Knowledge, Cancer Fatalism and Spirituality as Predictors of Breast Cancer Screening Practices for African American and Caucasian Women Staci T. Anderson, PhD, RN April 11, 2008

Background Breast cancer is the 2 nd most frequently diagnosed cancer in women. In 2007, an estimated 178,480 new cases of breast cancer will be diagnosed African American (AA) women die from breast cancer more than any other racial group Use of breast cancer screening practices influences mortality and survival rates

Breast Cancer Incidence Age-Adjusted (per 100,000) (National Center for Health Statistics, 2006)

Survival Rates (National Center for Health Statistics, 2006) 5-Year Relative Survival Rates Percentage of Women

Trends in Mortality Rates (National Center for Health Statistics, 2006) Age-Adjusted Rates Per 100,000

Louisiana Trends (NCI SEER State Cancer Profile, 2006) (per 100,000) Per 100,000

Mammography Screening Trends (Centers for Disease Control and Prevention, 2005)

Breast Cancer Screening Barriers –Structural Barriers –Organizational –Psychological Facilitators –Health Insurance –Source of Health Care –Physician Recommendation

Problem Statement Despite improvements in mammography screening rates, differences in breast cancer mortality and survival rates persist between AA and Caucasian women. Differences in utilization of breast cancer screening practices has been identified as a contributing factor to this phenomenon. Various complex and interrelated factors influence participation in breast cancer screening practices.

Purpose To explore relationships between knowledge related to breast cancer screening and detection, cancer fatalism, spirituality and breast cancer screening practices in African American and Caucasian women. To determine the ability of these variables to predict breast cancer screening practices in African American and Caucasian women.

Significance Findings could be used to develop more culturally specific educational interventions. Health care providers need to be aware of an individual’s knowledge, perceptions, beliefs, and attitudes about breast cancer.

Study Variables Breast Cancer Knowledge –Cognitive information about breast cancer and breast cancer detection and screening practices Breast Cancer Screening Practices –Methods used to detect breast cancer in persons who are asymptomatic. BSE CBE Mammogram

Research Hypotheses H 1 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in AA women. H 2 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in Caucasian women.

Research Hypotheses H 3 Breast cancer knowledge is a predictor of breast cancer screening practices in AA women. H 4 Breast cancer knowledge is a predictor of breast cancer screening practices in Caucasian women.

Methodology Study Design –Multicorrelational cross-sectional research design Sampling –Non-probability convenience sample –Inclusion/exclusion criteria Instruments

Measurements Breast Cancer Knowledge Test (BCK) (McCance et al., 1990) –Measures knowledge of detection and screening practices –Higher scores associated with greater knowledge Demographic Questionnaire

Demographic Characteristics Race – 53.7% AA; 46.3% Caucasian Age – 44.7 ± 12.8 Marital Status – 48.8% Married 63.6% Annual Income ≥ $50,000 Education –37.7% College Graduate –18.5% Completed Graduate School

Demographic Characteristics Health Resource Variables –Health Insurance Coverage % –Usual Source of Care – 90.1% Health History –Family history of BC diagnosis (n = 58) 43.1% Participates in BCSP –Family history of BC death (n = 28) 46.4% Participates in BCSP

Breast Cancer Screening Practices AA (n=87) Caucasian (n=75) Total (n=162) Participates % % % Does not Participate % % %

Breast Cancer Knowledge AA (n=87) M Caucasian (n=75) M Total (n=162) M Participates Does not Participate

H 1 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in AA women. Breast Cancer Knowledge Breast Cancer Screening Practices LimitedExtensiveTotal n%n%n% Participates Does Not Participate Totals X 2 = 1.816; df = 1; p =.178

H 2 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in Caucasian women. Breast Cancer Knowledge Breast Cancer Screening Practices LimitedExtensiveTotal n%n%n% Participates Does Not Participate Totals X 2 =.065; df = 1; p =.799

H 3 Breast cancer knowledge is a predictor of breast cancer screening practices in AA women. VariablebBetaSigPercent Explained Breast Cancer Knowledge Constant Multiple R R Total variance explained = 6.0%; variance unexplained = 94.0%.

H 4 Breast cancer knowledge is a predictor of breast cancer screening practices in Caucasian women. VariablebBetaSigPercent Explained Breast Cancer Knowledge Constant Multiple R R Total variance explained = 0.0%; variance unexplained = 100.0%.

Discussion/Conclusions Breast Cancer Screening Practices Breast Cancer Knowledge –No significant relationship found –Caucasian women had higher mean scores Demographics –Income –Education –Health Resources

Implications Nursing Research Nursing Practice Nursing Education –Health & Wellness Model Health Policy –Policy Initiatives –Funding for Research

Limitations Use of self-report data Non-probability convenience sample Recruitment settings Variability of study participants

Recommendations Study designed to determine breast cancer screening practices over time utilizing a larger and ethnically diverse sample Secondary analysis to determine if there are relationships between demographic variables, spirituality, and each method of breast cancer early detection Develop and test culturally specific interventions that focus on increasing breast health and breast cancer screening practices

THANK YOU! QUESTIONS?