Knowledge, perceptions, and mammography stage of adoption among older urban women

Introduction: Mammography is under-used among older minority women. Identifying differences in their attitudes and beliefs by stage of mammography adoption will guide interventions for these under-studied and under-served women. Methods: A total of 253 older urban women were interviewed, assessing breast cancer knowledge, perceived mammography benefits and barriers, stage of mammography adoption, personal experience with breast cancer, physical and cognitive functioning, smoking status, source and frequency of regular medical care, and demographics. Analyses compared scale scores and individual items by stage of mammography adoption. Multivariate analysis used linear and logistic regression with stepwise model selection. Results: Sample mean age was 72.5 years; 88% were African American. About half (52%) had had a mammogram within the past 2 years (i.e., action stage of mammography adoption). Of the rest, 16% were thinking about having a mammogram in the next 6 months (contemplators) and 32% were not thinking about having a mammogram within 6 months (precontemplators). Knowledge and benefit scores were lowest for precontemplators. Overall barrier scores were highest for precontemplators (P < .001), but contemplators were most likely to worry about finding a lump (P < .05). Lower perceived barriers, provider recommendation, regular medical care somewhere other than a private physician's office, and age <75 years were independently associated with more favorable mammography stage (R-2 = .47). Conclusion: Mammography interventions for older urban women should combine provider recommendations with barrier-reducing interventions. Knowledge is associated with mammography contemplation, but barriers may affect whether contemplation leads to action. Precontemplators may need explanation of the rationale for screening; contemplators may need intervention to assuage fears.