Barriers to Breast Cancer Screening and Coping Strategies: Findings from Qualitative Study

Background and Purpose: Breast cancer is the second leading cause of cancer-related deaths among women in the U.S, and Korean American immigrant women (KAIW) are no exception to the threat of breast cancer. It is known that KAIW have relatively low breast cancer screening rates compared to other racial/ethnic minority women. There is an increase in the literature examining breast cancer screening behavior in this population. A majority of literature has identified various barriers and facilitators, including sociodemographic characteristics, accessibility to health, and health beliefs. To develop effective intervention strategies, it is critical to understand KAIW’s coping strategies used to face the barriers. This study explored KAIW’s barriers to mammography and their coping strategies within their sociocultural context.

Methods: As part of a larger mixed method study, a total of 30 KAIW participated in semi-structured interviews. They were recruited at various community-based sites such as churches and social service agencies. The mean age of the participants was 54.8 years, and their average time of residence in the U.S was 38.7 years. About 70% of participants completed college or university. Approximately 60% of the participants had a mammogram within two years at the time of being interviewed while 6.7% had never gotten a screening. The interview questions addressed their views on breast cancer and screening, as well as screening experiences (e.g., barriers and motivations). Each interview took between one hour to three hours. All interviews were audio recorded and transcribed verbatim. A thematic analysis (Braun & Clarke, 2006) was used to analyze the data and develop the essential themes discussed.

Findings: Findings revealed two barriers: 1) accessibility issues to mammography (e.g., cost, time-consuming and complicated procedure, limited information, and language issue) and 2) psychosocial concerns to mammography (e.g., no symptoms or feeling safe, uncomfortableness and embarrassment, pain, modesty, and radiation exposure). Study participants had their own ways to deal with the barriers. Cost was reported as a major accessibility challenge. To cope with the financial issue, some participants used free mammogram services when necessary and possible. Other participants with family still living in Korea completed medical examinations including mammography when visiting their family. Given the health care system in Korea (e.g., universal health care and one stop service), having a mammogram in one’s home country was the easiest way to solve all the accessibility issues. The participants expressed a different level of psychosocial concerns and their coping ways were diverse. Some tried to be positive and accept their concerns as a part of procedure (e.g., “pain lasted for only a few seconds”), and others avoided screening or got one irregularly.

Conclusion and Implications:  The findings highlight KAIW’s coping strategies in their cultural context. In order to develop successful interventions, health professionals should account for cultural differences including, but not limited to, patient concerns, access to care, and beliefs surrounding screening processes. The present study provides rich in-depth detail regarding KAIW experiences in mammography screening that may be used in the development of cultural acceptable cancer screening interventions for this population.