Claiming health: Mammography screening decision making of African American women

Purpose/Objectives: To develop a substantive theory that explains how African American women aged 50 years and older of different socioeconomic status (SES) make decisions about mammography screening. Design: Qualitative, grounded theory. Setting: Churches, places of employment, or women's homes in a large city in Ohio. Sample: 30 women aged 52-72 years; 16 in the initial sample and 14 in the theoretical sample. Methods: Audiotaped interviews and extensive written field notes; interviews were transcribed verbatim and analyzed using the constant comparison method, resulting in saturation of data. Main Research Variables: Decision-making processes explaining mammography screening. Findings: "Claiming health" emerged as the substantive theory explaining decisions that affect mammography screening and was embedded in the social contexts of cultural heritage and learned kinship values, religious beliefs and supports, and prior negative experiences with healthcare professionals and the healthcare system. Claiming health involved sisterhood and fellowship relationships fostered in the church. Claiming health was differentiated by age and SES, with older women of lower SES reporting greater reliance on cultural heritage and negative recollections of the healthcare system when making decisions regarding mammography. Each subconcept of claiming health was equally important and influenced decision making. Conclusions: Oncology nurses can benefit from the information presented by assisting older women of lower SES who may have encountered negative experiences in the healthcare system to develop effective assertiveness and communication skills when interacting with healthcare professionals. Implications for Nursing: Further research is needed to determine whether claiming health is a way of thinking about health generally or is used solely to explain experiences with mammography screening.