Health beliefs, health locus of control, and women's mammography behavior

Research has shown that routine mammography screening can significantly reduce mortality from breast cancer. The use of mammography screening, however, remains well below national goals. In an effort to understand the factors that influence women's mammography behaviors, this study explored the relation between health beliefs, locus of control, and women's mammography practice. Survey instruments used were Champion's health belief scales and the Multidimensional Health Locus of Control (MHLC) scales. The study used a convenience sample of 25 African Americans and 72 white women ages 35 to 84. Findings showed that women who participated in mammography screening were significantly more likely to perceive greater benefits, greater health motivation, and fewer barriers to screening than those who did not participate. These same three variables were similarly associated with greater frequency of receiving mammograms. It also was found that perceived benefits and health motivation were significantly correlated with shorter duration of time since the last mammogram. No support was found for perceived susceptibility, perceived seriousness, and health locus of control as predictors of women's mammography behavior. Implications for nursing research in further examining the MHLC and the Health Belief Model construct of susceptibility as they relate to mammography behavior are identified. Practice implications for nurses are suggested.     

Correlates of recent and regular mammography screening among Asian-American women

Title.  Correlates of recent and regular mammography screening among Asian-American women.
Aim.  This paper is a report of a study of the health beliefs, knowledge and selected demographic variables that influence mammography utilization among Asian-American women.
Background.  Breast cancer is the most frequently occurring cancer in Asian-American women and its incidence is increasing at a greater rate than for other racial and ethnic groups in the United States of America (USA). Compared to White women, breast cancer also is more likely to be diagnosed at a later stage with larger tumours in Asian-Americans.
Method.  A self-administered questionnaire was used with Asian-American women residing in the USA. Data were collected in 2005 and 315 women participated in the study.
Results.  Fifty-five per cent of participants reported having their last mammogram within the past 13 months, and 33% reported having annual mammograms in each of the past 5 years. Based on multivariate logistic regression analyses, clinical breast examination, barriers and knowledge of recommendations of the frequency of mammography screening were associated with both recent and regular mammography practice after controlling for all other demographic, psychosocial and behavioural variables in the model.
Conclusion.  Intervention strategies tailored to knowledge, language and cultural factors associated with mammography use should target at-risk subgroups, particularly those who are recent immigrants and those with limited English language ability. Culturally appropriate strategies should be developed to promote lifelong mammography screening for this rapidly growing and diverse population.     

Breast and cervical cancer screening among Korean American elderly women

The purpose of this study was to estimate the prevalence and correlates of breast and cervical cancer screening tests among Korean American elderly women. This study examined the effects of individual socio-demographic background, acculturation level (e.g., proportion of life spent in the US, spoken English proficiency), health status and access to health care on uptake of mammography and Pap smear tests in the past 2 years. Subjects were 130 Korean American women aged 60 and older living in the Greater Metropolitan Baltimore Area. A cross-sectional face-to-face interview was conducted. The 2-year prevalence was only 35% for mammography and 29% for Pap smear tests. In multiple logistic regression analysis, educational attainment, government support, multiple chronic conditions, and routine checkups were associated with having mammography. Age, acculturation and insurance were associated with having a Pap test. Taking advantage of the positive influence of identified covariates may increase the effectiveness of cancer control interventions among Korean American elderly women.     

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.     

Promoting breast health: older women's perceptions of an innovative intervention to enhance screening

Aims and objectives. This study is a continuation of prior funded research in which we tested the use of age and ethnically sensitive video breast health kits to increase knowledge about breast cancer and enhance the screening practices of breast self‐examination and mammography among older Caucasian and African‐American women. Background. Breast cancer is the most frequent cancer in women worldwide and accounts for 23% of all cancers. Mammography is currently the best procedure available for mass screening of breast cancer. However, underutilization of mammography is a problem among older women in the United States. Elders are at the greatest risk for developing and dying from breast cancer but they are the least likely group to be screened routinely with mammograms or to practice breast self‐examination, particularly if they are African‐American. Design. Participatory qualitative evaluation focus groups were used to assess the overall impact of the video kit intervention programme and to elucidate the quantitative findings of the original study. Methods. Four focus groups were conducted in two diverse settings with a purposive sample of 23 participants (N = 23). The overall sample was predominantly African‐American (87%) with mean age of 71 ± 7.9 years and mean education completed of 12 ± 3.4 years. Results. Five major themes emerged from group discussions: usability and appeal of the intervention, fear and empowerment, personal relevance and intergenerational sharing, impact on screening behaviours, and story telling. Conclusions. Analyses suggest that customized media materials constructed especially for older African‐American women empowered participants in this sample to action regarding their own breast health. Relevance to clinical practice. These findings may translate to global populations where risk is increasing but screening programmes are not widely available. Given that older women are historically difficult to access and impact, further design and evaluation of innovative and sensitive educational programmes such as the one described here are recommended.     

Cancer fatalism and breast cancer screening in African American women.

Despite significant advances in science, medicine, and technology African American women are more likely to die from breast cancer than Caucasian women. There is a growing body of literature that describes strategies to improve breast cancer screening among African American women. However, data suggest that African American women, compared to Caucasian women, are less likely to participate in regular breast cancer screening. The belief that a diagnosis of cancer will result in death has been identified as a potential barrier to cancer screening in African American population groups. However, research examining the degree to which perceptions of fatalism influence breast cancer screening in culturally and ethnically diverse population groups is scant. This repot describes the outcomes of a study undertaken to examine relationships between perceptions of cancer fatalism and breast cancer screening in African American women. Findings support the postulation that fatalism negatively influences health promoting practices such as breast cancer screening. However, contrary to prior research findings age was observed to be inversely associated with cancer fatalism.     

Asian Indian women: knowledge, attitudes and behaviors toward breast cancer early detection

Education programs have been developed to promote adherence to recommended breast cancer screening guidelines. Few studies have assessed the degree to which ethnic subgroups are perceiving and acting on the proffered information. Such assessment is vital to the creation of efficient public health interventions. This paper describes the reported breast cancer knowledge, attitudes, and screening behaviors of 194 American Asian Indian women. While monthly breast self exam adherence was low, only 40.7%, 61.3% of women 40 and older, and 70% of women 50 and older, reported having had a mammogram within the past 12 months. These rates for annual mammography screening are high relative to many other ethnic groups. While the results are encouraging, the respondents may not be representative of all Asian Indian women. The majority of these women reported that their breast cancer knowledge is inadequate. They were willing to be called upon to share with others any knowledge they gained. There is a clear opportunity for public health nurses to provide Asian Indian women with a more comprehensive understanding of breast health and disease. Those women can then share their health knowledge with other women within their ethnic group.     

African American women's breast memories, cancer beliefs, and screening behaviors

African American women experience higher breast cancer mortality and lower survival rates compared with white women of comparable age and cancer stage. The literature is lacking in studies that address the influence of past events on current health behaviors among women of diverse cultural groups. This qualitative exploratory study used participant narratives to examine associations between women's memories and feelings concerning their breasts and current breast cancer screening behaviors. Twelve professional African American women, aged 42 to 64 years, shared stories about memories and feelings regarding their breasts. Codes grouped together with related patterns and recurrences revealed categories that encompassed the language and culture of the participants. The categories identified were Seasons of Breast Awareness, Womanhood, Self-Portraits, Breast Cancer and Cancer Beliefs, Breast Cancer Screening Experiences, and Participants' Advice for Change. These categories provide direction for further exploration of barriers to health promotion practices among African American women and women in general.     

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

Title. Do cultural factors predict mammography behaviour among Korean immigrants in the USA? Aim. This paper is a report of a study of the correlates of mammogram use among Korean American women. Background. Despite the increasing incidence of and mortality from breast cancer, Asian women in the United States of America report consistently low rates of mammography screening. A number of health beliefs and sociodemographic characteristics have been associated with mammogram participation among these women. However, studies systematically investigating cultural factors in relation to mammogram experience have been scarce. Methods. We measured screening‐related health beliefs, modesty and use of Eastern medicine in 100 Korean American women in 2006. Hierarchical logistic regression was used to examine the unique contribution of the study variables, after accounting for sociodemographic characteristics. Findings. Only 51% reported past mammogram use. Korean American women who had previously had mammograms were statistically significantly older and had higher perceived benefit scores than those who had not. Perceived benefits (odds ratio = 6·3, 95% confidence interval = 2·12, 18·76) and breast cancer susceptibility (odds ratio = 3·18, 95% confidence interval = 1·06, 9·59) were statistically significant correlates of mammography experience, whereas cultural factors did not correlate. Post hoc analysis showed that for women with some or good English skills, cultural factors statistically significantly correlated with health beliefs and breast cancer knowledge (P < 0·05). Conclusion. Nurses should consider the inclusion in culturally tailored interventions of more targeted outreach and healthcare system navigation assistance for promoting mammography screening in Korean American women. Further research is needed to unravel the interplay between acculturation, cultural factors and health beliefs related to cancer screening behaviours of Korean American women.     

Women's approaches to decision making about mammography.

Health professionals have an obligation to understand women's decision making about mammography and to advocate for their active participation in health care decision making. Although mammography is a major screening measure for the second largest cancer killer of women, only approximately half of women older than age 50 years, and fewer older than age 70 years, undergo mammography in accordance with American Cancer Society (ACS) guidelines. Therefore, the purpose of this study was to identify women's overall decision-making approaches when considering mammography. Subjects were a purposive, convenience sample of 50 women in the community who had made a decision about mammography; they included those who chose to have mammograms and those who decided not to have mammograms according to the pre-1997 ACS guidelines. Subjects participated in audiotaped interviews. Results indicated that women approached the mammography decision differently, regardless of the decision they made. Three overall decision-making approaches to addressing risk factors, issues about mammography, or other factors before their decision were evident. The approaches were (1) thoughtful consideration; (2) cursory consideration; and (3) little or no consideration. Each approach has implications for nurses who assist women in making decisions about mammography.     

Mammography stage of adoption and decision balance among Asian Indian and Filipino American women

Cancer is the leading cause of death among Asian American women, and the death rate has increased almost 200% since 1990. Previous research has applied the transtheoretical model constructs to examine cancer screening behavior; however, to our knowledge, this is the first such investigation to examine relationships between stages of mammography adoption and decision balance among Asian American women. This article presents study findings from a convenience sample of 228 women aged 40 to 81 years (mean = 55.0, SD = 9.6) residing in southeastern Michigan. The current study demonstrates excellent support for the psychometric properties of a pros and cons measure, with promising Cronbach alphas above .70. Results from confirmatory factor analysis also support the factor structure derived from exploratory factor analysis with good model fit indices. This study also provides some support on transtheoretical model-hypothesized relationships in this sample of Asian American women that, as the stages of adoption of mammography proceeded from earlier to later ones, the decisional balance would become more favorable. The specific beliefs (both positive and negative) associated with the various stages of mammography adoption have implications for health professionals in developing stage-matched interventions to motivate women in adopting regular mammography.     

Elderly African American women's knowledge and belief about colorectal cancer.

The purpose of this pilot study using focus groups was to 1) identify elderly African American women's knowledge and belief about colorectal cancer, 2) determine whether African American elderly women seek preventative measures for colorectal cancer, and 3) determine the educational needs to increase participation in colon cancer screening. The author used a convenience sample of 15 African-American women between the ages of 45-69 recruited from a moderately large church in a major urban city. Results of the study showed that there was a very low level of participation in colon cancer screening among the women in the group. Over 70 percent had a college degree or higher and 62 percent had no knowledge about colorectal cancer. 77 percent were employed with 69 percent having health insurance; 38 percent did not perceive themselves at any risk for colorectal cancer; and only 23 percent stated that they had been tested for colon cancer. Reasons for not getting screened were: fear; afraid of pain; doctor never recommended any tests; had no symptoms; competing health histories; embarrassment; and flaws in risk perception.     

Women's perceptions of early detection in breast cancer: how are we doing?

Breast cancer is a significant risk to many women in the United States. It is also a major cause of death among American women. The National Cancer Institute's Year 2000 breast screening goal is to increase the percentage of women aged 50 to 70 years who have physical examination and mammography to 80%. However, many barriers to screening remain. Providing correct information and education regarding risk and mammography may help to overcome these barriers and achieve this goal.     

Colorectal cancer knowledge, perceptions, and behaviors in African Americans

Disparities in healthcare among racial and ethnic minorities are associated with poor outcomes. African Americans have the highest incidence of colorectal cancer (CRC) among all racial groups. Using a nonrandom sample of 100 African American men and women, 50 years of age and older, the authors explored CRC knowledge, perceptions, and screening behaviors of African American men and women who resided or worked in an urban low-income housing residence. The extent to which screening may be attributed to demographic, sociopsychological, and structural variables was also investigated. Respondents demonstrated inadequate knowledge of CRC, with a significant difference in mean scores between males and females. Self-report of participation in CRC screening was above the national average, with almost half of the sample reporting fecal occult blood home kit use and more than half of the sample reporting completion of sigmoid and colonoscopy exams and double contrast barium enema exam. A majority perceived CRC as a threat. A very high percentage perceived numerous benefits to CRC screening in preventing CRC susceptibility. Perceived barriers of nearly half of the sample included screening may be painful and afraid to find out something is wrong if I have CRC screening, while more than half did not know how to schedule screening. Barriers and threat were correlated with grade school education. Barriers were negatively correlated with secondary education and post-secondary education and moderately correlated with threat. Predictor variables found in the Health Belief Model accounted for a significant amount of the variance in screening behavior, barriers, and threat. Older African American men and women need more information about CRC in order to increase their awareness of CRC and the importance of screening. There is a need to educate healthcare professionals about the causes, prevention, and detection of CRC and the importance of screening.     

Thai American women's perceptions regarding mammography participation

ABSTRACT Objectives: To identify the factors influencing mammography screening among Thai immigrant women in Southern California.
Background: Asian women have lower mammography screening rates than other U.S. women ( Centers for Disease Control [CDC], 2007 ), and only 53% of Thai women in Los Angeles had a mammogram in the prior 2 years ( Thai Community Development Center, 2004 ).
Design: A phenomenological approach was used to elicit Thai immigrant women's perceptions of the reasons for screening participation. Phenomenology is an appropriate means of describing screening as experienced by members of a population for which there is little information. Focus groups were used to collect data to provide a group perspective.
Sample: Thai women over 40 years of age in 2 Southern California counties were recruited at a local temple and a social services agency.
Measurement: Participants were asked about mammography participation and to describe the factors that influenced screening for themselves, family members, and friends. Thematic analysis identified major themes.
Results: Factors influencing mammography screening included knowledge, encouragement, health consciousness, physical factors, fear, cultural factors, social responsibilities, and logistical barriers.
Conclusions: Participants identified factors amenable to nursing intervention that may influence mammography screening in this population. Further study is needed to determine the prevalence of these factors.     

The intention of future mammography screening among Korean women

The purpose of this study was to understand factors that influence future mammography intention and to differentiate significant factors influencing future mammography intention between those who have past mammography experience and those who do not. A cross-sectional study design was used to analyze characteristics and factors that influence the intention to have a mammogram among middle-aged Korean women. A total of 310 women, aged 30 and older, participated in the study. The study results indicated that a combination of the Health Belief Model and the Theory of Reasoned Action was effective in predicting mammography intention of Korean women. It found that knowledge, perceived benefits, self-efficacy, and the subjective norm were significant factors affecting mammography intention in women who have past mammography experience. For women who have never had a mammogram, age, knowledge, perceived benefits, and self-efficacy provided a significant contribution to predicting mammography intention. Thirty-three to 43% of the variability in mammography intention can be explained by the combined influence of these independent variables. The findings from this study can be used to guide the design and implementation of tailored health education and promotion programs for Korean women according to their mammography experience, so as to increase mammography screening.     

Knowledge and beliefs related to cervical cancer and screening among Korean American women

The purpose of this article is to examine knowledge and health beliefs associated with cervical cancer screening among Korean American women. A telephone survey was conducted with 189 Korean American women in the Chicago area. Age, marital status, income, knowledge of early detection method for cervical cancer, and perceived beliefs about benefits of and barriers to receiving Pap tests were all related to outcomes of ever having a Pap test and having had one in the preceding 3 years. Variables uniquely related to ever having a Pap test were education, employment status, fluency in English, and proportion of life spent in the United States. Variables uniquely related to having had the test during the preceding 3 years were having a usual source of care and regular checkups. Different intervention components are suggested for the groups of Korean American women who have never had a Pap smear and for those who have not had one in the preceding 3 years, in addition to common intervention strategies that aim to increase knowledge and perceived benefit and to decrease perceived barriers to receiving Pap tests.     

Health Beliefs of African American Women on Breast Self-Exam

PurposeInvestigate the relationship between African American women's health beliefs in regard to breast cancer screening behaviors.Data sourcesA sample of 131 African American women, age 20–65, from a family practice clinic and 3 rural churches in Southeast.ConclusionsOne-hundred and nine of the participants reported practicing breast self-exam (BSE) within the past 12 months. However, 21 women had never practiced BSE. Fear of not doing it correctly was a main barrier.Implication for practiceSteps should be taken to increase confidence and resolve barriers of African American women through the development of culturally sensitive educational training on BSE and cancer prevention.