Breast screening by African-American women: insights from a household survey and focus groups.

This study uses quantitative and qualitative information to examine the relationships between predisposing, reinforcing, and enabling factors from a health education planning model and levels of mammography screening, clinical breast exam (CBE), and breast self-exam (BSE) among African-American women. We analyzed data from a random sample household survey of African-American women in a Florida community (n = 281) and three age-homogenous focus groups from the same population. Two thirds of the random sample and all of the focus group participants had less than a high school education and household incomes below $10,000. Even though both samples of women were likely to have a physician they see regularly, most had never had a mammogram and could not accurately describe more than two major techniques for BSE. Knowing guidelines for mammography, CBE, and BSE (predisposing factors), believing their screening behavior mattered to at least some family members (reinforcing factor), seeing a physician for health care and advice, and having been taught BSE in a physician's office (enabling factors) predicted one form of breast screening behavior or another in multivariate logistic regression analyses. In addition, knowing mammography and BSE guidelines and having been taught BSE in a physician's office were significant predictors of breast-screening behavior for both low- and moderate-income women. Focus-group participants unanimously reported a willingness to listen to physician instructions regarding breast screening and to receive a mammogram if their physician recommended one. Both survey and focus group results emphasize the particular importance of physicians in promoting breast screening among African-American women regardless of their income.