Baseline predictors of initiation vs. maintenance of regular mammography use among rural women

Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, 816 SPHPI (M/C 923), Chicago, IL 60612, USA.
Preventive Medicine (Impact Factor: 3.09). 07/2005; 40(6):822-30. DOI: 10.1016/j.ypmed.2004.09.029
Source: PubMed


Predictors of regular mammography screening over many years have not often been examined prospectively. We used data from baseline (1993-1994), first (1996-1997), and second follow-up (2000) interviews with 336 White and 314 African-American rural women in the North Carolina Breast Cancer Screening Program to evaluate baseline factors predictive of regular mammography use over 7 years.
We defined regular mammography use as a recent mammogram (past 2 years) at all three interviews. Using binomial and logistic regression models adjusted for age, we examined factors associated with initiation (for women without prior regular use) and maintenance (for women with prior regular use) of mammography.
Younger age and White race were predictive of initiation of regular mammography use. Physician recommendation was the strongest predictor of both initiation and maintenance of regular mammography use. Positive mammography attitudes and fewer personal barriers were strongly associated with initiation but not with maintenance.
Increased contact with providers and greater support for screening mammograms by providers could have an important impact on rural women initiating and maintaining regular mammography screening. Special efforts are needed to prompt rural African-American women and those over age 65 to initiate screening, since once they start they are likely to continue.

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Available from: Garth H Rauscher
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    • "An unanticipated and disturbing theme in the literature was the fact that many reported that they were not told by their healthcare provider that they needed to obtain screening, or were not told of the benefits and risks. In a longitudinal study involving 650 women, 42% of the women said that they did not receive a recommendation or referral from their provider for mammography , even though provider recommendation is one of the strongest predictors of initiation and maintenance of regular mammography, in a study by Rauscher et al. (2005). Women who were already obtaining routine screening before the study continued to do so throughout the 7-year study, although not all of them had received a recommendation from their provider during that time. "
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    ABSTRACT: This paper is a report of a review in which decision theory from economics and psychology was applied to understand why some women with access to care do not seek cancer screening. Mammography and cervical smear testing are effective modes of cancer screening, yet many women choose not to be screened. Nurses need to understand the reasons behind women's choices to improve adherence. Research papers published between January 1994 and November 2008 were identified using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PsycINFO data bases. The search was performed using the following terms: cervical cancer screening, breast cancer screening, decision, choice, adherence and framing. Forty-seven papers were identified and reviewed for relevance to the search criteria. Nineteen papers met the search criteria. For each paper, reasons for obtaining or not obtaining cancer screening were recorded, and organized into four relevant decision theory principles: emotions, Prospect Theory, optimism bias and framing. All women have fears and uncertainty, but the sources of their fears differ, producing two main decision scenarios. Non-adherence results when women fear medical examinations, providers, tests and procedures, do not have/seek knowledge about risk and frame their current health as the status quo. Adherence is achieved when women fear cancer, but trust care providers, seek knowledge, understand risk and frame routine care as the status quo. Nurses need to address proactively women's perceptions and knowledge about screening by openly and uniformly discussing the importance and benefits.
    Full-text · Article · May 2009 · Journal of Advanced Nursing

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