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

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.