Insurance, beliefs or both? Relative impact of insurance and lay models of cancer on mammography adherence

Introduction. Health insurance has been the mainstay for increasing mammography screening. Racial/ethnic disparities in screening adherence, however, persist even among the insured. Studies have failed to consistently demonstrate the role of cultural factors partly due to lack of empirically stable measures. This study linked self-reported knowledge of cancer cause to appropriate mammography utilization, in a multivariate approach. The purpose of this presentation is to demonstrate the complementary roles of health insurance and cultural explanations of cancer in predicting mammography adherence.

Design. 750 women: Caucasian (143), Haitian (284), African-American (163) and Caribbean/Latina (160), comprised the sample. Dependent variables were: age at first mammogram (Uptake) and annual or biennial mammography rate (adherence). Independent variables were 1) race/ethnicity and 2) self-reported knowledge of cancer cause. The key covariate was health insurance type. The impact of self-reported knowledge of cancer cause and the major concepts, on mammography, were explored using logistic regression.

Findings. Self-reported knowledge of cancer cause and non-biomedical concepts, remained independent predictors of mammography adherence and uptake, while insurance type independently predicted uptake and not adherence.

Conclusion. Eliminating disparities in mammography screening will require addressing both the cultural factors and insurance.