title: Identifying barriers and facilitating factors to improve screening mammography rates in women diagnosed with mental illness and substance use disorders.
abstract: Little is known about screening mammography rates among women diagnosed with mental illness-even though some studies have suggested that this population might be particularly vulnerable to breast cancer. The purpose of this pilot study was to identify facilitators and barriers to mammography among women diagnosed with mental illness and/or substance use disorders. Four focus groups were conducted, with a total of 26 women, ages 40-65 years, with mental illness and/ or substance use disorders. Analysis was performed using the grounded-theory editing approach. Several major themes emerged from the transcripts: (1) motivators for obtaining mammograms, (2) fears and concerns, (3) shame and embarrassment, (4) the clinical environment, (5) provider-patient communication, and (6) the need for increased patient education. A family history of breast cancer and/or cancer was the most powerful motivator among focus group participants for obtaining a mammogram. Doctor recommendations and referrals were also identified as key facilitating factors. The overall knowledge of mammography and breast cancer among these women suggested educational deficiencies-despite extensive breast cancer screening and awareness campaigns. The findings highlight the importance of patient education as well as the positive effects of physician recommendations to encourage patients to receive breast cancer screening.
authors.affiliation: Department of Family Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14215, USA. lskahn@buffalo.edu
authors.forename: Linda S
authors.initials: LS
authors.lastname: Kahn
authors.forename: Chester H
authors.initials: CH
authors.lastname: Fox
authors.forename: Julie
authors.initials: J
authors.lastname: Krause-Kelly
authors.forename: Diane E
authors.initials: DE
authors.lastname: Berdine
authors.forename: Renee B
authors.initials: RB
authors.lastname: Cadzow
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D005239:Fear; D005260:Female; D017144:Focus Groups; D006801:Humans; D008327:Mammography / Q000523:psychology*; D008403:Mass Screening / Q000379:methods*; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010865:Pilot Projects; D012752:Shame; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires