Using a community-based participatory approach to examine the behavior of getting a regular mammogram among rural women; An application of Reasoned Action Approach

Background: Breast cancer is a major health issue among women living in rural areas in the US. Getting a regular mammogram can detect breast cancer at early stages and reduce the mortality rate. The purpose of this study was to identify the salient beliefs rural women hold about getting a mammogram.

Methods: A paper-pencil, salient belief elicitation survey was conducted among women between the ages of 40 and 74 living in rural southern Indiana. This study was conducted using CBPR principles. Following the Reasoned Action Approach, open-ended questions were asked to elicit salient consequences, salient referents, and salient circumstances about getting a regular mammogram as well as demographic and health behavior questions.

Results: Content analyses of responses to open-ended responses revealed five salient consequences, including detecting cancer early, providing peace of mind, causing pain, exposure to radiation and leading to cancer diagnosis. Asking who approved of getting a mammogram revealed personal doctor, family including husband, mother and sister, friends, health insurance provider as salient referents.  Most commonly mentioned circumstances included having insurance, having enough time, being able to get convenient appointments, receiving a reminder, receiving fast results, and having friendly staff.

Implications: The results were used to develop a RAA-based quantitative closed-ended instrument to further examine the belief structure of women who intend to get a regular mammogram. Theory-driven and CBPR-based interventions should be designed by using perceived intrapersonal and interpersonal determinants of women in order to increase the rate of regular mammography in rural areas and changing policy.