title: A transformative decision-making process for mammography screening among rural, low-income women.
abstract: OBJECTIVE
  The study objective was to expand theoretical knowledge of the mammography-screening decision-making process. The purpose of this article was to report the decision-making process of participants who moved from nonscreening to screening.
  
  
  METHODS
  Grounded theory methodology was used. Seventeen rural, low-income women aged 46-64 years were recruited.
  
  
  METHODS
  In-depth, face-to-face interviews were conducted. Semi-structured questions focused on decision making, readiness for change, and health care experiences.
  
  
  RESULTS
  Two phases of decision making were identified. Phase I, A Dormant Period of Nonscreening Behavior, is an inactive screening period characterized by (a) knowledge deficits, (b) unengaged cognition, and (c) misleading perceptions. Phase II, A Transformative Learning Process Resulting in Screening Behavior, is characterized by (a) aroused affective responses, (b) awakened cognitive responses, (c) new knowledge construction, and (d) changed perceptual responses. A catalytic event provides the stimulus to move from Phase I to Phase II. Transformative learning emerged as the central conceptual category underlying the decision to obtain screening. Transformative learning includes a triggering event that facilitates questioning previously held assumptions about mammography.
  
  
  CONCLUSIONS
  Participants demonstrated a transformative process resulting in movement from nonscreening to screening. Further study is needed regarding nursing interventions that serve as catalysts for transformation and subsequent screening.
authors.affiliation: Fay W. Whitney School of Nursing, University of Wyoming, Laramie, Wyoming, USA. mpurtzer@uwyo.edu
authors.forename: Mary A
authors.initials: MA
authors.lastname: Purtzer
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D003071:Cognition; D003657:Decision Making; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008327:Mammography / Q000523:psychology*; D008875:Middle Aged; D011203:Poverty; D012424:Rural Population