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Increasing Screening Mammography Among Immigrant and Minority Women in Canada: A Review of Past Interventions

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Abstract

Screening mammograms are important to detect breast cancer at earlier and more treatable stages. Immigrant and minority women report low participation rates due to barriers related to cultural beliefs and norms, privacy/modesty, and language. This review examines whether screening mammogram interventions in Canada and other countries with comparable health-care systems have addressed the needs of these women. Our systematic literature search identified studies that focused on increasing screening mammogram participation among immigrant and/or minority women. We used the Health Belief Model and the PRECEDE-PROCEED Model to guide our critical synthesis of the reviewed interventions and the recommendations for the future. Eight studies met the search criteria. Overall, interventions showed some increase in mammogram participation rates. The barriers targeted were relatively similar across studies and there was a focus on increasing cues to screening. This review illustrates that it is essential to develop and implement programs to overcome the unique barriers to screening mammography if we are to increase participation among immigrants and minority women. We suggest other potentially effective health promotion strategies as a starting point for discussion and future research.

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Notes

  1. American studies were excluded because due to the USA’s privatized health care system, issues surrounding health insurance, cost of screening, and income, which have been reported to be associated with utilization of health services and mammograms in the USA [50], [61] would interfere with the generalizability to the Canadian context. In addition, much of the mammogram participation in the USA occurs via opportunistic screening, whereas Canada and other Westernized countries such as the United Kingdom and Australia have implemented organized screening programs to complement or gradually replace opportunistic screening [62]. Studies from non-Westernized countries were also excluded, because it was concluded that it would be important to highlight the difficulties immigrant and minority women face in screening participation in primarily Caucasian-populated/Westernized countries.

  2. We excluded anecdotal descriptive reports because of possible problems with analysis in terms of the reporting of study designs, statistical analyses, and participation rates.

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Acknowledgments

A version of this paper was awarded the Best Doctoral Paper in 2010 by the Justice Emmett Hall Memorial Foundation. We would like to acknowledge Dr. Sandra L. Bullock and Dr. Paul McDonald for their assistance in developing the topic for this paper, and Ashley Johns, MSc, for her help with editing. Partial work on this paper was supported by a Social Science and Humanities Research Council (SSHRC) Doctoral Award and a University of Waterloo President’s Graduate Scholarship.

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Authors and Affiliations

  1. School of Public Health & Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada

    Nour Schoueri-Mychasiw

  2. Propel Centre for Population Health Impact, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada

    Sharon Campbell

  3. Canadian Partnership Against Cancer, 1 University Avenue, 3rd Fl., Toronto, ON, M5 J 2P1, Canada

    Verna Mai

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  1. Nour Schoueri-Mychasiw
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Schoueri-Mychasiw, N., Campbell, S. & Mai, V. Increasing Screening Mammography Among Immigrant and Minority Women in Canada: A Review of Past Interventions. J Immigrant Minority Health 15, 149–158 (2013). https://doi.org/10.1007/s10903-012-9612-8

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