社区30—50岁女性乳腺X线检查意向及影响因素的调查分析

目的描述社区30～50岁女性参加乳腺X线检查的意向并探讨其影响因素。方法采取便利抽样法,使用自制问卷对某市2个社区300名30～50岁的女性进行调查。结果48．20％的调查对象有参加乳腺X线检查的意向;社区30—50岁女性乳腺X线检查知识、态度得分分别为（3．64±1．33）分和（22．934-392）分;文化程度、乳腺X线检查经验及他人对乳腺X线检查的建议是社区30～50岁女性乳腺X线检查意向的保护因素。结论社区30～50岁女性中有参加乳腺X线检查意向者较少,提示乳腺癌的预防工作亟待加强。     

Questionnaire development to predict mammography intention among women in southeastern Louisiana

This article summarizes the development and psychometric analysis of the Thoughts About Mammography (TAM) questionnaire to predict mammography intention using the Theory of Planned Behavior (TPB). Key themes, obtained from elicitation interviews (N = 45), were categorized, ranked and extracted for item construction. Initial pilot testing supported test-retest reliability (alpha = .85 to .97), internal consistency (alpha = .67 to .91), and content validity (0.86-1.00). After pilot testing, the TAM was administered to 302 rural women in southeastern (SE) Louisiana. The instrument was internally consistent (alpha = 0.77 to 0.92), construct valid (alpha = .18 to .64), and predicted 24% of the variance of mammography intention. The TAM adequately demonstrated reliability and validity to measure mammography intention in rural southeastern Louisiana women.     

The sociocultural context of breast cancer screening among Korean immigrant women

Korean immigrant women, who compose 1 of 6 major subpopulations in Asian Americans in the United States, are reported to have far lower rates of breast cancer screening than do women in general. Despite the sporadically reported cognitive, affective, and environmental constraints to the screening practices, to date, no research has been conducted to investigate the sociocultural contexts within which women in this population seek help for breast health. The purpose of this study is to explore and interpret the sociocultural processes of breast cancer screening among Korean immigrant women using the grounded theory method. Twenty Korean immigrant women, aged between 20 and 81 years, participated in a set of 2 consecutive qualitative interviews conducted in the Korean language. The qualitative data were transcribed and analyzed using the constant comparison technique. "Balancing relationships within a discordant world" is the core concept of the process of breast cancer screening among Korean immigrant women. There are sociocultural discord in perceptions of breast cancer and screening procedures between Asian ways of thinking and Western biomedical premises. The elicited situation-specific theory sheds light on what Western healthcare professionals have missed and what they should consider in caring for culturally diverse populations.     

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.     

Psychosocial consequences among women with false-positive results after mammography screening in Norway

Abstract

Background: Mammography screening may cause psychosocial harm for women experiencing a false-positive screening result. Previous studies suggest long-term consequences. The aim of the present study was to assess psychosocial consequences of false-positive findings on screening mammography within a six month follow-up.

Methods: A prospective matched cohort survey study using the questionnaire ‘Consequences of Screening for Breast Cancer’ (COS-BC), which was translated from Danish to Norwegian. Psychometric analyses investigated the measurement properties of the Norwegian version. Two screening clinics in Norway distributed the survey to 299 women with an abnormal mammogram and 541 women with a normal screen. Women received the questionnaire when receiving the screening result, and one and six months after screening.

Results: At six months, statistically significant differences appeared in two scales: existential values and breast examination. At six-month follow-up, women with false-positive results showed no statistically significant differences from women diagnosed with breast cancer in three outcomes: sense of dejection, anxiety, and keeping my mind off things.

Conclusion: Our results indicate that the psychosocial consequences from having false-positive screening mammography results diminish after six months. The results support previous research describing breast-specific outcomes. However, our results indicate that Norwegian women are less frightened than other Scandinavian mammography screening participants.     

Reliability and validity of the mammography screening beliefs questionnaire among Chinese American women

Cancer is the leading cause of death for Asian American women, and the breast is a primary site of cancer in Chinese women. Although a number of studies have used constructs from the Health Belief Model (HBM) to examine their relation to mammogram screening, the validity and reliability of the instruments on HBM constructs among Chinese women have not been consistently examined. The purpose of this study was to describe the psychometric properties of a culturally sensitive questionnaire for measuring Chinese women's beliefs (susceptibility, seriousness, benefits, and barriers) related to breast cancer and mammogram screening. The items developed for the questionnaire were drawn from a comprehensive literature review and focus groups. The instrument was translated using back translation technique and evaluated by a panel of professional experts and lay experts. A total of 220 Chinese American women ages 40 to 85 years residing in a suburban Midwestern community were included in the sample. Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for this group of women. The Cronbach alpha for the subscales ranged from.77 to.90. Construct validity was supported by exploring the factor structure of the instrument using confirmatory factor analysis and testing correlations with mammography compliance.     

Impact of hormone therapy on false-positive recall and costs among women undergoing screening mammography

OBJECTIVE: We sought to evaluate the effects of hormone therapy (HT) on false-positive (FP) recall for additional breast evaluation and costs. DESIGN: We undertook an observational cohort study of women ages 40-80 years with 2 mammography screenings in an integrated delivery system. MEASURES: FP recall, defined as mammograms resulting in a radiologist's recommendation for additional imaging, ultrasound, or invasive procedures among disease-free women, was compared for nonusers, initiators, discontinuers, and continuers of HT. Differences in health care costs by HT were assessed for total, primary care, specialty, laboratory, radiology, inpatient, mental health, and pharmacy. RESULTS: There was no association between HT and FP recall among women ages 40-49 years. Among women 50 years or older, current HT users, ie, initiators and continuers, had increased odds of FP recall (odds ratio; 95% confidence interval) compared with nonusers (1.2; 1.0-1.4 for women 50-59 years; 1.8; 1.5-2.2 for women 60-69; and 1.7; 1.4-2.0 for women 70-80 years). Among women 50-59 years, the odds of FP recall were attributed to opposed HT (ie, estrogen+progestin). Increases in FP recall among HT users 60 years and older was maintained for initiators, continuers, opposed, and unopposed (estrogen only). Increases in FP recall among HT users were for imaging and ultrasound but not invasive procedures. Costs for current HT users during the 12 months after screening were not higher than nonusers, except for pharmacy and outpatient mental health. CONCLUSION: The relationship between HT use and FP recall is greatest among older women and does not result in a differential use of invasive procedures.     

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.     

Age-related differences in health beliefs regarding cervical cancer screening among Korean American women

Cervical cancer screening rates among older Korean American (KA) women are much lower than the rates for younger KA women, even though the overall cancer screening rates in the population continue to have one of the lowest Papanicolaou (Pap) test adherence rates compared with non-Hispanic White women. Variables based on the Health Belief Model related to cervical cancer screening were compared by age group among KA women. A telephone survey was conducted with 189 KA women living in the midwestern United States. Perceived barriers to having a Pap test predicted the outcome variable of having had Pap tests in the preceding 3 years in older KA women who were 65 or older, but not in younger women who were between 40 and 64 years old. Having physical examinations without symptoms in the preceding 2 years predicted the outcome variable in both age groups. Intervention strategies for all KA women should focus on encouraging them to receive routine physical examinations. In addition, attempts should be made to reduce perception of barriers in older KA women to improve their cervical cancer screening behaviors.     

Work climate perception and turnover intention among Korean hospital staff

Aim: To examine the impact of work climate perception (WCP) on turnover intention among public hospital personnel in Korea. Background: With increased competition and high staff turnover in hospitals, managers focus on human resource management. Positive work climate is considered as a strategy to retain valued staff, but previous studies have shown occupationally different relationships between turnover intention and work environment characteristics as perceived by staff. Methods: A cross‐sectional questionnaire survey was conducted of employees (n = 852) in four public hospitals in Korea to gather information about WCP, intention to leave and demographics. The work climate was measured by 32 items categorized into 13 factors in five dimensions. For each occupation, logistic regression analyses were performed to determine the significant factors of WCP that influenced turnover intention. Findings: Positive WCP inversely influenced turnover intention. For all occupations, the most significant factor was ‘workgroup friendliness and warmth’ (OR = 0.01–0.21). For the nursing group, an additional significant factor was ‘adherence to job standard’ (OR = 0.63). In contrast, there were different significant factors for other hospital staff: ‘workgroup esprit de corps’ (OR = 0.16) and ‘role clarity’ (OR = 0.19) for physicians, ‘adherence to job standard’ (OR = 3.08) and ‘role adaptation’ (OR = 2.23) for paramedicals, and ‘flexibility and innovation’ (OR = 0.14) and ‘interdepartmental cooperation’ (OR = 0.19) for administrators. Conclusions: Nurses with perceptions of work climate emphasizing ‘workgroup friendliness and warmth’ and ‘adherence to job standard’ had lower turnover intention. Physicians, paramedicals and administrators have different WCPs. To retain qualified personnel, hospitals should focus on human relations, maintaining a consideration for occupation‐specific characteristics.     

The influence of social support relationships on mammography screening in African-American women.

Evidence indicates that mammography screenings have increased in African-American women who are 50 years of age or older; however, they continue to experience later-stage discovery and poorer survival rates from breast cancer compared to White women. Although research has consistently found that social support relationships affects mammography screening in African-American women, little is known about the preventive health behaviors of individuals in these relationships that may be associated with mammography screening. This study examined that association and found that social support relationships, defined as blood-relatives and extended kinship networks, stressed personal responsibility and accountability for preventive health; therefore, supporting mammography screening. Of perhaps the greatest importance, the relationships emphasized positive strengths of African-American culture and invoked the necessity to confront prior negative experiences in health-care systems. These relationships also negated the fears or fatalistic beliefs about breast cancer that had been perpetuated by myths through informal communication and "deliberate silence" from significant others who had previously discouraged or de-emphasized the importance of mammography screening. Further research is needed to determine if the emphasis on cultural heritage was the only motivator that encouraged personal responsibility for mammography screening.     

Predictors of mammography uptake in Korean women aged 40 years and over

Title. Predictors of mammography uptake in Korean women aged 40 years and over Aim. This paper is a report of a study performed to identify the predictors of mammography uptake for Korean women according to the stage of change, as determined by the transtheoretical model. Background. Although breast cancer is the most common female cancer in South Korea, its early detection rate here is low when compared with other developed countries. The transtheoretical model can be used to facilitate health promotion based on individual health behaviour and to devise stage‐tailored interventions. Method. The participants were a convenience sample of 920 women aged ≥40 years between December 2005 and February 2006. A cross‐sectional design was used in which participants completed a questionnaire that consisted of measures of the transtheoretical model. To provide a standard of measure, the variables were converted from raw scores to standard scores and then to T scores (mean = 50, sd = 10). Logistic regression analysis was then used to estimate predictors of the stage of maintenance of mammography uptake. Findings. The most frequent stage of mammography uptake was ‘contemplation’. Predictors of mammography uptake included decisional balance, commitment to regular screening and avoiding contact with the healthcare system. Commitment to regular screening and breast self‐examination were strongly related to mammography maintenance. Conclusion. The results of this study can be used for the development of theory‐based and empirically supported mammography uptake intervention strategies and programmes directed towards women aged ≥40 years.     

The role of physician communication in improving compliance with mammography screening among women ages 50-79 in a commercial HMO

Despite its efficacy, mammography is substantially underutilized by older women, even those who have access to regular health care. The factors influencing mammogram compliance status are distinctively examined in this study using a commercial health maintenance organization (HMO) population of women ages 50-79 in which there are no known barriers (financial, access, or knowledge) to mammogram compliance. Two variables were significant predictors of compliance status based on logistic regression analyses: belief that a woman should get a mammogram one or more times per year, and willingness to get a mammogram if the physician recommends it. Issues surrounding consistent physician referral are discussed.