Division of Acute, Critical, and Long Term Care, University of Michigan School of Nursing, 400 N. Ingalls Building, Room 2158, Ann Arbor, MI 48109, United States.
Int J Nurs Stud. 2010 Aug;47(8):975-83. doi: 10.1016/j.ijnurstu.2009.12.014. Epub 2010 Jan 20.
To examine whether and how distrust of the health system and predisposition to use healthcare services influence frequency of mammograms and Clinical Breast Exams (CBEs).
A community-based survey recruited 184 women (age 47+/-12); 49% were college-educated, 77% had health insurance, and 57% were non-white. Distrust was measured with a four-item scale (Cronbach alpha=0.71); predisposition to use health services with an 11-item scale (Cronbach alpha=0.84). Ordinal regression analysis was used to test two models examining "time since last mammogram" and "time since last CBE." The later model had a better goodness-of-fit, as indicated by a non-significant, Pearson coefficient.
Distrust to the health system was significantly correlated with age (r=-0.19*), income (r=-0.16*), and predisposition to use health services (r=-0.26**). Distrust predicted time since last CBE (B: 0.37, SE: 0.19*), which in turn was significantly correlated with time since last mammogram (r=0.44**). Predisposition to use health services predicted time since last CBE (B: -0.78, SE: 0.19**) and time since last mammogram (B: -0.47, SE: 0.22**). Insurance predicted time since last CBE (B: -0.94, SE: 0.44*), while age (B: -0.21, SE: 0.03**) and income (B: -0.19, SE: 0.09*) predicted time since last mammogram.
Distrust of the healthcare system and predisposition to use health services influence breast cancer screening directly. Distrust interferes with behavioral patterns that favor recurrent breast cancer screening.
Trustworthiness in the healthcare system and positive attitudes for the use of, health services enhance routine breast cancer screening. *p<0.05, **p<0.001.
探讨对医疗体系的不信任和使用医疗服务的倾向是否以及如何影响乳房 X 光检查和临床乳房检查（CBE）的频率。
一项基于社区的调查招募了 184 名女性（年龄 47+/-12 岁）；其中 49%受过大学教育，77%有医疗保险，57%是非白人。不信任程度用一个四项目量表（Cronbach alpha=0.71）来衡量；使用一个 11 项量表来衡量使用健康服务的倾向（Cronbach alpha=0.84）。有序回归分析用于检验两个模型，分别检查“上次乳房 X 光检查时间”和“上次 CBE 时间”。后者模型具有更好的拟合优度，皮尔逊系数无显著差异。
对医疗体系的不信任与年龄（r=-0.19*）、收入（r=-0.16*）和使用健康服务的倾向（r=-0.26**）显著相关。不信任预测了上次 CBE 的时间（B：0.37，SE：0.19*），而这又与上次乳房 X 光检查时间（r=0.44**）显著相关。使用健康服务的倾向预测了上次 CBE 的时间（B：-0.78，SE：0.19**）和上次乳房 X 光检查时间（B：-0.47，SE：0.22**）。保险预测了上次 CBE 的时间（B：-0.94，SE：0.44*），而年龄（B：-0.21，SE：0.03**）和收入（B：-0.19，SE：0.09*）预测了上次乳房 X 光检查时间。
对医疗体系的不信任和使用医疗服务的倾向直接影响乳腺癌筛查。不信任会干扰有利于乳腺癌常规筛查的行为模式。
医疗体系的可信度和对健康服务的积极态度有助于常规乳腺癌筛查。*p<0.05，**p<0.001。
