Academic journal article American Journal of Health Education

American Indian Women and Screening Mammography: Findings from a Qualitative Study in Oklahoma

Academic journal article American Journal of Health Education

American Indian Women and Screening Mammography: Findings from a Qualitative Study in Oklahoma

Article excerpt


Background: Breast cancer is an important public health issue within the American Indian (AI) community in Oklahoma; however, there is limited information to explain the low screening mammography rates among AI women. Purpose: To identify the motivational factors affecting an AI woman's decision to obtain a mammogram. Methods: Through the use of the Theory of Planned Behavior, 24 elicitation interviews were conducted with eligible for mammography AI women obtaining services a t an Oklahoma-based tribal clinic. Results: Most women had mixed attitudes toward screening mammography. Environmental-related factors also were cited as barriers in getting a screening mammogram and women recommended improved accessibility to mammography screening. Participants identified family members, friends and their personal physician as critical social referents. No specific culturally related beliefs or taboos were noted. Discussion: This study provides new theoretically guided insights into the motivation of AI women to obtain screening mammography. Future interventions to promote mammography screening among AI women may yield more effective results if key social referents are included in the decision-making process. Translation to Health Education Practice: Public health practitioners need to incorporate a socio-ecological approach to the design of a related intervention, and acknowledge the diversity in terms of cultural affiliation and beliefs within the AI population they serve.


Mammography is the single most effective method of early breast cancer detection because it can identify cancer several years before physical symptoms develop. (1,2) American Indian/Alaska Native (AI/AN) women have the lowest up-to-date mammography screening rates (70.4%) (3) and are dying disproportionately due to advanced breast cancer disease compared to Caucasian women. (4) Despite efforts to promote breast cancer screening, the number of Oklahoman women who died from breast cancer during the last two decades did not change substantially, (5) and women of ethnic minorities and low socioeconomic status (SES) remained disproportionally under-screened. (6) Among AI women residing in the Potawatomi county (the study location), between 1997 and 2006 almost half (43%) of American Indians with breast cancer were diagnosed at an advanced regional stage, compared to only 25% of white women. (7)

Moreover, at the Citizen Potawatomi Nation Health Services (CPNHS), a tribal clinic that serves AI women in the CPN jurisdictional area, mammography screening rates for women of ages 52 to 64 have been declining during the last four years; 81.1% in 2005, 74.5% in 2006, 66.9% in 2007 and 35.3% in 2008. These findings indicate under-screening among the AI women in Oklahoma and the need for culturally appropriate mammography-related health promotion interventions.

To plan better and develop interventions to increase screening mammography rates among AI women, it is critical to understand the factors that contribute to the screening decision-making processes. According to the literature on M women and mammography screening, reasons for not seeking mammography commonly are either personal or environmental. Personal reasons and beliefs include: (1) embarrassment; (8-10) (2) fatalistic beliefs; (8) (3) fears; (8,11) (4) family needs placed before a woman's needs; (12) (5) radiation from mammography causes cancer; (13) (6) breast cancer is a white woman's disease; (13) and (7) mammography is painful. (13) Environmental factors include: (1) mistrust of medical providers and conventional health care; (14-16) (2) long appointment waiting times; (15) (3) lack of transportation; (12,15) (4) lack of culturally sensitive care; (15) and (5e) lack of access to mammography screening. (14,15)

Physician recommendation has been established as woman's primary motivating factor to get a screening mammogram. (17, 18) However, within the M population, only one study by Risendal et al (10) showed that physician referral was positively associated with recent mammography experience. …

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