"Siempre Oro": A Grounded Theory Exploration of Faith's Influence on Breast Cancer Screening Among Rural Mexican-Born Women

Background: Health disparities among rural immigrants are a pressing social justice concern; low breast cancer screening rates yield later diagnoses and poorer outcomes. Mexican-born women in rural Oklahoma face barriers like geographic isolation, limited healthcare, language challenges, and immigration-related anxieties. Faith and spirituality influence identity, coping, community networks, and health decisions. Although cultural constructs such as familismo receive attention in the literature, many existing frameworks underestimate the specific impact of faith on the preventive health behaviors of this population. To address this gap, it is crucial to understand how various spiritual beliefs and practices intersect with cultural norms and structural obstacles. The present study investigated the multifaceted role of faith and spirituality in shaping breast cancer screening behaviors among Mexican-born women in rural Oklahoma. The overarching goal was to generate contextual insights for designing culturally resonant interventions and policies aimed at transforming health equity outcomes in this often overlooked community.

Methods: A Straussian grounded theory approach explored this underexplored intersection, building context-informed theory from participant experiences. This qualitative study targeted 350 Mexican-born women aged 40+ in rural Oklahoma. Purposive and snowball sampling via community partners (promotoras, churches, organizations) reached this dispersed population. Data were obtained through semi-structured, in-person interviews, conducted fully in Spanish by trained bilingual researchers in settings selected by participants. This method prioritized cultural humility and rapport, encouraging participants to share candid accounts of their experiences. The interview protocol encompassed questions on a range of spiritual expressions, religious practices (collective and individual), and faith-based worldviews, exploring how these factors inform perceptions of health risks and choices related to screening. Analysis adhered to the constant comparative method, featuring iterative coding with a focus on faith-related elements until theoretical saturation was reached. Rigor was ensured via memoing, journaling, and team coding consensus.

Results: Faith and spirituality emerged as central to health decisions; some prayed before appointments while others viewed check-ups as a sacred commitment. Organized religion often reinforced a sense of duty to stay healthy, whereas individualized spiritual practices focused on emotional calm over directly prompting screening behaviors. Faith operated in synergy with family dynamics, as familismo motivated relatives to encourage screening and reinforce health-promoting messages. In many cases, participants felt compelled to prioritize their family’s immediate needs above their own, revealing how collective cultural values can sometimes conflict with preventive self-care. Those disconnected from church experienced fewer faith-based motivators and limited support, while others exhibited fatalism, deferring health control to a higher power.

Conclusions: Faith has an intricate role, both driving and occasionally hindering screening for these women. Tailored micro/mezzo interventions can partner with faith leaders and promotoras, harnessing trusted church and family channels. Macro policies should address structural challenges like limited transportation, insurance gaps, and culturally competent service needs that compound barriers to preventive care. By highlighting how faith-based perspectives intersect with cultural values and systemic constraints, this study provides guidance for social work, public health, and related disciplines striving to design equitable health interventions that truly align with the experiences and strengths of underserved immigrant groups.