title: Perceived experiences of discrimination in health care: a barrier for cancer screening among American Indian women with type 2 diabetes.
abstract: OBJECTIVE
  Breast and cervical cancer-mortality disparities are prominent among American Indian women. These disparities, in part, may result from patients perceived experiences of discrimination in health care. This report evaluates the impact of perceived discrimination on screening for breast and cervical cancer in a sample of 200 American Indian women with type 2 diabetes.
  
  
  METHODS
  Data were collected from patient report and medical records. Prevalence of breast and cervical cancer screening were assessed. Unadjusted and adjusted logistic regression analyses were used to assess associations between perceived discrimination, cancer screening status, and patients' health care-seeking behaviors.
  
  
  RESULTS
  Substantial proportions of AI women in our sample were behind the recommended schedules of screening for breast and cervical cancer. Adjusted estimates revealed that perceived discrimination was significantly associated with not being current for clinical breast examination and Pap test, and was close to statistical significance with not being current for mammography. The number of suboptimal health care-seeking behaviors increased with higher mean levels of perceived discrimination.
  
  
  CONCLUSIONS
  Among AI women, perceived discrimination in health care may negatively influence use of breast and cancer screening services, and health care-seeking behaviors. More research is needed among AIs to examine features of health care systems related to the phenomenon patients perceived experience of discrimination.
authors: School of Community Health, College of Urban & Public Affairs, Portland State University, Portland, Oregon 97201, USA. kelly.gonzales@pdx.edu
authors: Kelly L
authors: KL
authors: Gonzales
authors: Anna K
authors: AK
authors: Harding
authors: William E
authors: WE
authors: Lambert
authors: Rongwei
authors: R
authors: Fu
authors: William G
authors: WG
authors: Henderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000523:psychology; D004192:Discrimination, Psychological; D055088:Early Detection of Cancer / Q000379:methods* / Q000523:psychology; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D016015:Logistic Models; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D010465:Perception; D011287:Prejudice; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult