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SUMMARY
Data was collected by a survey of Appalachian women (age 40 years and older) at a large three-day rural health fair, the Remote Area Medical (RAM) fair, in a rural underserved Virginia county. The health fair is free and attracts very rural and uninsured persons, many with untreated illnesses. The survey studied patterns of use of the healthcare system. Though 90% of survey participants received care at a doctor’s office or clinic within the last year, there appeared to be resistance to participating in breast cancer screening. Using standard national survey questions and definitions, 30% of participating women were defined as underscreened (rarely or never screened). A majority of the underscreened women believed early cancer detection resulted in lives saved and a vast majority believed that most women survive breast cancer beyond five years. These results suggested the presence of optimism, not fatalism, regarding screening and breast cancer survival. The data suggested the presence of understanding about the importance of breast screening. Barriers to screening behavior may include:
1) low perceived risk;
2) low life priority (e.g., “My health isn’t a high priority”);
3) poor access to screening facilities.
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SUMMARY
9.1 Screening rates were higher than expected, particularly compliance with annual screening in a population where financial and geographic access barriers are substantial. The women we surveyed also showed significant abilities to access healthcare (mammograms and visits for other medical reasons).
9.2 Attitudes and beliefs that might pose barriers to obtaining breast cancer screening were not widely evident in our survey participants.
9.3 More women in the “never screened” group believed their risk of getting breast cancer was below average.
9.4 Women in the “never screened” group also were more likely to think most women survived breast cancer. This sense of reduced disease severity (from Health Belief Model), combined with lower perceived self-risk for getting cancer (reduced susceptibility), may be a powerful deterrent to screening for women who need to overcome significant barriers to access healthcare services.
9.5 Recommendations
a. Interpersonal compliance-gaining techniques are vital to securing women’s regular participation in breast cancer screening.
b. Approaches to communicating breast cancer risk should be reconsidered: (a) by focusing messages to capture the attention of women who may be at higher risk, lower risk women may be ignored; and (b) there is the possibility to make substantial progress in reaching non-screened women if we focus on addressing perceptions of risk.
c. Form partnerships to help primary care physicians, already over-extended, form new scripts (communicative guidelines) about how to urge the “rarely” and “never” populations to have regular screening.
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