Revisiting rural communities: Novel discoveries and new directions in breast cancer and breast health services

There is growing evidence that breast cancer mortality rates are declining in the general population, however high rates of mortality still exist for populations who are poor, ethnic minorities, and those that live in dispersed, rural communities. Burgeoning research suggests that rural communities have a greater disparity due to limited resources that compromise access, utilization and availability of breast cancer services. The diversity that exists among rural communities including demographic, community, cultural, and organizational resources has not been fully understood. Moreover, gaining an in-depth understanding of these factors as they interface with access and utilization of breast cancer services are salient to ending breast health disparities. To examine these relationships a Community Based Participatory Research approach was implemented to facilitate five focus groups and twenty-four interviews in two communities in rural North Carolina. Comparisons were made to highlight unique factors that preclude and encourage breast cancer services across the continuum of care and identify collaboration and partnership opportunities. Results reveal themes of territorial ownership of health services, lack of communication, and a hierarchy of citizens that marginalizes the poor with racial/ethnic minorities and precludes them from being active participants in community health initiatives. A greater disparity for chronically dispersed populations is evident. This study confirms that unique factors among diverse rural communities exist and significantly influence access and utilization of breast health services in distinct ways. Understanding the underlying dynamics of community relations and perceptions are keys to developing vibrant and empowering health service partnerships and collaborations for priority populations.