Dissertation Abstract

Claiming Health: Mammography Screening Decision-Making of Older, Urban African-American Women

There have been few researchers in nursing and the behavioral sciences that examined the social contexts and processes that may influence mammography-screening decision making of older, urban, lower-income AA women. Researchers, public health officials, and nurses in education and clinical practice may use the findings of this study to increase use of mammography screening. Grounded Theory (GT) research methods were used to develop, expand, and verify the basic social psychological process (BSP) and interrelated concepts emerging from the data, and understand the potential influences of related factors on mammography-screening decision making in this group of AA women. Thirty AA women, aged 52 to 72, participated in two separate individual or dyad interviews in the privacy of their homes, church rectory, or places of employment. Data were obtained using audio-taped interviews which were transcribed verbatim by an experienced transcriptionist. Data analyses were done using constant comparison methods Three different mammography-screening decision-making styles ("taking charge", "enduring", and "protesting") emerged from the data resulting in a substantive GT of "Claiming Health" that was associated with seven interrelated components of health decision-making: (1) relying on religious beliefs and supports; (2) recognizing breast cancer risk factors; (3) caregiving of significant others; (4) valuing the opinions of significant others; (5) using familiar lay home remedies; (6) acknowledging experiences with healthcare professionals and systems; and (7) perceiving conjuring fatalistic beliefs of breast cancer and related treatment.

The differences in decision-making styles were influenced by age, educational levels, and income status. The women's health care decisions also were influenced by prior experiences with healthcare professionals, religious beliefs and supports, and use of various information sources, including significant others. Further theory development and research is needed to verify these findings in other groups of women. It is important for nurse administrators to support continuing education programs for nursing staff to integrate this information into their initial and ongoing plan of care. Legislators and policy makers should be aware that an understanding of health decision-making that was revealed in this study may be helpful to decrease the premature mortality rates and economic burden associated with later-stage diagnosis of breast cancer.

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