Breast cancer screening patterns related to mammography adherence among Northern Plains Tribes American Indian women

Sara Troske Becker
College of Nursing, University of Nebraska Medical Center
July, 2013


This study examined relationships among selected subject variables and MG adherence in 1121 Northern Plains Tribe (NPT) American Indian women 40 years of age and older utilizing Aberdeen Area Indian Health Services (AAIHS) in South Dakota between 1999 and 2004. Data for this retrospective study were obtained from an existing AAIHS database. Only 25% to 40% of American Indian women 40 years of age and older have been screened by mammography (MG) compared to 82% to 90% of Caucasian non-Hispanic women (Centers for Disease Control, 2004). The conceptual framework for the study was the Modified Health Belief Model (MHBM). Aims were to examine relationships: (a) among selected health promotion/disease prevention behaviors of women (tobacco use, Pap test adherence, number of ambulatory visits/year) and MG adherence, (b) among susceptibility to breast cancer (age, family history of breast cancer) and MG adherence, (c) among susceptibility to other health conditions (abnormal Pap tests, personal and family history of diabetes and/or colon cancer) and MG adherence, (d) among MG barriers (telephone access, distance to MG site, type of health insurance: Medicare, Medicaid, and private insurance) on MG adherence, and (e) describe the unique contribution of each of the susceptibility and barrier constructs in explaining the variance in MG adherence. Statistical analysis conducted included correlations, t-tests, ANOVA, and hierarchical regression. In this study, women were 100% MG adherent if they obtained a MG every 15 months. The average MG adherence rate for women during the 3-5 year period was 37.13% (SD = 39.5%), with 505 (45%) of the women obtaining no MG. The most significant predictors of MG adherence were Pap test adherence, number of IHS clinic visits per year, age, and having private insurance. The best fitting prediction model accounted for 49% of the variance in MG adherence and contained variables from all four MBHM constructs. Findings from this study can inform interventions promoting MG adherence in at-risk NPT American Indian women.