Follow-up of abnormal screening mammograms among low-income ethnically diverse women: findings from a qualitative study.
OBJECTIVE
To understand factors that women feel facilitate or hinder their receipt of diagnostic services following an abnormal screening mammogram.


METHODS
This qualitative study used a purposive sampling strategy to identify low-income, ethnically diverse women aged 40 or over who had a recent abnormal mammogram. Working with a community health center, breast evaluation center, and mobile mammography van, 64 women were interviewed to identify salient themes that differentiated women who received timely follow-up from those who did not.


RESULTS
Prominent themes among women who delayed follow-up included dissatisfaction with communication of results; perceived disrespect on the part of providers and clinic staff; logistical barriers to access of diagnostic services; anxiety and fear about a possible cancer diagnosis; and a lack of information about breast cancer screening and symptoms. Women who received timely care more often reported an appreciation of efforts by providers and clinic staff to support their prompt follow-up; availability of social support that facilitated appointment-keeping; confidence in their ability to advocate for their health; and a high priority placed on self-care.


CONCLUSIONS
A comprehensive approach to improving timely diagnostic follow-up among underserved groups must address patient beliefs and attitudes, provider practices and communication, and practices at the health care systems level.


CONCLUSIONS
Implications and strategies for improving patient education, patient-provider communication, and organizational practices are discussed.
Allen
Jennifer D
JD
Dana-Farber Cancer Institute, Boston, MA 02115, USA. Jennifer_allen@dfci.harvard.edu
Shelton
Rachel C
RC
Harden
Elizabeth
E
Goldman
Roberta E
RE
D000328:Adult; D001741:Black or African American / Q000208:ethnology; D000359:Aftercare / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D001900:Boston / Q000453:epidemiology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology; D003142:Communication; D018864:Cultural Diversity; D005239:Fear; D005260:Female; D006301:Health Services Needs and Demand; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000208:ethnology; D006801:Humans; D008327:Mammography / Q000523:psychology* / Q000706:statistics & numerical data; D008403:Mass Screening / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D011203:Poverty / Q000208:ethnology* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D036301:Qualitative Research; D020377:Self Efficacy; D012944:Social Support; D011795:Surveys and Questionnaires; D035502:Trust; D044465:White People / Q000208:ethnology; D014930:Women / Q000523:psychology*