Cultural background plays role in decision to have mammogram

Clinicians, social workers and medical professionals should be aware of how cultural factors influence whether individuals choose to receive preventative health care measures, according to new UB research.

Louanne Bakk, an assistant professor in the School of Social Work, is the co-author of the study that explores low rates of breast cancer screening in the older Hispanic population.

The research provides evidence that could help frame breast cancer screening interventions in order to increase participation. A broader sweeping patient assessment, for instance, that includes cultural considerations with other relevant health data can improve intake communication and better inform practitioners of their patients’ desires and needs.

“It’s asking the right questions within that initial screening instrument that can help explain to a provider why someone may or may not be taking advantage of a particular preventative health service,” says Bakk.

The findings have specific relevance given the ongoing conversations regarding possible repeal of the Affordable Care Act, which has provisions for no-cost preventative health screenings and services for older Medicare and Medicaid beneficiaries.

“If this benefit is repealed, it can further diminish older Hispanics’ ability to afford and obtain preventative health care,” says Bakk. “It is imperative to consider the current systematic factors that involve socioeconomic status as well as cultural considerations to address inequities.”

Tamara Cadet, assistant professor at the Simmons College School of Social Work, led the study with Bakk and Simmons’ colleagues Kathleen Stewart and Peter Maramaldi.

The results are published in the Journal of Ethnic & Cultural Diversity in Social Work.

The researchers analyzed time orientation — the extent to which a society places importance on the future instead of the past or present — and uncertainty avoidance — how individuals deal with uncertainty — two cultural dimensions that can be measured relative to other cultures to determine what might be contributing to 29 percent of older Hispanic women in their sample reporting not having a mammogram in the past two years.

Breast cancer is the leading cause of cancer death among Hispanic women. Diagnosis of late-stage cancer in this population is greater than other groups, partly because of underutilized mammography services.

While many studies have looked at racial differences when it comes to accessing preventative health, the influence of culture is not as widely studied.

Developing the questions Bakk mentions is critical. Demographers project the Hispanic population will reach 17.5 million people by 2050, making it the largest older minority group in the United States. Furthermore, there is great diversity within that population, which is represented by many parts of the world, including Mexico, the Dominican Republic, Puerto Rico, Cuba and Central and South American countries.

“I find this in my own work involving benefits access, like Medicare,” says Bakk, an expert in health care disparities and director of UB’s Institute on Aging Policy and Practice. “We often don’t consider ethnicity when it comes to receiving some of these benefits.”

The researchers drew their sample from the Health and Retirement Study, a longitudinal study administered by the Institute for Social Research at the University of Michigan.

As the research team expected, future-time-oriented Hispanic women were more likely to participate in breast cancer screening, but their analysis also suggests that Hispanic women with a higher ability to manage uncertainty may be less concerned about mammograms.

Bakk says clinicians should evaluate this outlook to determine patients’ views on breast cancer screening.

“We need to be aware of these cultural factors that can impact breast cancer screening among older Hispanic women, in particular,” says Bakk.

“It is important to remember that each patient brings unique perspectives to their care,” says Cadet.

And while the focus in this study was Hispanics, Cadet suggests providers consider what cultural factors affect other populations.