Mammography adherence: a qualitative study.
BACKGROUND
Regular mammography accounts for half of the recent declines in breast cancer mortality. Mammography use declined significantly in 2008. Given the success of regular breast cancer screening, understanding why mammography use decreased is important. We undertook a focus group study to explore reasons women who were previously adherent with regular mammography no longer were screened.


METHODS
We conducted 20 focus groups with white non-Hispanic, black non-Hispanic, Hispanic, Japanese American, and American Indian/Alaska Native women, and segmented the groups by age, race/ethnicity, and health insurance status. A conceptual framework, based on existing research, informed the development of the focus group guide. Discussion topics included previous mammography experiences, perceptions of personal breast cancer risk, barriers to mammography, and risks and benefits associated with undergoing mammography. Atlas.ti was used to facilitate data analysis.


RESULTS
All focus groups (n=128 women) were completed in 2009 in five cities across the United States. Half of the groups were held with white non-Hispanic women and the remainder with other racial/ethnic groups. Major barriers to routine mammography included (1) concerns about test efficacy, (2) personal concerns about the procedure, (3) access to screening services, (4) psychosocial issues, and (5) cultural factors. For uninsured women, lack of health insurance was the primary barrier to mammography.


CONCLUSIONS
Multilevel interventions at the health-care provider and system levels are needed to address barriers women experience to undergoing regular mammography screening. Ultimately, breast cancer screening with mammography is an individual behavior; therefore, individual behavioral change strategies will continue to be needed.
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Lisa C
LC
Watson-Johnson
Amy
A
DeGroff
C Brooke
CB
Steele
Michelle
M
Revels
Judith Lee
JL
Smith
Erin
E
Justen
Rachel
R
Barron-Simpson
Latasha
L
Sanders
Lisa C
LC
Richardson
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D001294:Attitude to Health / Q000208:ethnology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000517:prevention & control; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data*; D008403:Mass Screening; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology*; D017060:Patient Satisfaction / Q000208:ethnology*; D044465:White People / Q000706:statistics & numerical data