Date of Award

2018

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

Sub-Department

The Norman J. Arnold School of Public Health

First Advisor

Heather M. Brandt

Abstract

Extensive research indicates that false-positive mammograms (FPM) have been associated with negative psychosocial and cancer-related beliefs, but only a handful of studies examine Black women’s reactions to this experience. Additionally, these studies do not investigate how organizational and provider-level factors in concert with individual patient characteristics shape Black women’s experiences and reactions to FPM results. The purpose of this study was to determine the impact of organizational, provider, and individual-level factors on the processes and outcomes associated with FPM results in Black women. This study had two specific aims:

1) To describe, using a mixed methods approach, the organizational and provider-level characteristics of mammography facilities and their impact on Black women’s FPM experiences and outcomes.

2) To determine, through quantitative methods, the relationship between receiving a FPM result and future mammography intention among Black women.

Two phases of data collection were conducted as part of this study. Phase I began in March 2016 and concluded October 2016. Observations, key informant interviews, provider surveys, and analyses of screening and diagnostic data were used to describe the facility and provider-level characteristics of five mammography screening centers in the Columbia, South Carolina Metropolitan Statistical Area (MSA). Organizational and provider data collected during Phase I were linked to patient survey data collected during Phase II. The patient survey tool contained items that assessed demographic characteristics, breast cancer (BrCa) screening history, emotional states, coping behaviors, cancer-related beliefs and attitudes in Black women with FPM and normal results. Black women aged 40+, breast cancer free, who completed screening mammograms from January to August 2016 at one of the previously mentioned screening centers were eligible to participate. Women who received a FPM result were selected as cases, matched controls were selected from women screened on the same day and site but had normal mammograms. Patient surveys were administered from July 2016 to January 2017. Of the 132 patient surveys returned, 117 met the criteria for study inclusion.

No facility, provider, or patient factors were associated with two types of satisfaction: general and provider interpersonal style. FPM status was one of several patient characteristics associated with lower levels of satisfaction with convenience and provider information communication. Facility and provider-level factors had negative and positive effects on satisfaction with provider competence. Satisfaction with the clinical environment was also influenced by facility characteristics. FPM status was only associated with a higher perception of barriers to mammography, and perceived barriers were associated with a lower intention to complete mammography. Afrocentric coping behaviors moderated the perception of mammography barriers for women with FPM results, weakening this relationship.

A variety of organizational, provider, and individual-level patient factors were found to influence the processes and outcomes associated with FPM among Black women. Receipt of FPM results appear to have a detrimental effect on mammography satisfaction and intention in in Black women, but culturally-relevant behaviors such as collective coping strategies may reduce the negative effects of FPM status. Study results reinforce the need for incorporating culturally-appropriate theoretical influences and the operationalization of those influences to understand the contributions to racial inequities in BrCa burden.

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