Breast cancer screening in relation to access to health services.

PURPOSE/OBJECTIVES: This study examined mammography screening and breast self-examination (BSE) in relation to perceived access to health services to identify persistent barriers to earlier detection.

DESIGN: Community-based, cross-sectional, survey, and interview.

SETTING: More than 80 nonhealthcare-related, women's group settings in northern California.

SAMPLE: Convenience sample of 838 black/African American, Latina/Hispanic, and Caucasian/Anglo women varying in age, annual family income, sexual orientation, and educational history.

METHODS: Survey and interview (in English or Spanish) by on-site research assistants facilitating participation of women with limited reading capability.

MAIN RESEARCH VARIABLES: Perceived access to services, breast cancer screening behaviors, acculturation and spoken language, habits of use, perceived prejudice in health delivery, available economic resources, and other social and behavioral variables reported elsewhere.

FINDINGS: Healthcare habits, the perception of prejudicial treatment in health service delivery, spoken language, and three different measures of financial capability explained a large degree of perceived access to services. Perceptions of a lack of access to services were related to decreased mammography screening participation and to decreased BSE behavior.

CONCLUSIONS: Participation in cancer screening depends on real economic access and previous health service delivery experience. BSE behavior may be influenced by lack of money to pay for healthcare services, and experienced prejudice in healthcare delivery appears to have a lasting influence on mammography screening behavior.

IMPLICATIONS FOR NURSING PRACTICE: Tolerance and culturally sensitive service delivery coupled with economic access to both screening and necessary treatment will be vital to eliciting women's complete participation in attaining desired earlier detection goals for breast cancer.