ABSTRACT

Introduction: Women living in rural areas are more likely to be diagnosed with advanced-stage breast cancer than their urban counterparts. The advanced stage at diagnosis is potentially attributable to lower rates of mammogram screening. We aimed to elucidate factors affecting women in decision-making about mammogram screening in a rural area in Wisconsin served by a critical access hospital.

Methods: We conducted an observational cross-sectional mixed-methods study, collecting data from various sources using 3 methods. Virtual interviews with hospital staff, virtual focus groups with community members, and a survey of women 40 years and older occurred from September 2021 through February 2022. Qualitative data were organized into themes of facilitators and barriers to mammogram screening. Survey responses were reported descriptively.

Findings: Eleven hospital staff interviewed and 21 community members who joined 1 of 3 virtual focus groups voiced similar perceptions of facilitators and barriers to mammogram screening. Clinician recommendation was among facilitators, while insurance concerns were the primary barrier. Among survey respondents (N = 282), mean age was 58.7, 98% self-identified as White, and 91% saw a health care provider in the past year. Top reasons for having their first mammogram were doctor recommendation (70%), family history (19%), and personal decision (18%). Top reasons they did not have a mammogram screening at least every year were putting it off (23%), lack of problems (17%), and pandemic-related reasons (15%).

Conclusions: Improving patient education and supporting clinicians to deliver screening recommendations may increase appropriate screening. Future studies should focus on reaching women not engaged with the health system.