BARRIERS TO ABNORMAL MAMMOGRAM FOLLOW-UP

本回顾性研究的目的是探讨一个概念性的

The objective of this retrospective study is to examine a conceptual framework that tests the mechanisms by which lower socioeconomic status (SES), in relation to epidemiological and clinical risk factors, health care system barriers and psychosocial factors, contribute to African- American women experiencing inadequate diagnostic resolution of their abnormal screening mammograms. The specific aims are: 1. Test the first hypothesis that SES will be associated with delay in diagnostic resolution of an abnormal screening mammogram, controlling for family history, symptom status, and degree of mammographic abnormality; 2. Test the second hypothesis that SES will be associated with delay because: a) the port will experience fewer enabling factors (e.g. a regular source of care) and more structural barriers (e.g. no insurance coverage), and b) SES will also be associated with cognitive/attitudinal factors (i.e. perceptions of discrimination, health locus of control, and alienation) among African-American women; 3. Test the third hypothesis that perceived discrimination will be associated with affective factors (i.e. depressive symptoms and cancer anxiety) which in turn will be related to delay in the use of breast cancer diagnostic service; and 4. Supplement these investigation with a qualitative analysis of help- seeking behavior to identify unanticipated factors which influence the perceptions of an choices made by African-American women with abnormal mammograms and to examine the dynamics through which the hypothesized processes have their impact. All English-speaking, African-American (black) female patients with an abnormal mammography finding, requiring short-interval follow-up, will be identified and approached for study participation from a source population presenting for cancer screening services at four screening clinics based at two sites in the Harlem, New York community. Experience at these sites indicates that patients usually receive follow-up appointments one-to-three weeks following an abnormal finding. In order to afford them ample opportunity to follow through with a scheduled appointment (taking into consideration the possibility of broken or missed appointments), these women will be approached and enrolled in the study six months following their abnormal screening result. All eligible women who consent (N=225) will be interviewed in person with a 30-minute structured interviewed approximately six months after the screening test date. Also, a 33% random sample of study participants (n=75) will complete an additional in-depth, 45 minute open-ended, interview. Using a case/control analytic method, women who have not completed diagnostic follow-up within six months of the index mammogram will be defined as cases; and controls will be defined as women who have completed diagnostic follow-up within six months.