Mammgraphy Adherence among Northern Plains Tribes American Indian Women

American Indian women (AIW) are most frequently diagnosed with preventable late stage breast cancer. Purpose: A mixed-method research study was conducted to; 1) understand the cultural meanings of cancer among AIW from the Northern Plains tribes (NPT) and their experiential view of breast screening, 2) examine selected breast cancer screening variables and their relationship to mammography (MG) adherence. Theoretical Framework: The framework used was the Modified Health Belief Model (MHBM). Methods: Using an exploratory design, Talking Circles combined with Affonso's Focus Groups Analytic Schema yielded 10 contextual themes providing a unique perspective for conceptualizing women's cultural experiences with breast cancer screening. Findings were used to inform variables as predictors of MG adherence. The 15 variables selected and screened for inclusion in the final study model were determined by two expert panels. A correlational descriptive design was used to extract electronic data from an existing 5-year (1999-2004) Indian Health Service (IHS) database (n = 1121 women). IHS facilities provide breast cancer screening services to 90 % of NPT AIW residing in the research setting. Results: 1) MG adherence rate was 37.13% (SD = 39.5%); 2) significant predictors of MG adherence were Pap test adherence, number of IHS clinic visits per year, age, and having private insurance, 3) the best fitting prediction model accounted for 49% of the variance in MG adherence and contained variables from all four MBHM-related constructs; selected health promotion/disease prevention behaviors; susceptibility to breast cancer, susceptibility to other health conditions, and MG barriers. Implications: This study identified NPT AIW most at risk for not obtaining breast cancer screening. Such women can be targeted for interventions to improve MG rates and ultimately reduce breast cancer mortality in this “hard to reach” population.The science of health seeking behavior with such populations can be advanced through use of culturally informed, theory-based breast cancer screening interventions.