Understanding knowledge and attitudes about breast cancer. A cultural analysis
L. R. Chavez, F. A. Hubbell, J. M. McMullin, R. G. Martinez and S. I. Mishra
Department of Anthropology, University of California, Irvine.
OBJECTIVE: To evaluate knowledge and attitudes about breast cancer risk
factors among Latinas, Anglo-American women, and physicians. DESIGN:
Ethnographic interviews employing systematic data collection methods.
PARTICIPANTS: Twenty-eight Salvadoran immigrants, 39 Mexican immigrants, 27
Chicanas, and 27 Anglo-American women selected through an
organization-based network sampling and a convenience sample of 30 primary
care physicians in Orange County, Calif. MAIN OUTCOME MEASURES AND RESULTS:
Data analysis using qualitative content analysis and quantitative cultural
consensus analysis, a mathematical technique that determines the degree of
shared knowledge within groups and estimates "culturally correct" answers
(cultural models), was employed. The content analysis revealed different
beliefs about breast cancer risk factors, particularly between the Latinas
and the physicians. The cultural consensus analysis found two broad
cultural models (defined as groups with ratios between the first and second
eigenvalues of > or = 3 and no negative competency scores). A Latina
model (ratio = 3.4), formed by the Salvadorans, Mexicans, and Chicanas,
emphasized breast trauma and "bad" behaviors, including drinking alcohol
and using illegal drugs as risk factors. A biomedical model (ratio = 3.0),
embraced by physicians and Anglo-American women, emphasized risk factors
described in the medical literature, such as family history and age. Within
these broad models, each group of respondents also differed enough in their
beliefs to form their own, often stronger, cultural models. CONCLUSIONS:
Ethnography can provide important insights about culturally based knowledge
and attitudes about disease. An understanding of the distinctive cultural
models regarding breast cancer risk factors will aid future cancer control
interventions.
