Clustering very low-income, insured women's mammography screening barriers into potentially functional subgroups

Womens Health Issues. 2012 May-Jun;22(3):e259-66. doi: 10.1016/j.whi.2012.02.001. Epub 2012 Mar 28.


Background: Mammography screening is essential for early detection of breast cancer and increased survival rates. Women, particularly those of low socioeconomic status, face barriers that impede their screening adherence. Although many studies have sought to identify these barriers, more research is needed on to address these obstacles in practice. The objective of this study is to divide mammography screening barriers into functional clusters using empirical evidence, which may guide the development of effective mammography screening promotion messages.

Methods: A sample of 173 low-income White and Black women randomly selected from a managed care organization rated each of 21 potential mammography barriers on a scale ranging from "strongly agree" to "strongly disagree." A maximum clustering similarity method was used to identify relevant clusters of screening barriers.

Results: Five clusters were derived, with a high similarity index (0.881). Each cluster was named to reflect the shared theme of the barriers within it: Perceived Lack of Value in Health Care, Lack of Information, Mistrust/Skepticism, Medical Delay Behavior, and Anxiety/No Control. A dominant barrier within each cluster was identified, and bivariate correlation coefficients were reported.

Conclusion: Cluster analysis yielded five distinct subgroups of mammography screening barriers.

MeSH terms

  • Adult
  • African Americans / psychology
  • Aged
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / economics
  • Breast Neoplasms / prevention & control
  • Cluster Analysis
  • Cross-Sectional Studies
  • Early Detection of Cancer / psychology
  • Female
  • Health Behavior*
  • Health Knowledge, Attitudes, Practice*
  • Health Services Accessibility
  • Humans
  • Insurance Coverage
  • Interviews as Topic
  • Mammography / economics
  • Mammography / psychology
  • Mammography / statistics & numerical data*
  • Managed Care Programs*
  • Mass Screening / economics
  • Mass Screening / psychology
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Patient Acceptance of Health Care
  • Poverty
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Tennessee
  • Whites / psychology