The theory of planned behavior and intention to repeat mammography among African-American women

Because minority women remain underusers of mammography screening, strategies to increase preventive health behavior may involve affordable screening as well as cultural determinants. Most studies have used a theoretical model inconsistently to assess characteristics, such as attitudes, beliefs, and perceptions about adherence to screening, whereas other studies have lacked sociocultural dimensions that may be relevant in promoting repeat screening in certain populations. This two-phase study examined adherence to mammography screening among 150 African-American women aged 40 to 49 years who had received one to five mammograms. Phase I included an elicitation procedure, a focus group, and pretests as steps in constructing a telephone interview. In Phase II, 150 telephone interviews were completed. Women's intentions regarding repeat mammography screening were assessed using the theory of planned behavior, expanded to include sociocultural, religious, and psychological variables. Only the attitude and perceived behavioral control components of the theory explained the women's intentions. In the expanded model, a positive previous experience with mammography, low income and educational level, positive beliefs about breast health, and lack of trust in health care providers explained increased intention to have another mammogram. The study's clinical and policy implications were positive: When low-income African-American women are exposed to screening programs that provide positive experiences with mammography and include a strong component to enhance adherence, their intention to seek repeat screening increases. This level of health care needs to be adopted as standard practice for optimal breast health among all women.