Revisiting Access to Care in the Era of the Affordable Care Act: Mammography Screening in African-American Women

Purpose: To present thematic findings from interviews with African American women regarding their mammography experiences with an emphasis on the broad framework presented by Penchansky and Thomas in order to gain insight into how provision of health insurance via the Affordable Care Act fits into a larger scheme of access to care and its impact on health disparities research.

Methods: This qualitative study utilized a convenience sample of 39 African American women presenting to the emergency department (ED) of a public university hospital. These women were either seated in the ED or presented to the ED with non-urgent complaints. Qualitative data was gathered from a semi-structured open-ended participant interviews. The average length of the interview was 1-2 hours.  The in-depth interviews were designed to elicit the women’s salient beliefs regarding the physical, psychological, and social barriers and benefits associated with mammography screening, as well as her perceptions of personal susceptibility to breast cancer. The qualitative interviews were analyzed using qualitative description.

Results: Of the 39 women, who were interviewed, 10 of the participants were between the ages of 40 and 49, 17 were ages 50 to 59 and 12 were 60 and above.  Twenty-four reported having a mammogram within the past year and 15 reported that it had been more than a year since their last mammogram. Seven of the 15 women reported never having had a mammogram. After applying the five areas identified by Penchansky and Thomas the participants elaborated on barriers to screening.  These included personal barriers such as skepticism, mistrust, fear, pain, and spirituality as well as structural barriers such as transportation, childcare issues, provider demeanor and communication as well as cost.   

Conclusion: Access to health care encompasses more than the ability to pay for such care. By applying Penchansky & Thomas’ theoretical model of access to barriers to mammography screening the intricate webbing of the dimensions of access to care is realized further confounding the ability of the Patient Protection and Affordable Care Act to fully equalize health care.  Due to the complexity and multifaceted nature of the term “access” there needs to remain a focus on other dimensions that may impact health care for vulnerable populations.