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    Research Grants Awarded

    Needs and Barriers to Mammography in a Heterogeneous American Indian/Alaska Native Population

    Study Section:
    Population Specific

    Scientific Abstract:
    Background: Incidence rates of breast cancer have been steadily increasing in the American Indian/Alaska Native (AI/AN) population over the past 50 years and mortality rates are disproportionately high, due at least in part to their low rates of mammography (37% in the last year). No systematic ethnographic study has ever been done in a heterogeneous AI/AN population, including urban and both on-reservation and off-reservation rural people, to determine knowledge and attitudes about breast cancer and needs and barriers to mammography. Therefore, development of mammography interventions for this population cannot be tailored to the specific needs of such a heterogeneous group. We will work in collaboration with the Haskell Indian Health Service Health Center (HHC), the American Indian Heartland Cancer Network, and the American Indian Council of Kansas City to address mammography screening in our heterogeneous population of o ver 230 distinct AI/AN nations. Objective/Hypothesis: The objective of this study is to use an ethnographic approach to identify and understand needs and barriers to mammography, as well as knowledge and attitudes about breast cancer, in a heterogeneous group of AI/AN in Kansas and the Kansas City Metro Area. Specific Aims: We will address three specific aims in this study; (1) To identify what medical staff believe are the greatest needs and barriers to mammography for AI/AN; (2) To identify what AI/AN community members believe are the greatest needs and barriers to mammography; and (3) To understand knowledge and attitudes of AI/AN women with regards to breast cancer and mammography. Study Design: We plan 45 Key Informant interviews (15 with HHC personnel, 15 with community leaders in Kansas , and 15 with community leaders in Missouri ) and 24 focus groups with community members in a stratified, nested sampling frame with divisions based on use of HHC, age, and screening status. Data will be analyzed through text analysis using a grounded theory approach. Qualitative techniques will be augmented with systematic ethnographic data collection, including free lists with interview participants, and individual pile sorts and group ranking exercises with focus group participants. Potential Outcomes and Benefits of the Research: The data generated from this ethnographic assessment will help us to develop a culturally-tailored mammography screening intervention for a heterogeneous AI/AN population.

    Lay Abstract:
    American Indian and Alaska Native women are more likely to die from breast cancer than most other ethnic groups, even though they have low rates of the disease. Additionally, both incidence and death rates for breast cancer are increasing in this group. The increase in deaths from breast cancer among American Indian and Alaska Native women is probably due in part to their low use of mammograms. Women of this ethnic group are less likely than women of any other ethnic group to have had a mammogram in the last year or even in the last two years. A major challenge to developing mammography programs for American Indian and Alaska Native women is that they are a very diverse population, with over 500 different groups represented. No one has yet studied the needs and barriers to mammography for this underserved population. We plan to examine needs and barriers to mammography, as well as women’s knowledge and attitudes towards breast cancer in a diverse population in Kansas and Missouri , with nearly 250 different tribal affiliations represented. We are working with the major health care provider for American Indian and Alaska Native women in Kansas and the Kansas City Metro Area which encompasses counties in both Kansas and Missouri (Haskell Health Center), as well as two community organizations for the American Indian and Alaska Native population in the area (the American Indian Heartland Cancer Network and the American Indian Council of Kansas City). Together, we plan to interview health care providers and community leaders and conduct focus groups with women from the community. We will conduct 45 interviews and 24 focus groups of eight women each. By talking to people rather than simply surveying them, we believe we can learn more about why women do not often have mammograms. Once we know this information, we can begin to develop a mammogram program for American Indian and Alaska Native women that will target their specific needs and address the barriers they face.