Associate Professor University of South Dakota Sioux Falls, South Dakota, United States
Overview: This study conducted qualitative research to assess perspectives of American Indian women towards breast cancer screening, knowledge, barriers, and educational needs about breast cancer and screening.Proposal text:
Background:
American Indian and Alaska Native (AI/AN) women face increasing rates of breast cancer incidence and cancer death with low survival rates, resulting in cancer health disparities. These disparities remain persistent with no sustained improvement. Breast cancer remains the second leading cause of cancer death for AI/AN women. Although AI/AN breast cancer incidence is lower than the incidence in non-Hispanic White (NHW) women, AI/AN women exhibit the highest breast cancer mortality and lowest breast cancer screening rates in the U.S. Considerable regional disparities in cancer incidences and mortality rates exist within the AI population. AI women—particularly those residing in the Northern Plains—have the second highest cancer incident rate within the AI/AN population in the U.S. Within the AI/AN population nationally, Northern Plains AI/ANs have the highest cancer mortality rate (275.5 per 100,000 population). This rate is higher than all races combined in the U.S. (200.9 per 100,000 population). When compared to their NHW regional counterparts and in the U.S., Northern Plains AI/AN women (1) have an elevated risk of developing and/or dying from breast cancer and (2) are more likely to be diagnosed with advanced cancer. These rates indicate critical regional needs for interventions. Thus, this study conducted qualitative research to assess perspectives of AI women towards breast cancer screening, knowledge, barriers, and educational needs about breast cancer and screening.
Methods:
This study, in collaboration with the Yankton Sioux Tribe (YST), followed a community-based participatory research approach and conducted two focus groups with a total of 22 YST women aged 40-70 years living on reservation in rural South Dakota. Using a purposive sampling technique, each group represented one of the main stakeholder categories: (1) YST community members and (2) YST local professionals with backgrounds in cancer and health management (nurses, social service providers, and cancer researchers). A grounded theory was used for the qualitative analysis.
Results:
A large portion of participants reported having prior knowledge about breast cancer and screening methods; yet lacked awareness of the detailed procedure and recommended guidelines. The most important barriers included competing priorities, high cost of mammography, lack of health insurance coverage, lack of availability of screening facilities in the geographical area, transportation, and culturally inappropriate screening services. More important barriers might be related to deep-seated mistrust of medical systems and long-standing oppression and discrimination, highlighting the core importance of building trust over time. Participants wanted to learn—in a convenient and easy-to-understand manner—more about breast cancer and prevention from a credible source. Both groups were favorable toward the novel educational tools (e.g., the mobile web app-based interventions), and cited potential health benefits, particularly for women aged 40s to 60s.
Conclusion:
Our findings highlighted the importance of creating effective, culturally tailored interventions built into programs specific to AIs to increase understanding about breast cancer screening and promote screening behaviors among AI women. Particular attention to how AIs’ culture, beliefs, attitudes, and barriers affect screening behaviors may assist in developing culturally tailored health education tools for this population.
