Factors Associated with Breast Cancer Screening Adherence among Church-Going African American Women

Abstract

Relative to White women, African American/Black women are at an increased risk of breast cancer mortality. Early detection of breast cancer through mammography screening can mitigate mortality risks; however, screening rates are not ideal. Consequently, there is a need to better understand factors associated with adherence to breast cancer screening guidelines to inform interventions to increase mammography use, particularly for groups at elevated mortality risk. This study used the Andersen Behavioral Model of Health Services Use to examine factors associated with adherence to National Comprehensive Cancer Network breast cancer screening guidelines amongst 919 African American, church-going women from Houston, Texas. Logistic regression analyses measured associations between breast cancer screening adherence over the preceding 12 months (adherent or non-adherent) and predisposing (i.e., age, education, and partner status), enabling (i.e., health insurance status, annual household income, employment status, patient-provider communication, and social support), and need (i.e., personal diagnosis of cancer, family history of cancer, and risk perception) factors, separately and conjointly. Older age (predisposing: OR = 1.015 (1.007–1.023)), having health insurance and ideal patient–provider communication (enabling: OR = 2.388 (1.597–3.570) and OR = 1.485 (1.080–2.041)), and having a personal diagnosis of cancer (need: OR = 2.244 (1.058–4.758)) were each associated with greater odds of screening adherence. Only having health insurance and ideal patient-provider communication remained significantly associated with screening adherence in a conjoint model; cancer survivorship did not moderate associations between predisposing/enabling factors and screening adherence. Overall, results suggest that interventions which are designed to improve mammography screening rates amongst African American women might focus on broadening health insurance coverage and working to improve patient–provider communication. Implications for multi-level intervention approaches, including the role of churches in their dissemination, are proposed.

Factors promoting breast, cervical and colorectal cancer screenings participation: A systematic review

“…However, not only the patients but also the professionals highlight the need to thoroughly discuss the screening practice (including information on both harms and benefits, false‐positive results and over‐diagnosis) 84,89,96–99 . From the patient perspective, the possibility of having enough time for being listened 23 and for disclosing fears about screening with healthcare professionals can play a pivotal role in favoring screening participation 46,100–103 . Indeed, negative counseling/screening experiences may significantly hinder future attendance, requiring the healthcare staff to be properly trained about these needs 67 .…”

“…84,89,[96][97][98][99] From the patient perspective, the possibility of having enough time for being listened 23 and for disclosing fears about screening with healthcare professionals can play a pivotal role in favoring screening participation. 46,[100][101][102][103] Indeed, negative counseling/screening experiences may significantly hinder future attendance, requiring the healthcare staff to be properly trained about these needs. 67 For example, for pap-test, considering the invasiveness of the procedure, which may potentially recall previous adverse experiences, the presence of qualified professionals may significantly reduce women's anxiety, promoting future attendance.…”

“…While the healthcare system represents an important source of support, despite the efforts, it may still bring obstacles for cancer screening attendance, leading people from higher socioeconomic status to screen in the private sector. 112 Indeed, for all the types of screening, research highlights structural barriers such as high financial costs, 61,97 being underinsured/uninsured, 43,100 and residing in rural areas/with limited access to health care facilities. 75 In particular, the lack of access to care 21,54,61,62,81,82 the large distance between the primary care unit and their own place of residence/ work, 37,46,112,113 issues with transportation 58 all represent significant hindrances to screening participation.…”

The Relationship between Healthcare Providers and Preventive Practices: Narratives on Access to Cancer Screening

“…In a spirit of shared and informed decision making [ 12 ], several studies have highlighted the importance for people to have regular interaction with healthcare professionals and to receive clear and consistent information and recommendations on cancer screening [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ], with the possibility to have a certain time and space to be heard [ 25 ] and to reveal their concerns about preventive practices [ 26 , 27 , 28 , 29 , 30 ]. From the point of view of the health professionals, it is also important to be part of a shared decision-making process.…”

Examining Associations between Source of Cancer Information and Mammography Behavior among Black Church-Going Women

“…Many studies have investigated associations between preferred sources of cancer information and factors not including mammography behavior among Black woman [ 46 , 47 , 48 , 49 , 50 , 51 ]. Another examined associations between mammography behavior and other factors among Black church-going women (not including source of cancer information) [ 52 ]. Few have investigated the association between source of cancer information and mammography behavior among these women.…”