Rise Above through Latino Culture: Empowering Latina Immigrants in Breast Cancer Screening

Background: Health disparities in breast cancer screening and outcomes are stark among U.S. Latinas, particularly exacerbated in rural environments. Despite accounting for 9.8% of Oklahoma's population, Latina women face higher mortality rates from breast cancer compared to their non-Latino white counterparts, primarily due to late-stage diagnoses. Current research often aggregates Latina women into a monolithic group, overlooking critical differences by nationality and rural vs. urban residency, which could inform more effective screening interventions. This study targets this gap by focusing on Mexican immigrant women in Oklahoma, comparing rural and urban residents to uncover how distinct cultural and structural barriers shape their screening behaviours.

Methods: This study involved qualitative data from 60 in-depth interviews with Mexican immigrant women, equally divided between rural and urban settings in Oklahoma. The participants, all over 40 years old without a cancer diagnosis, were purposively selected in collaboration with community agencies, ensuring a culturally sensitive recruitment process. Data collection prioritized ethical considerations, including avoiding sensitive immigration status inquiries and providing incentives to respect participants' time and contributions. Interviews were conducted in Spanish, reflecting cultural unity, and audio-recorded with participants' consent. The transcription adhered to strict confidentiality protocols, anonymizing all data to protect participant identity. Data were analyzed using a grounded theory approach, beginning with open coding to identify emergent themes, followed by axial coding to explore the interconnections between cultural beliefs and structural challenges.

Results: The study identified various emotional and structural barriers impacting breast cancer screening among Mexican immigrant women in rural and urban settings. Emotional Barriers: Both groups reported fear and anxiety related to cancer and screening procedures, which often delayed timely screening. Rural participants highlighted fatalismo, a belief in predestination, which exacerbated feelings of helplessness regarding health outcomes. Familismo, or the prioritization of family needs, influenced screening behaviors by motivating women to maintain health for their family's benefit, yet also contributed to delays due to competing family obligations. Structural Barriers: Access to healthcare was inconsistent, with financial constraints and insurance coverage gaps prevalent among both groups. Rural women faced additional challenges, such as limited local healthcare resources and significant transportation issues. Despite these barriers, some women exhibited proactive health behaviors, motivated by a long-term commitment to family welfare, seeking screening to detect and address potential health issues early.

Implications: This study demonstrates the crucial role of culturally sensitive approaches in social work and public health, especially in leveraging cultural values like familismo to enhance health promotion efforts among Mexican immigrant women. It points to the importance of designing social work interventions and public health campaigns that incorporate familial responsibilities, thereby improving engagement with breast cancer screening services. Interventions should be practical, addressing barriers such as time constraints and providing necessary support like transportation and childcare to facilitate screening access. These strategies could significantly boost screening rates by aligning with this population's cultural and practical realities. Future research should tailor these approaches to meet the varied needs of rural and urban Mexican immigrant women, ensuring equitable healthcare access across different community settings.