A New Way of Looking at How Culture Affects 'Access, Availability, and Appropriateness' of Preventive Services
Newswise — Philadelphia, Pa. (May 8, 2012) – The disproportionately high impact of breast cancer on African American women may be related to cultural factors affecting perceived access to screening and other breast health care services, according to a paper in the May issue of Advances in Nursing Science. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
In the article, “Theory of perceived Access to Breast Health Care in African American Women,” Sandra Bibb, DNSc, RN, of the Uniformed Services University of the Health Sciences outlines a theory of "perceived access to breast health care"—and how it may help in understanding the increased breast cancer risks among African American women. In her paper, Dr. Bibb "proposes an alternative view of access to care based on an African American woman's perception of the necessity, availability, and appropriateness of breast health care."
An Alternative View of Breast Cancer DisparitiesBreast cancer is a major health problem for all American women, but has a disproportionate impact on African American women, who face higher risks of developing and dying from breast cancer than other racial/ethnic groups. Data suggest that breast cancer mortality rates among African American women are about 40 percent higher than for non-Hispanic white women.
Poor access to breast health care and delayed diagnosis have been viewed as the main reasons for this disparity. But even after accounting for disease stage and improved access to screening, breast cancer mortality rates remain higher for African American women. "These continuing health inequities indicate that the disparity in breast cancer mortality rates in African American women may also be the consequence of a social dynamic," according to Dr. Bibb.
Based on a synthesis of research and theory related to breast cancer, Dr. Bibb has developed a new way of thinking about perceived access to health care in African American women. The best way to reduce breast cancer risk and increase the chances of survival is a "breast health care" approach, which includes health-promotion and disease-prevention behaviors; routine screening and early detection; and early treatment to stop breast cancer progression and prevent complications.
Dr. Bibb believes that interactions between culture and "the shared experience of being an African American woman" have unique effects on perceived access to health care—which in turn affects the likelihood of participating in "clinical preventive services" related to breast health care (such as regular mammograms). Her theory offers a new way of exploring the differences in culture that may lead to a lack of participation in these services.
Cultural Definitions of Health Are Key Starting PointIn Dr. Bibb's view, the many different factors that combine to make up culture all influence the definition of health. To enable early diagnosis of breast cancer, the cultural definition of health must include health promotion and disease prevention practices. In addition, access to breast health care must be perceived as "necessary, available, and appropriate." If any one of these elements is missing, the result may be delayed diagnosis of breast cancer—resulting in fewer treatment options and an increased risk of death.
Thus asking African American women about their definitions of health—as shaped by cultural beliefs, values, and practices—is a critical starting point. Dr. Bibb outlines a research approach using her perceived theory of access to breast health care, including some suggested questions for examining the relationships between culture and definitions of health.
"Understanding how health is defined by African American women is…key to understanding and eliminating barriers which move beyond financial and structural availability of care," Dr. Bibb writes. She believes that acknowledging these perceptions is an essential step toward improving African American women's participation in clinical preventive services to promote breast health—and thus in improving breast cancer outcomes.
"Nurses have a long tradition of focus on culture as a factor in health and well-being," comments Peggy Chinn, RN, PhD, FAAN, Professor Emerita, University of Connecticut School of Nursing and Editor-in-Chief of Advances in Nursing Science. "Dr. Bibb's work is a major contribution to understanding the complex relationships of culture and health, and provides evidence that that guides nursing practice."
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About Advances in Nursing ScienceConsistently ranked as one of the most-read and most assigned journals by faculties of doctoral programs in nursing, Advances in Nursing Science (ANS) is the most stimulating publication in nursing science and education today. ANS is intellectually challenging, yet readable; innovative, yet scientifically sound; reliable research without the tedious, traditional hard science approach found in so many other journals. Each issue features a single timely research topic with exciting implications for patient care. Articles in ANS are peer-reviewed and chosen for their pioneering approaches and perspectives, which set the direction for nursing practice today.
About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).
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