Karmanos Cancer Institute, Wayne State University School of Medicine, Department of Oncology, Detroit, MI 48201, USA.
Karmanos Cancer Institute, Wayne State University School of Medicine, Department of Oncology, Detroit, MI 48201, USA.
Soc Sci Med. 2017 Dec;195:149-158. doi: 10.1016/j.socscimed.2017.10.006. Epub 2017 Oct 30.
Prior research shows between-race differences in women's knowledge and emotions related to having dense breasts, thus suggesting that between-race differences in behavioral decision-making following receipt of breast density (BD) notifications are likely. Guided by the theory of planned behavior, this study examined differences in emotion-related responses (i.e., anxiety, worry, confusion) and behavioral cognition (e.g., intentions, behavioral attitudes) following receipt of BD notifications among African American (AA) and European American (EA) women. This study also examined whether race-related perceptions (i.e., discrimination, group-based medical mistrust), relevant knowledge and socioeconomic status (SES) explained the between race differences.
Michigan women (N = 457) who presented for routine screening mammogram and had dense breasts, no prior breast cancer diagnoses, and had screen-negative mammograms were recruited from July, 2015 to March 2016. MANOVA was used to examine between race differences in psychological responses (i.e., emotional responses and behavioral cognition), and a multi-group structural regression model was used to examine whether race-related constructs, knowledge and SES mediated the effect of race on emotional responses and behavioral cognition. Prior awareness of BD was accounted for in all analyses.
AA women generally reported more negative psychological responses to receiving BD notifications regardless of prior BD awareness. AA women had more favorable perceptions related to talking to their physicians about the BD notifications. Generally, race-related perceptions, SES, and related knowledge partially accounted for the effect of race on psychological response. Race-related perceptions and SES partially accounted for the differences in behavioral intentions. Between-race differences in emotional responses to BD notifications did not explain differences in women's intentions to discuss BD notifications with their physicians.
Future examinations are warranted to examine whether there are between-race differences in actual post-BD notification behaviors and whether similar race-related variables account for differences.
先前的研究表明，女性对乳房致密的认知和情绪存在种族差异，这表明在收到乳房密度（BD）通知后，不同种族之间的行为决策可能存在差异。本研究以计划行为理论为指导，考察了在收到 BD 通知后，非裔美国女性（AA）和欧裔美国女性（EA）的情绪相关反应（即焦虑、担忧、困惑）和行为认知（如意图、行为态度）的差异。本研究还检验了种族相关认知（即歧视、基于群体的医疗不信任）、相关知识和社会经济地位（SES）是否能解释这种种族差异。
2015 年 7 月至 2016 年 3 月，从密歇根州参加常规筛查乳房 X 光检查且乳房致密、无乳腺癌既往病史且乳房 X 光检查阴性的女性中招募了 457 名参与者。采用多变量方差分析（MANOVA）比较了不同种族间的心理反应（即情绪反应和行为认知）差异，采用多组结构回归模型检验了种族相关变量、知识和 SES 是否在种族对情绪反应和行为认知的影响中起中介作用。所有分析均考虑了对 BD 的预先认识。
无论预先了解 BD 情况如何，AA 女性对收到 BD 通知的反应通常更为负面。AA 女性对与医生讨论 BD 通知的看法更为有利。总体而言，种族相关认知、SES 和相关知识部分解释了种族对心理反应的影响。种族相关认知和 SES 部分解释了行为意向的差异。对 BD 通知的情绪反应的种族差异并不能解释女性与医生讨论 BD 通知的意图差异。
未来的研究需要进一步检验不同种族之间在实际接受 BD 通知后的行为是否存在差异，以及是否有类似的种族相关变量可以解释这些差异。
