Identifying Sociocultural Barriers to Mammography Adherence Among Appalachian Kentucky Women

Abstract

Despite lower breast cancer incidence rates, Appalachian women evidence lower frequency of screening mammography and higher mortality risk for breast cancer compared to non-Appalachian women in Kentucky, and in the United States, overall. Utilizing data from 27 in-depth interviews from women in seven Appalachian Kentucky counties, this study examines how Appalachian women explain sociocultural barriers and facilitators to timely screening mammography, and explores their common narratives about their mammography experiences. The women describe how pain and embarrassment, less personal and less professional mammography experiences, cancer fears, and poor provider communication pose barriers to timely and appropriate mammography schedule adherence and follow-up care. The study also identifies how improving communication strategies in the mammography encounter may improve mammography experiences and adherence to screening guidelines.

Medicaid Expansion and Breast Cancer Screening in Appalachia and Non-Appalachia, United States, BRFSS 2003 to 2015

“…Specifically, we compared expansion status based on Appalachia status. Prior studies have shown that women in Appalachia regions have much lower breast cancer screening rates and significantly higher mortality rates compared to the national average, 11,16 although none of the prior studies have evaluated the role of ACA expansion in this region. Second, the analysis evaluated differences in screening rates by pre- and post-expansion status.…”

“…The National Cancer Institute recognizes the Appalachia region of the United States as a special priority area, given that it represents one of the most economically disadvantaged, and medically underserved regions in the United States. 7 -10 Several factors have been identified that may explain later stage at diagnosis and higher breast cancer mortality observed among women living in the Appalachian regions of the United States, 11 -13 including lower socioeconomic status and lack of access to health care, 9,14,15 lower prevalence of routine mammography, and a lower likelihood to receive recommended treatment for breast cancer. 16 -18…”

“…Despite the higher proportion of uninsured and low-income women in Appalachia regions of the United States, few studies have directly evaluated the impact of the ACA Medicaid expansion on breast cancer screening behaviors in this region relative to other parts of the US. 11 -13 The current study aims to examine changes in breast cancer screening before and after ACA Medicaid expansion comparing Appalachia and non-Appalachia states. Results may highlight the impact of health insurance changes due to the ACA on breast cancer screening rates in a historically under-served region, and highlight areas where additional strategies may be needed to narrow existing health disparities.…”

ESPN’s Coverage of Intimate Partner Violence in the National Football League

“…Multiple researchers were used to ensure sampling reliability. Working independently, two coders descriptively assessed the database (Cohen, Wilson, Vanderpool, & Collins, 2015). Two meetings were held to review interpretation, discuss discrepancies, and arrive at mutual consensus (Campbell & Wallace, 2015; Cohen et al, 2015).…”

“…Working independently, two coders descriptively assessed the database (Cohen, Wilson, Vanderpool, & Collins, 2015). Two meetings were held to review interpretation, discuss discrepancies, and arrive at mutual consensus (Campbell & Wallace, 2015; Cohen et al, 2015). In the case of any ambiguity with regard to the description of the situation (e.g., victim type, actions, charges), we conducted an Internet search for published information regarding the incident that could clarify information about the victim and offer more details about the interaction (i.e., current and former romantic partners vs. strangers).…”