ABSTRACT
This article focuses on the development of a health promotion model programme for elderly Puerto Rican women intended to minimize barriers for early detection of breast cancer and to increase women's compliance with recommended guidelines. The programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non-compliance. It involves the combination of educational and environmental support for actions and conditions conducive to health behaviour and consists of the following components: (i) a culture- and cohort-sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client-physician relationship; (ii) training for primary-care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico; and (iii) coordination of necessary support services to facilitate access to clinical breast exams and mammograms. Programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long-term impact of the programme. Results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p < 0.05) in beliefs after the health education sessions. Interventions in breast cancer early detection practices showed significant changes (p < 0.05) for mammogram and clinical breast examination. Different strategies must be combined to increase older women's compliance with breast cancer screening. Health system and access barriers to preventive care must be addressed.
Subject(s)
Breast Neoplasms/diagnosis , Health Knowledge, Attitudes, Practice , Health Promotion/methods , Aged , Female , Health Education/methods , Humans , Mammography , Outcome and Process Assessment, Health Care , Pilot Projects , Puerto Rico , Surveys and QuestionnairesABSTRACT
This is the first national study of breast-cancer knowledge, beliefs, and early detection practices among elderly women (65+) in Puerto Rico. Cancer breast examination (CBE) was the most common early detection practice, followed by the mammogram, with breast self exam (BSE) a distant third. The primary reasons most often cited for never having a mammogram related to both personal and external factors: not having symptoms, negligence or forgetfulness, and not having a physician's referral. No statistically significant difference (p < 0.05) was found between knowledge and early detection practices. Conversely, beliefs had an impact on preventive behavior. Those who had less misconceptions were most likely to have had a CBE or a mammogram. Bivariate analysis demonstrated that age was associated with performing a BSE once or twice monthly, ever having a mammogram, and having a mammogram in the past two years. A higher socioeconomic status was associated to performing BSE and ever having had a mammogram. Education correlated positively to ever having a mammogram or having a mammogram in the two years prior to the interview. Factors that explained compliance with a mammogram in the last two years included referral from a physician, owning a car, and receiving information after menopause on breast cancer from a health care provider. A gynecological visit increased the probability of having had a mammogram during the last two years. Logistic regression determined that a referral from a physician was the most important factor for mammogram compliance when a combination of variables were considered.
Subject(s)
Humans , Female , Aged , Breast Neoplasms , Health Knowledge, Attitudes, Practice , Mammography , Age Factors , Breast Neoplasms , Breast Self-Examination , Logistic Models , Puerto Rico , Socioeconomic FactorsABSTRACT
OBJETIVOS: Este es un estudio descriptivo y dirigido a identificar las barreras personales y externas, percibidas por las mujeres de 65 años o más en Puerto Rico, para el cumplimiento con las prácticas de detección tempranma del cáncer de mama. En este artículo se presentan los resultados de la primera fase de la investigación cuyo propósito fue el explorar ideas, opiniones y vocabulario utilizado por mujeres de 65 años y mayores en Puerto Rico sobre el cáncer de mama y las prácticas de detección temprana para la construcción de un cuestionario culturalmente apropriado. TRASFONDO: Las mujeres de edad avanzada tienen un riesgo mayor de enfermar y morir de cáncer de mama de las mujeres más jovens. Sin embargo, llevan a cabo con menor frecuencia las prácticas recomendadas para la detección temprana de la enfermedad. Hay muy poca evidencia empírica sobre las barreras que puedan tener estas mujeres para cumplir con dichas prácticas. METODOLOGIA: Se llevaron a cabo siete grupos focales con una población total de 62 mujeres de edad avanzada, estratificada por zona de residencia y nivel educativo. Mediante un análisis de contenido se identificaron las áreas de preocuopación, temas y asuntos relevantes, y el vocabulario utilizado por las mujeres participantes. RESULTADOS: Se evidenciaron barreras personales y relacionadas con el sistema de servicios de salud. La relación médico-paciente y el nivel educativo aparentan ser variables claves para que las mujeres de edad avanzada cumplan con las prácticas recomendadas para la detección temprana del cáncer de la mama.
