title: Perceptions of barriers and facilitators of cancer early detection among low-income minority women in community health centers.
abstract: African-American and Hispanic women receive fewer indicated cancer early detection services than do majority women. Low rates of cancer screening may, in part, explain the disproportionately higher rates of cancer deaths in this population. The aim of this qualitative study was to explore through individual interviews the perceptions of barriers and facilitators of colorectal, cervical and breast cancer screening among 187 low-income, primarily minority women in four New-York-City-based community/migrant health centers. We identified various barriers and facilitators within each of these categories. Clinician recommendation was the most commonly cited encouragement to cancer screening. Other facilitators of cancer screening identified by patients included personal medical history, such as the presence of a symptom. The perception of screening as routine was cited as a facilitator far more commonly for mammography and Pap tests than for either of the colorectal screenings. Less commonly cited facilitators were insurance coverage and information from the media. The most common barriers were a lack of cancer screening knowledge, patients' perception of good health or absence of symptoms attributable to ill health, fear of pain from the cancer test and a lack of a clinician recommendation. Using standard qualitative techniques, patients' responses were analyzed and grouped into a taxonomy of three major categories reflecting: (1) patients' attitudes and beliefs, (2) their social network experience and (3) accessibility of services. This taxonomy may serve as a useful framework for primary care providers to educate and counsel their patients about cancer screening behaviors.
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, 622 W. 168th St., PH-9W, Room 949, New York, NY 10032, USA. goo1@columbia.edu
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Cassells
authors.forename: Christina M
authors.initials: CM
authors.lastname: Robinson
authors.forename: Katherine
authors.initials: K
authors.lastname: DuHamel
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Tobin
authors.forename: Carol H
authors.initials: CH
authors.lastname: Sox
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Dietrich
mesh_terms: D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D003151:Community Health Centers / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006297:Health Services Accessibility; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D009519:New York City; D011203:Poverty / Q000208:ethnology*; D036301:Qualitative Research; D012938:Social Perception; D012959:Socioeconomic Factors; D013997:Time Factors; D016387:Women's Health / Q000191:economics / Q000208:ethnology*