Friday, September 27, 2002

This presentation is part of : Studies in Cancer: Care Interventions and Communications

Care-Seeking Behaviors of African-American Women with Breast Cancer Symptoms

Karen A. Reifenstein, RN, PhD, Rochester, NY, USA

Breast cancer threatens the health of many American women. African American women have more advanced stages of breast cancer on diagnosis and lower survival rates, despite the fact that their overall incidence of breast cancer is lower than Caucasian women. Black women have lower survival rates for all disease stages. As is true in Caucasian women, overall survival rates for younger women ( i.e.,< 50 years of age) are slightly lower compared to older women. Unlike Caucasian women who saw a decline in mortality of 7.1% from 1973-1995, African American women have seen an increase in mortality (19.4%) over this time period. The disparity in the rate of breast cancer survival between black and white women is significant. The five year survival rate between 1989-1994 in African American women was 16% lower (71% compared to 87%). Because the treatment of breast cancer is more effective at an earlier stage, the survival rate of women improves when the disease is detected early. Very few studies have focused on the psychosocial variables (e.g., fear) that influence womenís actual care-seeking behaviors for a breast cancer symptom. Little attention has been given to the study of actual care-seeking behaviors and psychosocial variables utilizing a care-seeking theoretical framework with a sample of only African American women. No studies were found on the relationship between psychosocial variables and care-seeking behaviors using only African American women with a breast cancer symptom, and no prior studies were found that focused specifically on the psychosocial variables of fear, denial, utility, norm and facilitating conditions as they relate to care-seeking behaviors in either Caucasian or African American women. Lauverís theory of care-seeking guided this research.

Objective: To improve the understanding of care-seeking behaviors for African American women so that earlier intervention for breast cancer symptoms will occur.

Design: Descriptive correlational.

Population, Sample, Setting, Years: Forty-eight African American women with a self-identified breast cancer symptom participated in this study. The sample was selected from a number of primary care clinics/offices, mammography clinics, obstetric/gynecology and surgery clinics/offices, two large African American churches, a womenís outreach ministry, and informal contacts in Rochester and Buffalo, New York. Rigorous recruitment efforts occurred from 1998-2000.

Variables Studied Together: The following intervariable relationships were assessed: a) The relationship between four selected psychosocial variables (fear,denial,utility, and social norm) and care-seeking. b) The relationship between three selected facilitator variables (having an identified health provider, having affordable health care services, and having accessible health-care services and care-seeking. c) Whether utility would moderate the effect of social norm on delay in care-seeking. d) Whether utility would moderate the effect of facilitating conditions on delay in care-seeking. e) Whether denial would mediate the effect of fear on delay in care-seeking.

Methods: A retrospective review of diagnosis codes from billing encounter forms was performed to identify women who presented with a breast complaint within the last year at some primary care clinics/offices located in Western, New York. Prospective identification of women was also conducted at some of these sites as well as other health care facilities (e.g., mammography breast clinics) Participants completed six mailed questionnaires and received a stipend of $10.00. The mean age of subjects was 40, their average income was $20,000)/year, and 58% had more than a high school education. Pearson Product Moment Correlation Coefficient was used to explore relationships among variables. Separate regression analysis was used to test whether denial mediated the effect of fear on delay in care-seeking. Regresssion analysis also was used to test whether utility moderated the effect of facilitating conditions on delay in care-seeking, as well as whether utility moderated the effect of social norm on delay in care-seeking. Additional exploratory analysis with the Ways of Coping Questionnaires was conducted to shed light on the study findings.

Findings: Results revealed that only denial resulted in a significant relationship with delay in care-seeking. In addition, confrontive coping strategies, social support strategies, and problem solving strategies resulted in significant inverse relationships with delayed care-seeking.

Conclusions: Interventions that focus on these coping strategies could be helpful in enhancing early care-seeking.

Implications: Development of interventions that teach African American women these types of coping strategies may be more beneficial in getting African American women to seek care earlier once they detect a symptom.

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