Awareness of and reactions to mammography controversy among immigrant women

• Published in: Health expectations : an international journal of public participation in health care and health policy Vol. 20; no. 4; pp. 638 - 647
• Main Authors: Nagler, Rebekah H., Lueck, Jennifer A., Gray, Lauren S.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.08.2017; John Wiley and Sons Inc
• Subjects: Adult; Age; Analysis; Awareness; Breast cancer; Breast Neoplasms - diagnosis; Choices; Clinical decision making; Communication; community‐engaged research; controversy; Debates; Decision making; Disputes; Early Detection of Cancer; Efficacy; Emigrants and Immigrants - psychology; Ethnic Groups - psychology; Female; Focus Groups; Grounded theory; Health; Health care access; Health disparities; Health information; Health Knowledge, Attitudes, Practice; Health literacy; Health promotion; Hispanic people; Hmong people; Humans; immigrant women; Immigrants; Inequality; Latin American cultural groups; Mammography; Mammography - psychology; Mass media; Media; Medical screening; Metropolitan areas; Middle Aged; Noncitizens; Original Research Paper; Original Research Papers; Participation; Population; Public opinion; Researchers; Self-efficacy; Socioeconomic Factors; Underserved populations; United States; Women; Womens health; United States > US; immigrant women; community-engaged research; awareness; mammography; controversy
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.12494

Background There is substantial expert disagreement about the use of mammography to screen for breast cancer, and this disagreement routinely plays out in the media. Evidence suggests that some women are aware of the controversy over mammography, but less is known about whether immigrant and other underserved women have heard about it and, if so, how they react to it. Objective To explore immigrant women's awareness of and reactions to mammography controversy. Design Community‐engaged qualitative study: we conducted six focus groups with 53 women aged 35–55 from three immigrant communities (Somali, Latina and Hmong) in a major US metropolitan area. A grounded theory approach was used to identify themes; NVivo 10 was used to enhance analyses. Results Several themes emerged: (i) low awareness of mammography controversy across groups, despite self‐reported attention to health information; (ii) high intentions to be screened, even after being told about the controversy; (iii) few reported discussions of mammography's risks and benefits with clinicians; (iv) substantial interest in learning more about mammography and breast cancer, but some low self‐efficacy to obtain such information; and (v) questions about whether health recommendations matter and what qualifies as evidence. Conclusion Given on‐going expert disagreement about mammography screening, it is important for clinicians to help women understand mammography's risks and benefits so they can make an informed choice. This is particularly critical for immigrant and other underserved women, who may be less able to access, attend to, process, retain and act on health information (a phenomenon known as communication inequality).