Influence of Sense of Coherence, Spirituality, Social Support and Health Perception on Breast Cancer Screening Motivation and Behaviors in African American Women

By Conway-Phillips, Regina; Janusek, Linda | ABNF Journal, Summer 2014 | Go to article overview

Influence of Sense of Coherence, Spirituality, Social Support and Health Perception on Breast Cancer Screening Motivation and Behaviors in African American Women


Conway-Phillips, Regina, Janusek, Linda, ABNF Journal


African American Women (AAW) have a higher breast cancer mortality rate and a lower survival rate than any other racial or ethnic group. Research demonstrates that barriers, such as high costs and lack of health insurance, reduce mammography screening among AAW (Byrne, Smith Glasgow, & DeShields,2011; Davis et al., 2012). Yet, despite these barriers, some AAW do access mammography and engage in breast cancer screening (BCS) behaviors. BCS includes mammography, clinical breast examination (CBE), and breast self examinations (BSE) (American Cancer Society, 2013a).

Understanding individual characteristics that motivate AAW to surmount barriers and adopt BCS behaviors can inform approaches to increase health behaviors. The salutogenic model of health focuses on factors that promote health, as opposed to those factors that increase risk for disease (Antonovsky, 1987). Salutogenesis emphasizes understanding individual differences in the ability to meet challenges, like barriers to BCS; and thus, offers a novel framework of health to investigate individual characteristics posited to motivate AAW to rise above adversity and engage in health behaviors to maintain breast health (Antonovsky, 1979). Sense of coherence (SOC) is central to salutogenesis. Persons with greater SOC view life as more manageable and are more likely to take advantage of available resources. Spirituality, social support, and health perception are key determinants of SOC and can serve as resources to motivate women to adopt BCS activities (Antonovsky, 1987).

Breast Cancer Screening Behaviors in African American Women

To understand the disparity in breast cancer mortality rates among AAW, prior research evaluated attitudes, beliefs, and perceptions of AAW regarding BCS (Garmon Bibb, 2012; Underwood, 2007). In parallel, other research identified barriers that prevent AAW from receiving mammograms including: cost, physicians' failure to discuss mammography, lack of health insurance, fear of radiation, misconceptions that BCS is unnecessary, distrust of the health care system, pain, fear of a cancer diagnosis, low level of education or income, lack of regular physician or source of health care, older age, and cancer fatalism, beliefs and attitudes (ConwayPhillips & Underwood, 2009). Knowledge of these barriers led to establishment of programs designed to increase BCS among AAW (Russell et al., 2010). Yet, little is known about individual characteristics that motivate AAW to overcome barriers and engage in BCS (Klassen, Smith, Shariff-Marco, & Juon, 2008).

Conceptual Framework

Few studies have used Antonovsky's Salutogenic Model of Health (Antonovsky, 1987), to understand health behaviors of AAW (George, 1999; Gibson, 2003; Nyamathi, 1993). Yet, this model offers several unique advantages. Salutogenesis has its origins in exploring the issue: if two people are confronted by an identical stressor, one has the wherewithal to successfully meet the challenge and the other does not (Antonovsky, 1979). The salutogenic focus on the origins of health and resources for health, contrasts with the pathogenic view of health/disease, which emphasizes factors that impede the attainment of health. The salutogenic model views health as movement along a continuum between total health (ease) and ill health (dis-ease), and offers a model to explain how individuals remain at a given point or move along the health continuum over time (Antonovsky, 1979; 1987). Antonovsky endorsed the use of salutogcnesis by nurses, as a viable model for health promotion research and practice (Antonovsky, 1996). Recent investigations have applied this model to address health promotion in various populations (Wainwright et al" 2007), including breast cancer survivors (Gibson, 2003) and the chronically ill (Delgado, 2007).

Salutogenesis incorporates three key concepts: problem solving/finding solutions, Generalized Resistance Resources (GRRs), and sense of coherence (SOC) (Eriksson, 2007). …

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