Effect of Health Care System Distrust on Breast and Cervical Cancer Screening in Philadelphia, Pennsylvania

Abstract

Objectives This study investigates whether health care system distrust is a barrier to breast and cervical cancer screening and whether different dimensions of distrust – values and competence – have different impacts on cancer screening. Methods We utilize data on 5,268 women 18 and older living in Philadelphia and analyze their use of screening services via logistic and multinomial logistic regression. Results High levels of health care system distrust are associated with lower utilization of breast and cervical cancer screening services. The associations differ by dimensions of distrust. Specifically, high competence distrust is associated with a reduced likelihood of having Pap smear tests, and women with high values distrust are less likely to have breast examinations within the recommended time period. Independent of other covariates, individual health care resources and health status are associated with utilization of cancer screening. Conclusions Health care system distrust is a barrier to breast and cervical cancer screening even after controlling for demographic and socioeconomic determinants. Rebuilding confidence in the health care system may improve personal and public health by increasing the utilization of preventive health services.

Delays in Cancer Care Among Low-Income Minorities Despite Access

“…At the individual level, obstacles to care identified have included low education level, 10 poor health literacy, 11 concerns about test efficacy, 12 and language and cultural beliefs related to cancer, distrust, and fear. [13][14][15] Compounded with these concerns, systems barriers such as difficulty accessing highquality diagnostic services, 16 variability in site of care, 17 poor access to primary care physicians or specialists, 18 and lack of insurance, 19,20 can impact adherence to cancer-related care. Health care reform provisions target financial barriers to access to cancer care but will unlikely attenuate the full range of obstacles to care.…”

Cancer Screening at a Federally Qualified Health Center: A Qualitative Study on Organizational Challenges in the Era of the Patient-Centered Medical Home

“…(6-8) Some organizational features have been shown to have a major impact on rates of breast, cervical, and colorectal cancer screening. (9-11) Stone et al (9), for example, identified three general clinic-based strategies that increased screening delivery: use of separate clinics devoted to prevention, use of a planned care visit for prevention, and designation of non-physician staff to do specific prevention activities.…”

Lung Cancer Stigma Predicts Timing of Medical Help-Seeking Behavior

“…One study found that a positive smoking status served as a barrier in an individual’s medical help–seeking behavior (Stuber, Galea, & Link, 2008), and another reported that individuals frequently delayed seeking medical help because they expected blame for their illness regardless of their smoking status (Tod et al, 2008). Healthcare system distrust has been identified as a barrier to timely breast and cervical cancer screening and may influence medical help–seeking behavior in people with lung cancer symptoms (Katapodi, Pierce, & Facione, 2010; Yang, Matthews, & Hillemeier, 2011). Healthcare system distrust was related to delayed medical help–seeking behavior in symptoms of breast cancer and subsequent advanced breast cancer stage at diagnosis (Friedman et al, 2006; Gould, Fitzgerald, Fergus, Clemons, & Baig, 2010; Taib, Yip, & Low, 2011).…”