Perspectives of African American, Amish, Appalachian And Latina women on breast and cervical cancer screening: implications for cultural competence

J Health Care Poor Underserved. 2008 Feb;19(1):56-74. doi: 10.1353/hpu.2008.0018.


Low-income and minority women are less likely to be screened for breast and cervical cancer and less likely than others to be diagnosed at an early stage in the cancer's growth. We consulted women and providers to understand how social, economic, and health care environments affect screening among African American, Amish, Appalachian, and Latina women, and to outline possible solutions. Women participated in 31 focus groups. Providers completed a mail survey (n=168) and follow-up interviews (n=12). We identified barriers women face: not always following recommendations; feeling intimidated during appointments; having incorrect information about risks, screening guidelines, and programs; and receiving information in ways they cannot understand or accept. Women indicated a strong desire for accurate information and, like the providers, identified strategies for reducing barriers to screening. In the terms of a social ecological model, our results point to three avenues along which to approach cultural competence: 1) policy, 2) health care provision, and 3) clinical care.

MeSH terms

  • Adult
  • African Americans
  • Appalachian Region / ethnology
  • Awareness
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / ethnology*
  • Breast Neoplasms / psychology
  • Cultural Competency*
  • Female
  • Focus Groups
  • Health Behavior / ethnology
  • Health Services Accessibility / organization & administration
  • Hispanic Americans
  • Humans
  • Language
  • Mammography / psychology
  • Middle Aged
  • Practice Guidelines as Topic
  • Protestantism
  • Quality of Life
  • Risk Factors
  • Social Environment
  • Socioeconomic Factors
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / ethnology*
  • Uterine Cervical Neoplasms / psychology
  • Vaginal Smears / psychology