Perceived Experiences of Discrimination in Health Care: A Barrier for Cancer Screening Among American Indian Women with Type 2 Diabetes

• Published in: Women's health issues 2013-01, Vol.23 (1), p.e61-e67
• Main Authors: Gonzales, Kelly L., MPH, PhD, Harding, Anna K., PhD, Lambert, William E., PhD, Fu, Rongwei, PhD, Henderson, William G., MPH, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - ethnology; Breast Neoplasms - prevention & control; Cervical cancer; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - psychology; Discrimination; Discrimination, Psychological; Early Detection of Cancer - methods; Early Detection of Cancer - psychology; Female; Health care; Health Care Surveys; Health Services Accessibility; Healthcare Disparities; Humans; Indians, North American - psychology; Logistic Models; Mammography - psychology; Mammography - statistics & numerical data; Mass Screening; Middle Aged; Obstetrics and Gynecology; Patient Acceptance of Health Care - ethnology; Patient Acceptance of Health Care - psychology; Perception; Prejudice; Screening; Socioeconomic Factors; Surveys and Questionnaires; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - ethnology; Uterine Cervical Neoplasms - prevention & control; Vaginal Smears - psychology; Vaginal Smears - statistics & numerical data; Women; Young Adult
• ISSN: 1049-3867; 1878-4321
• DOI: 10.1016/j.whi.2012.10.004

Abstract Purpose Breast and cervical cancer-mortality disparities are prominent among American Indian women. These disparities, in part, may result from patients perceived experiences of discrimination in health care. This report evaluates the impact of perceived discrimination on screening for breast and cervical cancer in a sample of 200 American Indian women with type 2 diabetes. Methods Data were collected from patient report and medical records. Prevalence of breast and cervical cancer screening were assessed. Unadjusted and adjusted logistic regression analyses were used to assess associations between perceived discrimination, cancer screening status, and patients' health care-seeking behaviors. Findings Substantial proportions of AI women in our sample were behind the recommended schedules of screening for breast and cervical cancer. Adjusted estimates revealed that perceived discrimination was significantly associated with not being current for clinical breast examination and Pap test, and was close to statistical significance with not being current for mammography. The number of suboptimal health care-seeking behaviors increased with higher mean levels of perceived discrimination. Conclusions Among AI women, perceived discrimination in health care may negatively influence use of breast and cancer screening services, and health care-seeking behaviors. More research is needed among AIs to examine features of health care systems related to the phenomenon patients perceived experience of discrimination.