Cancer Fatalism Among African American Women: Correlates and Change over Time

Background and Purpose: Screening mammography is important for prevention and wellness among middle-aged and older adults. Cancer fatalism, or the belief that there is little one can do to prevent or treat cancer, has been negatively associated with cancer screening.  Cancer fatalism is higher in African Americans than in Whites, and it may help explain disparities in cancer outcomes between these groups. This study investigated correlates of cancer fatalism in African American women, as well as change in fatalism over time.

Methods: In this longitudinal study, 489 African American women age 40 or older from a Midwestern metropolitan area were randomly assigned to watch one of two DVDs, one narrative and one non-narrative, which provided information about breast cancer and screening mammography. The narrative DVD contained videotaped stories from African American breast cancer survivors, whereas the non-narrative DVD presented similar cancer information delivered by a single narrator.  In the sample, 52% of participants reported incomes of $10,000 or less and 67% had a high school education or less.  Mean age was 61 (SD = 12), and at baseline 89% of participants had had at least one prior mammogram.  This secondary data analysis focused on cancer fatalism, which was assessed at baseline (pre-DVD), 3 months, and 6 months using the mean of 3 items from the Powe Fatalism Inventory.  Repeated-measures analysis of variance was used to measure change in fatalism over time, and linear regression was used to analyze correlates and predictors of fatalism.

Results:  Over the 6 months of the study, cancer fatalism declined significantly in both groups (p < .001). Significant correlates of higher baseline fatalism included lower income, lower education, and higher medical mistrust (p < .05); age, history of having a mammogram, numeracy, and valuing experiential knowledge were not significant. At 3 months, baseline fatalism and education were significant predictors of fatalism (p < .005). At 6 months, baseline fatalism and history of having a mammogram were significant predictors (p < .05). DVD group had no effect on cancer fatalism at 3 or 6 months (p = .271).

Conclusions and Implications: Cancer fatalism is more common in women who have lower incomes and lower levels of education.  Providing accurate information about cancer may significantly reduce cancer fatalism, and video methods of preventing information such as DVDs hold promise in conveying accurate and engaging information about cancer.  It may not matter, however, whether such videos are in narrative or non-narrative form.  In setting a research agenda for the future, it is important to continue to investigate the role of fatalism in health disparities and explore innovative strategies to increase laypeople’s knowledge about cancer, especially in vulnerable populations.