Academic journal article Health and Social Work

Advancing Social Workers' Responsiveness to Health Disparities: The Case of Breast Cancer Screening

Academic journal article Health and Social Work

Advancing Social Workers' Responsiveness to Health Disparities: The Case of Breast Cancer Screening

Article excerpt

As members of health and public health teams, social workers can provide leadership in addressing disparities in breast cancer screening and mortality rates. With their professional training in the ecological framework and their concern for equitable, accessible, and culturally respectful and responsive health care, social workers can help communities understand why breast cancer is a public health concern, why the incidence and mortality trends of this disease have fluctuated during the past 25 years, and why their impact has not been shared uniformly by all women.

The incidence of breast cancer for all women increases with age and is highest among white women; however, mortality rates are highest among older African American women (American Cancer Society, 2001). Although the National Cancer Institute and other medical organizations agree that women age 50 and older should undergo routine mammography every one to two years (Kerlikowske, Grady, Rubin, Sandrock, & Ernster, 1995; National Cancer Institute, 1997), estimates of breast cancer screening utilization show that participation in mammography screening is typically lowest among groups of women with whom social workers often work; that is, older, low-income, rural, and racially and culturally diverse women (Allen, Sorensen, Stoddard, Colditz, & Peterson, 1998; Montano, Thompson, Taylor, & Mahloch, 1997; Scott Collins et al., 1999).

Studies have investigated a variety of factors predictive of women's decisions about breast cancer screening, including socioeconomic factors, and to a lesser extent, psychological and cultural variables. Findings generally suggest that older and ethnic minority women, women with inadequate insurance coverage and no regular source of medical care, women who are less educated, women who live in medically underserved areas, and women who report strong religious values, attitudes, and beliefs about breast cancer, are less likely to obtain breast cancer screening and are at greater risk of dying from breast cancer than are white women who are younger, educated, have health insurance and access to medical care, and who do not express strong beliefs about breast cancer (Ashing-Giwa, 1999; Lannin et al., 1998; Mitchell, 2000; Skinner, Strecher, & Hospers, 1994). Furthermore, these and other studies corroborate the need for health promotion to be tailored to pertinent socioeconomic, psychological, interpersonal, and cultural factors to encourage women's optimal utilization of mammography and adherence to screening mammography guidelines (Altpeter, Earp, & Schopler, 1998; Earp et al., 1997; Michielutte, Dignan, & Smith, 1999; Skinner, Sykes, Monsees,Andriole, & Arfken, 1998). Hence, the purpose of this study is to provide the grist for public health social workers to customize breast cancer health promotion programs that are age- and culturally responsive and that will help eliminate disparities in breast cancer screening and mortality.

CONCEPTUAL FRAMEWORK

The conceptual framework of our study combines several theories common to public health social work practice, including the ecological perspective (Meyer, 1995), the Transtheoretical Stages of Change Model (Prochaska & DiClemente, 1982), the PRECEDE model (Green & Kreuter, 1991), and the Health Belief Model (Rosenstock, 1974). This integrated framework views a woman's intention to seek mammography (or to wait) as a proximal precursor of her actual screening utilization behavior and encompasses predisposing, reinforcing, and enabling factors that influence a woman's intention to pursue breast health care. A strength of the ecosystems perspective and the PRECEDE model is their attention to multiple components of the lives of rural women, including their health care beliefs and practices, their access to health care providers, their social networks, and normative and cultural influences. Because the influence of cultural beliefs about breast cancer on women's behavioral intentions has received relatively limited attention in other studies (Russell, Champion, & Perkins,2003), this indicator was of particular interest in our study. …

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