title: Differences in barriers to mammography between rural and urban women.
abstract: BACKGROUND
  Few studies have examined differences between rural and urban women in mammography barriers, knowledge, and experiences. Exploring differences can help inform tailored interventions.
  
  
  METHODS
  Women, aged ≥40, who had not been screened in the past 2 years were recruited from eight federally qualified health centers across Louisiana. They were given a structured interview assessing mammography knowledge, beliefs, barriers, experiences, and literacy.
  
  
  RESULTS
  Of the 1189 patients who participated, 65.0% were African American, 61.6% were rural, and 44.0% had low literacy. Contrary to guidelines, most believed mammography should be done annually (74.3%) before age 40 (70.5%). Compared to urban women, rural participants were more likely to believe mammography will find small breast lumps early (34.4% vs. 6.5%, p<0.0001) and strongly disagree that mammography is embarrassing (14.6% vs. 8.4%, p=0.0002) or that they are afraid of finding something wrong (21.2% vs.12.3%, p=0.007). Rural women were more likely to report a physician recommendation for mammography (84.3% vs. 76.5%, p=0.006), but they were less likely to have received education (57.2% vs. 63.6%, p=0.06) or to have ever had a mammogram (74.8% vs. 78.1%, p=0.007). In multivariate analyses controlling for race, literacy, and age, all rural/urban differences remained significant, except for receipt of a mammogram.
  
  
  CONCLUSIONS
  Most participants were unclear about when they should begin mammography. Rural participants reported stronger positive beliefs, higher self-efficacy, fewer barriers, and having a physician recommendation for mammography but were less likely to receive education or screening.
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA. tdavis1@lsuhsc.edu
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Connie L
authors.initials: CL
authors.lastname: Arnold
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Stacy C
authors.initials: SC
authors.lastname: Bailey
authors.forename: Daci J
authors.initials: DJ
authors.lastname: Platt
authors.forename: Cristalyn
authors.initials: C
authors.lastname: Reynolds
authors.forename: Julie
authors.initials: J
authors.lastname: Esparza
authors.forename: Dachao
authors.initials: D
authors.lastname: Liu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D055088:Early Detection of Cancer / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D057220:Health Literacy; D006297:Health Services Accessibility / Q000592:standards; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D008145:Louisiana; D008327:Mammography / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012923:Social Class; D014505:Urban Population / Q000706:statistics & numerical data*