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Int J Nurs Stud. 2010 Aug;47(8):975-83. doi: 10.1016/j.ijnurstu.2009.12.014. Epub 2010 Jan 20.

Distrust, predisposition to use health services and breast cancer screening: results from a multicultural community-based survey.

Author information

1
Division of Acute, Critical, and Long Term Care, University of Michigan School of Nursing, 400 N. Ingalls Building, Room 2158, Ann Arbor, MI 48109, United States. mkatapo@umich.edu

Abstract

PURPOSE:

To examine whether and how distrust of the health system and predisposition to use healthcare services influence frequency of mammograms and Clinical Breast Exams (CBEs).

METHODS:

A community-based survey recruited 184 women (age 47+/-12); 49% were college-educated, 77% had health insurance, and 57% were non-white. Distrust was measured with a four-item scale (Cronbach alpha=0.71); predisposition to use health services with an 11-item scale (Cronbach alpha=0.84). Ordinal regression analysis was used to test two models examining "time since last mammogram" and "time since last CBE." The later model had a better goodness-of-fit, as indicated by a non-significant, Pearson coefficient.

FINDINGS:

Distrust to the health system was significantly correlated with age (r=-0.19*), income (r=-0.16*), and predisposition to use health services (r=-0.26**). Distrust predicted time since last CBE (B: 0.37, SE: 0.19*), which in turn was significantly correlated with time since last mammogram (r=0.44**). Predisposition to use health services predicted time since last CBE (B: -0.78, SE: 0.19**) and time since last mammogram (B: -0.47, SE: 0.22**). Insurance predicted time since last CBE (B: -0.94, SE: 0.44*), while age (B: -0.21, SE: 0.03**) and income (B: -0.19, SE: 0.09*) predicted time since last mammogram.

CONCLUSION:

Distrust of the healthcare system and predisposition to use health services influence breast cancer screening directly. Distrust interferes with behavioral patterns that favor recurrent breast cancer screening.

PRACTICE IMPLICATIONS:

Trustworthiness in the healthcare system and positive attitudes for the use of, health services enhance routine breast cancer screening. *p<0.05, **p<0.001.

PMID:
20089252
DOI:
10.1016/j.ijnurstu.2009.12.014
[Indexed for MEDLINE]

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