title: Distrust, predisposition to use health services and breast cancer screening: results from a multicultural community-based survey.
abstract: OBJECTIVE
  To examine whether and how distrust of the health system and predisposition to use healthcare services influence frequency of mammograms and Clinical Breast Exams (CBEs).
  
  
  METHODS
  A community-based survey recruited 184 women (age 47+/-12); 49% were college-educated, 77% had health insurance, and 57% were non-white. Distrust was measured with a four-item scale (Cronbach alpha=0.71); predisposition to use health services with an 11-item scale (Cronbach alpha=0.84). Ordinal regression analysis was used to test two models examining "time since last mammogram" and "time since last CBE." The later model had a better goodness-of-fit, as indicated by a non-significant, Pearson coefficient.
  
  
  RESULTS
  Distrust to the health system was significantly correlated with age (r=-0.19*), income (r=-0.16*), and predisposition to use health services (r=-0.26**). Distrust predicted time since last CBE (B: 0.37, SE: 0.19*), which in turn was significantly correlated with time since last mammogram (r=0.44**). Predisposition to use health services predicted time since last CBE (B: -0.78, SE: 0.19**) and time since last mammogram (B: -0.47, SE: 0.22**). Insurance predicted time since last CBE (B: -0.94, SE: 0.44*), while age (B: -0.21, SE: 0.03**) and income (B: -0.19, SE: 0.09*) predicted time since last mammogram.
  
  
  CONCLUSIONS
  Distrust of the healthcare system and predisposition to use health services influence breast cancer screening directly. Distrust interferes with behavioral patterns that favor recurrent breast cancer screening.
  
  
  CONCLUSIONS
  Trustworthiness in the healthcare system and positive attitudes for the use of, health services enhance routine breast cancer screening. *p<0.05, **p<0.001.
authors.affiliation: Division of Acute, Critical, and Long Term Care, University of Michigan School of Nursing, 400 N. Ingalls Building, Room 2158, Ann Arbor, MI 48109, United States. mkatapo@umich.edu
authors.forename: Maria C
authors.initials: MC
authors.lastname: Katapodi
authors.forename: Penny F
authors.initials: PF
authors.lastname: Pierce
authors.forename: Noreen C
authors.initials: NC
authors.lastname: Facione
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000523:psychology; D003466:Cultural Characteristics; D003625:Data Collection; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D035502:Trust