DETERMINANTS OF ADHERENCE AMONG HEALTH DEPARTMENT PATIENTS REFERRED FOR A MAMMOGRAM

This paper examines adherence to a referral for a screening mammogram among an ethnically diverse sample of 576 female county health departm ent patients age 50 and over. Data were obtained by interview approxim ately one year after the referral for a screening mammogram. Overall, approximately 80% of the sample were adherent to the referral. Medical record validation of self-reports of mammography receipt verified rec eipt of a mammogram for 82% of those reporting one. In logistic regres sion analysis, determinants of adherence included: transportation barr iers, fear of immigration authorities, perceived control over getting breast cancer, self-rated health status, age, and perceived quality of provider-patient communication. The most prevalent concerns about mam mography were concern over finding cancer, treatment for breast cancer , and removal of a breast. Reporting of these concerns was not signifi cantly related to adherence. Also reported are barriers to health care experienced by this population over the past 12 months. The high adhe rence rate found in this study emphasizes the importance of provider r eferral in the delivery of screening mammography, and invalidates assu mptions that women of lower education and lower income are less likely to adhere to provider recommendations.