title: Clustering very low-income, insured women's mammography screening barriers into potentially functional subgroups.
abstract: BACKGROUND
  Mammography screening is essential for early detection of breast cancer and increased survival rates. Women, particularly those of low socioeconomic status, face barriers that impede their screening adherence. Although many studies have sought to identify these barriers, more research is needed on to address these obstacles in practice. The objective of this study is to divide mammography screening barriers into functional clusters using empirical evidence, which may guide the development of effective mammography screening promotion messages.
  
  
  METHODS
  A sample of 173 low-income White and Black women randomly selected from a managed care organization rated each of 21 potential mammography barriers on a scale ranging from "strongly agree" to "strongly disagree." A maximum clustering similarity method was used to identify relevant clusters of screening barriers.
  
  
  RESULTS
  Five clusters were derived, with a high similarity index (0.881). Each cluster was named to reflect the shared theme of the barriers within it: Perceived Lack of Value in Health Care, Lack of Information, Mistrust/Skepticism, Medical Delay Behavior, and Anxiety/No Control. A dominant barrier within each cluster was identified, and bivariate correlation coefficients were reported.
  
  
  CONCLUSIONS
  Cluster analysis yielded five distinct subgroups of mammography screening barriers.
authors.affiliation: Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, USA. ahmedn@fiu.edu
authors.forename: Nasar U
authors.initials: NU
authors.lastname: Ahmed
authors.forename: Kelly
authors.initials: K
authors.lastname: Winter
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Albatineh
authors.forename: Gillian
authors.initials: G
authors.lastname: Haber
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000523:psychology; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D007407:Interviews as Topic; D008327:Mammography / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D008329:Managed Care Programs; D008403:Mass Screening / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011203:Poverty; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013714:Tennessee; D044465:White People / Q000523:psychology