Although the incidence of breast cancer is almost the same for middle-aged African American and Caucasian women, the rate of patients' following breast cancer screening and following up recommendations differs. African American women are less likely to follow recommendations and have higher mortality rates when compared to Caucasian women. One factor thought to affect compliance with breast cancer screening and follow up is culturally sensitive communication. This purpose of this quantitative correlational study was to determine if the culturally sensitive communication of a medical center influenced compliance with breast cancer screening and follow up and if compliance has an effect on the stage of breast cancer when diagnosed for African American women between the ages of 50 and 74. The research questions were aligned with the theoretical pathways of the Patient-Centered Culturally Sensitive Healthcare Model. This quantitative cross-sectional study was based on secondary data of African American women aged 50-74 from electronic systems for each Southern California location of a national health maintenance organization between the years 2012-2016. The results of the regression analysis from averages of the scores from the Member Appraisal of Physician/Provider Services questionnaire, determined associations between the cultural sensitivity scores of the African American woman's medical center and their compliance with recommendations for breast cancer screening and follow up after screening. However, no association between the stage of cancer and medical center's cultural sensitivity was found. Results can be used to develop cultural sensitivity interventions at medical centers aimed to enhance African American women's compliance with breast cancer screening and follow-up recommendations.

This dissertation examines sociodemographic determinants and preventive health behaviors among women 40-64 years of age who participated in the Virginia Department of Health’s Every Woman’s Life breast cancer screening program. Utilizing secondary data, this research sought to explore patterns of breast cancer incidence, mammography screening utilization and sources of health information among low-income women. The Virginia Department of Health provided a large sample size (N=34,942) on which to perform binary logistic regression analyses. Sociodemographic determinants and preventive health behaviors were analyzed as potential influencing factors in the diagnosis of breast cancer, the stage at the time of diagnosis and source of health information. Additionally, frequencies across all variables were explored and compared to state and national statistics, where appropriate. In this study, cancer and preventive health disparities reported in the literature persist within this sample of low income women. The binary regression analyses demonstrated that there are marginally worse outcomes for each level of decreasing income. Those with the most “wealth” were less likely to be diagnosed with invasive breast cancer and were more likely to obtain health information from a health provider. Additionally, it was determined that those without a prior mammogram were more likely to be diagnosed with breast cancer and the cancer was more likely to be invasive. The aims of the Every Woman’s Life program align with Affordable Care Act (2010) to strengthen health care and eliminate cancer disparities. Highlighting program characteristics and presenting these analyses allows policymakers, program officials and practitioners an opportunity to tailor health promotion activities while considering all tiers of influence.

Breast cancer is a serious illness that often has fatal consequences. Adherence to the recommendations for breast cancer surveillance is poorly practiced among African American women. The purpose of this phenomenological study was to seek individual professed barriers to breast cancer screening among African American women to better understand why breast cancer continues to be one of the principal basis of mortality among African American women. The theoretical framework for this study was the behavioral model of health services use. Purposeful selection was used to invite 14 African American women to participate in the in-depth interview process. Interview data were transcribed and then coded for recurring themes and meaning. The findings of this study demonstrate that these women's perceived barriers to breast cancer screening were lack of information, a belief that genetics dictates who gets breast cancer, embarrassment, a norm of people not going for health checkups, the procedure of breast cancer screening, and fear. Participants noted that the improved method of mammography may promote utilization within the population. Breast cancer disparities among African American women may decline if healthcare providers promote awareness of the availability and accessibility of breast cancer prevention resources and if African American women understand the barriers to breast cancer prevention and change their own screening practices.

The most common and enduring explanation for the way research is used (or abused or not used) in policy is the ‘two communities’ theory. According to this theory, the problematic relationship between research and policy is caused by the different ‘cultures’ inhabited by policy makers and researchers. The most common and enduring types of strategies that are put forward to increase research use in policy involve bridging or linking these ‘two communities’. This study challenges this way of thinking about the relationship between research and policy. Four case studies of national public health policy in Australia—breast cancer screening, prostate cancer screening, needle and syringe programs in the community, and needle and syringe programs in prisons—are used to present the context, events, processes, research, and actors involved in policy making. Three theories are deployed to explore the relationship between research and policy in each of the cases individually and across the cases as a whole. These theories bring different determinants and dynamics of the relationship to light and each is at least partially successful in increasing our understanding of the relationship between research and policy. The Advocacy Coalition Framework (ACF) understands the relationship in terms of a power struggle between competing coalitions that use research as a political resource in the policy process. The Policy Making Organisation Framework (PMOF) understands the relationship in terms of institutional and political factors that determine the way data is selected or rejected from the policy process. The Governmentality Framework (GF) understands the relationship in terms of the Foucauldian construct of power/knowledge that is created through discourse, ‘regimes of truth’ and ‘regimes of practices’ found in public health policy and research. This study has found that in three of the four case studies, public health policy was strongly influenced by research, the exception being NSP in prisons. In all cases, however, it is not possible to construct a robust and coherent account of the policy process or the policy outcome without considering the multifaceted role of research. When these theories are explored at a more fundamental level they support the argument that when research influences policy it is transformed into knowledge-for-policy by being invested with meaning and power. This process of transformation occurs through social and political action that mobilises ideal structures (such as harm minimisation and the World Health Organisation’s principles for evaluating screening programs) and material structures (such as medical journals and government advisory bodies) to resolve meta-policy problems (such as how to define complex public health problems in a way that makes them amenable to empirical research and practical action). This study provides good evidence that the notion of ‘research transfer’ between ‘two communities’ is a flawed way of understanding the research–policy relationship. Rethinking the relationship between research and policy involves building an enhanced theoretical repertoire for understanding this complex social interaction. This step is essential to the success of future efforts to make public health policy that is effective, just and emancipatory. This study makes a contribution to this task.

In 2014, breast cancer was the second leading cause of death among Canadian women, with women over age 50 years making up 82% of the identified cases. To address this issue, the Ontario Breast Screening Program developed a media campaign that promoted the benefits of mammogram screening, but not the associated risks (i.e., false-positive, false-negative, radiation exposure, and overdiagnosis). This study was designed to determine whether there was a statistically significant relationship between knowledge of overdiagnosis and participation in mammogram screening. This cross-sectional, correlational study used schema theory supported by the effective health communication model. Forty-one women were invited to listen to a brief presentation on the benefits and risks of screening mammograms and then completed a modified Champion Health Belief Model Scale survey. Two sample t tests and logistic regression analyses of the survey scores showed that the data did not support any correlations with education and screening, but did indicate a correlation between overdiagnosis and participation. The less a participant felt that overdiagnosis was a negative consequence, the more likely they were to participate in breast screening. Survey participants also stated that promotions of mammograms should present balanced information about the benefits and risks of screening. The positive social change and policy implications of this study include providing women aged 50-69 years more information on overdiagnosis in mammograms so they are more informed participants in the decision-making process, and educating Ontario government policymakers with information about the barriers that women aged 50-69 years face in getting balanced information on mammography programs.

Breast cancer is the second leading cause of cancer death in women in the United States. Several factors have been identified that interfere with women's breast cancer screening practices, including lack of knowledge and confidence in the breast self-examination (BSE) technique, and lack of information provided by health care provider. One of the reasons nurses do not teach breast cancer detection could be the little emphasis given to breast cancer examination in nursing schools. The BSE is a measure of significant value in detecting cancer of the breast. However, less than half of the women in the United States are participating in breast cancer screening. The purpose of this quantitative study was to investigate the relationship between the freshman and senior nursing students' breast cancer knowledge (BCK) and breast self-examination technique confidence (BSE_TC). An online survey was administered to measure the students' BCK and their BSE_TC. The social cognitive theory guided this study. A sample 100 nursing students (54 senior and 46 freshman) were included for hypothesis testing. The study results indicate that senior nursing students had higher mean scores on the BCK and BSE_TC, as would be expected. However, senior nursing students' BCK_BSE_TC scores were also very low. This is a concern for the future of breast cancer detection. This study provides data showing breast cancer screening concepts are unclear to freshman students, and remain unclear with senior students. Nursing educational curricula in breast cancer screening should be revised to affect improvements in nurses' role in advising and educating patients.

Réalisé en cotutelle avec Dr. Béatrice Godard, Professeure titulaire à l'Université de Montréal. / Les écrits scientifiques ont démontré un écart important entre les populations, quant à la survie du cancer du sein. Il s’avèrerait que les femmes immigrantes meurent davantage du cancer du sein que les non-immigrantes. Plusieurs études attribuent ce phénomène à une faible adhérence à la mammographie chez ces femmes. Ainsi, une détection trop tardive de la maladie réduit évidemment les chances de survie. Au Québec, le Programme Québécois de Dépistage du Cancer du Sein envoie une lettre d’invitation aux femmes dès qu’elles atteignent 50 ans. Cette lettre est une prescription pour une mammographie de dépistage. Cette étude a démontré que cette lettre est une barrière à la mammographie pour les communautés immigrantes de Montréal, plus précisément la communauté haïtienne défavorisée, et ce en raison de leur faible niveau de littératie. Suite aux résultats obtenus, nous suggérons des modifications à cette lettre d’invitation, afin qu’elle puisse être accessible à toutes les femmes, dont les femmes de milieux défavorisés. / Research has demonstrated significant disparities amongst populations in regard to chances of survival to breast cancer. It has proven to be the case that immigrant women are more likely to die of breast cancer than non-immigrants. Several studies attribute this to poor adherence to mammography testing within this group of women. Thus, late detection of this disease unavoidably reduces their chances of survival. In Quebec, the Quebec Breast Cancer Screening Program sends a letter of invitation to women when they attain 50 years of age. This letter is a prescription for a screening mammogram. The present study has demonstrated that this letter is a barrier for immigrant communities in Montreal, ore specifically the underprivileged Haitian community. This is due to their low level of literacy. Consecutive to the results obtained in this study, we suggest modifications to the letter of invitation, in order to ensure that its content is accessible to all women, including women in underprivileged circumstances.

Les écrits scientifiques ont démontré un écart important entre les populations, quant à la survie du cancer du sein. Il s’avèrerait que les femmes immigrantes meurent davantage du cancer du sein que les non-immigrantes. Plusieurs études attribuent ce phénomène à une faible adhérence à la mammographie chez ces femmes. Ainsi, une détection trop tardive de la maladie réduit évidemment les chances de survie. Au Québec, le Programme Québécois de Dépistage du Cancer du Sein envoie une lettre d’invitation aux femmes dès qu’elles atteignent 50 ans. Cette lettre est une prescription pour une mammographie de dépistage. Cette étude a démontré que cette lettre est une barrière à la mammographie pour les communautés immigrantes de Montréal, plus précisément la communauté haïtienne défavorisée, et ce en raison de leur faible niveau de littératie. Suite aux résultats obtenus, nous suggérons des modifications à cette lettre d’invitation, afin qu’elle puisse être accessible à toutes les femmes, dont les femmes de milieux défavorisés. / Research has demonstrated significant disparities amongst populations in regard to chances of survival to breast cancer. It has proven to be the case that immigrant women are more likely to die of breast cancer than non-immigrants. Several studies attribute this to poor adherence to mammography testing within this group of women. Thus, late detection of this disease unavoidably reduces their chances of survival. In Quebec, the Quebec Breast Cancer Screening Program sends a letter of invitation to women when they attain 50 years of age. This letter is a prescription for a screening mammogram. The present study has demonstrated that this letter is a barrier for immigrant communities in Montreal, ore specifically the underprivileged Haitian community. This is due to their low level of literacy. Consecutive to the results obtained in this study, we suggest modifications to the letter of invitation, in order to ensure that its content is accessible to all women, including women in underprivileged circumstances. / Réalisé en cotutelle avec Dr. Béatrice Godard, Professeure titulaire à l'Université de Montréal.

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