1. Knowledge, Cancer Fatalism and Spirituality as Predictors of Breast Cancer Screening Practices for African American and Caucasian Women Staci T. Anderson, PhD, RN April 11, 2008

2. Background Breast cancer is the 2 nd most frequently diagnosed cancer in women. In 2007, an estimated 178,480 new cases of breast cancer will be diagnosed African American (AA) women die from breast cancer more than any other racial group Use of breast cancer screening practices influences mortality and survival rates

3. Breast Cancer Incidence Age-Adjusted (per 100,000) (National Center for Health Statistics, 2006)

4. Survival Rates (National Center for Health Statistics, 2006) 5-Year Relative Survival Rates Percentage of Women

5. Trends in Mortality Rates (National Center for Health Statistics, 2006) Age-Adjusted Rates Per 100,000

6. Louisiana Trends (NCI SEER State Cancer Profile, 2006) (per 100,000) Per 100,000

7. Mammography Screening Trends (Centers for Disease Control and Prevention, 2005)

8. Breast Cancer Screening Barriers –Structural Barriers –Organizational –Psychological Facilitators –Health Insurance –Source of Health Care –Physician Recommendation

9. Problem Statement Despite improvements in mammography screening rates, differences in breast cancer mortality and survival rates persist between AA and Caucasian women. Differences in utilization of breast cancer screening practices has been identified as a contributing factor to this phenomenon. Various complex and interrelated factors influence participation in breast cancer screening practices.

10. Purpose To explore relationships between knowledge related to breast cancer screening and detection, cancer fatalism, spirituality and breast cancer screening practices in African American and Caucasian women. To determine the ability of these variables to predict breast cancer screening practices in African American and Caucasian women.

11. Significance Findings could be used to develop more culturally specific educational interventions. Health care providers need to be aware of an individual’s knowledge, perceptions, beliefs, and attitudes about breast cancer.

12. Study Variables Breast Cancer Knowledge –Cognitive information about breast cancer and breast cancer detection and screening practices Breast Cancer Screening Practices –Methods used to detect breast cancer in persons who are asymptomatic. BSE CBE Mammogram

13. Research Hypotheses H 1 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in AA women. H 2 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in Caucasian women.

14. Research Hypotheses H 3 Breast cancer knowledge is a predictor of breast cancer screening practices in AA women. H 4 Breast cancer knowledge is a predictor of breast cancer screening practices in Caucasian women.

15. Methodology Study Design –Multicorrelational cross-sectional research design Sampling –Non-probability convenience sample –Inclusion/exclusion criteria Instruments

16. Measurements Breast Cancer Knowledge Test (BCK) (McCance et al., 1990) –Measures knowledge of detection and screening practices –Higher scores associated with greater knowledge Demographic Questionnaire

17. Demographic Characteristics Race – 53.7% AA; 46.3% Caucasian Age – 44.7 ± 12.8 Marital Status – 48.8% Married 63.6% Annual Income ≥ $50,000 Education –37.7% College Graduate –18.5% Completed Graduate School

18. Demographic Characteristics Health Resource Variables –Health Insurance Coverage - 94.4% –Usual Source of Care – 90.1% Health History –Family history of BC diagnosis (n = 58) 43.1% Participates in BCSP –Family history of BC death (n = 28) 46.4% Participates in BCSP

19. Breast Cancer Screening Practices AA (n=87) Caucasian (n=75) Total (n=162) Participates39 44.8% 27 36.0% 66 40.7% Does not Participate48 55.2% 48 64.0% 96 59.3%

20. Breast Cancer Knowledge AA (n=87) M Caucasian (n=75) M Total (n=162) M Participates13.7714.5614.09 Does not Participate12.3514.2113.28

21. H 1 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in AA women. Breast Cancer Knowledge Breast Cancer Screening Practices LimitedExtensiveTotal n%n%n% Participates1737.02253.73944.8 Does Not Participate2963.01946.34855.2 Totals46100.041100.087100.0 X 2 = 1.816; df = 1; p =.178

22. H 2 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in Caucasian women. Breast Cancer Knowledge Breast Cancer Screening Practices LimitedExtensiveTotal n%n%n% Participates832.01938.02736.0 Does Not Participate1768.03162.04864.0 Totals25100.050100.075100.0 X 2 =.065; df = 1; p =.799

23. H 3 Breast cancer knowledge is a predictor of breast cancer screening practices in AA women. VariablebBetaSigPercent Explained Breast Cancer Knowledge.042.244.0226.0 Constant-.100-- Multiple R R 2. 244.060 Total variance explained = 6.0%; variance unexplained = 94.0%.

24. H 4 Breast cancer knowledge is a predictor of breast cancer screening practices in Caucasian women. VariablebBetaSigPercent Explained Breast Cancer Knowledge.021.092.452-- Constant-.080-- Multiple R R 2.099.010 Total variance explained = 0.0%; variance unexplained = 100.0%.

25. Discussion/Conclusions Breast Cancer Screening Practices Breast Cancer Knowledge –No significant relationship found –Caucasian women had higher mean scores Demographics –Income –Education –Health Resources

26. Implications Nursing Research Nursing Practice Nursing Education –Health & Wellness Model Health Policy –Policy Initiatives –Funding for Research

27. Limitations Use of self-report data Non-probability convenience sample Recruitment settings Variability of study participants

28. Recommendations Study designed to determine breast cancer screening practices over time utilizing a larger and ethnically diverse sample Secondary analysis to determine if there are relationships between demographic variables, spirituality, and each method of breast cancer early detection Develop and test culturally specific interventions that focus on increasing breast health and breast cancer screening practices

29. THANK YOU! QUESTIONS?