Lilian M. Wells

Influences on breast cancer screening behaviors in Tamil immigrant women 50 years old and over.

Objective To investigate, using the Health Belief Model as a theoretical framework, the incentives and barriers to breast cancer screening in a recent immigrant group, older Tamil women from Sri Lanka. Method Tamil women who had had a mammogram and Tamil women who had never had a mammogram were compared on the following variables: socio-demographics, personal risk estimates for breast cancer, risk-reduction expectancies, beliefs and knowledge about breast cancer and screening recommendations, and acculturation. Results Groups differed significantly in terms of education, years living in North America, acculturation, and beliefs/knowledge about breast cancer. When education and acculturation were controlled, perceived barriers to mammography were most predictive of mammography utilization. Discussion Results are discussed with a view to developing culture-appropriate educational campaigns.

Older immigrant Tamil women and their doctors: attitudes toward breast cancer screening.

Cultural beliefs have been hypothesized to be powerful barriers to breast cancer screening in minority women and physician recommendation is consistently reported to be the strongest incentive. This study investigated (1) beliefs regarding breast cancer and (2) the perception of barriers to mammography and clinical breast examination in a sample of immigrant Tamil women, as well as in a sample of primary care physicians. Three focus groups, each consisting of 10 immigrant Tamil women from Sri Lanka aged 50 years or over were conducted and 52 primary care physicians who serve this population completed mailed surveys. The most common barriers to screening reported by the women were (1) lack of understanding of the role of early detection in medical care, (2) religious beliefs and, (3) fear of social stigmatization. Physicians reported the most common barriers to their screening recommendations for this group of women to be (1) womens episodic care, (2) unrelated presenting problems and, (3) women refusing to be screened. Interventions to increase screening in this and other minority groups requires an elaborated understanding of utilization barriers for both women and their doctors.

Book reviews : Goldberg, E. Matilda, Jane Gibbons and Ian Sinclair (1985) Problems, Tasks and Outcomes: The Evaluation of Task-centered Casework in Three Settings. London: George Allen and Unwin. 273 pp

ent populations. These British studies build on previous work on both sides of the Atlantic and have clear relevance for social work in other countries. Each study found that task-centred methods could be applied with a sizeable number of clients, and that clients who completed an episode of task-centred work had reduced problems. In each research project social workers received special training in the use of a task-centred approach, the application was closely monitored to provide a detailed description of the process, and the effectiveness in practice was evaluated. Part I of the book reports on a study located in a social service department, Part II in a probation setting and Part III in a follow-up service for parasuicide. One flaw in the book is that the authors of Part I do not include a description of the mandate for social service departments which were set up following the Seebohm Report of 1970 in Britain. This makes it difficult for the non-British reader who might not be familiar with the purpose and functions of such settings. Parts II and III are enriched by reviews of the literature on the effectiveness of probation and on general considerations of parasuicide and treatment issues, respectively. Each of the three studies uses both quantitative and qualitative data, and, while the process and methods of their study and analysis is evident, the focus of this book is on the findings and their implications for practice, for policy and for research. Outcomes, as seen by clients, social workers and independent appraisers, are evaluated and the task-centred model itself is discussed. The skilful use of case