A Salutogenic Framework to Understand Disparity in Breast Cancer Screening Behavior in African American Women

African American women (AAW) have the highest breast cancer mortality rate than any other racial or ethnic group. Limited access to care reduces mammography screening for AAW. Despite barriers, some AAW engage in breast cancer screening (BCS) behaviors like mammography. The salutogenic theory of health focuses on positive health behaviors and offers a framework to understand personal factors which allow some AAW to overcome adversity and engage in BCS. Sense of coherence (SOC) is central to salutogenic theory. Individuals with greater SOC utilize available resources to attain optimal health. This study: 1) Evaluated the contribution of SOC, social support and spirituality to BCS motivation and behaviors in AAW, and 2) Determined whether there are differences in SOC, health perception, spirituality, and social support among AAW who utilize free mammography programs compared to AAW who do not. A 2-group cross-sectional design was used. Participants completed self-report questionnaires. Findings revealed that SOC was directly correlated with social support, spirituality, health perception and BCS motivation. Social support moderated the effect of SOC on BCS behaviors, in that low social support increased BCS behaviors in women with high SOC. Moreover, spirituality significantly predicted greater BCS motivation. Logistic regression demonstrated that women enrolled in the Illinois Breast and Cervical Cancer Program (IBCCP) reported a greater incidence of performing and intent to perform breast self-exam and to obtain clinical breast-exam and mammograms. Women in the IBCCP program were more likely to be compliant with BCS guidelines than women not enrolled in IBCCP. In conclusion, SOC, social support and spirituality influence BCS behaviors and motivation in AAW. Also, free mammogram programs, like IBCCP, promote greater BCS behaviors and compliance with BCS guidelines in AAW. The findings can guide the development of cultural-specific salutogenic programs to motivate and improve compliance of AAW with breast cancer screening guidelines