Psychosocial Correlates of Mammography Screening in Older African American Women

Does Neighborhood Social Cohesion Influence Participation in Routine Cancer Screening? Findings From a Representative Sample of Adults in South Florida

BACKGROUND AND OBJECTIVES

Neighborhood social cohesion (NSC) has been associated with a variety of health outcomes, but limited research has examined its impact on behaviors that support cancer control. The purpose of this study was to examine associations between NSC and guideline-concordant breast, cervical and colorectal cancer screening.

METHODS

Data are from a cross-sectional survey administered to 716 adults in South Florida from 2019 to 2020. The analytic samples included adults eligible for breast (n = 134), cervical (n = 195), and colorectal cancer (n = 265) screening. NSC was measured using a validated 5-item instrument. Associations between NSC and guideline-concordant screening were examined using multivariable logistic regression.

RESULTS

In fully adjusted analyses, the odds of guideline-concordant breast cancer screening increased by 86% for every unit increase in NSC (aOR = 1.86; 95% CI, 1.03-3.36). NSC was not statistically significantly associated with guideline-concordant cervical cancer screening (aOR = 0.86; 95% CI, 0.54-1.38) or colorectal cancer screening (aOR = 1.29; 95% CI, 0.81-2.04).

CONCLUSIONS

These findings suggest that NSC supports some screening behaviors, namely, mammography use. To better understand heterogeneous relationships between NSC and utilization of preventive care services such as cancer screening, more research is needed that disaggregates effects by sex, age, race/ethnicity, and socioeconomic status.

Fatalism and depressive symptoms among Chinese college students: Mediation models of locus of control and positive coping

Fatalistic voluntarism and classic fatalism have opposite effects on depression. This study attempted to measure fatalistic voluntarism with the magnanimity of Taoist values and examined the internal mechanism by which classic fatalism and magnanimity influenced depression. A total of 525 Chinese college students effectively completed self-reported questionnaires. Results showed that classic fatalism is positively correlated with depression, and magnanimity is negatively correlated with depression. Furthermore, classic fatalism and magnanimity can influence depression in Chinese college students through serial mediation by locus of control and positive coping. These findings illuminate the mediating role of locus of control and positive coping, providing specific ways to use two different belief systems, which can help reduce depressive symptoms among college students. In addition, our study may provide some ideas for the development of local culture in the promotion of mental health in different regions.

Government Housing Assistance and Cancer Screening Among Adults With Low Income

INTRODUCTION

Access to affordable housing may support cancer control for adults with low income by alleviating financial barriers to preventive care. This study examines relationships between cancer screening and receipt of government housing assistance among adults with low income.

METHODS

Data are from the 2019 and 2021 National Health Interview Survey. Eligible respondents were classified as up-to-date or not with breast cancer (BC), cervical cancer (CVC) and colorectal cancer (CRC) screening guidelines. Multivariable logistic regression was used to model guideline-concordant screening by receipt of government housing assistance, overall and stratified by urban-rural status, race/ethnicity, and age. Analyses were performed in 2023.

RESULTS

Analyses for BC, CVC and CRC screening included 2,258, 3,132, and 3,233 respondents, respectively. There was no difference in CVC screening by housing assistance status, but screening for BC and CRC was higher among those who received assistance compared to those who did not (59.7% vs. 50.8%, p<0.01 for BC; 57.1% vs. 44.1%, p<0.01 for CRC). In models adjusted for sociodemographic characteristics, health status and insurance, these differences were not statistically significant for either BC or CRC screening. In stratified adjusted models, housing assistance was statistically significantly associated with increased BC screening in urban areas (aOR=1.35, 95% CI=1.00-1.82) and among Hispanic women (aOR=2.20, 95% CI=1.01-4.78) and women 45-54 years of age (aOR=2.10, 95% CI=1.17-3.75).

CONCLUSIONS

Policies that address housing affordability may enhance access to BC screening for some subgroups, including women in urban areas, Hispanic women, and younger women. More research on the mechanisms that link housing assistance to BC screening is needed.

Experience of Pain and Unpleasantness during Mammography Screening: A Cross-Sectional Study on the Roles of Emotional, Cognitive, and Personality Factors

BACKGROUND

Breast cancer is the most frequent cause of malignant tumors among women worldwide. Its successful prevention depends on the degree of participation in screening programs, which can be influenced by psychological factors, including fear.

METHOD

A cross-sectional study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. Twenty-six healthy women aged 50-69 years took part in this study, all of whom were summoned for routine mammography screening and were randomly selected. Prior mammography screening, breast pain intensity, unpleasantness (visual analog scale), and psychological (catastrophizing, state anxiety, and fear of pain) and personality (neuroticism, psychoticism, and extraversion) variables were evaluated. Pain, unpleasantness, and state anxiety were further evaluated pre- and post-mammography screening.

RESULTS

During the mammography screening, pain and unpleasantness levels were higher than those observed pre- and post-screening. Residual unpleasantness remained post-screening. State anxiety was positively associated with pain, and psychoticism with unpleasantness, as reported by participants during the mammography screening.

CONCLUSIONS

Anxiety levels influence the pain experienced in association with the mammography procedure. Women subjected to mammography screenings might benefit from relaxation strategies aimed at reducing anxiety to pre-mammography levels and, by extension, pain and unpleasantness during mammography. The inclusion of these strategies in breast cancer prevention campaigns could improve the rates of mammography reattendance, and therefore, benefit cancer prevention efforts.

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.

Willingness to Receive Periodic Health Examination Based on the Health Belief Model Among the Elderly in Rural China: A Cross-Sectional Study

PURPOSE

This study aimed to explore factors affecting behavioral intention of receiving periodic health examinations (hereafter, BIE) among people aged 60 and over in rural China, namely, Shandong Province, using the extended health belief model (EHBM).

PATIENTS AND METHODS

Participants were selected using stratified multi-stage random sampling. Three cities were selected based on economic level. Subsequently, three counties and three villages were selected from each sample city and county. Finally, 30 respondents were selected from each sample village. Face-to-face surveys were conducted using a structured questionnaire between March and September 2017. Multiple linear regression was conducted to investigate the association between BIE and eight dimensions of EHBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues to action, health knowledge, and social support.

RESULTS

Of the 509 rural respondents aged 60 years and older, the average score of behavioral intention was 4.43±0.80. Multivariate linear regression analysis demonstrated poor BIE among participants who were men, were current smoker, were current drinker, were aged 70 years or over, had lower social support, and perceived lower self-efficacy, less benefits, and more barriers. Among them, barriers were found to have the strongest association with BIE (B'=-0.556; p<0.001). Qualitative interviews revealed that reasons for not receiving periodic health examinations (PHE) included pain, cost, difficulty in finding a health care provider, time and scheduling, potential lack of trust in the physician, and value of the PHE.

CONCLUSION

This study highlighted the importance of psychological variables in the acceptance of PHE among the elderly in rural China and provided insights for further intervention designs targeting identified groups and performed by general practitioners. Addressing medical mistrust, strengthening, and enhancing one's social support network and health communication channels, such as bulletin boards, may serve to facilitate BIE.

Fatalism and Depressive Symptoms: Active and Passive Forms of Fatalism Differentially Predict Depression

Classic fatalism is the belief that regardless of actions, events are predestined to occur (Straughan and Seow 1998). Researchers have found that fatalism is positively correlated with depression symptoms and higher endorsement of an external locus of control. Although fatalism is thought to be a unitary construct, based on the current literature, we hypothesized fatalism may take on other forms. We defined active fatalism as the belief in a predestined personal and global future, combined with the belief that one must do their part to bring this predestined future into fruition. Therefore, we predicted that active fatalism will be negatively correlated with depression symptoms, external locus of control, and negative coping skills. We recruited a sample of religious participants online (n = 282; 49.3% female) who completed self-report scales measuring depression symptoms, classic fatalism, active fatalism, coping skills, and locus of control. We found that while classic fatalism was significantly and positively associated with depression and negative coping, active fatalism was positively correlated with positive coping skills, and negatively correlated with depression and external locus of control. Finally, the present study found that active fatalism explained variance in both depression and anxiety symptoms above and beyond the classic form of fatalism. This confirmed our hypotheses and suggested that there may be several forms of fatalism, each differentially predicting mental health processes and outcomes. The significant positive correlation of positive coping and negative correlations of depression and external locus of control with active fatalism offer evidence in support of the notion that this form of fatalism may in fact be associated with protective mechanisms against depression. Differential assessment of these varying concepts may be appropriate for assessment and psychotherapy.

Health Beliefs and Breast Cancer Screening Practices Among African American Women in California

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.

Factors that Influence Mammography Use for Breast Cancer Screening among African American Women

OBJECTIVES

The purpose of this study was to assess factors that influence use of mammography screening among African American women, with a focus on social and cultural influences using Andersen's behavioral model (ABM), and to assess the methodological quality of the included studies.

METHODS

A literature review was conducted using PubMed, CINAHL, PSYCINFO, and Web of Science. Search terms included a combination of the following words using Boolean operators: breast cancer screening, mammography, repeat mammography, and African American. Studies that met the following criteria were included in the review: 1) examined factors associated with mammography screening, 2) included African American women as a majority, 3) published in a peer-reviewed English language journal between 2005 and 2017, and 4) conducted in the United States. Literature reviews, commentaries and non-research studies were excluded. Cited references from identified studies were examined for additional, relevant articles. Associated factors were grouped into predisposing, enabling, and need factor domains of ABM. The reviewed studies were rated using a methodological quality score (MQS) ranging from 0 to 20, with higher scores indicating higher methodological quality.

RESULTS

Twenty-four studies met the inclusion criteria. Fifteen factors that affect breast cancer screening in African American women were identified: predisposing (age, education, knowledge, beliefs, mistrust, religiosity, fears and fatalism), enabling (health insurance, access to care, income, health utilization), and need (physician recommendation, family/personal history, pain/discomfort, family responsibilities) factors. The most common factor was insurance status, although cultural issues (e.g., mistrust) were evident. Most of the identified factors are modifiable. The mean MQS was 12.2, indicating that the studies were slightly above average in quality.

CONCLUSIONS

Financial and cultural issues were important hindrances to breast cancer screening in African American women. These findings highlight the importance of affordable health care for preventive health services as well as the relevance of culturally embedded issues to health, while the MQS accentuates the need for more rigorous research articles. Breast cancer screening interventions in this population should attend to barriers identified in this review.

Fatalism in breast cancer and performing mammography on women with or without a family history of breast cancer

Background

Breast cancer is the most prevalent cancer in women, and in those with a positive family history, it is important to perform mammography. One of the probable barriers in doing mammography is fatalism.

Methods

This is a descriptive/cross-sectional study conducted on 400 women residing in Isfahan, Iran, randomly selected in 2017. Sampling was done randomly among the enrolled women in Health Integrity System. The data collection tool was a questionnaire regarding the demographic-fertility information and fatalism. The data analysis was done by SPSS software. A P-value < 0.05 was considered statistically significant.

Results

The results showed that the mean rate of fatalism was 59.5 ± 23.2 in women with the experience of mammography, and 65.9±18.7 in women without the experience. Moreover, the mean rate of fatalism was 73.1±15.2 in subjects with a family history of breast cancer, and 59.3 ± 22.5 in those no family history related to this condition. Accordingly, fatalism was statistically significant associated (P < 0.001) with a family history of breast cancer and experience of mammography. There was no significant relationship between demographic information and fatalism (P > 0.05).

Conclusion

The results indicated that fatalism in women with no experience of mammography was higher than in those with a positive history. Regarding the necessity of mammography in women with a family history of breast cancer, the required interventions seem to be essential to changing the viewpoints of women regarding the importance and effect of mammography as a screening method for breast cancer.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0810-6) contains supplementary material, which is available to authorized users.

Factors Associated with Adherence to Preventive Breast Cancer Screenings among Middle-aged African American Women

Medical and other health professionals recommend biyearly screening for breast cancer for women 40-74 years of age. However, the breast cancer screening rate of African American women aged 45 and up is lower than that of other ethnicities. The present study intended to identify factors impacting African American women's participation in breast cancer screening. This study is a longitudinal secondary data analysis of 3,911 African American participants of the Study of Women's Health Across the Nation. By using Systems Model of Clinical Preventive Care, multinomial logistic regression was applied to explore the likelihood of having breast cancer screenings (breast exam and/or mammogram) associating with predisposing factors, enabling factors, referencing factors, and situational factors. Participants with older age, with higher education, having a healthcare provider for female health, in far distance, and with a cancer(s) were significantly more likely to adhere to the recommendations of breast cancer screenings. However, participants who did not have time to visit doctors, did not trust the physicians, and who smoked regularly were significantly less likely to adhere to the recommendations of breast cancer screenings. Implications for policy and practice are discussed.

Determinants of Breast Cancer Screening by Mammography in Women Referred to Health Centers of Urmia, Iran

Background:

In women, breast cancer accounts for 30 percent of all cancers and it is the second leading cause of mortality. Mammography is considered an effective procedure to detect early breast cancer recommended by World Health Organization. This study was aimed to evaluate breast cancer screening determinants in women referred to health centers of Urmia for mammography in 2017.

Materials and Methods:

In this descriptive-analytic cross-sectional study, 348 women referred to health centers of Urmia were selected using multistage sampling. Data were collected using a standard questionnaire for mammography screening determinants, with a checklist including demographic characteristics, family, social and economic factors and midwifery background. Analysis was with SPSS software version 20for descriptive and inferential statistic tests, P<0.05 being considered significant.

Results:

The proportion performing mammography was 12%. Significant relationships were noted with income, menopause status, a history of breast cancer in close relatives, beliefs, inaccessibility, knowledge, cues to action, emotions, self-care, and life priorities (P<0.05). There were no significant links with age at marriage, first age of delivery, number of children, duration of breastfeeding, status of residency, education, marital status, occupation, history of breastfeeding, and previous breast problems (P>0.05).

Conclusions:

The findings of this study showed that the status of breast cancer screening in participating women was not satisfactory. Therefore, promotion of screening methods by health policy makers in Iran is necessary and given that reliance solely on education is not sufficient, it is essential to pay attention to barriers and eliminate them.

A national cross-sectional study of adherence to timely mammography use in Malta

BACKGROUND

Routine mammography improves survival. To achieve health benefits, women must attend breast screening regularly at recommended time intervals. Maltese women are routinely invited to undergo mammography at three-year intervals at an organized breast screening programme (MBSP) or can opt to attend a private clinic. Previous research shows that health beliefs, particularly perceived barriers, were the most significant predictors of uptake to the first MBSP invitation. Whether these beliefs and other factors are predictive of adherence with recommended time intervals for mammography at organized or private screening in Malta is unknown. For the first time, this paper explores the predictors for Maltese women screened within or exceeding the recommended three-year frequency in organized or private screening in Malta.

METHODS

Information was obtained from a cross-sectional survey of 404 women, aged 50 to 60 years at the time of their first MBSP invitation, where women's characteristics, knowledge, health beliefs and illness perceptions were compared. The main variable of interest was women's mammography attendance within a three-year interval (ADHERENT) or exceeding three years (NON-ADHERENT). Data were analysed using descriptive statistics, chi-square test, Mann Whitney test, Independent Samples t-test and Shapiro Wilk test.

RESULTS

At the time of the survey, 80.2% (n = 324) had been screened within three years (ADHERENT), 5.9% (n = 24) had exceeded the three-year frequency (NON-ADHERENT) while 13.9% (n = 56) never had a mammogram. No significant associations were found between ADHERENT or NON-ADHERENT women in relation to sociodemographic or health status variables (p > 0.05). Knowledge of screening frequency was significantly associated with women's mammography adherence (χ2 = 5.5, p = 0.020). Health beliefs were the strongest significant predictors to describe the variance between ADHERENT and NON-ADHERENT screeners. When Mann Whitney test and Independent Samples t-test were applied on mammography adherence, perceived barriers and cues to action were found to be the most important predictors (p = 0.000, p = 0.039 respectively).

CONCLUSIONS

To increase routine and timely mammography practices, women who are non-adherent to recommended time frequency guidelines should be targeted, together with their health beliefs, predominantly perceived barriers and cues to action.

Breast cancer screening utilization among women from Muslim majority countries in Ontario, Canada

Breast cancer screening disparities continue to prevail with immigrant women being at the forefront of the under screened population. There is a paucity of knowledge about the role of religious affiliation or cultural orientation on immigrant women's cancer screening uptake. This study examined differences in uptake of breast cancer screening among women from Muslim and non- Muslim majority countries in Ontario, Canada. A cohort of 1,851,834 screening-eligible women living in Ontario during April 1, 2013 to March 31, 2015 was created using linked health and social administrative databases. The study found that being born in a Muslim majority country was associated with lower breast cancer screening uptake after adjusting for region of origin, neighbourhood income, and primary care-related factors. However, screening uptake in Muslim majority countries varied by world region with the greatest differences found in Sub-Saharan Africa and South Asia. Screening uptake was lower for women who had no primary care provider, were in a traditional fee-for service model of primary care, had a male physician, had an internationally trained physician, resided in a low income neighbourhood, and entered Canada under the family class of immigration. Religion may play a role in screening uptake, however, the variation in rates by regions of origin, immigration class, and access to primary care providers alludes to confluence of socio-demographic, cultural beliefs and practices, immigration trajectories and system level factors. Facilitating access for immigrant women to regular primary care providers, particularly female providers and enrollment in primary care models could enhance screening uptake.

Psychosocial Predictors of HBV Screening Behavior among Vietnamese Americans

OBJECTIVE

We evaluated the influence of psychosocial factors on HBV screening.

METHODS

Sample consisted of 1716 Vietnamese participants in our previous HBV intervention trial, recruited from 36 community-based organizations in Pennsylvania, New Jersey, and New York City between 2009 and 2014. Using the Health Belief Model and Social Cognitive Theory, we measured self-efficacy, knowledge, perceived barriers, perceived benefits, perceived severity, and risk susceptibility. Analysis of covariance was used to compare pre- and post-intervention changes of psychosocial variables. Structural equation modeling was used to explore the direct and indirect effects of the psychosocial variables on HBV screening.

RESULTS

Knowledge, self-efficacy, perceived benefits, and perceived barriers were directly associated with HBV screening; knowledge had the strongest effect. Perceived severity and risk susceptibility had indirect association with HBV screening through other variables. Indirect paths among the 6 psychosocial variables were also identified.

CONCLUSION

To promote HBV screening among Vietnamese Americans, intervention efforts should focus on increasing knowledge, self-efficacy, and perceived benefits, decreasing perceived barriers, and accounting for the dynamic cognitive processing.

Cultural and emotional determinants of cervical cancer screening among older Hispanic women

Older adults are at highest risk of cancer and yet have the lowest rates of cancer screening participation. Older minority adults bear the burden of cancer screening disparities leading to late stage cancer diagnoses. This investigation, utilization data from the 2008 wave of the Health and Retirement study examined the cultural and emotional factors thought to influence cervical cancer screening among older Hispanic women. We utilized logistic regression models to conduct the analyses. Findings indicate that the emotional factors were not significant but the cultural factor, time orientation was a significant predictor for older Hispanics' cervical cancer screening behaviors.

Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: a cross-sectional survey

BACKGROUND

Women's beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. This study utilized the health belief model (HBM) and common-sense model (CSM) of illness self-regulation to explore factors associated with BS uptake in Malta and subsequently, to identify the most important predictors to first screening uptake.

METHODS

This cross-sectional survey enrolled Maltese women (n = 404) ages 50 to 60 at the time of their first screening invitation, invited to the National Breast Screening Programme by stratified random sampling, with no personal history of BC. Participants responded to a 121-item questionnaire by telephone between June-September 2015. Data were analyzed using descriptive statistics, chi-square tests and logistic regression.

RESULTS

There is high awareness of BC signs and symptoms among Maltese women (>80% agreement for 7 out of 8 signs), but wide variation about causation (e.g., germ or virus: 38.6% 'agree', 30.7% 'disagree'). 'Fear' was the key reason for non-attendance to first invitation (41%, n = 66) and was statistically significant across all subscale items (p < 0.05). Most items within HBM constructs (perceived barriers; cues to action; self-efficacy) were significantly associated with first invitation to the National Breast Screening Programme, such as fear of result (χ2 = 12.0, p = 0.017) and life problems were considered greater than getting mammography (χ2 = 38.8, p = 0.000). Items within CSM constructs of Illness Representation (BC causes; cyclical cancer timeline; consequences) were also significantly associated, such as BC was considered to be life-changing (χ2 = 18.0, p = 0.000) with serious financial consequences (χ2 = 13.3, p = 0.004). There were no significant associations for socio-demographic or health status variables with uptake, except for family income (χ2 = 9.7, p = 0.047). Logistic regression analyses showed that HBM constructs, in particular perceived barriers, were the strongest predictors of non-attendance to first invitation throughout the analyses (p < 0.05). However, the inclusion of illness representation dimensions improved the model accuracy to predict non-attendance when compared to HBM alone (65% vs 38.8%).

CONCLUSIONS

Interventions should be based on theory including HBM and CSM constructs, and should target first BS uptake and specific barriers to reduce disparities and increase BS uptake in Malta.

Psychosocial correlates of cervical cancer screening among older Hispanic women

Early detection through screening can reduce mortality rates of cervical cancer, and yet Hispanic women who have incidence rates higher than their non-Hispanic White counterparts are least likely to participate in cancer screening initiatives. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the psychosocial correlates associated with older Hispanic women's participation in cervical cancer screening services. Logistic regression models were used. Findings indicated that greater life satisfaction and religiosity were associated with a greater likelihood of participating in cervical cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

Predictors of breast self-examination performance among Jordanian university female students

Breast cancer is considered one of the main types of cancer among female worldwide and in Jordan also. Early detection of it will improve the prognosis and decrease the mortality rate also. Thus, this study was conducted to assess the predictors of breast self-examination performance among Jordanian university female students. Across-sectional design was utilised in this study. A sample of 100 participants was completed the study survey (The Champion's Health Belief Model Scale). The main results or regression analysis showed that confidence (β = .71, p < .0001) and perceived barriers (β = -.061, p = .0004) were significant predictors of breast self-examination performance. In summary, other variables of Health belief model were found not be significant indicators of BSE performance in this study. However, the HBM is considered a valid framework to assess the predictors of breast self-examination knowledge, attitude, beliefs and barriers among Jordanian college female students.

Self-assessed health, perceived stress and non-participation in breast cancer screening: A Danish cohort study

OBJECTIVE

Population-based cancer screening is offered in many countries to detect early stages of cancer and reduce mortality. Screening efficiency and equality is susceptible due to a group of non-participants. We investigated associations between self-assessed health, perceived stress and subsequent non-participation in breast cancer screening.

METHODS

This population-based cohort study included 4512 women who had participated in a Health Survey in 2006 and who were also the target group (aged 50-69 years) for the first organised breast cancer screening programme -3 years later in the Central Denmark Region in 2008-2009.

RESULTS

A U-shaped association was observed for physical health assessment as women with the highest (PR=1.28, 95% CI: 1.06-1.55), and the lowest (PR=1.41, 95% CI: 1.18-1.68) physical health scores were less likely to participate in the programme than women with physical health scores in the middle range. Women with low mental health assessment were more likely not to participate than women with mental health scores in the middle range (PR=1.44, 95% CI: 1.22-1.69). Higher non-participation propensity was also observed for women with the highest perceived stress scores (PR=1.27, 95% CI: 1.07-1.51) compared with women scoring in the middle range.

CONCLUSIONS

Women with highest and lowest self-assessed physical health, with lowest mental health or highest perceived stress were significantly more likely not to participate in breast cancer screening 2-3 years later than women who reported average health. Interventions targeting these groups may promote equal participation in future breast cancer screening programmes.

Breast cancer screening disparities among urban immigrants: a population-based study in Ontario, Canada

BACKGROUND

Breast cancer is one of the leading cause of mortality and morbidity in Canada. Screening is the most promising approach in identification and treatment of the disease at early stage of its development. Research shows higher rate of breast cancer mortality among ethno-racial immigrant women despite their lower incidence which suggests disparities in mammography screening. This study aimed to compare the prevalence of appropriate mammography screening among immigrant and native borne women and determine predicators of low mammography screening.

METHODS

We conducted secondary data analyses on Ontario linked social and health databases to determine the proportion of women who were screened during the two-year period of 2010-2012 among 1.4 million screening-eligible women living in urban centres in Ontario. We used multivariate Poisson regression to adjust for various socio-demographic, health care-related and migration related variables.

RESULTS

64% of eligible women were appropriately screened. Screening rates were lowest among new and recent immigrants compared to referent group (Canadian-born women and immigrant who arrived before 1985) (Adjusted Rate Ratio (ARR) (0.87, 95% CI 0.85-0.88 for new immigrants and 0.90, 95% CI 0.89-0.91 for recent immigrants. Factors that were associated with lower rates of screening included living in low-income neighborhoods, having a male physician, having internationally-trained physician and not being enrolled in primary care patient enrolment models. Those not enrolled were 22% less likely to be screened compared to those who were (ARR 0.78, 95% CI 0.77-0.79).

CONCLUSION

To enhance immigrant women screening rates efforts should made to increase their access to primary care patient enrolment models and preferably female health professionals. Support should be provided to interventions that address screening barriers like language, acculturation limitations and knowledge deficit. Health professionals need to be educated and take an active role in offering screening guidelines during health encounters.

Factors influencing breast cancer screening in low-income African Americans in Tennessee

This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for breast cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n = 334) were selected from the Meharry CNP community survey database. There were several predictors of breast cancer screening such as marital status and having health insurance (P < .05). Additionally, there were associations between obstacles to screening and geographic region such as transportation and not having enough information about screenings (P < .05). Educational interventions aimed at improving breast cancer knowledge and screening rates should incorporate information about obstacles and predictors to screening.

The relationship between psychosocial factors and breast cancer screening behaviors of older Hispanic women

Guided by the theory of planned behavior, this study utilized data from the 2008 wave of the Health and Retirement Study to investigate psychosocial factors associated with older Hispanic women's participation in breast cancer screening services. Hierarchical logistic regression models were used to assess the odds of breast cancer screening participation. Findings indicate that satisfaction with aging and constraints were associated with a reduced likelihood of participating in breast cancer screening. These findings suggest the continued importance to assess older women's attitudes when discussing preventive services.

Breast and cervical cancer screening and associated factors among older adult women in South Africa

BACKGROUND

Little is known about the cancer screening prevalence and correlates in older adults from different racial backgrounds. In the context of heightened efforts for prevention and early diagnosis, we collected information on screening for two major types of cancers: cervical and breast cancer in order to establish their prevalence estimates and correlates among older South African women who participated in the Study of Global Ageing and Adults Health (SAGE) in 2008.

MATERIALS AND METHODS

We conducted a national population-based cross-sectional study with a multi-stage stratified cluster sample of 3,840 individuals aged 50 years or older in South Africa in 2008. In this analysis, we only considered the female subsample of (n=2202). The measures used included socio-demographic characteristics, health variables, anthropometric and blood pressure measurements. Multivariable regression analysis was performed to assess the association of socio-demographic factors, health variables and cancer screening.

RESULTS

Overall, regarding cervical cancer screening, 24.3% ever had a Papanicolaou (PAP) smear test, and regarding breast cancer screening, 15.5% ever had a mammography. In multivariate logistic regression analysis, younger age, higher education, being from the White or Coloured population group, urban residence, greater wealth, and suffering from two or more chronic conditions were associated with cervical cancer screening, and higher education, being from the White or Indian/Asian population group, greater wealth, having a health insurance, and suffering from two or more chronic conditions were associated with breast cancer screening.

CONCLUSIONS

Cancer screening coverage remains low among elderly women in South Africa in spite of the national guideline recommendations for regular screening in order to reduce the risk of dying from these cancers if not detected early. There is a need to improve accessibility and affordability of early cervical and breast cancer screening for all women to ensure effective prevention and management of cervical and breast 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.

Interpretative repertoires that shape low-income African American women's reproductive health care seeking: "don't want to know" and "taking charge of your health"

In the context of reproductive and sexual health, African American women have higher incidence of disease and poorer outcomes on key indicators when compared with White women. In this study, we used discourse analysis to identify and examine the workings of two clusters of interpretive resources ("interpretative repertoires") associated with reproductive/sexual health care seeking among low-income African American women who participated in semistructured interviews as part of a health promotion initiative. Interpretative repertoires are ways of accounting for engaging in or refraining from engaging in actions, which are shared by people in a community. We labeled the two interpretative repertoires "Don't Want to Know," and "Take Charge of Your Health." Within the "Don't Want to Know" repertoire, that testing would lead to threatening findings was assumed, a chain of devastating consequences was imagined, and a preference for uncertainty over certain knowledge was expressed. Conversely, the "Take Charge of Your Health" repertoire valued certainty over uncertainty, though in both interpretive frameworks, knowledge-based and emotion-based decision-making were intertwined. We conclude that health promotion initiatives--if they are to succeed in encouraging women to obtain valuable preventive health care services--must respond, in their choices of language and outreach strategies, to the expressed dilemma of wishing for reassurance but fearing bad news, to the intertwining of emotional reasoning and technorationality in health decision making, and to the particular relational experiences of African American women. Failure to do so will contribute to the continuation of reproductive and sexual health disparities.

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.

Validation of a cultural cancer screening scale for mammogram utilization in a sample of African American women

BACKGROUND

The Cultural Cancer Screening Scale (CCSS) was developed to identify cultural factors relevant to breast and cervical cancer screening in a sample of Hispanic and white women in Southern California. This scale identified 5 distinct cultural factors as relevant in cancer screening decision making.

OBJECTIVE

The purpose of this study was to consider psychometric estimates of the validity and reliability of this scale in a sample of African American women residing in an urban area of New Jersey.

INTERVENTIONS/METHODS

A total of 122 women, aged 40 to 90 years, with no history of breast cancer participated in the study. Internal consistency, reliability, construct, and predictive validity were assessed.

RESULTS

Exploratory factor analysis resulted in the formation of 5 subsets: cancer screening fatalism, negative beliefs about health professionals, catastrophic disease expectations, symptomatic deterrents, and sociocultural deterrents, all clearly independent of each other. The Cronbach's α for the composite score of the scale was .89. Predictive validity of the composite scale score was not significant, but 4 cultural items were significant: problems making an appointment, lack of transportation, discomfort with health professionals, and health professionals inappropriately touch their patients.

CONCLUSIONS

Overall, the CCSS demonstrated acceptable preliminary values of reliability and validity in this population.

IMPLICATIONS FOR PRACTICE

Cultural and social factors relevant to cancer screening are very important for all women. The CCSS has not yet been used in nursing research but would be very appropriate for nurses to use to better understand why women choose to access cancer screening services.

Psychosocial factors and attendance at a population-based mammography screening program in a cohort of Swedish women

Background

A better understanding of the factors that influence mammography screening attendance is needed to improve the effectiveness of these screening programs. The objective of the study was to examine whether psychosocial factors predicted attendance at a population-based invitational mammography screening program.

Methods

Data on cohabitation, social network/support, sense of control, and stress were obtained from the Malmö Diet and Cancer Cohort Study and linked to the Malmö mammography register in Sweden. We analyzed 11,409 women (age 44 to 72) who were free of breast cancer at study entry (1992 to 1996). Mammography attendance was followed from cohort entry to December 31, 2009. Generalized Estimating Equations were used to account for repeated measures within subjects. Adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported.

Results

Among 69,746 screening opportunities there were 5,552 (8%) cases of non-attendance. Higher odds of non-attendance were found among women who lived alone (OR = 1.47 (1.33-1.63)) or with children only (OR = 1.52 (1.29-1.81)), had one childbirth (OR = 1.12 (1.01-1.24)) or three or more childbirths (OR = 1.34 (1.21-1.48)), had low social participation (OR= 1.21 (1.10-1.31)), low sense of control (OR = 1.12 (1.02-1.23)), and experienced greater stress (OR = 1.24 (1.13-1.36)).

Conclusions

Public health campaigns designed to optimize mammography screening attendance may benefit from giving more consideration of how to engage with women who are less socially involved.

Social support, self-efficacy for decision-making, and follow-up care use in long-term cancer survivors

OBJECTIVE

Cancer survivors play an important role in coordinating their follow-up care and making treatment-related decisions. Little is known about how modifiable factors such as social support are associated with active participation in follow-up care. This study tests associations between social support, cancer-related follow-up care use, and self-efficacy for participation in decision-making related to follow-up care (SEDM). We also identified sociodemographic and clinical factors associated with social support among long-term survivors.

METHODS

The FOllow-up Care Use among Survivors study is a cross-sectional, population-based survey of breast, prostate, colon, and gynecologic cancer survivors (n=1522) 4-14 years post-diagnosis. Multivariable regression models were used to test associations between perceived social support (tangible and emotional/informational support modeled separately), follow-up care use (past 2 years), and SEDM, as well as to identify factors associated with perceived support.

RESULTS

Neither support type was associated with follow-up care use (all p>0.05), although marital status was uniquely, positively associated with follow-up care use (p<0.05). Both tangible support (B for a standard deviation increase (SE)=9.75(3.15), p<0.05) and emotional/informational support (B(SE)=12.61(3.05), p<0.001) were modestly associated with SEDM. Being married, having adequate financial resources, history of recurrence, and better perceived health status were associated with higher perceived tangible and emotional support (all p<0.05).

CONCLUSIONS

While perceived social support may facilitate survivor efficacy for participation in decision-making during cancer follow-up care, other factors, including marital satisfaction, appear to influence follow-up care use. Marital status and social support may be important factors to consider in survivorship care planning.

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.

Trends in breast cancer stage and mortality in Michigan (1992-2009) by race, socioeconomic status, and area healthcare resources

The long-term effect of socioeconomic status (SES) and healthcare resources availability (HCA) on breast cancer stage of presentation and mortality rates among patients in Michigan is unclear. Using data from the Michigan Department of Community Health (MDCH) between 1992 and 2009, we calculated annual proportions of late-stage diagnosis and age-adjusted breast cancer mortality rates by race and zip code in Michigan. SES and HCA were defined at the zip-code level. Joinpoint regression was used to compare the Average Annual Percent Change (AAPC) in the median zip-code level percent late stage diagnosis and mortality rate for blacks and whites and for each level of SES and HCA. Between 1992 and 2009, the proportion of late stage diagnosis increased among white women [AAPC = 1.0 (0.4, 1.6)], but was statistically unchanged among black women [AAPC = −0.5 (−1.9, 0.8)]. The breast cancer mortality rate declined among whites [AAPC = −1.3% (−1.8,−0.8)], but remained statistically unchanged among blacks [AAPC = −0.3% (−0.3, 1.0)]. In all SES and HCA area types, disparities in percent late stage between blacks and whites appeared to narrow over time, while the differences in breast cancer mortality rates between blacks and whites appeared to increase over time.

Barriers to screening mammography

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

Results of a randomized controlled trial testing the efficacy of a culturally targeted and a generic video on mammography screening among chinese-american immigrants

BACKGROUND

Research comparing the effects of culturally targeted and generic but linguistically appropriate intervention programs is limited. We conducted a randomized controlled trial comparing the efficacy of a culturally targeted video, a generic video, and a fact sheet (control) in promoting mammography screening among Chinese-American immigrants.

METHODS

We randomized 664 Chinese-American women from the Washington, DC, and New York City areas who were older than 40 years and nonadherent to annual mammography screening guidelines to three study arms (each with ∼221 women). The outcome was self-reported mammography screening 6 months post intervention. Measures of knowledge, Eastern cultural views, and health beliefs were administered before and after the intervention.

RESULTS

The culturally targeted video, the generic video, and the fact sheet increased mammography use by 40.3%, 38.5%, and 31.1% from baseline, respectively. A significant intervention effect was observed only in one subgroup: The culturally targeted video significantly increased mammography screening among low-acculturated women over the fact sheet [OR, 1.70; 95% confidence interval (CI), 1.04-2.78]. Overall, women who obtained a mammogram during the follow-up period reported significantly fewer barriers to screening after intervention than those who had not obtained screening. Both of the video groups reported fewer barriers after intervention than the control group.

CONCLUSIONS

Both theoretically guided videos increased the likelihood of mammography use to a similar extent. Cultural targeting was only effective for low-acculturated women. Both videos reduced perceived barriers to screening and consequently increased screening behavior.

IMPACT

The results of this study provide empirical evidence on the efficacy of cultural targeting for minority immigrants.

Intervention tailoring for Chinese American women: comparing the effects of two videos on knowledge, attitudes and intentions to obtain a mammogram

This study utilized data from an ongoing randomized controlled trial to compare a culturally tailored video promoting positive attitudes toward mammography among Chinese immigrant women to a linguistically appropriate generic video and print media. Intervention development was guided by the Health Belief Model. Five hundred and ninety-two immigrant Chinese Americans from the metropolitan Washington, DC, and New York City areas completed telephone interviews before and after intervention. Changes in knowledge, Eastern views of health care (fatalism and self-care), health beliefs (perceived susceptibility, severity, benefits and barriers) and screening intentions were measured. Results showed that both videos improved screening knowledge, modified Eastern views of health care, reduced perceived barriers and increased screening intentions relative to print media (all P < 0.05). The generic video increased screening intention twice as much as the cultural video, although subgroup analysis showed the increase was only significant in women aged 50-64 years. Only Eastern views of health care were negatively associated with screening intentions after adjusting for all baseline covariates. These data suggest that a theoretically guided linguistically appropriate video that targets women from various ethnic groups is as efficacious in modifying attitudes toward mammography screening as a video that is exclusively tailored for Chinese immigrant women.

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.

Increasing mammography and cervical cancer knowledge and screening behaviors with an educational program

PURPOSE/OBJECTIVES

To evaluate the effectiveness of using an educational program based on self-efficacy to increase knowledge and create behavior change regarding recommended mammography and Papanicolaou (Pap) test screening guidelines.

DESIGN

Pretest and post-test, prospective.

SETTING

An urban county in northern Indiana.

SAMPLE

56 women who attended one of four educational programs and 47 women who responded 15 months later.

METHODS

The one-hour educational programs based on self-efficacy included vicarious experiences and verbal persuasion regarding breast and cervical screening practices. Two programs were offered to local church groups as part of a health fair, and two were offered through health promotion initiatives sponsored by private businesses.

MAIN RESEARCH VARIABLES

Demographics, knowledge of breast and cervical cancer, and screening behaviors.

FINDINGS

Knowledge of risk and screening guidelines increased significantly immediately following the educational program (p < 0.001) and did not decrease significantly 15 months later (p = 0.57). Family history and history of human papillomavirus and sexually transmitted diseases were the top known risk factors for breast and cervical cancers, respectively. Participant-reported rates of screening behaviors increased 15 months later for mammography (100%) and Pap test (84%).

CONCLUSIONS

Educational interventions based on self-efficacy increased knowledge of breast and cervical health and helped increase the rate of mammography and Pap tests.

IMPLICATIONS FOR NURSING

Preparing women with strategies to complete a mammogram and Pap test is an important approach to enhancing self-efficacy and increasing screening behaviors.

Healthcare access and mammography screening in Michigan: a multilevel cross-sectional study

BACKGROUND

Breast cancer screening rates have increased over time in the United States. However actual screening rates appear to be lower among black women compared with white women.

PURPOSE

To assess determinants of breast cancer screening among women in Michigan USA, focusing on individual and neighborhood socio-economic status and healthcare access.

METHODS

Data from 1163 women ages 50-74 years who participated in the 2008 Michigan Special Cancer Behavioral Risk Factor Survey were analyzed. County-level SES and healthcare access were obtained from the Area Resource File. Multilevel logistic regression models were fit using SAS Proc Glimmix to account for clustering of individual observations by county. Separate models were fit for each of the two outcomes of interest; mammography screening and clinical breast examination. For each outcome, two sequential models were fit; a model including individual level covariates and a model including county level covariates.

RESULTS

After adjusting for misclassification bias, overall cancer screening rates were lower than reported by survey respondents; black women had lower mammography screening rates but higher clinical breast examination rates than white women. However, after adjusting for other individual level variables, race was not a significant predictor of screening. Having health insurance or a usual healthcare provider were the most important predictors of cancer screening.

DISCUSSION

Access to healthcare is important to ensuring appropriate cancer screening among women in Michigan.

Understanding narrative effects: the impact of breast cancer survivor stories on message processing, attitudes, and beliefs among African American women

OBJECTIVE

Examine the longitudinal effects of personal narratives about mammography and breast cancer compared with a traditional informational approach.

METHODS

African American women (n = 489) ages 40 and older were recruited from low-income neighborhoods in St. Louis, Missouri, and randomized to watch a narrative video comprised of stories from African American breast cancer survivors or a content-equivalent informational video. Effects were measured immediately postexposure (T2) and at 3- (T3) and 6-month (T4) follow-up. T2 measures of initial reaction included positive and negative affect, trust, identification, and engagement. T3 message-processing variables included arguing against the messages (counterarguing) and talking to family members about the information (cognitive rehearsal). T4 behavioral correlates included perceived breast cancer risk, cancer fear, cancer fatalism, perceived barriers to mammography, and recall of core messages. Structural equation modeling examined interrelations among constructs.

RESULTS

Women who watched the narrative video (n = 244) compared to the informational video (n = 245) experienced more positive and negative affect, identified more with the message source, and were more engaged with the video. Narratives, negative affect, identification, and engagement influenced counterarguing, which, in turn, influenced perceived barriers and cancer fatalism. More engaged women talked with family members more, which increased message recall. Narratives also increased risk perceptions and fear via increased negative affect.

CONCLUSIONS

Narratives produced stronger cognitive and affective responses immediately, which, in turn, influenced message processing and behavioral correlates. Narratives reduced counterarguing and increased cognitive rehearsal, which may increase acceptance and motivation to act on health information in populations most adversely affected by cancer disparities.

Psychosocial factors influencing breast cancer risk appraisal among older women

Although the incidence of breast cancer increases with age, many older women are uninformed about the increased risk and have lower mammography screening rates than younger women. Understanding older women's perceptions of risk might assist health care providers in offering appropriate resources that result in screening. In this study, we explored psychosocial components influencing older women's breast cancer risk appraisal. To identify key psychosocial components of breast cancer risk appraisal, we conducted focus group interviews. Data saturation occurred with four groups (N = 36) of older Black (58%) and White (42%) women with no prior history of breast cancer. On analysis of the data, we found three themes representing psychosocial factors influencing breast cancer risk appraisal with this cohort. Our findings revealed that worry/fear/anxiety, self-regulating empowerment, and realistic optimism were psychosocial mechanisms older Black and White women in this sample used in appraising breast cancer risk.

Older African American women's beliefs, attitudes, and behaviors about breast cancer

Breast cancer poses a greater risk for African American than Caucasian women due to persistent health disparities. To reduce mortality risk, culturally specific knowledge is needed to support and encourage regular breast cancer screening and risk-reduction behaviors in older African American women. The specific aims of this study were to identify social, cultural, and behavioral factors associated with regular participation in breast cancer screening and risk-reduction behaviors; examine health beliefs that may influence regular participation in breast cancer screening and risk-reduction behaviors; and identify perceived facilitators and barriers to regular breast cancer screening and risk-reduction behaviors. African American women older than 65 (N = 57) participated in six focus groups. Analysis of focus group data revealed six major themes: Being Blessed, Cancer as a Death Sentence, Fear/Fear of Disfigurement, Avoiding Finding Out, Beliefs About Breast Cancer, and Tending to One's Family. These themes could be used by health care providers to develop culturally relevant educational initiatives to promote breast health practices and risk-reduction behaviors in this vulnerable population, thus helping reduce breast cancer disparities.

Correlates of mammography utilization among working Muslim Iranian women

Most countries in Middle East have been successful in establishing and furthering basic facilities for screening, diagnosis, and treatment of breast cancer. The rate of compliance with mammography screening, however, remains well below North American and Western European countries. We utilized the Health Belief Model (HBM) to explore factors associated with mammography screening behavior among a sample of 320 Muslim women aged > or = 35. Carrying out this cross-sectional study, we found that screening behavior was associated with older age, higher perceived benefit of breast cancer screening, and lower perceived barrier. Additionally, we demonstrate the importance of religious beliefs in influencing mammography screening behavior and explaining the link between religious involvement and mammography behavior.

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.