Regular Mammography Screening Among African American (AA) Women: Qualitative Application of the PEN-3 Framework

Abstract

Introduction: Breast cancer mortality rates among African American (AA) women are at 29.2 deaths per 100,000 persons compared with 20.6 deaths per 100,000 persons among Caucasian women. Regular mammography screening may significantly reduce breast cancer mortality and narrow this disparity. This study guided by PEN-3 model aims to explore the relationships and expectations domain and identify perceptions, enablers, and nurturers of regular mammography among AA women. Method: As part of an intervention study, in-depth interviews were conducted with 39 AA women recruited from the emergency department of a public university hospital. Results: Women’s perceptions included fear and limited knowledge. Enablers identified were cost, socioeconomic, and race-related discrimination, and health care previous experiences. Nurturers identified included observation of family experiences and lack of health-related social support. Discussion: Findings underscore the need to develop culturally tailored interventions to address the issues salient to this population.

Leveraging human-centered design and causal pathway diagramming toward enhanced specification and development of innovative implementation strategies: a case example of an outreach tool to address racial inequities in breast cancer screening

“…Determinants identified were cataloged and prioritized based on relevance to the implementation strategy. For example, one study found perceptions of lower quality of care if mammograms were done in a mobile clinic setting; we did not include this as a priority determinant because this would not be particularly modifiable in the chatbot design [ 33 ]. Priority determinants included facilitators such as having personal or family history of breast cancer and recommendations from PCPs and barriers such as medical mistrust (Table 1 ).…”

“…Talk about the cost of it. Talk about resources that individuals can tap into…to be able to get a mammogram.”—56 year old woman • Conflicts with work and/or other competing priorities • Lack of PCP [ 33 , 76 , 77 ] • Anxiety about what to expect • Fear about pain, exposure to radiation or other negative outcomes [ 33 ] associated with procedure • Medical mistrust [ 78 ] • Prior negative experience including experiences of racism [ 33 , 77 ] • Lack of knowledge about breast cancer screening [ 33 , 76 , 78 ] • Inadequate preparation/ information given prior to procedure [ 33 ] • Lack of discussion with friends and family [ 76 ] • Tailored information about breast cancer Participants emphasized the importance of outreach to get information about breast cancer screening to the community. It was mentioned that a barrier to screening is not being aware that it was something they should do “How do you know if you're carrying something around, you're sick and you're not knowing what it is, and when you get to the hospital, they diagnosed … you.…”

“…But there's things that you could have done prior, if you was told. Some people don't know how to reach out.”—56 year old woman • Family or personal history of breast cancer (or other cancers) as facilitator to screening [ 33 , 76 , 79 , 80 ] • Recommendations from PCP Participants discussed lack of or equivocal recommendations by physicians for breast cancer screening, even if they initiated discussion. They also discussed reminders, the time it takes to make an appointment and time until appointment as determinants to scheduling screening “And now, I just need to bring it up again to my physician.…”

Faktor Sosiobudaya yang Menghambat Perilaku Skrining Kanker Payudara pada Wanita: Systematic Review

“…Terdapat keyakinan fatalistik pada wanita tentang kanker payudara, yaitu terkait dengan kurangnya kontrol wanita ketika terkena kanker payudara. Beberapa wanita dalam penelitian menyebutkan bahwa kanker payudara tidak dapat dicegah dengan cara apapun (20). Informan pada penelitian lagi juga mengungkapkan bahwa mereka harus menerima takdir mereka, dimana keyakinan tersebut menjadi salah satu penghalang untuk melakukan skrining kanker payudara (21).…”

“…"Skrining kanker tidak mengubah apa pun, jika Anda akan mati karenanya, Anda akan mati karenanya." (20) "Kanker payudara adalah musibah dari Allah… apapun yang Allah tetapkan akan terjadi, apapun yang kita lakukan." (21).…”