BARRIERS TO ABNORMAL MAMMOGRAM FOLLOW-UP

这项回顾性研究的目的是探讨一个概念 一个测试较低社会经济地位的机制的框架 (SES)在流行病学和临床风险因素方面， 护理系统的障碍和心理社会因素，有助于非洲- 美国妇女经历的诊断分辨率不足， 乳房X光检查异常 具体目标是： 1. 测试第一个假设，即SES将与延迟 异常筛查乳房X线照片的诊断分辨率，控制 家族史、症状状态和乳房X线摄影异常程度; 2. 检验第二个假设，即SES与延迟相关 因为：a）港口将经历较少的有利因素（例如， 常规护理来源）和更多的结构性障碍（例如，没有保险 覆盖范围），和B）SES也将与认知/态度 因素（即对歧视的看法，健康控制点， 异化）在非洲裔美国妇女; 3. 检验第三个假设，即感知到的歧视 与情感因素（即抑郁症状和癌症）相关 焦虑），这反过来又与延迟使用乳房有关 癌症诊断服务;以及 4.用帮助的定性分析补充这些调查- 寻求行为，以确定影响 对非裔美国妇女做出的选择的看法， 乳房X光片，并检查动态，通过假设 过程有其影响。 都是说英语的非裔美国人 （黑人）乳房X线摄影异常的女性患者，需要 短期随访，将被确定并接近研究 参加癌症筛查的来源人群 在纽约哈莱姆的两个地点的四个筛查诊所提供服务 约克社区。 这些研究中心的经验表明， 通常会接受后续任命后一到三个星期， 异常发现 为了给他们足够的机会 通过预约（考虑到 可能会中断或错过预约），这些女性将 在他们的异常行为发生后六个月， 筛选结果 所有同意的合格女性（N=225）将被 亲自面试，30分钟结构化面试 筛选试验日期后约6个月。 此外，33% 研究参与者的随机样本（n=75）将完成额外的 45分钟的开放式访谈。 使用病例/对照分析 方法，在6个月内未完成诊断随访的妇女 将首次乳房X光检查的月数定义为病例;对照组将 被定义为在六个月内完成诊断随访的妇女 个月

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.