Health Outcomes & Pharmacy Practice, University of Texas, Austin, TX, USA.
Health Outcomes & Pharmacy Practice, University of Texas, Austin, TX, USA.
J Natl Med Assoc. 2020 Dec;112(6):578-592. doi: 10.1016/j.jnma.2020.05.004. Epub 2020 Jul 5.
The purpose of this study was to assess factors that influence use of mammography screening among African American women, with a focus on social and cultural influences using Andersen's behavioral model (ABM), and to assess the methodological quality of the included studies.
A literature review was conducted using PubMed, CINAHL, PSYCINFO, and Web of Science. Search terms included a combination of the following words using Boolean operators: breast cancer screening, mammography, repeat mammography, and African American. Studies that met the following criteria were included in the review: 1) examined factors associated with mammography screening, 2) included African American women as a majority, 3) published in a peer-reviewed English language journal between 2005 and 2017, and 4) conducted in the United States. Literature reviews, commentaries and non-research studies were excluded. Cited references from identified studies were examined for additional, relevant articles. Associated factors were grouped into predisposing, enabling, and need factor domains of ABM. The reviewed studies were rated using a methodological quality score (MQS) ranging from 0 to 20, with higher scores indicating higher methodological quality.
Twenty-four studies met the inclusion criteria. Fifteen factors that affect breast cancer screening in African American women were identified: predisposing (age, education, knowledge, beliefs, mistrust, religiosity, fears and fatalism), enabling (health insurance, access to care, income, health utilization), and need (physician recommendation, family/personal history, pain/discomfort, family responsibilities) factors. The most common factor was insurance status, although cultural issues (e.g., mistrust) were evident. Most of the identified factors are modifiable. The mean MQS was 12.2, indicating that the studies were slightly above average in quality.
Financial and cultural issues were important hindrances to breast cancer screening in African American women. These findings highlight the importance of affordable health care for preventive health services as well as the relevance of culturally embedded issues to health, while the MQS accentuates the need for more rigorous research articles. Breast cancer screening interventions in this population should attend to barriers identified in this review.
本研究旨在评估影响非裔美国女性进行乳房 X 光筛查的因素，重点关注使用安德森行为模型（ABM）的社会和文化影响，并评估纳入研究的方法学质量。
使用 PubMed、CINAHL、PSYCINFO 和 Web of Science 进行文献回顾。搜索词使用布尔运算符组合了以下词：乳腺癌筛查、乳房 X 光检查、重复乳房 X 光检查和非裔美国人。符合以下标准的研究被纳入综述：1）检查与乳房 X 光筛查相关的因素，2）以非裔美国女性为多数，3）发表在 2005 年至 2017 年期间的同行评议的英文期刊上，4）在美国进行。排除文献综述、评论和非研究性研究。从确定的研究中检查参考文献以获取其他相关文章。将相关因素分为 ABM 的倾向因素、促成因素和需求因素领域。使用 0 到 20 分的方法学质量评分（MQS）对综述研究进行评分，分数越高表示方法学质量越高。
24 项研究符合纳入标准。确定了影响非裔美国女性乳腺癌筛查的 15 个因素：倾向因素（年龄、教育、知识、信念、不信任、宗教信仰、恐惧和宿命论）、促成因素（健康保险、获得医疗服务的机会、收入、医疗利用）和需求因素（医生推荐、家族/个人病史、疼痛/不适、家庭责任）。最常见的因素是保险状况，但文化问题（如不信任）很明显。大多数确定的因素都是可以改变的。平均 MQS 为 12.2，表明这些研究在质量上略高于平均水平。
财务和文化问题是非裔美国女性进行乳腺癌筛查的重要障碍。这些发现强调了为预防性保健服务提供负担得起的医疗保健的重要性，以及文化因素与健康的相关性，而 MQS 则强调了需要更严格的研究文章。针对这一人群的乳腺癌筛查干预措施应关注本综述中确定的障碍。
