Background: Access to affordable breast cancer screening is essential for early detection among underserved women. Underserved women's screening rates are consistently low, and they frequently present with later stage diagnoses. Those with a history of breast cancer become part of the survivor population adding an increased risk of recurrence in addition to cultural, linguistic, and geographic barriers. Reducing disparities and increasing access to screening for the underserved has become Public Health Priority. Access to screening, and screening utilization may be compromised by spatial and non-spatial factors present in the environment such as lengthy travel time to service and decreased clinic capacity.
Purpose. In this dissertation we examined the role of spatial and non-spatial factors to identify current gaps in access to preventive breast health services for underserved breast cancer survivors across Texas.
Data Sources. Data was provided by the Texas Cancer Registry (TCR) and the Health Resources Services Administration (HRSA). The study group was comprised on 4,264 underserved women aged 40-64, diagnosed with breast cancer from 2007-2010. 69 FQHC grantees and their respective 199 operating sites represented the supply of services. Methods. Methods used to complete this dissertation included: a systematic review, adapted STROBE/GRADE quality measures, multinomial logistic regression, Moran's I, enhanced two step floating catchment area (E2SFCA), inverse distance weighting (IDW) interpolation.
Results. Results indicated increased distance from FQHC, Hispanic ethnicity, offering mobile mammography and transportation services, and higher proportion of physician's assistants were associated with later stage diagnoses. Insurance (Medicaid vs. Uninsured), Black race, increase in grant funding, and an interaction between Hispanic ethnicity*offering mobile mammography were associated with early stage diagnoses. Spatial access to free mammography was poor across the state with 41% of survivors have zero access to screening. 25% of survivors had zero access to FTE providers.
Conclusion. Additional research is needed to confirm the availability and quality of mobile mammography, amount of mammograms provided from outside screening sources, how funding is being spent, as well as provider characteristics, screening recommendations, and referral practices. Future intervention targets include mobile mammography for underserved Hispanic women, inclusion of Physician's Assistants, and improved outreach to both underserved women and outside screening resources.
|Advisor:||Highfield, Linda D., Bartholomew, Leona K.|
|School:||The University of Texas School of Public Health|
|Department:||Health Promotion & Behavioral Sciences Management|
|School Location:||United States -- Texas|
|Source:||DAI-B 76/03(E), Dissertation Abstracts International|
|Subjects:||Behavioral psychology, Public health|
|Keywords:||Breast cancer, Capacity, Spatial access, Underserved|
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