title: Breast cancer screening in relation to access to health services.
abstract: OBJECTIVE
  This study examined mammography screening and breast self-examination (BSE) in relation to perceived access to health services to identify persistent barriers to earlier detection.
  
  
  METHODS
  Community-based, cross-sectional, survey, and interview.
  
  
  METHODS
  More than 80 nonhealthcare-related, women's group settings in northern California.
  
  
  METHODS
  Convenience sample of 838 black/African American, Latina/Hispanic, and Caucasian/Anglo women varying in age, annual family income, sexual orientation, and educational history.
  
  
  METHODS
  Survey and interview (in English or Spanish) by on-site research assistants facilitating participation of women with limited reading capability.
  
  
  METHODS
  Perceived access to services, breast cancer screening behaviors, acculturation and spoken language, habits of use, perceived prejudice in health delivery, available economic resources, and other social and behavioral variables reported elsewhere.
  
  
  RESULTS
  Healthcare habits, the perception of prejudicial treatment in health service delivery, spoken language, and three different measures of financial capability explained a large degree of perceived access to services. Perceptions of a lack of access to services were related to decreased mammography screening participation and to decreased BSE behavior.
  
  
  CONCLUSIONS
  Participation in cancer screening depends on real economic access and previous health service delivery experience. BSE behavior may be influenced by lack of money to pay for healthcare services, and experienced prejudice in healthcare delivery appears to have a lasting influence on mammography screening behavior.
  
  
  CONCLUSIONS
  Tolerance and culturally sensitive service delivery coupled with economic access to both screening and necessary treatment will be vital to eliciting women's complete participation in attaining desired earlier detection goals for breast cancer.
authors.affiliation: Department of Physiological Nursing, University of California, San Francisco (UCSF), USA.
authors.forename: N C
authors.initials: NC
authors.lastname: Facione
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000517:prevention & control*; D016504:Breast Self-Examination; D002140:California; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011287:Prejudice; D012959:Socioeconomic Factors