A transformative decision-making process for mammography screening among rural, low-income women

The study objective was to expand theoretical knowledge of the mammography-screening decision-making process. The purpose of this article was to report the decision-making process of participants who moved from nonscreening to screening.

Grounded theory methodology was used. Seventeen rural, low-income women aged 46-64 years were recruited.

In-depth, face-to-face interviews were conducted. Semi-structured questions focused on decision making, readiness for change, and health care experiences.

Two phases of decision making were identified. Phase I, A Dormant Period of Nonscreening Behavior, is an inactive screening period characterized by (a) knowledge deficits, (b) unengaged cognition, and (c) misleading perceptions. Phase II, A Transformative Learning Process Resulting in Screening Behavior, is characterized by (a) aroused affective responses, (b) awakened cognitive responses, (c) new knowledge construction, and (d) changed perceptual responses. A catalytic event provides the stimulus to move from Phase I to Phase II. Transformative learning emerged as the central conceptual category underlying the decision to obtain screening. Transformative learning includes a triggering event that facilitates questioning previously held assumptions about mammography.

Participants demonstrated a transformative process resulting in movement from nonscreening to screening. Further study is needed regarding nursing interventions that serve as catalysts for transformation and subsequent screening.