The fact that there are significant disparities in selected health conditions between whites and various racial and ethnic minority groups has been documented in the literature. According to a recent study conducted by the Henry J. Kaiser Family Foundation (1999), the reasons for these disparities are "complex and remain poorly understood." This study also indicated that there are major gaps and limitations in the literature which seeks to present an understanding of these disparities. Additionally, it is concluded that many of the findings presenting explanations need to be clarified and validated in future research.

Although access to screening services for African American women compared to white women for breast and cervical cancer are close to equivalent according to recent findings, studies have found that minorities are more likely than whites to be diagnosed with cancer at advanced stages. Additionally, they are less likely than whites to receive major therapeutic interventions. This is true for African-Americans women, and especially true for older African-Americans, who are at greater risk for breast cancer in general.

Again the reasons for these disparities are complex. However, scholars and federal agencies managing health care issues are more and more suggesting that to better understand these complexities, qualitative data collection and analysis is required. This has especially been brought to light in recent years by the Health Care Financing Administration (HCFA). HCFA has been able to document disparities, but not able to explain them to the extent necessary to adequately address them. The HCFA Medicaid Historically Black Colleges and Universities Program aims to go beyond the identification of disparities and evaluation of interventions through statistical analysis to exploring barriers that result in poor health status.

The specific aim of this project is to develop hypotheses which will lead to better understanding of the social, cultural, spiritual and other factors that influence beliefs and practices preventing early detection of breast cancer among the target population. The objectives are: (1) To identify unexplored barriers to early detection of breast cancer among African-American women over the age of 50, and (2) To identify strategies for reducing these barriers, including methods for testing the effectiveness of these strategies.

This proposal is to conduct a qualitative exploratory study which will identify hypothesis for further study. The specific question to be explored will be: Why is breast cancer among African-American females over the age of 55 identified at later stages than among their White counterparts? The Principal Investigator, will herself, conduct 50 face-to-face, in-depth interviews with 50 women who have been diagnosed with breast cancer to examine beliefs and practices prior to the diagnosis and how these affected decisions to have mammograms and their decisions about the timing of these tests. Additionally, beliefs and practices about breast self examination prior to diagnosis will be explored. Each interviewee will receive an incentive of $50 for participation in the study. All interviews will be tape recorded and transcribed to facilitate content analysis for detailed nuances of decision making about health care in general and specifically about breast cancer screening.

Using networking and snowball sampling, the 50 interviewees will be identified. Data collection and analysis will be based on the grounded theory approach where a real life phenomena may be examined inductively building theory as data is collected. Interview schedules will be developed to provide maximum flexibility for exploring all possible issues through stories told by subjects. Issues to be covered will include family background and norms regarding health care, influence of significant others, trust of the health care system and other sources of health care information, alternatives practices to traditional health care, spiritual and religious beliefs about health status and its control, and intergenerational transfer of information about health care within the family and informal network. Content analysis will be conducted on all field notes by the Principal Investigator to assure that all data are represented as collected.

This proposal is based on the assumption that qualitative research can add new insight into the real life issues that contribute to the health disparities among minorities, especially focusing on the differences in stages of detection of breast cancer for African-Americans and Whites, affecting survival rates. The Principal Investigator's decision to conduct all interviews herself is based on the evidence that race and gender of the interviewer has an impact on the types of information that the subjects are willing to divulge. Finally, the proposal is based on the assumption that to identify nuances of beliefs and practices that are not already known, non-traditional outreach of a qualitative nature is required. (top)