An Investigation Into the Social Context of Low-Income, Urban Black and Latina Women

Abstract

Understanding factors that promote or prevent adherence to recommended health behaviors is essential for developing effective health programs, particularly among lower-income populations who carry a disproportionate burden of disease. We conducted in-depth qualitative interviews (n=64) with low-income Black and Latina women who shared the experience of requiring diagnostic follow-up after having an abnormal screening mammogram. In addition to holding negative and fatalistic cancer-related beliefs, we found that the social context of these women was largely defined by multiple challenges and major life stressors that interfered with their ability to attain health. Factors commonly mentioned included competing health issues, economic hardship, demanding caretaking responsibilities and relationships, insurance-related challenges, distrust of healthcare providers, and inflexible work policies. Black women also reported discrimination and medical mistrust, while Latinas experienced difficulties associated with immigration and social isolation. These results suggest that effective health interventions not only address change among individuals, but must also change healthcare systems and social policies in order to reduce health disparities.

Neighborhood-level Influences on Delays in Diagnostic Follow-up from Mammography Screening in African-American Women: A Systematic Review

“…In Fair et al study of 76 medically-underserved women age >40 years with inadequate follow-up imaging or biopsy (≥ 6 months since mammogram results), 48% of African-American women perceived low benefits and high barriers to follow-up from screening and care, and reported a decrease in internal health locus of control. Gullatte et al [8] and Lannin et al [9] reported that African-American women held fatalistic views, coupled with fears of finding cancer accounted for delays in follow-up from abnormal MS. Several researchers found that "wait time' in ambulatory settings prohibited follow-up from abnormal MS in African-American women [4,10,11]. Similar to the previous findings, Jones et al [12] found that 'wait time' was much longer for racial and ethnic minority patients being served in public-hospitals than private hospitals with the majority White patients (94 days vs. 77 days).…”

“…Similar to the previous findings, Jones et al [12] found that 'wait time' was much longer for racial and ethnic minority patients being served in public-hospitals than private hospitals with the majority White patients (94 days vs. 77 days). Furthermore, perceptions of racial discrimination in healthcare systems negatively affected interactions with primary care providers and therefore, decreased diagnostic follow-up in African-American women [11,13,14].…”

Geographic disparities amongst patients with gynecologic malignancies at an urban NCI-designated cancer center

“…(1) Those patients living extremely close to the cancer center were at risk of non-completion potentially as a result of non-adherence to treatment recommendations. Non-adherence has been described among the urban poor as secondary to the unique social stresses of the urban poor and distrust of the medical profession [24]. The resources available to those patients through navigation and social work may not have been utilized or trusted.…”

Race: Ethnicity and Health

“…In multivariable analyses, race was the only factor found to be significantly predictive of higher mistrust and lower satisfaction scores. Numerous studies have reported similar findings whether it is beliefs concerning being an organ donor (Breitkopf, 2009), adherence to recommended medical regiments (Shelton et al, 2011), or receiving genetic testing (Suther and Kiros, 2009). In each case, people of color, compared to whites, were significantly more mistrusting of health care providers, and thus, more likely to avoid interacting with health providers and less likely to adhere to recommended health regimes.…”