BREAST SCREENING BY AFRICAN-AMERICAN WOMEN - INSIGHTS FROM A HOUSEHOLD SURVEY AND FOCUS GROUPS

This study uses quantitative and qualitative information to examine th e relationships between predisposing, reinforcing, and enabling factor s from a health education planning model and levels of mammography scr eening, clinical breast exam (CBE), and breast self-exam (BSE) among A frican-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 third s of the random sample and all of the focus group participants had les s than a high school education and household incomes below $10,000. Ev en though both samples of women were likely to have a physician they s ee regularly, most had never had a mammogram and could not accurately describe more than two major techniques for BSE. Knowing guidelines fo r mammography, CBE, and BSE (predisposing factors), believing their sc reening behavior mattered to at least some family members (reinforcing factor), seeing a physician for health care and advice, and having be en 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 guideli nes and having been taught BSE in a physician's office were significan t predictors of breast-screening behavior for both low- and moderate-i ncome women. Focus-group participants unanimously reported a willingne ss 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 physic ians in promoting breast screening among African-American women regard less of their income.