Underutilizers of mammography screening today: Characteristics of women planning, undecided about, and not planning a mammogram

  • Lynn Clemow
  • Mary E. Costanza
  • William P. Haddad
  • Roger Luckmann
  • Mary J. White
  • Deborah Klaus
  • Anne M. Stoddard
Empirical Articles

Abstract

Using concepts from the Precaution Adoption Process Model, we identified behavioral factors, sociodemographic and psychosocial variables, and beliefs about breast cancer that discriminated among women at different stages with regard to their intention to obtain mammography screening. An independent survey company conducted telephone interviews with 2,507 women aged 50 to 80 who were identified as underutilizers of mammography screening. Each underutilizer was assigned to one of three stages with regard to intention to get a mammogram: (a) definitely planning, (b) thinking about, and (c) not planning. Estimated actual risk of breast cancer, perceived risk to breast cancer, worry about breast cancer, and fear of learning from a mammogram that one has breast cancer were variables found to be significantly associated with intention to obtain a mammogram for several subgroups of underutilizing women. There are significant behavioral and psychosocial variables, beliefs and feelings about breast cancer, and demographic characteristics that distinguish underutilizing women at various stages with regard to intention to obtain mammography screening. Our findings provide new information that could help the health care professional motivate women who are not planning to utilize this preventive health measure to become regular utilizers.

References

  1. (1).
    Kerlikowske K, Grady D, Rubin SM, Sandcrock C, Ernster VL: Efficacy of screening mammography.Journal of the American Medical Association. 1995,273(2): 149–154.PubMedCrossRefGoogle Scholar
  2. (2).
    Centers for Disease Control and Prevention: Use of mammography-United States, 1990.Morbidity and Mortality Weekly Report. 1990,39(36): 621–630.Google Scholar
  3. (3).
    Martin LM, Calle E, Wingo PA, Heath, CW: Comparison of mammography and pap test use from the 1987 and 1992 National Health Interview Surveys: Are we closing the gaps?American Journal of Preventive Medicine. 1996,12: 82–90.PubMedGoogle Scholar
  4. (4).
    Hedegarrd HB, Davidson AJ, Wright RA: Factors associated with screening mammography in low-income women.American Journal of Preventive Medicine. 1996,12: 51–56.Google Scholar
  5. (5).
    Zapka JG, Stoddard AM, Costanza ME, Greene HL: Breast cancer screening by mammography: Utilization and associated factors.American Journal of Public Health. 1989,79: 1499–1502.PubMedGoogle Scholar
  6. (6).
    Costanza ME: The extent of breast cancer screening in older women.Cancer. 1994,74(7 Suppl.): 2046–2050.PubMedCrossRefGoogle Scholar
  7. (7).
    Rakowski W, Pearlman D, Rimer B, Ehrich B: Correlates of mammography among women with low and high socioeconomic resources.Preventive Medicine. 1995,24: 149–158.PubMedCrossRefGoogle Scholar
  8. (8).
    Lerman C, Rimer B, Engstrom PF: Reducing avoidable cancer mortality through prevention and early detection regimens.Cancer Research. 1989,49(18): 4955–4962.PubMedGoogle Scholar
  9. (9).
    Rakowski W, Rimer BK, Bryant SA: Integrating behavior and intention regarding mammography by respondents in the 1990 National Health Interview Survey of Health Promotion and Disease Prevention.Public Health Report. 1993,108(5): 605–624.Google Scholar
  10. (10).
    NCI Breast Cancer Screening Consortium: Screening mammography: A missed clinical opportunity? Results of the NCI Breast Cancer Screening Consortium and National Health Interview Studies.Journal of the American Medical Association. 1990,264(1): 54–58.CrossRefGoogle Scholar
  11. (11).
    Zapka JG, Hosmer D, Costanza ME, Harris DR, Stoddard AM: Changes in mammography use: Economic, need, and service factors.American Journal of Public Health. 1992,82(10): 1345–1351.PubMedGoogle Scholar
  12. (12).
    Curry SJ, Emmons KM: Theoretical models for predicting and improving compliance with breast cancer screenings.Annals of Behavioral Medicine. 1994,16(4): 302–316.Google Scholar
  13. (13).
    Coyne CA, Hohman K, Levinson A: Reaching special populations with breast and cervical cancer public education.Journal of Cancer Education. 1992,7: 293–303.PubMedCrossRefGoogle Scholar
  14. (14).
    Rosenstock IM: Historical origins of the Health Belief Model.Health Education Monographs. 1974,2: 1–8.Google Scholar
  15. (15).
    Becker MH: The Health Belief Model and personal health behavior.Health Education Monographs. 1974,2: 324–508.Google Scholar
  16. (16).
    Becker MH, Rosenstock IM: Comparing social learning theory and the Health Belief Model. In Ward WB (ed),Advances in Health Education and Promotion (Vol. 2). Greenwich, CT: JAI Press, 1987.Google Scholar
  17. (17).
    Montano DE, Thompson B, Taylor VM, Mahloch J: Understanding mammography intention and utilization among women in an inner city public hospital clinic.Preventive Medicine. 1997,26: 817–824.PubMedCrossRefGoogle Scholar
  18. (18).
    Phillips KA, Kerlikowske K, Baker LC, Chang SW, Brown ML: Factors associated with women’s adherence to mammography screening guidelines.Health Services Research. 1998,33: 29–53.PubMedGoogle Scholar
  19. (19).
    Aiken LS, West SG, Woodward CK, Reno RR: Health beliefs and compliance with mammography—Screening recommendations in asymptomatic women.Health Psychology. 1994,13: 122–129.PubMedCrossRefGoogle Scholar
  20. (20).
    Hynes DM, Bastian LA, Rimer BK, Sloane R, Feussner JR: Predictors of mammography use among women veterans.Journal of Women’s Health. 1998,7: 239–247.PubMedGoogle Scholar
  21. (21).
    Simon MS, Gimotty PA, Coombs J, et al: Factors affecting participation in a mammography screening program among members of an urban Detroit health maintenance organization.Cancer Detection and Prevention. 1998,22(1): 30–38.PubMedCrossRefGoogle Scholar
  22. (22).
    Cole SR, Bryant CA, McDermott RJ, Sorrell C, Flynn M: Beliefs and mammography screening.American Journal of Preventive Medicine. 1997,13: 439–443.PubMedGoogle Scholar
  23. (23).
    Meischke H, Andersen R, Bowen D, Kuniyuki A, Urban N: A health priorities model: Application to mammography screening.Health Education and Behavior. 1998,25: 383–395.PubMedCrossRefGoogle Scholar
  24. (24).
    Rakowski W, Dube CE, Marcus BH, et al: Assessing elements of women’s decisions about mammography.Health Psychology. 1992,11: 111–118.PubMedCrossRefGoogle Scholar
  25. (25).
    Rakowski W, Fulton JP, Feldman JP: Women’s decision-making about mammography: A replication of the relationship between stages of adoption and decisional balance.Health Psychology. 1993,12: 209–214.PubMedCrossRefGoogle Scholar
  26. (26).
    Weinstein ND: The precaution adoption process.Health Psychology. 1988,7: 355–386.PubMedCrossRefGoogle Scholar
  27. (27).
    Weinstein ND, Sandman PM: A model of the precaution adoption process: Evidence from home radon testing.Health Psychology. 1992,11: 170–180.PubMedCrossRefGoogle Scholar
  28. (28).
    Prochaska JO, DiClemente CC: Stages and processes of self-change of smoking: Toward an integrative model of change.Journal of Consulting and Clinical Psychology. 1983,51: 390–395.PubMedCrossRefGoogle Scholar
  29. (29).
    Weinstein ND, Rothman AM, Sutton SR: Stage theories of health behavior: Conceptual and methodological issues.Health Psychology. 1998,17: 290–299.PubMedCrossRefGoogle Scholar
  30. (30).
    Prochaska JO, DiClemente CC: Common processes of self-change in smoking, weight control, and psychological distress. In Shiffman S, Wills TA (eds),Coping and Substance Use. San Diego, CA: Academic Press, 1985, 345–363.Google Scholar
  31. (31).
    Harrison JA, Mullen PD, Green LW: A meta-analysis of studies of the Health Belief Model with adults.Health Education Research. 1992,7: 107–116.PubMedCrossRefGoogle Scholar
  32. (32).
    Janz NK, Becker MH: The health belief: A decade later.Health Education Quarterly. 1984,11: 1–47.PubMedGoogle Scholar
  33. (33).
    Rakowski W, Stoddard AM, Rimer BK, et al: Confirmatory analysis of opinions regarding the pros and cons of mammography.Health Psychology. 1997,16(5): 433–441.PubMedCrossRefGoogle Scholar
  34. (34).
    Stoddard AM, Rimer BK, Lane D, et al: Underusers of mammogram screening: Stage of adoption in five U.S. subpopulations.Preventive Medicine. 1998,27: 478–487.PubMedCrossRefGoogle Scholar
  35. (35).
    Rakowski W, Fulton JP, Feldman JP: Women’s decision-making about mammography: A replication of the relationship between stages of adoption and decisional balance.Health Psychology. 1993,12(3): 209–214.PubMedCrossRefGoogle Scholar
  36. (36).
    Rimer B, Conaway M, Lyna P, et al: Cancer screening practices among women in a community health center population.American Journal of Public Health. 1996,12(5): 351–357.Google Scholar
  37. (37).
    Gail MH, Brinton LA, Byar DP, et al: Projecting individualized probabilities of developing breast cancer for White females who are being examined annually.Journal of the National Cancer Institute. 1989,81: 1879–1886.PubMedCrossRefGoogle Scholar
  38. (38).
    Hosmer DW, Lemeshow S:Applied Logistic Regression. New York: Wiley, 1989.Google Scholar
  39. (39).
    SAS Institute, Inc:SAS/STAT Statistical Software, Version 6.10. Cary, NC: 1989–1993.Google Scholar
  40. (40).
    Stata Corporation:Stata Statistical Software: Release 5.0. College Station, TX: 1996.Google Scholar
  41. (41).
    Lipkus IM, Rimer B, Strigo T: Relationships among objective and subjective risk for breast cancer and mammography stages of change.Cancer Epidemiology and Biomarkers Prevention. 1996,5: 1005–1011.Google Scholar
  42. (42).
    Rimer BK, Trock B, Engstrom PF, Lerman C, King E: Why do some women get regular mammograms?American Journal of Preventive Medicine. 1991,7(2): 69–74.PubMedGoogle Scholar
  43. (43).
    Siegler IC, Feaganes JR, Rimer B: Predictors of adoption of mammography in women under age 50.Health Psychology. 1995,14(3): 274–278.PubMedCrossRefGoogle Scholar
  44. (44).
    Costanza ME, Stoddard A, Gaw V, Zapka JG: The risk factors of age and family history and their relationship to screening mammography utilization.Journal of the American Geriatric Society. 1992,40: 774–778.Google Scholar
  45. (45).
    Smith RA, Haynes S: Barriers to screening for breast cancer.Cancer. 1992,69(7): 1968–1978.PubMedCrossRefGoogle Scholar
  46. (46).
    Lerman C, Rimer BK, Trock B, Balshem A, Engstrom PF: Factors associated with repeat adherence to breast cancer screening.Preventive Medicine. 1990,19: 279–290.PubMedCrossRefGoogle Scholar
  47. (47).
    Weinstein ND: Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide, sample.Journal of Behavioral Medicine. 1987,10: 481–500.PubMedCrossRefGoogle Scholar
  48. (48).
    Sox CH, Dietrich AJ, Tosteson TD, Winchell CW, Lebaree CE: Periodic health examinations, and the provision of cancer prevention services.Archives of Family Medicine. 1997,6: 223–230.PubMedCrossRefGoogle Scholar
  49. (49).
    Elmore EG, Barton MB, Moceri VM, et al: Ten-year risk of false positive screening mammograms and clinical breast examinations.New England Journal of Medicine. 1998,338: 1089–1096.PubMedCrossRefGoogle Scholar
  50. (50).
    King E, Rimer BK, Trock B, Balshem A, Engstrom P: How reliable are mammography self reports?American Journal of Public Health. 1990,80: 1386–1388.PubMedGoogle Scholar
  51. (51).
    Zapka JG, Bigelow C, Hurley T, et al: Mammography use among sociodemographically diverse women: The accuracy of self-report.American Journal of Public Health. 1996,86: 1016–1021.PubMedCrossRefGoogle Scholar
  52. (52).
    Clemow LP, Luckmann R, Mitchell M, Savegeau J, Costanza ME: Telephone counseling to promote mammography utilization: For whom is it successful?Annals of Behavioral Medicine. 1999,21(Suppl.): 120.Google Scholar

Copyright information

© The Society of Behavioral Medicine 2000

Authors and Affiliations

  • Lynn Clemow
    • 1
  • Mary E. Costanza
    • 1
  • William P. Haddad
    • 1
  • Roger Luckmann
    • 1
  • Mary J. White
    • 1
  • Deborah Klaus
    • 1
  • Anne M. Stoddard
    • 2
  1. 1.University of Massachusetts Medical SchoolUSA
  2. 2.University of MassachusettsUSA

Personalised recommendations