Reasons Why Low-Income Women in Northwest Missouri Do Not Access No-Cost Mammography Services

Abstract

Mammography is one of the best screening methods to detect early breast cancer, identify the cancer at a more treatable stage, expand treatment options, and reduce mortality. Despite access to no-cost mammography services, Missouri women experience the lowest mammography utilization rate in the nation. In Northwest Missouri the rate of mammography utilization is particularly low: 1 in 3 women over the age of 40 years have never had a mammogram. The purpose of this study was to identify factors that prevent uninsured, low-income women from Northwest Missouri from accessing no-cost mammography services. A narrative descriptive design was utilized to: 1) examine attitudes concerning mammography, 2) gain insight into perceived barriers and facilitators to mammography, 3) gain an understanding of factors influencing mammography behavior and 4) identify potential strategies to increase mammography access and utilization among uninsured, low-income women age 40 to 64 years in Northwest Missouri who have never had a mammogram. Participants in this study (n=12) were recruited from community agencies that provided social services to low-income families. Semi-structured individual interviews were conducted, guided by the Integrated Behavioral Model. Data were analyzed using content analysis to formulate narrative descriptions about attitudes, perceived norms, perceived control, and self-efficacy concerning mammography use. There were four themes that emerged from the data: Competing priorities, the costs of having a `free' mammogram, attitudes about mammography, and navigating the `red tape'. Findings indicated that the participants in this study experienced competing priorities and viewed screening behaviors, such as mammography, as a low priority. These women had conflicting attitudes about the advantages and disadvantages of mammography. Their perceptions about mammography were greatly influenced by family and friends. The overarching barrier to no-cost mammography for each of the participants was the amount of "red tape" encountered when navigating the healthcare system in order to obtain a "free" mammogram. Findings from this study may serve to inform future intervention strategies that may reduce barriers and increase utilization of no-cost mammography programs by eligible women.