Abstract

Blacks, in comparison to other racial or ethnic groups, suffer higher rates of illness and death from many preventable or treatable diseases. Despite the significantly higher rates of mortality and disease, Blacks are least likely to utilize clinical preventive care services. Black women, who are more likely to have advanced breast cancer at time of diagnosis (Chu, Lamar, & Freeman, 2003) are least likely to seek mammography screening (National Health Interview Study, 2000). Allen, Bastani, Bazargan and Leonard (2002) examined predictors of mammography screening among women 40 years old and older residing in the South Central area of Los Angeles, California. Mammography screening rates were significantly lower among Black women than White women, 74.7% and 86.7% % respectively. Possible factors that contribute to this disparity among Black women include lack of knowledge about mammography screening, specific health beliefs, and cultural beliefs such as distrust of doctors and procedures (Reisch et ah, 2000).

In this cross-sectional, mixed-methods study we applied the Health Belief Model to explore perceived mammography related health beliefs, benefits, barriers, and cues to action among Black women in the Inland Empire region of Southern California. Focus groups were conducted with 16 women and data analyzed using grounded theory methods. One hundred and fifty-three women who had been recruited from community settings completed a self-administered quantitative survey. The focus group participants overwhelmingly responded that fear of detecting breast cancer was a considerable barrier to mammography screening among Black women. In addition to fear, respondents identified lack of knowledge regarding breast cancer prevention as a factor in not being screened. Despite this, we found surprisingly high rates of age appropriate mammography screening (90.1%) among our survey respondents. Having a regular physician (p < .000) and patient-healthcare provider communication (p < .001) were predictive of ever having a mammogram. The Health Belief Model construct that was predictive of ever participating in mammography screening was cues to action (p < .002). Perceived severity was predictive of mammography screening within the last 12 months (p < .018).

Utilizing preventive care services such as mammography screening may greatly reduce the higher rates of morbidity and mortality in breast cancer that persist among Black women. Identifying and addressing these barriers from the voice and perspective of Black women may lead to increased adherence to mammography screening recommendations and decreased disparities in breast health outcomes.

School

School of Public Health

First Advisor

Susanne Montgomery

Second Advisor

Patti Herring

Third Advisor

Colwick Wilson

Fourth Advisor

V. Diane Woods

Degree Name

Doctor of Public Health (DrPH)

Degree Level

Ph.D.

Year Degree Awarded

2010

Date (Title Page)

10-2010

Language

English

Library of Congress/MESH Subject Headings

Mammography -- utilization; Breast Neoplasms -- prevention & control; Women's Health; Attitude to Health; Health Behavior -- ethnology; Socioeconomic Factors; Cross-Sectional Studies

Type

Dissertation

Page Count

xv; 180

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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