Unpacking rural Heterogeneity: A proof-of-concept study of how varying rural contexts shape breast cancer screening behaviors.

Area of Science:

• Public Health
• Rural Health Disparities
• Health Services Research

Background:

• Persistent inequities exist in breast cancer (BrCa) screening access for rural women in the U.S.
• Rural populations are often oversimplified in research and practice, masking important variations.
• Understanding contextual heterogeneity is crucial for addressing BrCa screening disparities.

Purpose of the Study:

• To examine how contextual differences in rural South-Central Washington shape BrCa screening behaviors and access.
• To explore the intersection of structural, cultural, and environmental factors influencing screening through a community lens.
• To serve as a proof of concept for disaggregating rural settings in health research.

Main Methods:

• Utilized the Community Capitals Framework to guide the study.
• Conducted focus groups with women in two demographically and economically distinct rural communities.
• Analyzed barriers to BrCa screening across seven domains of community capital.

Main Results:

• Identified overlapping and unique, context-specific barriers to BrCa screening across the two communities.
• Emergent themes included seasonality, distance-related constraints, gendered expectations, and race/place influences on resource access.
• Demonstrated how intersecting systems of power and community assets shape health behaviors and access to care.

Conclusions:

• Generic rural interventions are insufficient for addressing BrCa screening inequities.
• Screening disparities manifest differently across diverse rural contexts, requiring tailored approaches.
• Disaggregating rural populations in health research is essential for developing effective, context-specific interventions.