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    Assessing Barriers to Mammography: Reducing Disparities for Women with Disabilities

    Scientific Abstract:
    Assessing Barriers to Mammography: Reducing disparities for women with disabilities Scientific Abstract Background: Challenges faced by disadvantaged populations in obtaining mammography services have recently become the focus of many breast health initiatives. However, the considerable and unique barriers faced by women with disabilities in obtaining mammography services have often been overlooked in these outreach efforts. Physical and attitudinal barriers need to be identified and addressed in order to enable women with disabilities to be proactive about their breast health and to define opportunities to educate clinicians and outreach specialists about disability awareness and sensitivity. Objective: This study will identify and describe major barriers faced by women with physical, psychiatric and cognitive disabilities in receiving mammography services, such as: physical access; lack of knowledge about breast health; lack of physician referral; perceived low risk for breast cancer; and attitudes and behaviors of providers. These barriers contribute to the disparity in mammography utilization rates reported for women with disabilities and other populations. Specific Aims: 1. Collect and discuss experiences women with disabilities report when trying to access mammography services to increase our understanding of the knowledge, attitudes and behaviors regarding breast health practices among this population. 2. Identify and classify specific barriers faced by women with different types of disabilities in obtaining mammography services through systematic qualitative analysis of focus group data. 3. Utilize information gathered in this study to develop a model that incorporates interventions to address specific barriers with the goal of increasing the use of mammography services by women with disabilities. Study Design: This is an exploratory study that will collect data through a series of eight facilitated focus groups of women with several types of disabilities. A focus group protocol will be developed, with input from the Advisory Board and an experienced facilitator will be trained to administer this protocol. Focus group participants will be recruited in partnership with disability-specific agencies and community organizations. The evaluation plan for this study will involve monitoring the recruitment for participation in the scheduled focus groups to ensure that the target population is reached. Qualitative data analysis will be conducted on the audiotapes and transcriptions of these focus groups to identify common themes, experiences, and barriers. To facilitate the analysis, an a priori list of barriers will be developed based on the literature and our prior work with this population. Then, the transcripts will be coded for electronic data entry using QSR International's NVivo Version 2.0 software. The Principal Investigator and other members of the research team will review the transcripts to identify new themes and disability-specific responses. Additional code categories are expected to emerge from the in-depth review of the transcripts and the electronic analysis of the coded comments. The findings will be used to produce a taxonomy of identified barriers, including barriers common across all participants and barriers that are unique to specific disabilities. A report will be prepared that can be disseminated to the partnering organizations, describing the kinds of issues that may prevent or discourage women with disabilities from obtaining regular mammograms. Potential Outcomes: This study will include recommendations regarding interventions that may be helpful in promoting the importance of overall breast health care, addressing specific barriers faced by women with disabilities, and enabling women with disabilities to gain better access to mammography services. The results of this study will also help health care clinicians understand barriers and challenges faced by women with disabilities and to improve service delivery to this underserved population. Ultimately, these recommendations to change current behaviors and practices will strive to reduce the disparity in mammography utilization for women with disabilities and help to ensure overall breast health among this disadvantaged population.

    Lay Abstract:
    Lay Abstract Background: One health problem that concerns many women is breast cancer. Scientists know that breast cancer affects one in eight women in their lifetime. Early detection is the key to diagnosing breast cancer at an early stage when it is easier to treat. Early detection also reduces the risk of death from breast cancer. Rationale: Research shows that women who are limited in mobility or have other types of disabilities do not have mammograms as often as others. What are the reasons? For example, physical accessibility may be a barrier, or this population may not think that breast cancer is important because their primary concern is other serious health conditions related to a disability. The purpose of this study is to understand these and other challenges that present barriers for women with physical, psychiatric, and cognitive disabilities. Objectives: Specifically, this study will invite women with different disabilities – including developmental, sight, hearing and mobility impairments - to participate in a series of discussions called “focus groups”. Eight focus groups will be held in different geographical areas in Connecticut. About 10-15 women will be asked to attend each focus group to share their experiences, attitudes, beliefs and practices concerning breast health care and mammography services. A trained and experienced facilitator will lead the groups, and similar questions will be asked among the groups. The specific aims of these groups are: · Learn what women with different disabilities think about breast health and the importance of early detection; · Learn about the problems and difficulties faced by women with disabilities in getting a mammogram; and · Suggest ways that women with disabilities and their health care clinicians may overcome the barriers in getting mammograms to increase breast cancer screening. Outcome: This study will develop a plan to promote breast health practices, address specific barriers faced by women with disabilities, and enable these women to be proactive in seeking preventive health care services. The results of this study will also help clinicians understand barriers and challenges women with disabilities face and educate them about the service delivery needs of this underserved community. Ultimately, these changes in current behaviors and practices will strive to improve and encourage mammography use among women with disabilities and help to ensure their overall breast health.