Table 1 Determinants to breast cancer screening from rapid evidence review and analysis of qualitative data
Breast cancer screening determinant* | Qualitative themes | Representative quotes |
|---|---|---|
• Lack of resources (cost, insurance, transportation) [74, 75] | Participants discussed barriers including lack of resources, such as finances, transportation, work conflicts, anxiety about what to expect during the mammogram, and prior painful and/or negative experience | “I was in West Seattle….a low-income area. And … there need to be more resources …that help out women of color… and explain what mammograms consist of. Talk about the cost of it. Talk about resources that individuals can tap into…to be able to get a mammogram.”—56 year old woman |
• Conflicts with work and/or other competing priorities | ||
• Anxiety about what to expect | ||
• Fear about pain, exposure to radiation or other negative outcomes [33] associated with procedure | ||
• Medical mistrust [78] | ||
• Prior negative experience including experiences of racism [33, 77] | ||
• Lack of knowledge about breast cancer screening [33, 76, 78] | ||
• Inadequate preparation/ information given prior to procedure [33] | ||
• Lack of discussion with friends and family [76] | ||
• Tailored information about breast cancer | Participants emphasized the importance of outreach to get information about breast cancer screening to the community. It was mentioned that a barrier to screening is not being aware that it was something they should do | “How do you know if you're carrying something around, you're sick and you're not knowing what it is, and when you get to the hospital, they diagnosed … you. But there's things that you could have done prior, if you was told. Some people don't know how to reach out.”—56 year old woman |
• Family or personal history of breast cancer (or other cancers) as facilitator to screening [33, 76, 79, 80] | ||
• Recommendations from PCP | Participants discussed lack of or equivocal recommendations by physicians for breast cancer screening, even if they initiated discussion. They also discussed reminders, the time it takes to make an appointment and time until appointment as determinants to scheduling screening | “And now, I just need to bring it up again to my physician. Because I did talk to her about it two to three appointments ago, and she's not putting the referral.” – 42 year old woman |
• Advocacy (or lack of) from PCP | ||
• Time spent to make an appointment | ||
• Time until appointment | ||
• Health-related social support [33] | ||
“I don't think I have been screened this year because of the COVID-19. I've probably seen an email, which is kind of not really personable…because I think in the past I would've got a call…so it didn't make it as urgent or important at the top of the list.” – 52 year old woman |