to move forward with mammography adherence. Interventions are needed to increase the perception of mammography benefit and to subsequently reduce breast cancer mortality rates in that population.

Theory of perceived access to breast health care in African American women

The theory presented in this article proposes an alternative view of access to care on the basis of an African American woman's perception of the necessity, availability, and appropriateness of breast health care. The theory of perceived access to breast health care in African American women may also be useful in framing future research studies exploring the relationship between access to care and utilization of primary, secondary, and tertiary clinical preventive services related to breast health care.

Influence of demographic factors, knowledge, and beliefs on Jordanian women's intention to undergo mammography screening

PURPOSE

The purpose of this study was to determine the influence of demographic characteristics, breast cancer knowledge, fatalistic beliefs, health beliefs, and subjective norms on Jordanian women's intention to participate in mammography screening.

DESIGN

A cross-sectional survey was used to collect data at 14 comprehensive healthcare centers in Amman and Zarqa, Jordan. A convenience sample of 142 Jordanian women 40 years of age or older with no history of breast cancer and able to read and write in Arabic participated.

METHODS

Self-report surveys included a combination of researcher-designed and existing instruments to measure the study variables. Data were analyzed using descriptive statistics, Pearson's correlation, t tests, and multiple logistic regression.

FINDINGS

Jordanian women surveyed lacked knowledge about breast cancer. Social norms and self-efficacy highly influenced these women's intention to engage in mammography screening. Younger women were more willing to indicate intention to engage in mammographic screening.

CONCLUSIONS

Self-efficacy and the social connectedness of Jordanian society, but not religious beliefs or perceived barriers to screening, influence Jordanian women's intention to undergo mammography. Future research should examine cultural influences, rather than religious beliefs, and investigate Jordanian women's potentially unique perspectives on barriers to actual mammography screening behavior.

CLINICAL RELEVANCE

The prevalence of mammography screening may be enhanced by focusing interventions on Jordanian women's support systems and empowering women by providing knowledge and skills needed to engage in the procedure.

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.

Sociocultural differences and colorectal cancer screening among African American men and women

PURPOSE/OBJECTIVES

To examine sociocultural factors that influence an informed decision about colorectal cancer (CRC) screening among African American men and women.

DESIGN

Descriptive, cross-sectional.

SETTING

A medical center, a National Cancer Institute-designated comprehensive cancer center, and various social organizations and barbershops in a midwestern city of the United States.

SAMPLE

A purposive sample of African American women (n = 65) and African American men (n = 64) aged 50 years and older.

METHODS

Participants completed a self-administered survey.

MAIN RESEARCH VARIABLES

Cultural identity, CRC beliefs, family support, and informed decision.

FINDINGS

Family support was positively related to CRC beliefs among participants, and CRC beliefs were positively related to an informed decision. However, among men, family support positively related to an informed decision about CRC screening. In addition, t-test results indicated that the men and women were significantly different. Family support predicted CRC beliefs among men (p < 0.01) and women (p < 0.01). CRC beliefs predicted CRC screening informed decisions among men (p < 0.01) and women (p < 0.05). However, the accounted variance was dissimilar, suggesting a difference in the impact of the predictors among the men and women.

CONCLUSIONS

Family support has a significant impact on CRC beliefs about CRC screening among African Americans. However, how men and women relate to the variables differs.

IMPLICATIONS FOR NURSING

To improve CRC screening rates, informed decision-making interventions for African Americans should differ for men and women and address family support, CRC beliefs, and elements of cultural identity.

Prostate cancer health and cultural beliefs of black men: The Florida Prostate Cancer Disparity Project

BACKGROUND

Since behavioral factors are significant determinants of population health, addressing prostate cancer (CaP)-related health beliefs and cultural beliefs are key weapons to fight this deadly disease. This study investigated the health beliefs and cultural beliefs of black men relative to CaP, and the key socio-demographic correlates of these beliefs.

METHODS

The study design was a cross-sectional survey of 2,864 Florida black men, age 40 to 70, on their perceived susceptibility, perceived severity, attitude, outcomes beliefs, perceived behavioral control, CaP fatalism, religiosity, temporal orientation, and acculturation relative to CaP screening and prevention.

RESULTS

The men reported favorable attitude and positive outcome beliefs, but moderate perceived behavioral control, CaP susceptibility and CaP severity. They also had low level of acculturation, did not hold fatalistic beliefs about CaP, had high religious coping skills and had high future time perspective. Several demographic variables were found to be associated with health beliefs and cultural beliefs.

DISCUSSION

Our study provides rich data with regard to the health and cultural beliefs that might serve to inform the development of CaP control initiative for US-born and foreign-born black men.

Mammography Screening according to Breast Cancer Disease and Social Network Characteristics of Married Korean Women

PURPOSE

This study was done to examine differences in mammography screening according to breast cancer and social network characteristic.

METHODS

Data were collected from 187 married women 35 years and older who were using public health centers, health promotion centers, cultural centers, obstetrics and gynecology hospitals or other relevant community sites. Data were collected between October 24 and December 4, 2008. Data were analyzed using the SPSS/WIN 15.0 program.

RESULTS

The participation rate for mammography screening was 35.3%. The following general and breast cancer characteristics showed statistically significant differences: religion, family incomes, regular medical-care, general health examinations during past 2 years, and history of breast disease. The following social network characteristics showed statistically significant differences: social norms and subjective norms. Using logistic regression analysis, regular medical-care, breast cancer risk appraisal, social norm, and subjective norms were highly predictive of subsequent mammography.

CONCLUSION

The results of this study indicate that it is important to develop and provide tailored intervention programs through integrated socially mediated programs. By consciously including social network and support systems, breast cancer detection efforts would not end as a one-time event, but naturally build on network structure of adults women, thus facilitating regular mammography screening.

Black women and breast health: a review of the literature

AIM

In the UK, it is known that screening inequalities exist involving ethnic minority groups such as Black women (Patnick, 2009). To date, there is limited UK data on Black British women and breast health awareness. Black British women appear to be an underrepresented group in breast cancer studies (Breast Cancer Care, 2004, 2005). This literature review aimed to explore Black women's perceptions of breast health and factors that influence breast cancer screening practices.

METHODS

A literature search for the period 1994 to September 2009 was undertaken using BNI, CINAHL, PubMed, OSH-ROM, PsyInfo, Google scholar, and Scopus databases. Key words used included: breast cancer, breast health, African American women, Black British women, black women, breast cancer screening, qualitative studies. Hand-searching was also done, and reference lists of papers were examined for relevant studies.

RESULTS

Black women hold a variety of views and perceptions on the risk that breast cancer poses. These perceptions are strongly related to existing knowledge, related stigmatization, spiritual and religious beliefs, all of which can adversely influence motivation to engage in self-breast examination and breast cancer screening.

CONCLUSION

US based studies identified several influential factors: religion, educational awareness of breast cancer screening, breast health awareness. Breast health interventions and research are needed to increase breast health awareness in Black British women.

Self-reported acne severity, treatment, and belief patterns across multiple racial and ethnic groups in adolescent students

Acne vulgaris is a common condition among adolescents regardless of age, gender, and race. We compare the frequency, severity, help-seeking behavior, treatment, and beliefs about acne among students based on race, ethnicity, gender, and age. Anonymous surveys were administered to 1,214 students aged 10-19 years of varied gender, race, and ethnicity in public middle and high schools in New Jersey. Results showed the frequency and severity of acne were high (76% and 65%, respectively) and more prevalent in white compared to non-white respondents (RR = 1.13, 95% CI = 1.04-1.24 and RR = 1.22, 95% CI = 1.09-1.37, respectively), and also in older compared to younger ages (RR = 1.24, 95% CI = 1.17-1.32 and RR = 1.43, 95% CI = 1.32-1.55, respectively). The majority of respondents (83%) reported never having seen a physician for their acne; however, those reporting acne of some severity were more likely to have seen a physician compared with those who did not report acne (21% vs. 8%, p < 0.001). Blacks who reported mild or moderate severity of acne were more likely to have seen a health professional compared to white respondents with same the acne severity (RR = 3.63, 95% CI = 2.06-6.37 and RR = 3.06, 95% CI = 2.02-4.65, respectively). Conversely, Hispanic respondents with mild or moderate acne were less likely to have seen a health professional compared to whites with the same acne severity (RR = 0.56, 95% CI = 0.35-0.89 and RR = 0.47, 95% CI = 0.26-0.86, respectively). Beliefs about external factors affecting acne also varied by race and ethnicity. In conclusion, the severity, frequency, and beliefs about acne all play a role in help-seeking behaviors, which vary to a significant extent by race and ethnicity.

Adherence to a breast cancer screening program and its predictors in underserved women in southern Brazil

BACKGROUND

Adherence to breast cancer screening is a key element to ensure effectiveness of programs aiming at downstaging of breast cancer. In this study, we evaluated adherence to a screening program and its predictors in underserved women in southern Brazil.

METHODS

Attendance to the program, which is based on yearly mammogram and clinical examination, was evaluated prospectively. Mean time frames between visits were calculated. Possible predictors of adherence (defined as mean intervals ≤18 mo), such as socioeconomic indicators and health/lifestyle behaviors, were investigated.

RESULTS

A total of 3,749 women (age 51 ± 8 y, illiteracy rate of 6.8%, 57.4% with parity ≥3) were analyzed. Median time between screening rounds was 16.5 months (interquartile range, 13.1-25.7), and median number of rounds attended was 3 (interquartile range, 2-4); 57.6% had mean intervals ≤18, and 71% ≤24 months. The most important independent predictors of adherence were high genetic risk [relative risk (RR), 1.25; 95% confidence interval (95% CI), 1.11-1.40], illiteracy (RR, 0.77; 95% CI, 0.67-0.90), parity ≥5 (RR, 0.89; 95% CI, 0.83-0.96), and smoking (RR, 0.82; 95% CI, 0.77-0.88).

CONCLUSIONS

Although the proposed screening interval was 1 year, compliance to biannual screening (accepted in several international programs) was high, especially when considering the low socioeconomic level of the sample.

IMPACT

This project aims to test a breast cancer screening model for underserved populations in limited-resource countries where adherence is an issue. The identification of worst adherence predictors can point to interventions to improve outcomes of similar public health screening strategies.

Effects of personal characteristics on African-American women's beliefs about breast cancer

PURPOSE

This study measured the effect of demographic and clinical characteristics on health and cultural beliefs related to mammography.

DESIGN

Cross-sectional study.

SETTING

Interviews were conducted during 2003 and 2004 in a Midwestern urban area.

SUBJECTS

Subjects were 344 low-income African-American women 40 years and older who had not had mammography within the previous 18 months.

MEASURES

The instrument measured personal characteristics, belief and knowledge scales, and participants' mammography experience and plans.

ANALYSIS

Multiple regression analysis assessed the effect of specific demographic and clinical characteristics on each of the scale values and on subjects' stages of readiness to change.

RESULTS

The subjects' levels of education significantly affected six of the 12 belief and knowledge scales. Higher-educated women felt less susceptible to breast cancer, had higher self-efficacy, had less fear, had lower fatalism scores, were less likely to be present-time oriented, and were more knowledgeable about breast cancer. Older women felt they were less susceptible to breast cancer, had higher fatalism scores, were more present-time oriented, and were less knowledgeable about breast cancer.

CONCLUSIONS

The findings suggest that mammography promotion programs for African-Americans should consider the education levels and ages of the target women to be most effective.

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.

Do cultural factors predict mammography behaviour among Korean immigrants in the USA?

AIM

This paper is a report of a study of the correlates of mammogram use among Korean American women.

BACKGROUND

Despite the increasing incidence of and mortality from breast cancer, Asian women in the United States of America report consistently low rates of mammography screening. A number of health beliefs and sociodemographic characteristics have been associated with mammogram participation among these women. However, studies systematically investigating cultural factors in relation to mammogram experience have been scarce.

METHODS

We measured screening-related health beliefs, modesty and use of Eastern medicine in 100 Korean American women in 2006. Hierarchical logistic regression was used to examine the unique contribution of the study variables, after accounting for sociodemographic characteristics.

FINDINGS

Only 51% reported past mammogram use. Korean American women who had previously had mammograms were statistically significantly older and had higher perceived benefit scores than those who had not. Perceived benefits (odds ratio = 6.3, 95% confidence interval = 2.12, 18.76) and breast cancer susceptibility (odds ratio = 3.18, 95% confidence interval = 1.06, 9.59) were statistically significant correlates of mammography experience, whereas cultural factors did not correlate. Post hoc analysis showed that for women with some or good English skills, cultural factors statistically significantly correlated with health beliefs and breast cancer knowledge (P < 0.05).

CONCLUSION

Nurses should consider the inclusion in culturally tailored interventions of more targeted outreach and healthcare system navigation assistance for promoting mammography screening in Korean American women. Further research is needed to unravel the interplay between acculturation, cultural factors and health beliefs related to cancer screening behaviours of Korean American women.

Longitudinal predictors of nonadherence to maintenance of mammography

BACKGROUND

Regular adherence to screening mammography, also known as maintenance of mammography, reduces breast cancer morbidity and mortality. However, mammography maintenance is uncommon and little is known about why women do not maintain regular screening schedules. We investigated longitudinal predictors of women not maintaining adherence.

METHODS

Participants were insured women enrolled in an intervention trial who had screening mammograms 8 to 9 months before study enrollment (n = 1,493). Data were collected from 2003 to 2008. We used discrete event history analysis to model nonadherence to mammography maintenance over three successive annual screening intervals (+ 2 months).

RESULTS

Most (54%) women did not maintain screening adherence over 3 years. Women who did not maintain adherence were more likely to be ages 40 to 49 years, rate their health fair or poor, be less satisfied with their last mammography experiences, report one or more barriers to getting mammograms, be less than completely confident about getting their next mammograms (lower self-efficacy), or have weaker behavioral intentions. The odds of not maintaining adherence decreased over time.

DISCUSSION

Although great strides have been achieved in increasing the proportion of women who have received mammograms, most women still are not maintaining regular mammography use over time. Our findings provide insights into targets for future mammography maintenance interventions.

Randomized trial of a lay health advisor and computer intervention to increase mammography screening in African American women

BACKGROUND

Low-income African American women face numerous barriers to mammography screening. We tested the efficacy of a combined interactive computer program and lay health advisor intervention to increase mammography screening.

METHODS

In this randomized, single blind study, participants were 181 African American female health center patients of ages 41 to 75 years, at < or =250% of poverty level, with no breast cancer history, and with no screening mammogram in the past 15 months. They were assigned to either (a) a low-dose comparison group consisting of a culturally appropriate mammography screening pamphlet or (b) interactive, tailored computer instruction at baseline and four monthly lay health advisor counseling sessions. Self-reported screening data were collected at baseline and 6 months and verified by medical record.

RESULTS

For intent-to-treat analysis of primary outcome (medical record-verified mammography screening, available on all but two participants), the intervention group had increased screening to 51% (45 of 89) compared with 18% (16 of 90) for the comparison group at 6 months. When adjusted for employment status, disability, first-degree relatives with breast cancer, health insurance, and previous breast biopsies, the intervention group was three times more likely (adjusted relative risk, 2.7; 95% confidence interval, 1.8-3.7; P < 0.0001) to get screened than the low-dose comparison group. Similar results were found for self-reported mammography stage of screening adoption.

CONCLUSIONS

The combined intervention was efficacious in improving mammography screening in low-income African American women, with an unadjusted effect size (relative risk, 2.84) significantly higher (P < 0.05) than that in previous studies of each intervention alone.

Screening mammography utilization in Tennessee women: the association with residence

CONTEXT

Approximately 70% of US women over age 40 report mammography screening within 2 years. However, rates are likely to vary by age, income, educational level, and residence.

PURPOSE

To describe the prevalence of screening mammography and associated factors in women living in rural and urban areas of Tennessee.

METHODS

Using pooled data from the Tennessee Behavioral Risk Factor Surveillance System (BRFSS; 2001 and 2003), utilization of screening mammography within a 2-year period was examined for a sample of 1,922 women, 40 years and older. Demographic, behavior, and health-related variables were used to examine associations with utilization.

FINDINGS

The prevalence of screening mammography utilization (71.3% 95% CI 67.4-75.2) in women living in rural areas of Tennessee was significantly lower than utilization among women living in urban areas (78.3% 95% CI 75.9-80.7). Higher utilization was associated with having attained at least a high school education, having health insurance, identifying a personal health care provider, being a nonsmoker, recent use of alcohol, having had a recent clinical breast exam or Papanicolau (Pap) test done, and meeting the Healthy People 2010 (HP 2010) recommendation for physical activity. After controlling for all other factors, rural residence was not associated with utilization. For rural women, identifying a personal health care provider was significantly associated with increased likelihood of utilization.

CONCLUSIONS

Lower income and lower education, each associated with lower screening utilization, were more common in rural Tennessee women. The significance of a personal health care provider for utilization in rural women is meaningful for service providers.

Perceived susceptibility to chronic kidney disease among high-risk patients seen in primary care practices

BACKGROUND

Patients' views of their risk for the development or progression of chronic kidney disease (CKD) are poorly characterized.

OBJECTIVE

To assess perceived risk and concern regarding CKD development or progression among high-risk patients seen in primary care, identify predictors of perceptions, and correlate perceptions with adherence to high blood pressure management.

DESIGN AND PARTICIPANTS

Cross-sectional study of 195 patients enrolled in a randomized controlled trial on hypertension management in 40 Maryland primary care practices.

MEASUREMENTS

We assessed independent predictors (sociodemographics, health literacy, clinical presence of CKD, co-morbid conditions, and health behaviors) of perceived susceptibility (assessed via questionnaire) and adherence (assessed via Hill-Bone blood pressure adherence scale) in multivariable analyses.

MAIN RESULTS

In this hypertensive majority African American (63%) population, many participants had uncontrolled blood pressure (44%) or diabetes (42%). Few (20%) felt "very likely" to develop CKD and one third (33%) were "very concerned" about developing CKD. Participants who were female and had low health literacy had lower perceived susceptibility to CKD compared to males and those with higher health literacy. Race and diabetes were also associated with perceived susceptibility. Greater perceived susceptibility was associated with poorer blood pressure management adherence scores.

CONCLUSIONS

Many high-risk patients have low perceived susceptibility to CKD. Poor blood pressure therapy adherence scores among those with greatest perceived susceptibility suggest fatalistic attitudes about CKD. If our findings are confirmed in larger studies, interventions targeting patient perceptions of CKD risk and other attitudes associated with these perceptions could impact adherence to therapies and health outcomes.

Behavioral constructs and mammography in five ethnic groups

Intention, self-efficacy, perceived susceptibility, perceived benefits, and subjective norms are key constructs of health behavior theories; their predictive validity for cancer screening has not been ascertained in multiethnic populations. Participants were 1,463 African American, Chinese, Filipina, Latina, and White women aged 40 to 74 interviewed by telephone in their preferred languages. The relationship between baseline constructs and mammography 2 years later was assessed using multivariable logistic regression. Intention predicted mammography overall and among Whites (odds ratio [OR] = 5.0, 95% confidence interval [CI] = 2.4, 10), with racial/ethnic differences in association (p = .020). Self-efficacy predicted mammography overall and among Whites (OR = 3.5, 95% CI = 1.1, 11), with no racial/ethnic interaction. Perceived benefits and subjective norms were associated with screening overall and in some racial/ethnic groups. These results generally support cross-cultural applicability of four of the five constructs to screening with mixed predictive value of measures across racial/ethnic groups. Additional in-depth inquiry is required to refine assessment of constructs.

Attitudes and Beliefs Associated With Mammography in a Multiethnic Population in Israel

This article highlights beliefs, attitudes, and barriers that are associated with mammography use in four distinct cultural and ethnic groups in Israel: veteran, ultra-orthodox, and immigrant Jewish and Arab women. A random telephone survey of 1,550 women was performed. Information from claims records concerning mammography use was obtained for each woman from Maccabi Health Services. Of the barriers studied, no one barrier was associated with mammography performance in all population groups. However, the combined measure was associated with mammography use in all groups. Subjective norms, fatalism, fear of breast cancer, and perceived effectiveness were associated with mammography in some of the population groups but not in others. Each population seems to have a unique set of variables predicting mammography use. It is not possible to generalize from one population to another and it implies that information concerning beliefs and attitudes should be studied in each subpopulation before planning interventions.

Language use and the receipt of cancer screening recommendations by immigrant Chinese American women

BACKGROUND

Cancer screening rates are low among Chinese American women, a mostly immigrant minority population. This is possibly because they do not receive cancer screening recommendations from their physicians. The objective of this study was to determine if the rate at which physicians recommend cancer screening to older Chinese American women differs according to the language used during visits.

METHODS

Data for the cross-sectional study were collected from a telephone survey of older Chinese American women residing in the Washington, DC, area. A total of 507 asymptomatic Chinese American women aged > or =50 who had a regular physician participated in this study. The main outcome was women's self-reported perception of having received a recommendation from their physician for mammography, Pap tests, or colorectal cancer screening in the past 2 years. The main independent variable was the language used during visits (English vs. Chinese). Patient age, educational level, employment status, cultural views, physician specialty, physician gender, and length of relationship with the physician were included in the multiple logistic regression analyses.

RESULTS

Chinese women who communicated with their physicians in English were 1.71 (95% CI 1.00-2.96) and 1.73 (95% CI 1.00-3.00) times more likely to report having received mammography and colorectal cancer screening recommendations, respectively (p < 0.05). Physicians in family medicine or general practice were 2.11 (95% CI 1.31-3.40) and 1.70 (95% CI 1.06-2.48) times more likely to recommend cancer screening than those in other specialties.

CONCLUSIONS

Chinese American women who conversed with their physicians in Chinese were less likely to perceive receiving cancer screening recommendations. Future research is needed to identify physician-specific knowledge, attitude, and cultural barriers to recommending cancer screening.