Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor's Name

William W. Darrow

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Elena Bastida

Second Advisor's Committee Title

committee member

Third Advisor's Name

Jessy G. Devieux

Third Advisor's Committee Title

committee chair

Fourth Advisor's Name

Maria E. Villar

Fourth Advisor's Committee Title

committee member

Fifth Advisor's Name

Mary Shaw-Ridley

Fifth Advisor's Committee Title

committee member

Keywords

culture, ethnic identity, social cohesion, ethnic diversity, mammograms, community-based strategies

Date of Defense

5-22-2017

Abstract

Purpose

Study explored the relationships of ethnic identity, culture, and social cohesion to mammography, cancer screening, and preventive medical visits among African-American and Afro-Caribbean women in Broward County, FL. Purpose was to understand non-compliance to screening recommendations for breast cancer among disadvantaged Black women in an area of high prevalence.

Methods

A bounded convenience sample of 117 women (49% African-American and 51% Afro-Caribbean) completed a cross-sectional survey and a subset (n=87) participated in semi-structured discussion groups. Both measured perceptions related to breast cancer, defined ethnic identity or culture, and suggested social and cultural factors influence of ethnic identity, culture, and social cohesion on participation with mammograms and preventive medical care visits. Survey included the Multi-Group Ethnic Identity Measure (MEIM) and Other-Group Orientation Scale (OGO) for ethnic identity and the Risk Behavior Diagnosis Scale for cancer perceptions. Methods were bivariate, Mann-Whitney U, linear, and logistic regression.

Results

Half of participants (51%) self-identified as Caribbean. OGO was positively associated with overall attitudes (p< 0.01), perceived urgency (p = 0.05), and perceived benefit related to breast cancer. Linear regression indicated that Afro-Caribbean women (referent) would perceive less urgency to screen (p = 0.05) and lower risk for breast cancer (p = 0.03) than African-American women. Participants explained that personal and neighborhood cultural norms along with health perceptions along with structural factors connected to access and use of medical services influence Black women’s participation in preventive medical services and cancer screening.

Conclusions

Ethnic identity was associated with women’s perceptions of risk, urgency, and benefit for breast cancer screenings. These perceptions may have had a greater influence on the decisions of Afro-Caribbean women not to comply with screening recommendations or participate in preventive medical care actives than for African-American women. Compliance was also mediated by cultural perceptions of fear, relevance, motivation, and sense of support along with other structural factors. All had contributed to the varying degrees that Black women had sought medical care in this community. Thus, tailoring health interventions to account for variations in within-group characteristics is warranted.

[This research was supported in part by NIH/NIGMS R25 GM061347.]

Identifier

FIDC001967

 

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