American Indian Community Leader and Provider Views of Needs and Barriers to Mammography

Abstract

Breast cancer incidence is rising and mortality is disproportionately high among American Indians and Alaska Natives, yet screening rates remain low. Using community-based participatory research, we conducted interviews with community leaders (n = 13) and providers from the Indian Health Service, tribal clinics, and urban safety-net clinics (n = 17). Participants in both groups identified similar needs, including culturally-appropriate mammography education, use of Native elders as patient navigators, and an emphasis on preventive care. Pertinent barriers included culturally-specific issues (e.g., historic mistrust and gender roles), cost, transportation, and fear of mammography and potential results. The results reflect the struggles of promoting mammography across diverse populations.

Colorectal Cancer Screening in First Nations People Living in Manitoba

“…First Nations individuals who lived in northern The number of individuals in the age group and year categories will not sum to the total number of individuals in the ethnicity and gender categories as some individuals may have been screened more than once over the 12-year time frame. Barriers to CRC screening arise from a variety of demographic, psychologic, and provider-related factors (24). In a review of literature on the equity of participation in CRC screening among different ethnic populations, Javanparast and colleagues found that sociocultural factors play an important role in the acceptability, accessibility, and utilization of screening (16).…”

“…The most common barriers cited among American Indian men were privacy, embarrassment, and distrust of the health care system (28). American Indian community leaders also felt that there was little knowledge about CRC, risk factors, or screening recommendations (24).…”

“…Since its introduction, the provincial CRC screening program has used several multilevel strategies to encourage screening participation within First Nations communities, including working with Health Canada's First Nations and Inuit Health Branch and local primary health care providers, sending personalized invitation letters, media messaging, and social marketing campaigns. Previous research has found that addressing First Nations cultural structures and traditional ways are important aspects of reducing cancer screening disparities (24,28). Therefore, further work exploring the comprehensibility of the FOBT kit's instructions in First Nations communities and the development of culturally specific education and training is underway.…”

Sorting it out: pile sorting as a mixed methodology for exploring barriers to cancer screening

“…Full details of methods and results of these interviews are published elsewhere (Daley et al 2012). Free list items were analyzed using Smith’s Saliency Index (Smith 1993), a weighted mean that takes into account the number of items on a participant’s list, placement of the item on the participant’s list, and the frequency with which an item was mentioned (Smith and Borgatti 1997).…”

American Indian Health: Integrating Traditional Native Healing Practices and Western Medicine

“…(Disincentive factors that they share with non-Native women include cost, transportation, and fear of the test and its potential results.) 14 From a survey of low-income American Indian, African American, and Caucasian women age 18 and older (N = 367) relating to their food-related environment, health beliefs, and behavior, investigators concluded that nutrition education and intervention efforts require tailored approaches that take into account racial/ethnic identity among the many environmental, personal, and behavioral factors contributing to the obesity epidemic. 15…”