Identify and describe a populationof interest to you. Knowledgeof Preventive Breast Cancer Screening in Low-income WomenAccording to the National Breast CancerFoundation(NBCF), breast cancer is the most commonly diagnosed cancer in women,the second leading cause of death among women in the world and one in eightwomen will be diagnosed with cancer in their life time, (2012). However, breastcancer deaths are preventable when detected early and treated. Although deathfrom breast cancer has been declining since the 1990s due to increase inknowledge, screening, early detection and improved treatment, it has not beenthe case in low income women, (NBCF, 2012). My focus is on mammography as themost effective preventive cancer screening tool, since “Regular mammography is the best tool availableto detect breast cancer in its earliest stages, availing opportunities foreffective life-saving treatment,” (American Cancer Society, 2011).
Studieshave demonstrated that there exists an inaccurate knowledge of breast cancerscreening among low income women around the world which leads to low screeningand consequently high breast cancer death among low income women in the world. A study done in Kenya showed that ruraland urban low-income women said that they saw no reason to have one’s breastschecked if they appeared healthy and were not painful. And while most of theurban middle-income women were able to describe early detection measures suchas self-breast exam, clinical breast exam, mammography in detail and even hadexperienced them, most urban low-income and rural women had heard vague knowledgethat such things existed, (Muthoni & Miller, 2009).
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Another study conductedamong low income Hispanics, native Americans and Caucasians in Wyoming showedthat they had a poor knowledge regarding breast cancer screening and believed that the absence of a familyhistory of breast cancer implied a low risk for breast cancer, therefore, noneed to get a mammogram. Some of the women thought that an “Inverted nipple”would be a sign for one to get a mammogram done, (Purtzer, 2012).A hospital based cross sectional study wasconducted in Ibadan, Nigeria to investigate the level of awareness ofmammography among 818 randomly selected women attending the General outpatientclinic of the University College Hospital.
Only 5% of the women had heard ofmammography and their knowledge of the procedure was poor. The women with nocollege education were far less likely to be aware of mammography compared withthose college educated ones. The most common source of information regardingmammography screening were newspapers and magazines. (Obajimi et al, 2013).Inadequate health literacy is stronglyassociated with lower mammography screening as suggested by a study amongMexican American women in Texas. Out of a sample of 722 women age 40 and above,only 44% had a mammogram within the last one year. Participants in the surveywere also given the Short Test of Functional Health Literacy (STOFHLA) ineither English or Spanish.
STOFHLA consisted of patient medical instructionsfor X-ray preparation and the rights/responsibilities part of a Medicaidapplication form. Out of 36 questions, 50.42% scored below 22, meaning they hadinadequate health literacy, and consequently a lower mammography screeningamong the Hispanic women residing in the Lower RioGrandeValley of Texas, (Pegan et al, 2012). Identify three factors that may affectachievement of optimal health in the selected population.
Low Socio-economic status, older age and lowerlevel of education with inadequate health literacy were associated with poorknowledge of mammography screening in low income women. The studies examinedsupported that the above factors are interrelated in contributing to the poorknowledge and use of mammography screening among low income women. Breast cancer screening knowledge andpractices among women in southeast of Iran study shows that overall knowledgeof breast cancer screening was inadequate in 67.4% and only 1.3% had amammography throughout their life. Further about mammography, 72.7% had poor knowledge, 24% had averageknowledge and 3.4% had good knowledge.
A questionnaire was used that haddemographic characteristics such as age, educational level, socioeconomicstatus and knowledge of mammography. Statistically, there was a significantrelationship between the overall knowledge of breast cancer screening and levelof education. The lower the level of education and socio-economic status, thelower the knowledge of breast cancer screening. Also, statistically there wasan inverse relationship between knowledge of mammography with age. The olderthe women, the poorer the knowledge of mammography. In older women of40-49years of age, 94.4% had poor knowledge while women 15-24, 66% had poorknowledge, (Heidari, Mahmoudzadeh-Sagheb & Sakhavar, 2008).
Select from these factors the onethat you believe is both a priority and most amenable to nursing The Iran study above revealed thatthere is a direct relationship between low level of education and poorknowledge on mammography screening in low income women. As a result, both lowlevel of education and poor literacy on mammography screening will beconsidered as one factor and nursing interventions will target this factor. It isimperative to say that low income women with low level education have poorknowledge of mammography screening for breast cancer leading to the higher rateof death from breast cancer among low income level.
Poor and insufficientknowledge of preventive breast cancer screening of mammography among poorlyeducated low income women might be the reason why the decline in death frombreast cancer since 1990 has not been the case for themImplicationsfor practice Low income women with low level ofeducation need to be educated on preventive breast cancer screening of mammography.Healthcare providers should not only recommend mammography screening for lowincome women but teach them that preventive breast cancer screening isimportant at age 40 and above, whether or not risk factors and symptoms arepresent, in order to detect breast cancer in its earliest stages. Primary care nurses need to teach lowincome patients with only high school deploma or lower level of education thatat age 40 and above, women need to get mammogram screening for breast cancerevery 2 years. Community health nurses practicing in low income neighborhoodsneed to educate community members and encourage them to get mammogram screeningevery 2 years.
Advanced practice nurse care providers need recognize riskfactors for poor knowledge of mammogram screening such as low level ofeducation in low income patients. And provide resources such as breast cancerclinics to low income women with no college degree.Myapproach to low income women with low level of education; As an acute care nurse who alsoworks in a Subacute, Rehab and Nursing home facility, there are alwayseducational pamphlets or materials regarding breast cancer screening on thecompany’s educational website that could be handed over to patients and families.In the near future when I become a primary care provider at the forefront ofhealth care, I would incorporate into my practice the habit of teaching andencouraging my patients about breast cancer screening. When I come acrosspatients in teachable states, regardless of the healthcare setting, it would beimportant to recognize these risk factors: Are they low income women? Is highschool their highest level of education? If the answer to my assessments isyes, then it would be important to go ahead and make them aware of mammogramscreening for breast cancer at age 40 and above even if symptoms of breastcancer are not present. Provide them with resources