Cultural barriers to cancer screening among African American women: a critical review of the qualitative literature.

There have been numerous studies demonstrating the enormous cancer burden for African American women and the impact of structural barriers in the dissemination of cancer control interventions. Few of these studies have dealt with the influence of cultural factors in the success or failure of intervention research. The purpose of this review is to provide a critical appraisal of qualitative studies that inform on social-cultural factors in cancer screening programs for African American women, and to evaluate the extent to which general methodologic criteria have been used in these studies. The article discusses the theoretical underpinnings of social science qualitative methodologies, including ethnography, hermeneutics, ethnomethodology, and symbolic interactionism. Published qualitative studies from 1980 to 1996 on cancer screening among African American women are critically reviewed. Among the themes identified were bruises as contributory to breast cancer development; the low priority women placed on personal preventive screening behaviors in the context of other family health priorities; and the importance of female friends, relatives, and social networks in the flow of cancer information. The importance of qualitative approaches to cancer prevention and control programs and policies is threefold: (a) collection of greater depth of information, (b) identification of processes and relations among behaviors, and (c) framing of variables and hypotheses for quantitative research. Greater emphasis on methodologic rigor will be necessary, however, if qualitative studies of cancer screening are to effectively inform the development of research, programs, and policies.