Differences in Barriers to Mammography Between Rural and Urban Women

Background: Few studies have examined differences between rural and urban women in mammography barriers, knowledge, and experiences. Exploring differences can help inform tailored interventions. Methods: Women, aged 40, who had not been screened in the past 2 years were recruited from eight federally qualified health centers across Louisiana. They were given a structured interview assessing mammography knowledge, beliefs, barriers, experiences, and literacy. Results: Of the 1189 patients who participated, 65.0% were African American, 61.6% were rural, and 44.0% had low literacy. Contrary to guidelines, most believed mammography should be done annually (74.3%) before age 40 (70.5%). Compared to urban women, rural participants were more likely to believe mammography will find small breast lumps early (34.4% vs. 6.5%, p < 0.0001) and strongly disagree that mammography is embarrassing (14.6% vs. 8.4%, p = 0.0002) or that they are afraid of finding something wrong (21.2% vs. 12.3%, p = 0.007). Rural women were more likely to report a physician recommendation for mammography (84.3% vs. 76.5%, p = 0.006), but they were less likely to have received education (57.2% vs. 63.6%, p = 0.06) or to have ever had a mammogram (74.8% vs. 78.1%, p = 0.007). In multivariate analyses controlling for race, literacy, and age, all rural/urban differences remained significant, except for receipt of a mammogram. Conclusions: Most participants were unclear about when they should begin mammography. Rural participants reported stronger positive beliefs, higher self-efficacy, fewer barriers, and having a physician recommendation for mammography but were less likely to receive education or screening.