Analyzing Psychosocial Determinants of Mammography Screening Uptake Among Asian American Women Using a Transtheoretical Model

Background and Purpose: Korean American (KA) women experience higher prevalence and lower survival rates of Breast Cancer (BC) than other ethnic groups in the United States, with BC being the most commonly diagnosed form of cancer and the second leading cause of death. Despite the BC burden for KA women, their mammography rate has been significantly lower than the goal specified by the Healthy People 2020. Literature has shown that mammography uptake for KA women is associated with knowledge and doctor’s recommendations. However, there are still many individuals who are aware of mammography and recommended by health providers, yet do not complete the screening. Thus, this study aimed to investigate psychosocial determinants associated with a decisional stage of mammography adoption among KA women using the Precaution Adoption Process Model (PAPM) as a theoretical framework.

Methods: Convenience sampling was conducted to recruit KA women ages 50 to 80 from communities in a southeast metropolitan area. The recruitment strategies included advertisements through a local ethnic radio, senior centers, religious organizations, and referrals. KA women ages below 50 were excluded because the health institutes commonly recommend beginning mammography screening at 50.

A total of 308 KA women participated in a cross-sectional survey, but only 295 of the participants completed the survey. The participants were asked to provide information regarding sociodemographics, regular medical check-up, family cancer history, mammography history, doctor’s recommendation, mammography knowledge, decisional balance scores, and PAPM stage. The main outcome was PAPM stage of mammography adoption in the last two years: stage 1—Unaware, stage 2—Unengaged, stage 3—Deciding, stage 4—Decided No, stage 5—Decided Yes, stage 6—Action, & stage 7—Maintenance.

Results: Descriptive analysis showed that 78.1% of the participants had ever had mammography, while 52.4% had mammography within the past two years. About 21% were in stage 1 (Unaware), 15.3% in stage 2 (Unengaged), 9% in stage 3 (Deciding), 15% in stage 4 (Decided No), 6% in stage 5 (Decided Yes), and 35% in stage 6/7 (Action/Maintenance). Multinomial logistic regression analysis revealed that those in stages 1/2/4 who had never considered nor decided for mammography uptake were likely to have lower scores of decisional balance (OR=0.39; 95% CI=0.16–0.95) and be uninsured (OR=0.20; 95% CI=0.04–0.99), compared to those in stage3 who were considering mammography uptake. Additionally, this study found that those in stage5/6/7 who had ever decided to uptake mammography were likely to have greater perceived mammography self-efficacy (OR=2.99; 95% CI=1.61–5.54) and regular medical check-up (OR=5.10; 95% CI=1.30–20.06), compared to those in stage 3 who were considering mammography uptake.

Conclusions and Implications: The findings suggest interventions designed to deliver stage-matched information of BC screening for increasing the screening among underserved populations. For progress from lower to higher decisional stage of screening adoption, the tailored information should focus on improving self-efficacy, decisional balance, and health insurance coverage pertinent to the screening among targeted audience. Eliminating disparities in cancer screening is critical in advancing health equity in vulnerable people.