Dissertation Abstract

Cultural concepts of cancer and mammography uptake and adherence: Lessons from the Haitian breast cancer study

Introduction . Most accounts of breast cancer burden inequalities emphasize (a) the cost benefit/cost utility of seeking care or (b) equity, including insurance status and other determinants of access. However, these factors do not fully explain racial/ethnic disparities. The purpose of this study was to explore the utility of an alternative explanatory framework---the 'cultural-explanatory model' of illness and health proposed by Kleinman (1978) in predicting appropriate mammography initiation (uptake) and timely continuous use (adherence). This study examines: (1) major themes, differences in cancer concepts between racial/ethnic groups and how these themes differed or paralleled professional concepts particularly the biomedical and (2) the marginal impact of self-reported knowledge on mammography uptake and adherence controlling for health insurance type, provider factors and other structural access barriers.

Design . A multi-ethnic group of 750 women from Eastern Massachusetts: Caucasian (143), Haitian (284), African-American (163) and Caribbean/Latina (160), comprised the sample. The main independent variables were (1) race/ethnicity and (2) measures of self-reported knowledge derived from qualitative analysis of open-ended questions addressing the nature of cancer, its causes, and potential cures. The covariate of interest was health insurance type. The dependent variables were multiple measures of appropriate mammography use, defined as: age at first mammogram (<=40 years vs. over 40 years), annual or biennial mammography rate and number of mammograms per decade of life (5 or more). Racial/ethnic group differences in breast cancer knowledge were described using bivariate tests and multivariate logistic regression analyses that explored the main effects of knowledge measures and their interactions in explaining mammography use.

Findings . Important racial/ethnic differences were revealed in major themes about what is cancer, what can cause cancer, and what can cure cancer. Self-reported knowledge of cause remained a significant predictor of mammography adherence and uptake in a multivariate adjustment. In construct health insurance was only a significant predictor of uptake and not adherence.

Conclusion . The Cultural Explanatory Model can improve understanding of racial/ethnic patterns in mammography uptake and adherence. Future studies should explore other knowledge structures, other than the explanatory framework.

[ARRT registrant]

This dissertation citation and abstract are published with permission of ProQuest Information and Learning. Further reproduction is prohibited without permission.