title: Factors that influence mammography use among older American Indian and Alaska Native women.
abstract: BACKGROUND
  American Indian and Alaska Native (AIAN) women have relatively high breast cancer mortality rates despite the availability of free or low-cost screening.
  
  
  OBJECTIVE
  This qualitative study explored issues that influence the participation of older AIAN women in mammography screening through tribally directed National Breast and Cervical Cancer Early Detection Programs (NBCCEDPs).
  
  
  METHODS
  We interviewed staff (n = 12) representing five tribal NBCCEDPs and conducted four focus groups with AIAN women ages 50 to 80 years (n = 33).
  
  
  RESULTS
  Our analysis identified four main areas of factors that predispose, enable, or reinforce decisions around mammography: financial issues and personal investments, program characteristics including direct services and education, access issues such as transportation, and comfort zone topics that include cultural or community-wide norms regarding cancer prevention.
  
  
  CONCLUSIONS
  This study has implications for nurse education and training on delivering effective mammography services and preventive cancer outreach and education programs in AIAN communities.
authors.affiliation: University of Washington, Seattle, WA, USA rdjames@u.washington.edu.
authors.forename: Rosalina D
authors.initials: RD
authors.lastname: James
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Dana E
authors.initials: DE
authors.lastname: Gold
authors.affiliation: Cheyenne River Sioux Tribe CDC NBCCEDP, Eagle Butte, SD, USA.
authors.forename: Arlene
authors.initials: A
authors.lastname: St John-BlackBird
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Brown Trinidad
mesh_terms: D000368:Aged; D000413:Alaska; D001943:Breast Neoplasms / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008327:Mammography / Q000523:psychology* / Q000706:statistics & numerical data; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D016387:Women's Health
keywords: Alaska Native; American Indian; breast cancer; community health; mammography; screening; transcultural health; women’s health