Kathleen M. Russell

Sociocultural context of mammography screening use.

PURPOSE/OBJECTIVES To examine variations in cultural and health beliefs about mammography screening among a socioeconomically diverse sample of African American and Caucasian women and to identify which set of beliefs predicted mammography screening adherence. DESIGN Descriptive, retrospective, cross-sectional study. SETTING Community-based organizations and public housing. SAMPLE 111 African American women and 64 Caucasian women, aged 40 years or older, with no history of breast cancer. METHODS Telephone and in-person structured interviews were conducted. Items used previously validated scales based on the Cultural Assessment Model for Health and the Health Belief Model. MAIN RESEARCH VARIABLES Race or ethnicity, education, income, personal space, health temporal orientation, personal control, fatalism, susceptibility, benefits, barriers, self-efficacy, and mammography screening adherence. FINDINGS African American women were more fatalistic about breast cancer and perceived fewer benefits to screening. Mammography screening-adherent women were more future oriented, believed that they had less control over finding health problems early, had fewer barriers to screening, and experienced more physical spatial discomfort during the screening procedure than nonadherent women. CONCLUSIONS Several of the cultural beliefs were not significantly different by race or ethnicity. However, cultural and health beliefs were significant predictors of mammography screening. IMPLICATIONS FOR NURSING Theoretically based cultural beliefs are important to consider for behavioral interventions to increase mammography screening in African American and Caucasian women.

Measuring Mammography and Breast Cancer Beliefs in African American Women

Although intervention trials have demonstrated significant improvement in mammography adherence for African American women, many of the current measurement tools used in these interventions have not been assessed for validity and reliability in ethnic minorities. This study assessed the validity and reliability of Health Belief Model (HBM) variables that are often the target of mammography interventions. Scale validity and reliability was assessed for HBM scales in a sample of 344 low-income African American women. Validity was supported through exploratory factor analysis and theoretical prediction of relationships. Internal consistency reliability was .73 or above for all scales.

Quality of life of African American breast cancer survivors: how much do we know?

Women affected by breast cancer experience an array of quality-of-life issues that affect their daily living in both short-term and long-term survivorship. Because African American women experience disparities in breast cancer survival, their quality-of-life concerns may paint a different picture from those of other racial and ethnic groups. To gain a better understanding of quality of life in African American women breast cancer survivors, we conducted a review, using an adaptation of Brenners quality-of-life proximal-distal continuum, of studies that have investigated these womens experiences and associated variables. Twenty-six studies, qualitative and quantitative, were reviewed that identified both deficits and positive outcomes of breast cancer treatment and sequelae, including physical, emotional, social, and patient-provider problems as well as heightened spirituality and positive growth. Although overall global quality of life was favorable in both African American and white survivors, differences existed in the nature and extent of deficits between these 2 survivor groups. Nursing implications of this review point to the need for further rigorous research and wide dissemination of results. Recommendations for practice include tailoring assessments and interventions within the context of the lives of African American women breast cancer survivors.

Randomized Trial of a Lay Health Advisor and Computer Intervention to Increase Mammography Screening in African American Women

Background: Low-income African American women face numerous barriers to mammography screening. We tested the efficacy of a combined interactive computer program and lay health advisor intervention to increase mammography screening. Methods: In this randomized, single blind study, participants were 181 African American female health center patients of ages 41 to 75 years, at ≤250% of poverty level, with no breast cancer history, and with no screening mammogram in the past 15 months. They were assigned to either (a) a low-dose comparison group consisting of a culturally appropriate mammography screening pamphlet or (b) interactive, tailored computer instruction at baseline and four monthly lay health advisor counseling sessions. Self-reported screening data were collected at baseline and 6 months and verified by medical record. Results: For intent-to-treat analysis of primary outcome (medical record–verified mammography screening, available on all but two participants), the intervention group had increased screening to 51% (45 of 89) compared with 18% (16 of 90) for the comparison group at 6 months. When adjusted for employment status, disability, first-degree relatives with breast cancer, health insurance, and previous breast biopsies, the intervention group was three times more likely (adjusted relative risk, 2.7; 95% confidence interval, 1.8-3.7; P < 0.0001) to get screened than the low-dose comparison group. Similar results were found for self-reported mammography stage of screening adoption. Conclusions: The combined intervention was efficacious in improving mammography screening in low-income African American women, with an unadjusted effect size (relative risk, 2.84) significantly higher (P < 0.05) than that in previous studies of each intervention alone. Cancer Epidemiol Biomarkers Prev; 19(1); 201–10

Psychosocial Factors Related to Repeat Mammography Screening Over 5 Years in African American Women

The purpose of this study was to investigate health beliefs associated with repeat mammography screening in African American women 51 years or older over a 5-year period. Long-term repeat mammography screening is inconsistent in African American women; therefore, this study measured demographic, knowledge, and health belief predictors of repeat screening. The theoretical framework for this study was the health belief model. Baseline data from a larger randomized controlled trial were analyzed using descriptive statistics and logistic regression. The sample consisted of 602 African American women with no breast cancer history and at least 1 reported screening mammogram in the past 5 years. They were recruited from 3 primary care health settings. Having been screened 4 to 5 times in the past 5 years was associated with more knowledge about screening guidelines and fewer perceived barriers to screening. Results point to the importance of collaborating with African American communities to promote life-long mammography screening by increasing access to culturally appropriate information on screening guidelines and ameliorating barriers to screening within the context of the African American experience.

Health-related quality of life of African American breast cancer survivors compared with healthy African American women

Background: The diagnosis and treatment of breast cancer can result in an array of late cancer-specific side effects and changes in general well-being. Research has focused on white samples, limiting our understanding of the unique health-related quality of life outcomes of African American breast cancer survivors (BCSs). Even when African American BCSs have been targeted, research is limited by small samples and failure to include comparisons of peers without a history of breast cancer. Objective: The purpose of this study was to compare health-related quality of life of African American female BCSs with that of African American women with no history of breast cancer (control group). Methods: A total of 140 women (62 BCSs and 78 controls), 18 years or older and 2 to 10 years postdiagnosis, were recruited from a breast cancer clinic and cancer support groups. Participants provided informed consent and completed a 1-time survey based on the proximal-distal health-related quality of life model of Brenner et al (1995). Results: After adjusting for age, education, income, and body mass index, results show that African American BCSs experienced more fatigue (P = .001), worse hot flashes (P < .001), and worse sleep quality (P < .001) but more social support from their partner (P = .028) and more positive change (P = .001) compared with African American female controls. Conclusions: Our results suggest that African American female BCSs may experience unique health-related outcomes that transcend age, education, socioeconomic status, and body mass index. Implications for Practice: Findings suggest the importance of understanding the survivorship experience for particular racial and ethnic subgroups to proactively assess difficulties and plan interventions.

Development of cultural belief scales for mammography screening.

PURPOSE/OBJECTIVES To develop instruments to measure culturally related variables that may influence mammography screening behaviors in African American women. DESIGN Instrumentation methodology. SETTING Community organizations and public housing in the Indianapolis, IN, area. SAMPLE 111 African American women with a mean age of 60.2 years and 64 Caucasian women with a mean age of 60 years. METHODS After item development, scales were administered. Data were analyzed by factor analysis, item analysis via internal consistency reliability using Cronbachs alpha, and independent t tests and logistic regression analysis to test theoretical relationships. MAIN RESEARCH VARIABLES Personal space preferences, health temporal orientation, and perceived personal control. FINDINGS Space items were factored into interpersonal and physical scales. Temporal orientation items were loaded on one factor, creating a one-dimensional scale. Control items were factored into internal and external control scales. Cronbachs alpha coefficients for the scales ranged from 0.76-0.88. Interpersonal space preference, health temporal orientation, and perceived internal control scales each were predictive of mammography screening adherence. CONCLUSIONS The three tested scales were reliable and valid. Scales, on average, did not differ between African American and Caucasian populations. IMPLICATIONS FOR NURSING These scales may be useful in future investigations aimed at increasing mammography screening in African American and Caucasian women.

Cultural constructs, stage of change, and adherence to mammography among low-Income African American women

The purpose of this study was to explore the predictive relationships between cultural belief and stage of change and mammography adherence in low-income Midwestern African American urban women (N = 321). Secondary analysis of questionnaire data measuring religiosity, racial pride, family collectivism, future and present time orientation, and stage of mammography screening adoption was conducted. Religiosity (OR = 1.12; p = .002) and future time orientation (OR = 1.12; p = .05) predicted mammography adherence with a positive association, while present time orientation (OR = 0.91; p = .05) was significantly negatively associated. Religiosity (OR = 1.11; p = .002) and future time orientation (OR = 1.12; p = .05) were positive predictions of stage progression, whereas present time orientation (OR = 0.90; p = .03) had a significant negative relationship. By identifying cultural variables that are related to mammography adherence in African American women, mammography-promoting interventions can be more effectively tailored.

The Interaction of Perceived Risk and Benefits and the Relationship to Predicting Mammography Adherence in African American Women

PURPOSE/OBJECTIVES To test the interaction of perceived risk and benefits and how they impact stage of mammography readiness and adherence. DESIGN Cross-sectional study. SETTING Community gathering centers and healthcare clinics across Indiana. SAMPLE 299 African American women who had not had a mammogram in more than 18 months. METHODS In-person interviews were used to collect data on sociodemographics, health belief variables, and stage of readiness to undertake mammography screening. Four categories were created to measure the combined magnitude of high or low levels of perceived risk and benefit, with health belief variables linked to modified mammography screening behavior. MAIN RESEARCH VARIABLES Perceived risks and benefits, stage of readiness, and mammography adherence. FINDINGS The lowest rate of mammography adherence was in women with a high perceived risk and low perceived benefit toward mammography adherence (26%). The highest rate of adherence was in women with a high perceived benefit and low perceived risk (46%). Differences in mammography adherence were statistically significant between the groups (p = 0.009). CONCLUSIONS The interaction of high perceived risk and low perceived benefits impacted readiness to undergo screening mammography. IMPLICATIONS FOR NURSING Reducing disparities in breast cancer diagnosis and survival requires timely and efficient mammography adherence. African American medically underserved women with high perceived risk and low perceived benefits exhibited a reluctance to move forward with mammography adherence. Interventions are needed to increase the perception of mammography benefit and to subsequently reduce breast cancer mortality rates in that population.