Differences in the practice of breast self-examination by Latina & caucasian-American women: the role of acculturation, group orientation, locus of control and health beliefs
This study was carried out to better understand differences in the practice of breast selfexamination (BSE) by Latinas and Caucasian-American women. Current estimates from the American Cancer Society (ACS) place Latinas at much greater risk for morbidity and mortality from breast cancer compared with Caucasian-American women. This increased risk may result from their disinclination to practice early screening techniques. Several studies examining breast cancer screening among Latinas have found acculturation, low self-efficacy, nervousness, and embarrassment to predict the infrequent practice of BSE. The variables that have been found to predict the infrequent practice of BSE among Caucasian-American women are: barriers (e.g., forgetting), low self-efficacy, and low response-efficacy. Previous comparisons of these two groups of women have often relied on comparing women across different studies. This limits our ability to infer that differences in BSE performance are related to one's cultural background. In addition, research on Latina breast health care is in its infancy. This study contributes to this field of research by recruiting women from the same location, structuring questions in a theoretical framework, measuring BSE performance observationally in addition to self-repo~ and applying multivariate statistics. Sixty-eight Latinas and fifty Caucasian-American women visiting a primary health care facility in north San Diego County agreed to participate in this study. The women were interviewed individually, either in Spanish or English, using standardized and unstandardized measures of acculturation, health locus of control, group orientation, breast cancer screening beliefs, and current breast health care practices. Women were also asked to demonstrate how they performed BSE and then demonstrated their ability to detect lumps in an artificial breast model. Finally, as a measure of motivation for information, women were given the opportunity to select from several brochures on breast health produced by the ACS. It was predicted that Latinas would practice BSE less often and less proficiently compared with Caucasian-American women. Results demonstrated no differences between Latinas and Caucasian American women on frequency of BSE and proficiency at demonstrating BSE. However, differences were noted in the number of breast cancer symptoms identified and the number of lumps correctly detected on an artificial breast model. Latinas knew significantly fewer symptoms of breast cancer and detected significantly fewer lumps on the model. For both Latinas and Caucasian-American women, greater perceived barriers were associated with more frequent practice of BSE. However, there was an interaction between ethnicity and perceived benefits. There were fewer differences in perceived benefits between Latinas and Caucasian-American women who reported practicing BSE more than once a month, compared with those who reported practicing BSE less than once a month or those who did not practice BSE. There was also an interaction between ethnicity and social normative influences. Among Latinas, social normative influences were not associated with frequency of BSE performance. However, for CaucasianAmerican women, greater social normative influences were associated with more frequent practice of BSE. Perceived barriers to BSE performance predicted knowledge of correct BSE techniques. Amount of pressure used on the model predicted lump detection abilities, in addition to interactions between ethnicity and number of fingers used on the model, and ethnicity and type of motion used during the examination. Latinas using fewer fingers found more lumps compared with Caucasian-American women who found more lumps using more fingers. In addition, Latinas using a circular motion detected more lumps than Latinas using a patting motion, whereas Caucasian-American women found equivalent number of lumps, irrespective of type of motion used during the examination. No one variable predicted differences in breast cancer symptom knowledge. The typical monthly performer of BSE reported greater perceived barriers to BSE performance in addition to greater feeling of self -efficacy for its performance. The lack of differences between Latinas and Caucasian-American women on frequency of BSE is discussed, as are the counterintuitive findings concerning the role of perceived barriers on frequent and adequate performance of BSE.