Effects of Social Injustice on Breast Health—Seeking Behaviors of Low-Income Women

Abstract

Purpose The study uses qualitative research to gain a better understanding of what occurs after low-income women receive an abnormal breast screening and the factors that influence their decisions and behavior. A heuristic model is presented for understanding this complexity. Design Qualitative research methods used to elicited social and cultural themes related to breast cancer screening follow-up. Setting Individual telephone interviews were conducted with 16 women with confirmed breast anomaly. Participants Low-income women screened through a national breast cancer early detection program. Method Grounded theory using selective coding was employed to elicit factors that influenced the understanding and follow-up of an abnormal breast screening result. Interviews were digitally recorded, transcribed, and uploaded into NVivo 8, a qualitative management and analysis software package. Results For women (16, or 72% of case management referrals) below 250% of the poverty level, the impact of social and economic inequities creates a psychosocial context underlined by structural and cultural barriers to treatment that forecasts the mechanism that generates differences in health outcomes. The absence of insurance due to underemployment and unemployment and inadequate public infrastructure intensified emotional stress impacting participants’ health decisions. Conclusion The findings that emerged offer explanations of how consistent patterns of social injustice impact treatment decisions in a high-risk vulnerable population that have implications for health promotion research and systems-level program improvement and development.

Time from Screening Mammography to Biopsy and from Biopsy to Breast Cancer Treatment among Black and White, Women Medicare Beneficiaries Not Participating in a Health Maintenance Organization

“…While definitive timelines associated with increased harm have yet to be established (Kaufman et al, 2010), we agree with Chen et al (2008) that , “Studies do not suggest that there is a threshold below which delay has a lesser impact on the risk of local recurrence” (p. 8). Furthermore, the results support the call for continued investigation of correlates of treatment delays affecting mammograms, biopsies, and treatments (Tian et al, 2012) and suggestions that equalization of timely diagnosis and treatment following abnormal screening results is an essential step toward reducing disparities in mortality for all women (Bowen et al, 2013; Kiely, 2014). The longer duration of time from diagnosis to treatment among Black women in the present data suggests that such equalization may remain to be achieved among a significant portion of Medicare beneficiaries.…”

The implications of insurance status on presentation, surgical management, and mortality among nonmetastatic breast cancer patients in Indiana

“…25 For this study, we believe the difference in all-cause mortality between the IN-BCCP and their insured counterparts is most likely multifactorial and may include an interplay among greater unmet medical needs, socioeconomic stress, and delays in pursing treatment once diagnosed. 10,[26][27][28] . Future studies should consider tracking how long patients have been screened in different breast cancer screening programs, or insurance programs for that matter, to better understand whether any cancers diagnosed were based upon first-time or interval screenings, which may be associated with different prognoses.…”

A Strategic Framework for Utilizing Late-Stage (T4) Translation Research to Address Health Inequities

“…This pattern can give rise to persistent health inequities 7 that can be exacerbated further by upstream factors such as cultural barriers and segregation. 8,9 The combined effects of such influences result in considerable disparities in morbidity and mortality among various population subgroups. 10 The purpose of this article is to Achieving health equity requires that every person has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.…”