From ethnography to intervention: developing a breast cancer control program for Latinas

Latinas are less likely than Anglo women to have appropriate breast cancer screening for reasons that may include culturally based beliefs as well as socioeconomic factors. This study employed ethnographic methods to explore breast cancer-related knowledge, attitudes, and behaviors among Latinas, Anglo women, and physicians, tested the generalizability of the findings in a telephone survey of randomly selected women, and used the results to design a culturally sensitive breast cancer control intervention in Orange County, Calif. Respondents for the ethnographic interviews included 28 Salvadoran immigrants, 39 Mexican immigrants, 27 Chicanas (U.S.-born Latinas of Mexican heritage), 27 Anglo women, and 30 physicians selected through organization-based network sampling. Latinas had very different beliefs about risk factors for breast cancer and held more fatalistic attitudes about the disease. For example, they believed that trauma to the breast was among the most important risk factors. Results of a telephone survey of 1225 randomly selected women (269 U.S.-born Latinas, 425 Mexican immigrants, 109 other Latina immigrants, and 422 Anglo women) generally confirmed the dissimilar beliefs among Latinas and Anglo women. The findings influenced our decision to design and pilot-test a breast cancer control intervention based on Bandura's self-efficacy theory and Freire's empowerment pedagogy. The methodology and findings of this study have important implications for future cancer control research and interventions.