Medical Advocacy and Supportive Environments for African-Americans Following Abnormal Mammograms

Abstract

African American women experience disproportionately adverse outcomes relative to non-Latina White women after an abnormal mammogram result. Research has suggested medical advocacy and staff support may improve outcomes among this population. The purpose of the study was to understand reasons African American women believe medical advocacy to be important and examine if and how staff can encourage and be supportive of medical advocacy. A convenience-based sample of 30–74 year old women who self-identified as African American/Black/of African descent and who had received an abnormal mammogram result was recruited from community-based organizations, mobile mammography services, and the local department of health. This qualitative study included semi-structured interviews. Patients perceived medical advocacy to be particularly important for African Americans, given mistrust and discrimination present in medical settings and their own familiarity with their bodies and symptoms. Respondents emphasized staff can encourage medical advocacy through offering information in general in a clear, informative, and empathic style. Cultural competency interventions that train staff how to foster medical advocacy may be a strategy to improve racial disparities following an abnormal mammogram.

Racism and the Reproductive Health Experiences of U.S.-Born Black Women

“…Some studies have shown that Black women are less likely to self-advocate during a medical encounter, 33 whereas others have found that increased self-advocacy by Black women is associated with better outcomes. 34,35 These prior studies frame self-advocacy behaviors positively, as an effective strategy on the individual level to improve outcomes and reduce health inequities. 34 In contrast, our findings suggest that selfprotective behaviors are reactive, adaptive survival strategies in the face of persistent cultural and structural racism.…”

Organization Communication Factors and Abnormal Mammogram Follow-up: a Qualitative Study Among Ethnically Diverse Women Across Three Healthcare Systems

“…[27][28][29][30][31][32][33][34] Patient navigation has been successful in gaining appropriate follow-up and shortening time following abnormal mammograms. 3,32,35,36 Although patient navigation programs are a strategy to address mammogram process barriers, particularly for vulnerable women, [35][36][37][38][39][40] these programs can be costly and require additional trained personnel. While the safety-net facility was the only facility in our study that had an established patient navigator program, some women in the safety-net facility still experienced delays to follow-up.…”

Ethnic differences in social support after initial receipt of an abnormal mammogram.

“…This study combines data from two projects conducted between February 2012 and July 2013 (Mujeres Poderosas/Powerful Women (MPPW) - Molina, Hohl et al, 2014, Molina, Beresford, et al, 2014; Sisters-Healing-Advocating-Praising-Empowering-Sisters (SHAPES) - Molina, Hempstead et al, 2015). Staff recruited women from the Puget Sound area, wherein African American and Latina residents represent respectively 8% and 6% of the population (WA Department of Public Health, 2013) and exhibit breast cancer disparities that mirror those observed at a national level (Adams et al, 2009; Arnsberger et al, 2006; Press et al, 2008; Ramirez et al, 2013).…”