title: Assessment of mammography experiences and satisfaction among American Indian/Alaska Native women.
abstract: BACKGROUND
  American Indian/Alaska Native (AI/AN) women have lower breast cancer (BCA) screening and 5-year survival rates than non-Hispanic Whites. Understanding reasons for low screening rates is important to combatting later stage diagnoses. The purpose of this study was to assess mammography experiences and satisfaction among AI/AN women.
  
  
  METHODS
  Nine focus groups were held with rural (N = 15) and urban (N = 38) AI/AN women 40 years and older in Kansas and Kansas City, Missouri, living both near and far from Indian Health Service (IHS) and tribal facilities, to examine experiences and satisfaction with mammography. Transcripts were coded and themes identified using a community-based participatory research approach.
  
  
  RESULTS
  Themes were classified under knowledge, communication, and awareness of BCA; barriers to mammography; mammogram facility size; impressions of mammogram technologist; motivations for getting a mammogram; and how to improve the mammogram experience. Participants had knowledge of prevention, but described cultural reasons for not discussing it and described better experiences in smaller facilities. Participants indicated having a mammogram technologist who was friendly, knowledgeable, respectful, competent, and explained the test was a determining factor in satisfaction. Other factors included family history, physician recommendation, and financial incentives. Barriers included transportation, cost, perceptions of prejudice, and time constraints. Participants on reservations or near IHS facilities preferred IHS over mainstream providers. Suggestions for improvement included caring technologists, better machines with less discomfort, and education.
  
  
  CONCLUSIONS
  Interventions to enhance the professionalism, empathy, and cultural awareness of mammogram technologists; reduce barriers; and provide positive expectations and incentives could improve satisfaction and compliance with screening mammography.
authors.affiliation: Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, Kansas; University of Kansas Cancer Center, Kansas City, Kansas; Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, Kansas. Electronic address: fndikum-moffor@kumc.edu.
authors.forename: Florence M
authors.initials: FM
authors.lastname: Ndikum-Moffor
authors.forename: Stacy
authors.initials: S
authors.lastname: Braiuca
authors.forename: Christine Makosky
authors.initials: CM
authors.lastname: Daley
authors.forename: Byron J
authors.initials: BJ
authors.lastname: Gajewski
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Engelman
mesh_terms: D000328:Adult; D000413:Alaska; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D055812:Community-Based Participatory Research; D055088:Early Detection of Cancer / Q000523:psychology; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D008327:Mammography / Q000523:psychology* / Q000706:statistics & numerical data; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D016549:United States Indian Health Service; D014505:Urban Population