'I Fell between the Cracks:' A Qualitative Analysis of the Factors that Influence Mammography Use among Low-Income and Uninsured/Underinsured Women Pubblico

Abstract

Background: Breast cancer is a leading cause of cancer death among women in the United
States. Prevention strategies for breast cancer typically focus on early detection and initiation
of treatment through routine mammography screening. Despite the availability of free breast
cancer screening services, mammography rates among low-income and
uninsured/underinsured women remain substantially lower than that of the general
population.

Objectives: The purpose of this study was to explore the factors that influence the
mammography use of low-income and uninsured/underinsured women. In particular, the
reasons that women do or do not receive routine screening mammography are of interest.

Methods: The data consisted of 21 interviews with African American and Caucasian
women who had a breast cancer diagnosis and were currently enrolled in the Georgia
Women's Health Medicaid Program. The transcripts were coded using MAXqda 10 software,
and the data were analyzed qualitatively using a deductive approach. Descriptive analyses
were compiled for 1) the factors that influenced mammography use among women who
received routine mammography, and 2) the factors that influenced mammography use among
women who did not receive routine mammography.

Results: Two main behavioral patterns of mammography use were identified: 1) women
who were receiving routine mammography screening, and 2) women who were not receiving
routine mammography screening. For both these groups, the influence of a healthcare
provider was a main influential factor of their mammography use. Healthcare insurance
status appeared to only affect receiving mammograms for the women who were not routinely
screened. Additionally, knowledge about breast cancer either motivated women to seek
mammograms or caused delays in receiving mammograms for these women.

Discussion: The recommendation for mammography by a healthcare provider was one of the
most influential factors observed in women's mammography use behavior. There is an
apparent need for all healthcare providers to be aware of the available free breast cancer
screening services. All women at risk for breast cancer should also be educated about the
importance of self breast exams and having abnormal breast changes examined by a
healthcare provider.

Table of Contents

I.
Introduction ..................................................................................................................1
A. Background/Problem Statement ..............................................................................1
B. Purpose Statement1 ..................................................................................................3
C. Specific Aims ...........................................................................................................3
D. Study Significance ...................................................................................................3

II.
Literature Review ........................................................................................................5
A. Breast Cancer: Facts and Statistics ..........................................................................5
B. The Issue of Race .....................................................................................................7
C. Income Level and Insurance Status .......................................................................10
D. Available Free Screening Services ........................................................................13

III.
Methods .......................................................................................................................16
A. Study Design ..........................................................................................................16
B. Study Population and Recruitment ........................................................................17
C. Data Analysis .........................................................................................................18

IV.
Results .........................................................................................................................20
A. Women Who Received Routine Mammograms ....................................................20
Influence of a Healthcare Provider .....................................................21
Influence of a Previous Medical Condition .........................................24
Knowledge of Cancer ...........................................................................27
Absence of Delays in Receiving Mammograms ...................................30
B. Women Who Did Not Receive Routine Mammograms ........................................31
Influence of a Healthcare Provider .....................................................32
Influence of Health Insurance ..............................................................35
Knowledge about Cancer .....................................................................38
Delays in Receiving Mammograms .....................................................42

V.
Discussion....................................................................................................................44
A. Implications for Prevention....................................................................................45
B. Recommendations ..................................................................................................47
C. Study Limitations and Strengths ............................................................................48

VI.
References ...................................................................................................................50

VII.
Appendices ..................................................................................................................54

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	low-income breast cancer uninsured mammography
Committee Chair / Thesis Advisor	Andes, Karen, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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