Health behavior change models and their socio-cultural relevance for breast cancer screening in African American women

Effect of trans-theoretical model-based nursing intervention on emotion and fear in post-liver cancer surgery patients

OBJECTIVE

To investigate the efficacy of nursing interventions grounded in the trans-theoretical model on emotion and fear among patients undergoing surgery for hepatocellular carcinoma (HCC).

METHODS

The study included 188 surgical patients from the Second People's Hospital of Lanzhou City who underwent HCC intervention between March 2020 and May 2022. The control group comprised 81 patients receiving standard postoperative care, while the observation group included 107 patients who received nursing interventions based on the trans-theoretical model. We assessed outcomes using the Fear of Progression Questionnaire-Short Form (FOP-Q-SF), Quality of Life Questionnaire Core 30 (QLQ-C30), Gastrointestinal Comfort Questionnaire (GCQ), Self-Rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) before and after the intervention. Logistic regression was used to identify factors influencing post-intervention fear.

RESULTS

Both groups showed improvement in FOP-Q-SF, QLQ-C30, GCQ, SAS, and SDS scores after the intervention. However, the observation group demonstrated significantly greater improvements (P < 0.05). There was a positive correlation between FOP-Q-SF scores and both SAS and SDS scores (all P < 0.05), and a negative correlation with QLQ-C30 and GCQ scores (both P < 0.05). Multifactorial logistic regression revealed that age (P < 0.001, OR: 8.328), gender (P < 0.001, OR: 0.181), literacy level (P < 0.001, OR: 0.354), and nursing care regimen (P < 0.001, OR: 0.078) were significant independent risk factors for persistence of fearpost-intervention.

CONCLUSION

The implementation of nursing interventions based on the trans-theoretical model significantly reduces postoperative fear and anxiety, improves pain perception, and enhances overall comfort in patients after liver cancer surgery.

Written Advice Given by African American Smokers to Their Peers: Qualitative Study of Motivational Messages

BACKGROUND

Although African Americans have the lowest rates of smoking onset and progression to daily smoking, they are less likely to achieve long-term cessation. Interventions tailored to promote use of cessation resources in African American individuals who smoke are needed. In our past work, we demonstrated the effectiveness of a technology-assisted peer-written message intervention for increasing smoking cessation in non-Hispanic White smokers. In this formative study, we have adapted this intervention to be specific for African American smokers.

OBJECTIVE

We aimed to report on the qualitative analysis of messages written by African American current and former smokers for their peers in response to hypothetical scenarios of smokers facing cessation challenges.

METHODS

We recruited African American adult current and former smokers (n=41) via ResearchMatch between April 2017 and November 2017. We asked participants to write motivational messages for their peers in response to smoking-related hypothetical scenarios. We also collected data on sociodemographic factors and smoking characteristics. Thematic analysis was conducted to identify cessation strategies suggested by the study participants.

RESULTS

Among the study participants, 60% (25/41) were female. Additionally, more than half (23/41, 56%) were thinking about quitting, 29% (12/41) had set a quit date, and 27% (11/41) had used electronic cigarettes in the past 30 days. Themes derived from the qualitative analysis of peer-written messages were (1) behavioral strategies, (2) seeking help, (3) improvements in quality of life, (4) attitudes and expectations, and (5) mindfulness/religious or spiritual practices. Under the behavioral strategies theme, distraction strategies were the most frequently suggested strategies (referenced 84 times in the 318 messages), followed by use of evidence-based treatments/cessation strategies. Within the seeking help theme, subthemes included seeking help or support from family/friends or close social networks (referenced 56 times) and health care professionals (referenced 22 times). The most frequent subthemes that emerged from improvements in the quality of life theme included improving one's health (referenced 22 times) and quality of life (referenced 21 times). Subthemes that emerged from the attitude and expectations theme included practicing positive self-talk (referenced 27 times), autonomy/independence from the smoking habit (referenced six times), and financial cost of smoking (referenced five times). The two subthemes that emerged from the mindfulness/religious or spiritual practices theme were use of self-awareness techniques (referenced 36 times) and religious or spiritual practices to cope (referenced 13 times).

CONCLUSIONS

Our approach to adapt a prior peer-message intervention to African American smokers yielded a set of evidence-based messages that may be suitable for smokers at all phases of motivation to quit (ready to quit or not ready to quit). In future research, we plan to assess the impact of texting these messages to African American smokers in a smoking cessation trial.

Breast cancer screening and migrants: exploring targeted messages for Moroccan migrant women in Brussels

Objectives: This study explored views of Moroccan migrant women on barriers and facilitators to the organized breast cancer screening program in Brussels (Belgium), and the potential of targeted printed invitations to increase this population's attendance to the program. Methods: We conducted one expert interview with the breast cancer screening program coordinator on current practices and challenges with regards to inviting Moroccan migrant women in Brussels for screening. Secondly, we held focus groups with Moroccan women aged 26-66. Sessions focused on perspectives on breast cancer screening and the existing generic program invitations. Directed content analysis of transcripts was based on the Health Belief Model. Alternative communication packages were developed based on barriers and suggestions from the focus groups. A second round of focus groups looked at the alternative communication packages and their potential to encourage Moroccan migrant women in Brussels to participate in the organized breast cancer screening program. Results: Alternative packages were appreciated by some, but a number of adjustments did not catch participants' attention. Printed communication delivered by post does not appear to be the preferred means of communication to encourage breast cancer screening for Moroccan migrant women in Brussels, nor does it seem appropriate to address the barriers to screening found in this study. Conclusions: The benefit of targeted postal invitation packages for Moroccan migrant women in Brussels seems limited for a variety of reasons. For future research, a large-scale study analyzing the topic in a cross-cultural perspective is warranted.

Effects of Model-Based Interventions on Breast Cancer Screening Behavior of Women: a Systematic Review

Background: Breast cancer is a great concern for women’s health; early detection can play a key role in reducing associated morbidity and mortality. The objective of this study was to systematically assess the effectiveness of model-based interventions for breast cancer screening behavior of women. Methods: We searched Scopus, PubMed, Web of Science, Science Direct, Cochrane library and Google scholar search engines for systematic reviews, clinical trials, pre- and post-test or quasi-experimental studies (with limits to publication dates from 2000-2017), Keywords were: breast cancer, screening, systematic review, trials, and health model. In this review, qualitative analysis was used to assess the heterogeneity of data. Results: Thirty six articles with 17,770 female participants were included in this review. The Health belief model was used in twenty three articles as the basis for intervention. Two articles used both the Health belief model and the Health Promotion Model, 5 articles used Health belief model and The Trans theoretical Model, 2 used Hthe ealth belief model and Theory planned behavior, 2 used the Health belief model and the Trans theoretical Model, 2 used the Trans theoretical Model, 1 used social cognitive theory, and 1 used Systematic Comprehensive Health Education and Promotion Model. The results showed that model-based educational interventions are more effective for BSE and CBE and mammography screening behavior of women compare to no model based intervention. The Health belief model was the most popular model for promoting breast cancer screening behavior. Conclusions: Educational model-based interventions promote self-care and create a foundation for improving breast cancer screening behavior of women and increase policy makers’ awareness and efforts towards its enhancement breast cancer screening behavior.

The role of perceived benefits and barriers in colorectal cancer screening in intervention trials among African Americans

The Health Belief Model (HBM) is widely used in health behavior interventions. The lack of diverse samples in the development of this theory warrants additional study on how it performs among minorities. While studies have utilized HBM to address colorectal cancer (CRC) screening, limited information exists confirming how these constructs influence screening. Data from three CRC screening trials were used to examine how perceived benefits/barriers perform among African Americans (AA) and whether they serve as mechanisms of the intervention effects on screening. The data were collected in AA churches (Study 1: N = 103; Study 2: N = 285; Study 3: N = 374) where lay members conducted CRC education to increase screening. Participants perceived benefits from colonoscopy (M = 2.4/3, SD = 0.87) and perceived few barriers (M = 0.63/8, SD = 1.1). Benefits were perceived for the fecal occult blood test (M = 11.4/15, SD = 2.1), and few barriers were reported (M = 11.7/30, SD = 3.4). Benefits more consistently predicted pre-intervention screening relative to barriers. For Study 3, individuals with fewer barriers reported a greater increase in colonoscopy screening at 12-months versus those with higher barriers (OR = 0.595, 95% CI = 0.368-0.964), P = 0.035). Benefits/barriers did not mediate the relationship. Potential measurement limitations, particularly for barriers, were uncovered and further research on how to assess factors preventing AA from screening is needed.

"Where Did This [PrEP] Come From?" African American Mother/Daughter Perceptions Related to Adolescent Preexposure Prophylaxis (PrEP) Utilization and Clinical Trial Participation

Despite the demonstrated effectiveness of preexposure prophylaxis (PrEP) to reduce incident HIV infections, PrEP's potential as an HIV prevention strategy for adolescent populations is unknown. This study assessed perceptions of adolescent PrEP use and clinical trial participation among African American women and their adolescent daughters. We conducted focus group discussions with 15 African American mother/daughter pairs ( N = 30). Findings suggest a general lack of PrEP awareness, favorable attitudes toward adolescent PrEP use, altruistic attitudes regarding research participation among daughters, and less favorable attitudes toward adolescent clinical trial participation among mothers. Study findings have the potential to inform strategies that provide equitable access to HIV scientific advances among African American women and girls and promote informed parent-child research decision making.

Coping With Prediagnosis Symptoms of Colorectal Cancer: A Study of 244 Individuals With Recent Diagnosis

BACKGROUND

Colorectal cancer (CRC) symptoms are often vague and vary in severity, intensity, type, and timing. Receipt of medical care is dependent on symptom recognition and assessment, which may impede timely diagnosis.

OBJECTIVE

The aim of this study was to describe and categorize how CRC patients coped with symptoms prior to seeking medical care, examine sociodemographic differences in these coping strategies, and determine the strategies associated with time to seek medical care and overall time to diagnosis.

METHODS

Two hundred forty-four white and African American patients in Virginia and Ohio who received a diagnosis of CRC and who experienced symptoms prior to diagnosis were administered a semistructured interview and the Brief COPE questionnaire.

RESULTS

Eighty-three percent used more than 1 coping strategy. Common symptom-specific coping strategies were to "wait-and-see," self-treat, and rationalize symptoms. Males were more likely to wait and see (P < .001); African Americans and Medicaid recipients were more likely to self-treat via lifestyle changes (P's < .01). Younger individuals (<50 years old) had higher Brief COPE reframing, planning, and humor scores; those with lower education and income had higher denial scores (P's < .01). Using more symptom-specific coping strategies and engaging in avoidance/denial were associated with longer time to seek medical care and overall time to diagnosis (P's < .01).

CONCLUSIONS

Individuals experiencing CRC symptoms use multiple, diverse coping strategies that are influenced by sociodemographic characteristics. Denial is particularly relevant for delay in seeking care and timely diagnosis.

IMPLICATIONS FOR PRACTICE

Public health campaigns could focus on secondary prevention of CRC by targeting at-risk groups such as males, African Americans, or Medicaid recipients, who choose waiting or self-treatment in response to initial symptoms.

Health Perceptions of Latinos With Intellectual Disabilities: The Results of a Qualitative Pilot Study

A pilot study among Latinos with intellectual disabilities (ID) was conducted. Focus groups and Photovoice methodology were employed to explore participants' health perceptions and beliefs. Three focus groups were conducted for a total of 15 participants. An additional member check focus group was conducted to verify results of the analysis. Photovoice methodology was employed with four Latinos with ID to explore health beliefs and perceptions of the influence of the social and physical environment. Participants' perceptions of health focused on social and mental aspects of health. Latinos with ID believed that social relationships are important to health. They believed in a connection among social, mental, and physical well-being and health. Cultural beliefs related to the role of God and traditional therapies were identified. Latinos with ID reported that they believed that health was influenced by behaviors and that diet and physical activity were beneficial, but this did not necessarily translate into regular practice.

Breast care screening for underserved African American women: Community-based participatory approach

Traditional health promotion models often do not take into account the importance of shared cultural backgrounds, beliefs, and experiences unique to underserved African American women when designing community-based cancer screening and prevention programs. Thus, the purpose of this study was the development, implementation, and evaluation of a community-based participatory research (CBPR) program designed to increase breast cancer screening awareness in an underserved African American population by providing culturally appropriate social support and information. The study includes 357 African American women who participated in the program and completed the 6-month follow-up questionnaire. The program consisted of a 45-minute play, using community members and storytelling to honor and incorporate five different cultural experiences (skits) with breast care and cancer. Overall, findings indicate that the educational intervention was effective. In addition, these findings are consistent with the literature that suggests that educational interventions that include knowledge to alleviate concerns, dispel myths, and create awareness can increase breast cancer screening participation rates. Furthermore, these findings confirm the importance of CBPR in health promotion activities in reducing health and cancer disparities.

Predictors of Intention to Seek Medical Help by Peruvian Mothers for Children Who Have Signs of Pneumonia

The Theory of Planned Behavior was used to assess predictors of Peruvian mothers seeking medical help when they believed their child had signs of pneumonia. Open-ended interviews to identify beliefs were followed by a questionnaire administered to 500 mothers from low-income settlements in Lima in June and July 2000. Subjective norm (what important referents want) was the best predictor of intention, followed by mothers' feelings about how easy it would be to take the child to the clinic. Attitude toward taking the child to a clinic was not a significant predictor of intention. This study indicates a stronger role for subjective norm than attitudes and perceived control in similar studies done with this model in other settings. It, of course, only predicts intention to act and not behavior, important here given social-economic barriers, e.g., cost, to access to care among this study group.

Collective-Intelligence Recommender Systems: Advancing Computer Tailoring for Health Behavior Change Into the 21st Century

BACKGROUND

What is the next frontier for computer-tailored health communication (CTHC) research? In current CTHC systems, study designers who have expertise in behavioral theory and mapping theory into CTHC systems select the variables and develop the rules that specify how the content should be tailored, based on their knowledge of the targeted population, the literature, and health behavior theories. In collective-intelligence recommender systems (hereafter recommender systems) used by Web 2.0 companies (eg, Netflix and Amazon), machine learning algorithms combine user profiles and continuous feedback ratings of content (from themselves and other users) to empirically tailor content. Augmenting current theory-based CTHC with empirical recommender systems could be evaluated as the next frontier for CTHC.

OBJECTIVE

The objective of our study was to uncover barriers and challenges to using recommender systems in health promotion.

METHODS

We conducted a focused literature review, interviewed subject experts (n=8), and synthesized the results.

RESULTS

We describe (1) limitations of current CTHC systems, (2) advantages of incorporating recommender systems to move CTHC forward, and (3) challenges to incorporating recommender systems into CTHC. Based on the evidence presented, we propose a future research agenda for CTHC systems.

CONCLUSIONS

We promote discussion of ways to move CTHC into the 21st century by incorporation of recommender systems.

Personalized Weight Management Interventions for Cardiovascular Risk Reduction: A Viable Option for African-American Women

Obesity is an independent contributor to cardiovascular disease (CVD) and a major driving force behind racial/ethnic and gender disparities in risk. Due to a multitude of interrelating factors (i.e., personal, social, cultural, economic and environmental), African-American (AA) women are disproportionately obese and twice as likely to succumb to CVD, yet they are significantly underrepresented in behavioral weight management interventions. In this selective review we highlight components of the limited interventions shown to enhance weight loss outcomes in this population and make a case for leveraging Web-based technology and artificial intelligence techniques to deliver personalized programs aimed at obesity treatment and CVD risk reduction. Although many of the approaches discussed are generally applicable across populations burdened by disparate rates of obesity and CVD, we specifically focus on AA women due to the disproportionate impact of these non-communicable diseases and the general paucity of interventions targeted to this high-risk group.

Medical Advocacy and Supportive Environments for African-Americans Following Abnormal Mammograms

African-American women experience disproportionately adverse outcomes relative to non-Latina White women after an abnormal mammogram result. Research has suggested medical advocacy and staff support may improve outcomes among this population. The purpose of the study was to understand reasons African-American women believe medical advocacy to be important and examine if and how staff can encourage and be supportive of medical advocacy. A convenience-based sample of 30-74-year-old women who self-identified as African-American/Black/of African descent and who had received an abnormal mammogram result was recruited from community-based organizations, mobile mammography services, and the local department of health. This qualitative study included semi-structured interviews. Patients perceived medical advocacy to be particularly important for African-Americans, given mistrust and discrimination present in medical settings and their own familiarity with their bodies and symptoms. Respondents emphasized that staff can encourage medical advocacy through offering information in general in a clear, informative, and empathic style. Cultural competency interventions that train staff how to foster medical advocacy may be a strategy to improve racial disparities following an abnormal mammogram.

Cultural Factors Associated with Breast and Cervical Cancer Screening in Korean American Women in the US: An Integrative Literature Review

PURPOSE

This study examined current research theories and methods, cultural factors, and culturally relevant interventions associated with breast and cervical cancer screening in Korean American (KA) women.

METHODS

Based on Ganong's guidelines, the literature on cultural factors associated with breast and cervical cancer screening in KA women was searched using MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Sixty-eight articles on breast cancer screening and 66 articles on cervical cancer screening were retrieved from both databases, and a total of 22 articles were included in the literature review based on the selection criteria.

RESULTS

Of the 22 studies reviewed, 14 (63.6%) were descriptive and 8 (36.4%) were interventional. Many studies have used individual focused cognitive theories such as health belief model and different types of operationalization for measures of cultural beliefs. Cultural factors associated with breast and cervical cancer screening in KA women that were identified in descriptive quantitative and qualitative studies included family, embarrassment, preventive health orientation, fatalism, and acculturation. Most culturally relevant interventional studies used education programs, and all education was conducted by bilingual and bicultural health educators at sociocultural sites for KA women.

CONCLUSIONS

Theories focusing on interpersonal relationships and standardized, reliable, and valid instruments to measure cultural concepts are needed to breast and cervical cancer screening research in KA women. Traditional cultural factors associated with cancer screening should be considered for practical implications and future research with KA women.

Applying the Theory of Planned Behavior to Explain Women’s Role in Prostate Cancer Screening

Objective:To test the suitability of the theory of planned behavior (TPB) for explaining Italian women’s role in prostatic cancer screening promotion.Design/Methods:A descriptive, cross-sectional, online self-report survey was conducted with a convenience sample of 235 Italian women. Variables included attitudes women’s role, perceived behavioral control, subjective norm, behavioral intention, and prostate cancer screening promotion behavior. A survey composed of the Eastland Prostate Cancer Survey subscales that were consistent with the TPB was distributed via e-mail to potential participants. The survey was live for 12 weeks (March 2013 to May 2013). Responses were collated with eSurv.org. Data were analyzed using latent path analysis and structural equation modeling.Results:Behavioral intentions in promoting prostate cancer screening significantly predicted the likelihood of the Italian women to adopt self-reported prostate cancer screening promotion behaviors. In addition, the exclusive direct impact of the intentions explained 39% of the variance in self-reported behaviors.Conclusions:The TPB could represent a good framework to explain the role of Italian women in prevention behaviors related to the prostatic screening domain. Consistent with literature findings in social and nursing sciences, the intention to promote prostate cancer screening was a powerful “predictor” of the behavior itself.

Recruitment and retention of pregnant women into clinical research trials: an overview of challenges, facilitators, and best practices

Pregnant women are a vulnerable group who are needed in clinical research studies to advance prevention and treatment options for this population. Yet, pregnant women remain underrepresented in clinical research. Through the lens of the socioecological model, we highlight reported barriers and facilitators to recruitment and retention of pregnant women in studies that sought their participation. We trace historical, policy-based reasons for the exclusion of pregnant women in clinical studies to present-day rationale for inclusion of this group. The findings highlight why it has been difficult to recruit and retain this population over time. A body of literature suggests that integrative sampling and recruitment methods that leverage the influence and reach of prenatal providers will overcome recruitment challenges. We argue that these strategies, in combination with building strong engagement with existing community-based organizations, will enable teams to more effectively promote and retain pregnant women in future longitudinal cohort studies.

Perceived cancer risk and risk attributions among African-American residents of a low-income, predominantly African-American neighborhood

OBJECTIVE

In some national surveys, African-Americans have had lower scores on perceived cancer risk items than whites. Our goals were to confirm low perceptions of cancer risk in an African-American community sample and explore participants' attributions for their perceived cancer risk.

DESIGN

Data were from three cross-sectional surveys. We report levels of perceived absolute and comparative cancer risk in a community sample of African-Americans (N = 88), and African-Americans (Ns = 655, 428) and whites (Ns = 5262, 1679) from two nationally representative Health Information National Trends Surveys (HINTS). We analyzed the content of spontaneously-provided explanations for perceived risk from the community sample.

RESULTS

Perceived absolute and comparative cancer risk were lower in the community and national samples of African-Americans than in the national sample of whites. Participants' spontaneous attributions for low or lower than average risk included not having family history or behavioral risk factors, classes of attributions noted elsewhere in the literature. However, participants also explained that they wanted to avoid wishing cancer on themselves (positive affirmations) and hoped their risk was low (wishful thinking), responses rarely reported for majority-white samples.

CONCLUSIONS

Results provide further evidence that cancer risk perceptions are lower among African-Americans than whites. Some participant explanations for low perceived risk (wishful thinking, affirmations) are inconsistent with behavioral scientists' assumptions about perceived risk questions. Results reveal a need to expand cancer risk attribution typologies to increase applicability to diverse populations, and may indicate that perceived cancer risk questions have lower validity in African-American populations.

Crowdsourced peer- versus expert-written smoking-cessation messages

BACKGROUND

Tailored, web-assisted interventions can reach many smokers. Content from other smokers (peers) through crowdsourcing could enhance relevance.

PURPOSE

To evaluate whether peers can generate tailored messages encouraging other smokers to use a web-assisted tobacco intervention (Decide2Quit.org).

METHODS

Phase 1: In 2009, smokers wrote messages in response to scenarios for peer advice. These smoker-to-smoker (S2S) messages were coded to identify themes. Phase 2: resulting S2S messages, and comparison expert messages, were then e-mailed to newly registered smokers. In 2012, subsequent Decide2Quit.org visits following S2S or expert-written e-mails were compared.

RESULTS

Phase 1: a total of 39 smokers produced 2886 messages (message themes: attitudes and expectations, improvements in quality of life, seeking help, and behavioral strategies). For not-ready-to-quit scenarios, S2S messages focused more on expectations around a quit attempt and how quitting would change an individual's quality of life. In contrast, for ready-to-quit scenarios, S2S messages focused on behavioral strategies for quitting. Phase 2: In multivariable analysis, S2S messages were more likely to generate a return visit (OR=2.03, 95% CI=1.74, 2.35), compared to expert messages. A significant effect modification of this association was found, by time-from-registration and message codes (both interaction terms p<0.01). In stratified analyses, S2S codes that were related more to "social" and "real-life" aspects of smoking were driving the main association of S2S and increased return visits.

CONCLUSIONS

S2S peer messages that increased longitudinal engagement in a web-assisted tobacco intervention were successfully collected and delivered. S2S messages expanded beyond the biomedical model to enhance relevance of messages.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT00797628 (web-delivered provider intervention for tobacco control [QUIT-PRIMO]) and NCT01108432 (DPBRN Hygienists Internet Quality Improvement in Tobacco Cessation [HiQuit]).

Perceived risk for breast cancer and its relationship to mammography in Blacks, Hispanics, and Whites

A challenge for health behavior science is to develop theory and best practices that take cultural diversity into account. Using data from Black, Hispanic, and White respondents to the 2003 Health Information National Trends Survey, we examined racial/ethnic differences in: (1) breast cancer risk perceptions/worry; (2) the associations between perceived risk/worry and ever having received a mammogram; and (3) perceived risk/worry and having had at least 2 mammograms over a 4-year period (consecutive mammography). Compared to White race/ethnicity, Black race/ethnicity was associated with lower perceived absolute risk and comparative risk for developing cancer. For the sample as a whole, higher perceived risk (both absolute risk and comparative risk) and worry predicted greater odds of mammography use; however, this was not true for Hispanics. In stratified analyses, perceived risk and worry were not associated with mammography use for either Hispanics or Blacks whereas they were for Whites; however, this interaction effect was significant only for Hispanics vs. Whites. Results support the need for formative research to identify determinants of health behavior prior to cancer prevention message planning for diverse audiences in order to accommodate racial/ethnic differences not only in the level of perceived risk, but also the association between risk perception to behavior change in that community.

"It's up to you and God": understanding health behavior change in older African American survivors of colorectal cancer

This study investigated the beliefs and attitudes of older African American colorectal cancer (CRC) survivors that may influence health behavior changes after treatment. Drawing from existing theories of health behavior change and cultural beliefs about health, a semi-structured interview guide was developed to elicit survivors' perspectives. Qualitative focus groups and interviews were conducted with 17 survivors identified through the Detroit Surveillance Epidemiology and End Results registry. Using verbatim transcripts from the sessions and NVivo software, thematic analysis was conducted to analyze patterns of responses. Transcripts were coded for seven categories (health behaviors, who/what motivates change, self-efficacy, fatalism, religion/spirituality, beliefs about cancer, race/ethnicity). Five themes emerged from the data (personal responsibility, resilience, desire for information, intentions to change, beliefs in divine control). Findings support the relevance of existing theories of health behavior change to older African American CRC survivors. Cultural considerations are suggested to improve interventions seeking to maximize changes in diet and exercise among this group of survivors.

Eating behaviors of older African Americans: an application of the theory of planned behavior

PURPOSE

The study applies the theory of planned behavior to explain the fruit and vegetable eating behaviors, a broad construct consisting of preparing, self-monitoring, and consuming fruits and vegetables, of older African Americans.

DESIGN AND METHODS

Structural equation modeling was used to examine the applicability of the theory of planned behavior with data from 211 older African American women and men (73% women, 26% men; median age range of 57-63 years) participating in a larger intervention study.

RESULTS

Attitudes about eating fruit and vegetables, subjective social norms, and perceived behavioral control were related to older African Americans' intentions to consume fruits and vegetables. Social norms and behavioral intentions were associated with fruit and vegetable eating behaviors. Perceived control did not moderate the influence of behavioral intentions on actual behavior.

IMPLICATIONS

Results indicated that the theory of planned behavior can be used to explain variation in older African Americans' eating behavior. This study also emphasizes the value of considering broader behavioral domains when employing the theory of planned behavior rather than focusing on specific behaviors. Furthermore, social service programs aimed at reducing the incidence of diseases commonly associated with poor eating behaviors among older African Americans must consider promoting not only fruit and vegetable consumption but also related behaviors including preparing and self-monitoring by eliminating structural, cognitive, and normative constraints.

An exploration of patient perceptions of adherence to tuberculosis treatment in Tanzania

In this study, we aimed to explore patient perceptions of adherence to tuberculosis (TB) treatment and construct a theoretical model of treatment adherence behavior. We conducted semistructured interviews with 11 adherent patients from Tanzania whom we recruited by purposive sampling. The interview data were analyzed by content analysis. We found that the patient's intention to adhere is the most important determinant of adherence behavior. This intention is preceded by the decision to seek biomedical health care, and based on knowledge and beliefs about TB treatment and the motivation to be cured. The intention to adhere helps patients to cope with perceived barriers to adherence, such as socioeconomic difficulties, and to create an adherence-enabling environment in which the presence of social support plays an important role. Our preliminary adherence behavior model should be validated in larger, nonadherent patient populations and evaluated for its applicability to the development of adherence-promoting strategies.

The art and science of patient storytelling-harnessing narrative communication for behavioral interventions: the ACCE project

Narrative communication is an emerging form of persuasive communication used in health education to solicit actual patient stories. Eliciting a narrative is an open-ended process and may or may not map to desired intervention objectives or underlying behavioral constructs. In addition, incorporating actual, unscripted narratives into multimedia interventions is challenging. The authors evaluated a protocol of editing narratives for a multimedia intervention to promote smoking cessation in the African American community that maintains fidelity to the original message and was related to behavioral constructs from social cognitive theory. The authors used four steps: (a) narrative collection (videotaping), (b) narrative review (rating of content), (c) narrative editing (documentary style), and (d) pilot testing (usability and assessment of transportation). The authors videotaped 50 personal smoking cessation narratives. After coding for presence of theoretical constructs, perceived risks of smoking (present in 53% of narratives) was the most common related behavioral construct. Four narratives were chosen for inclusion in the DVD. Pilot testing showed viewers reported high level of transportation into the narrative. The authors found that some behavioral constructs were rare and difficult to solicit in this population but that the final product was engaging to the viewers. Lessons learned may be useful for other video-based behavioral interventions that incorporate personal narratives.

Traditional-Westernizing continuum of change in screening behaviors: comparison between Arab women in Israel and the West Bank

Health perceptions are changing, but the pace of change varies across societies, exercising different effects on women's screening behaviors. Our aim is to assess the rate of mammography and clinical breast examination (CBE) attendance in younger and older Arab women in Israel and in the West Bank, and the effect of health beliefs on the screening behaviors. A random sample of 697 Arab women, 300 from Israel and 397 from the West Bank, aged 30-65 years, answered questionnaires on screening behaviors, the Arab culture-specific barriers, fatalism, worry, and health beliefs. The participation rate was 93.5% in Israel and 98.3% in the West Bank. Higher fatalistic perceptions, traditional beliefs, barriers to bodily exposure, and social, environmental, and personal barriers to screening were reported by women from the West Bank compared to Arab women in Israel and by older women compared to the younger women. Adjusted lower likelihood of attending screening was predicted by group (AOR 3.55, 95% CI 1.25-10.11 for mammography and AOR 2.36, 95% CI 1.19-3.65 for CBE), higher fatalism (AOR 0.52, 95% CI 0.30-76 for mammography and AOR 0.68, 95% CI 0.54-92 for CBE), more traditional beliefs (AOR 0.61, 95% CI 0.48-0.80 for mammography and AOR 0.51, 95% CI 0.39-0.68 for CBE), and higher barriers to self-exposure (AOR 0.69, 95% CI 0.48-0.83 for mammography and AOR 0.76, 95% CI 0.62-0.95 for CBE), higher perceived personal barriers (AOR 0.36, 95% CI 0.12-1.08 for mammography and AOR 0.77, 95% CI 0.60-0.98 for CBE), and lower perceived benefits (AOR 1.98, 95% CI 1.17-3.34 for mammography and AOR 1.39, 95% CI 1.06-1.81 for CBE). Also, adjusted lower likelihood of CBE attendance was predicted by younger age, higher religiosity, and higher social barriers. Differences in screening behaviors of younger and older Arab women from the West Bank and from Israel represent a traditional-westernizing continuum of change, but are also related to the social and situational context.

Community health workers' support for cancer clinical trials: description and explanation

Ethnic differences in participation in cancer clinical trials slow advances in medical knowledge that can reduce health care disparities. Community health workers (CHWs) are an increasingly important bridge between the health care system and underserved communities and could play an important role in increasing rates of clinical trial participation. We investigated community health workers' orientations to medical research and cancer clinical trials with a mixed methods design: two focus groups, 11 intensive interviews, and a structured survey of 76 CHW training workshop participants. CHWs demonstrated high levels of commitment to improving the health of community members but considerable distrust of researchers' motives, low levels of knowledge about cancer clinical trials, and frequent perceptions of bias in the health care system. Support for research is associated with more research experience, self-assessed knowledge, and Hispanic ethnicity, but with less seniority as a CHW. Neither actual knowledge of cancer clinical trials nor perceptions of bias in the health care system were related to degree of support for medical research. Community health workers perceive bias in the health care system but recognize the importance of medical research and are interested in learning more about cancer clinical trials. Research experience increases support for medical research; education increases perceptions of health care system bias.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Mammography screening and the theory of planned behavior: suggestions toward an extended model of prediction

Mammography screening is probably the most effective method for the early detection of breast cancer. Existing models of health behavior, such as the theory of planned behavior, could improve their predictive validity and, therefore, their ability to promote health-related interventions by identifying additional factors associated with health decision making. This review provides an overview of research on factors related to mammography screening within the context of the theory of planned behavior and identifies the potential benefits of adding motivational factors, such as time perspective, optimism, and risk perception, in an attempt to enhance its explanatory power.

Social and cultural factors are related to perceived colorectal cancer screening benefits and intentions in African Americans

Models that explain preventive behaviors, such as colorectal cancer (CRC) screening, do not account for social and cultural factors relevant to African Americans. This exploratory study examined the relationship between socio-cultural factors (e.g., traditional acculturative strategy, group-based medical mistrust, physician ethnicity, and group-level perceptions of susceptibility) and perceived benefits, perceived barriers, and CRC screening intentions among African Americans (N = 198; Age: M = 59.7, SD = 9.9; 65% female; 44% household income $50,000+). Hierarchical multiple regression was used to test the following models with perceived benefits, perceived barriers, and screening intentions as the outcomes: (a) traditional acculturative strategy x medical mistrust; (b) physician's ethnicity x medical mistrust; (c) group susceptibility x medical mistrust; and (d) group susceptibility x traditional acculturative strategy. Results revealed that perceiving high group susceptibility while being both more culturally traditional and less mistrustful was associated with more perception of screening benefits. Greater intention to be screened was associated with perceiving high group susceptibility while having a more traditional cultural orientation and low levels of mistrust in those with African American physicians. These results suggest that it may be beneficial to include these social and cultural factors in behavioral interventions to increase CRC screening among African Americans.

The Latina Breast Cancer Screening Sacle: beliefs about breast cancer and breast cancer screening

The Latina Breast Cancer Screening (LBCS) was developed to measure Latinas' culturally-shared health beliefs about breast cancer and breast cancer screening. A 60-item LBCS scale was tested with 288 participants and reduced to 35 items using principal components analyses. The 35-item LBCS scale and other measures were administered to a second sample of 147 participants to establish the scale's validity and reliability. A six-factor solution suggested six LBCS sub-scales. The LBCS in its entirety displayed strong internal consistency (alpha =.93) with adequate estimates of convergent, discriminant, and predictive validity. The LBCS scale appears to be a valid and reliable measure.

Intention, subjective norms, and cancer screening in the context of relational culture

Research targeting disparities in breast cancer detection has mainly utilized theories that do not account for social context and culture. Most mammography promotion studies have used a conceptual framework centered in the cognitive constructs of intention (commonly regarded as the most important determinant of screening behavior), self-efficacy, perceived benefit, perceived susceptibility, and/or subjective norms. The meaning and applicability of these constructs in diverse communities are unknown. The purpose of this study is to inductively explore the social context of Filipina and Latina women (the sociocultural forces that shape people's day-to-day experiences and that directly and indirectly affect health and behavior) to better understand mammography screening behavior. One powerful aspect of social context that emerged from the findings was relational culture, the processes of interdependence and interconnectedness among individuals and groups and the prioritization of these connections above virtually all else. The authors examine the appropriateness of subjective norms and intentions in the context of relational culture and identify inconsistencies that suggest varied meanings from those intended by behavioral theorists.

Perceived susceptibility to illness and perceived benefits of preventive care: an exploration of behavioral theory constructs in a transcultural context

This article describes how the social context of transculturation (cultural change processes) and transmigration (migration in which relationships are sustained across national boundaries) can directly influence use of mammography screening. The authors conducted semistructured interviews with Latino and Filipino academics and social service providers and with U.S.-born and immigrant Latinas and Filipinas to explore direct and indirect influences of social context on health behavior (Behavioral Constructs and Culture in Cancer Screening study). Iterative analyses identified themes of the transcultural domain: colonialism, immigration, discrimination, and therapeutic engagement. In this domain, the authors examine two key behavioral theory constructs, perceptions of susceptibility to illness and perceptions of benefits of preventive medical care. The findings raise concerns about interventions to promote mammography screening primarily based on provision of scientific information. The authors conclude that social context affects behavior directly rather than exclusively through beliefs as behavioral theory implies and that understanding contextual influences, such as transculturation, points to different forms of intervention.

Embodiment and breast cancer among African American women

African American women have historically been screened for breast cancer less than other women, contributing to higher mortality rates. Previous research has focused on social and cultural factors, such as discrimination and religiosity, as shaping African American women's screening practices. This article extends this research by (a) examining the decisions and justifications of African American women with regard to screening practices, and (b) using a theoretical focus on embodiment to better understand women in relation to their own bodies. Ethnographic research consisted of 5 months of participant observation at an Indiana (USA) breast cancer care center, and 15 in-depth, semi-structured interviews along the continuum of screening practices. The results showed that embodied understandings of the body, personal (rather than biomedical) considerations of screening and treatment, and the quality of doctor/patient interactions all play a significant role in women's decisions about whether to screen for breast cancer or not. Based on these results and a review of the literature, six ways to include embodiment in public health initiatives are outlined.

Do ethnicity and gender matter when using the theory of planned behavior to understand fruit and vegetable consumption?

A majority of Americans do not meet the recommendation to eat five servings of fruits and vegetables per day (5-A-Day). The purpose of the present study was to examine the utility of the theory of planned behavior (TPB) for understanding 5-A-Day intentions and behavior and to determine whether any of the TPB relationships were moderated by ethnicity or gender. A total of 413 participants completed a baseline TPB questionnaire and a fruit and vegetable consumption measure 2 weeks later. Path analyses showed that affective attitude and perceived behavioral control significantly predicted intention for blacks, whites, males and females (R(2) ranged from .32 to .40), whereas subjective norm was a significant predictor for blacks, males, and females only. Intention significantly predicted 5-A-Day (R(2) ranged from .17 to .22) for all groups. Follow-up invariance analyses showed that the subjective norm/intention relationship was significantly stronger for black compared to white students. Finally, several key beliefs were identified for all four demographic groups. Therefore, the current results suggest that the TPB may be a useful framework to utilize when developing 5-A-Day interventions.

A critical review of theory in breast cancer screening promotion across cultures

This article reviews the contribution and potential of widely used health behavior theories in research designed to understand and redress the disproportionate burden of breast cancer borne by diverse race/ethnic, immigrant, and low-income groups associated with unequal use of mammography. We review the strengths and limitations of widely used theories and the extent to which theory contributes to the understanding of screening disparities and informs effective intervention. The dominant focus of most theories on individual cognition is critically assessed as the abstraction of behavior from its social context. Proposed alternatives emphasize multilevel ecological approaches and the use of anthropologic theory and methods for more culturally grounded understandings of screening behavior. Common and alternative treatments of fatalism exemplify this approach, and descriptive and intervention research exemplars further highlight the integration of screening behavior and sociocultural context.

Medical pluralism of Chinese women living in the United States

This study provides national prevalence estimates for complementary and alternative (CAM) use, visits to doctors for health problems, and the effects of acculturation on health practices in Chinese women living in the United States. A national telephone survey of 3,172 women on their use of complementary and alternative medicine was conducted in 2001. This study focuses on a subsample of 804 Chinese-American women who were asked about health practices and service utilization. Interviews were conducted in Mandarin, Cantonese and English. Forty-one percent of Chinese-American women used some form of CAM in 2001. Socio-economic status, a common predictor of CAM use in other studies of the general population in the United States, did not predict use in this sample. Traditional Chinese medicine (TCM) is used across acculturation levels. As Chinese women adapt to American culture they tend to use a greater variety of healthcare practices and to adopt mainstream CAM practices, but they also continue to use TCM.

First Nations people's challenge in managing coronary artery disease risk

First Nations peoples bring a particular history and cultural perspective to healing and well-being that significantly influences their health behaviors. The authors used grounded theory methods to describe and explain how ethnocultural affiliation and gender influence the process that 22 First Nations people underwent when making lifestyle changes related to their coronary artery disease (CAD) risk. The transcribed interviews revealed a core variable, meeting the challenge. Meeting the challenge of CAD risk management was influenced by intrapersonal, interpersonal (relationships with others), extrapersonal (i.e., the community and government), sociodemographic, and gendered factors. Salient elements for the participants included their beliefs about origins of illness, the role of family, challenges to accessing information, financial and resource management, and the gendered element of body image. Health care providers need to understand the historical, social, and culturally embedded factors that influence First Nations people's appraisal of their CAD.

Photovoice With Vulnerable Populations: Addressing Disparities in Health Promotion Among People With Intellectual Disabilities

Cardiovascular diseases (CVD) are the leading causes of death among Mexican American adults living in the United States. Using data from a modified Behavioral Risk Factor Surveillance Survey and guided by the Anderson model, this study examined the effect of nativity on CVD screening practices among 423 Mexican American adults in Chicago. Dependent variables included having had a blood pressure and cholesterol screening and a routine checkup in the past 2 years. Multivariate analyses were used to control for sociodemographic factors while accounting for complex sampling design. Compared to those born in Mexico, U.S.-born Mexican Americans had greater odds of obtaining blood pressure (OR = 5.61) and cholesterol screenings (OR = 1.60) and having a routine checkup (OR = 2.69) in the past 2 years. Health professionals wishing to increase screenings for CVD risk factors among Mexican Americans in northern cities should understand the impact of nativity on screening practices.

Storytelling for promoting colorectal cancer prevention and early detection among Latinos

OBJECTIVE

Health promotion efforts directed at Latinos may be more effective when culturally adapted methods are used. Our study was designed to test a novel communication modality for promoting colorectal cancer (CRC) prevention and screening messages among Latinos.

METHODS

We compared a culturally aligned, brief storytelling educational intervention (ST) to a numeric risk tool intervention (NR) based on the Harvard Cancer Risk Index. Both interventions included risk factor information and recommendations for primary prevention and screening for CRC. Sixty-four Latinos (mean age 46.8, 86% female) were randomized and completed pre- and post-tests.

RESULTS

Participants in ST indicated intent to add significantly more servings of vegetables (p=.030) and more minutes of exercise (p=.018) to daily routines than those in NR. Most respondents (ST and NR) reported intentions to recommend CRC screening to friends and relatives.

CONCLUSIONS

These data provide support for storytelling's potential to promote health behavior change with cultural relevance for Latinos.

PRACTICE IMPLICATIONS

Storytelling shows promise as an effective method for reaching one of the historically underserved ethnic groups with cancer prevention and screening information.

A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS?

BACKGROUND

Suboptimal treatment adherence remains a barrier to the control of many infectious diseases, including tuberculosis and HIV/AIDS, which contribute significantly to the global disease burden. However, few of the many interventions developed to address this issue explicitly draw on theories of health behaviour. Such theories could contribute to the design of more effective interventions to promote treatment adherence and to improving assessments of the transferability of these interventions across different health issues and settings.

METHODS

This paper reviews behaviour change theories applicable to long-term treatment adherence; assesses the evidence for their effectiveness in predicting behaviour change; and examines the implications of these findings for developing strategies to improve TB and HIV/AIDS medication adherence. We searched a number of electronic databases for theories of behaviour change. Eleven theories were examined.

RESULTS

Little empirical evidence was located on the effectiveness of these theories in promoting adherence. However, several models have the potential to both improve understanding of adherence behaviours and contribute to the design of more effective interventions to promote adherence to TB and HIV/AIDS medication.

CONCLUSION

Further research and analysis is needed urgently to determine which models might best improve adherence to long-term treatment regimens.

Chinese immigrants' management of their cardiovascular disease risk

The authors have undertaken a series of grounded theory studies to describe and explain how ethnocultural affiliation and gender influence the process that cardiac patients undergo when faced with making behavior changes associated with reducing their cardiovascular disease (CVD) risk. Data were collected through audiorecorded semistructured interviews (using an interpreter as necessary), and the authors analyzed the data using constant comparative methods. The core variable that emerged through the series of studies was "meeting the challenge." Here, the authors describe the findings from a sample of Chinese immigrants (10 men, 5 women) to Canada. The process of managing CVD risk for the Chinese immigrants was characterized by their extraordinary diligence in seeking multiple sources of information to enable them to manage their health.

Health beliefs among African American women regarding genetic testing and counseling for sickle cell disease

PURPOSE

The Health Belief Model can help in understanding low acceptance of disease prevention and screening. We studied health beliefs of African American women to determine causes of low acceptance of genetic testing and counseling despite high prevalence of sickle cell disease and heterozygotes in this population.

METHODS

An anonymous questionnaire using a 12-question measure with a 5-point Likert scale response was administered to 101 African American women attending an obstetrics and gynecology clinic to determine knowledge of sickle cell disease, perception of risk, severity, likelihood of benefit and barriers to counseling.

RESULTS

The cumulative mean perceived scores on the 5-point Likert scale were 4.22 +/- 0.88 for severity of sickle cell disease, 4.10 +/- 1.03 for benefit of genetic testing, 2.28 +/- 1.00 for barriers to testing, and 2.62 +/- 1.06 for risk of having a child with sickle cell disease. High average level knowledge was associated with high perception of severity and benefit to screening (P < 0.05).

CONCLUSION

African American women have a relatively high belief of the severity of sickle cell disease and benefits of genetic counseling but frequently do not appear to believe that they are at risk of having a child with the disease. This should be taken into account in the design of educational and counseling strategies.

Collaborative Breast Health Intervention for African American Women of Lower Socioeconomic Status

PURPOSE/OBJECTIVES

To describe all phases of a collaborative breast health intervention delivered by paraprofessionals or specially trained community health advisors (CHAs) for African American women designed to increase mammography screening.

DESIGN

Collaborative pretest, post-test breast health intervention.

SETTING

Large city in Ohio.

SAMPLE

68 African American women with a median age of 57.8 (SD = 5.28) obtained mammography screening and participated in the breast health intervention.

METHODS

Specially trained CHAs used aggressive recruitment strategies to increase mammography screening and knowledge of breast health and mammography screening in African American women aged 50 and older.

MAIN RESEARCH VARIABLES

Knowledge scores of breast health and mammography screening.

FINDINGS

Ninety women (81%) met the inclusion criteria and were recruited into the intervention, but only 68 (76%) obtained mammography screening. The women demonstrated increased knowledge by change in pre- to post-test scores. Several questions were statistically significant.

CONCLUSIONS

Collaborative breast health interventions delivered by trained CHAs are effective in increasing screenings as well as knowledge of breast health and mammography screening in African American women. The unique role of the CHA is especially important in recruitment of hard-to-reach women and was vital to the success of the educational intervention. Most importantly, the women valued the individualized attention to their breast health and agreed to share the information with significant others. Further collaborative interventions designed to increase screenings and increase knowledge of breast health and mammography screening are needed to reduce the health disparities of later-stage detection and poorer survival of breast cancer in African American women.

IMPLICATIONS FOR NURSING

Oncology nurses should build on the findings and deliver further outreach programs to increase mammography screening and knowledge of breast health in a larger number of women of lower socioeconomic status. Future research is needed to determine the influence of reminder phone calls for mammography screening. Oncology nurses should incorporate evaluation strategies at baseline and periodically throughout an intervention to provide more comprehensive data and enhance the credibility of findings. To maximize success, oncology nurses should work collaboratively with other healthcare professionals such as certified x-ray technicians and influential people in the community to increase knowledge of breast health and mammography screening.

Claiming health: mammography screening decision making of African American women

PURPOSE/OBJECTIVES

To develop a substantive theory that explains how African American women aged 50 years and older of different socioeconomic status (SES) make decisions about mammography screening.

DESIGN

Qualitative, grounded theory.

SETTING

Churches, places of employment, or women's homes in a large city in Ohio.

SAMPLE

30 women aged 52-72 years; 16 in the initial sample and 14 in the theoretical sample.

METHODS

Audiotaped interviews and extensive written field notes; interviews were transcribed verbatim and analyzed using the constant comparison method, resulting in saturation of data.

MAIN RESEARCH VARIABLES

Decision-making processes explaining mammography screening.

FINDINGS

"Claiming health" emerged as the substantive theory explaining decisions that affect mammography screening and was embedded in the social contexts of cultural heritage and learned kinship values, religious beliefs and supports, and prior negative experiences with healthcare professionals and the healthcare system. Claiming health involved sisterhood and fellowship relationships fostered in the church. Claiming health was differentiated by age and SES, with older women of lower SES reporting greater reliance on cultural heritage and negative recollections of the healthcare system when making decisions regarding mammography. Each subconcept of claiming health was equally important and influenced decision making.

CONCLUSIONS

Oncology nurses can benefit from the information presented by assisting older women of lower SES who may have encountered negative experiences in the healthcare system to develop effective assertiveness and communication skills when interacting with healthcare professionals.

IMPLICATIONS FOR NURSING

Further research is needed to determine whether claiming health is a way of thinking about health generally or is used solely to explain experiences with mammography screening.

Behavioral science and the task of resolving health disparities in cancer

BACKGROUND

Behavioral scientists use health behavior theories to assess beliefs, feelings, and coping styles that predict cancer screening, choice of cancer treatments, or postcancer quality of life.

METHODS

However, research testing these theories is typically based on middle-class, White populations.

RESULTS

Research needs to be culturally appropriate and relevant for minority and underserved populations.

CONCLUSIONS

The knowledge gained from such studies will help in designing and evaluating culturally sensitive interventions to reduce health disparities by modifying unhealthy behaviors such as poor diet, smoking, lack of regular physical activity, or failure to get timely cancer screening.