Toward Patient-Centered Care: Understanding Latina Patients’ Perceptions of Screening Mammography

Special Article – Patient-Centered Care

J Fam Med. 2016; 3(6): 1071.

Toward Patient-Centered Care: Understanding Latina Patients’ Perceptions of Screening Mammographys

Martinez-Gutierrez J1,2*, Jhingan E1, Black LE3, Hayes Constant T4 and Coronado GD5

1Cancer Prevention Program, Fred Hutchinson Cancer Research Center, M3-B232, Seattle, WA 98109, USA

2Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile

3School of Medicine, University of Washington, 1959 N.E. Pacific St, Seattle, WA 98195, USA

4Department of Anthropology, University of Washington, Box 353100, Seattle, WA 98195, USA

5Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave. Portland, OR 97227, USA

*Corresponding author: Martinez-Gutierrez J, Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Av. Vicua McKenna 4686 Macul, Santiago, Chile

Received: June 13, 2016; Accepted: July 20, 2016; Published: July 25, 2016


Background: Understanding patient perceptions of breast cancer screening is important for developing breast-cancer screening programs and can enhance the delivery of patient-centered care. We identified factors influencing receipt of mammography screening among Latina patients at a Federally-Qualified Health Center.

Methodology: We held eight focus groups among Latina patients at four clinics in Washington State; focus groups were conducted in Spanish, recorded, and transcribed verbatim.

Results: We identified factors associated with individual health behaviors, social relationships, and institutional factors influencing cancer screening attitudes. One unique concept emerged from our participants: desidia. Translated as a “lack of motivation or inertia”, it was described as unconsciously allowing barriers to interfere with taking care of oneself, to “let life get in the way” or to make one’s personal health a low priority.

Discussion: Our findings will inform future patient-centered interventions to increase cancer screening rates among Latinas.

Keywords: Patient-centered care; Latina patients; Public health; Cancer screening


Breast cancer is the most common cancer and leading cause of cancer death among Latinas. An estimated 19,800 Hispanic women were estimated to be diagnosed with breast cancer in 2015 [1]. Compared to non-Hispanic whites, Latinas have lower rates of early breast cancer detection and poorer 5-year survival [1]. A key behavioral factor underlying these racial/ethnic disparities is participation in breast cancer screening; breast cancer rates have been historically low among Latinas but have increased over the last five years Data from the American Cancer Society show that in 2013, the proportion of Hispanic women 40 and older who obtained a mammogram in the previous two years was 64%, compared to 69% for non-Hispanic whites [1]. Understanding and diminishing these disparities has been a major goalof legislators, researchers, and health professionals for decades.

For more than a decade, patient-centered care has been proposed as a strategy to raise quality of care [2,3]. In 2001, the Institute of Medicine (IOM) in their “Crossing the Quality Chasm” report described six specific areas for improvement to achieve a safe, effective, patient centered, timely, efficient and equitable health care system. Patient centered care (PCC) is described as “providing care that is compassionate, empathetic, and responsive to the needs, values, and expressed preferences of each individual patient; patients should be informed decision makers in their care” [4]. Patient centered care has proven to be effective in improving health outcomes related to patient satisfaction, and clinical outcomes such as treatment adherence in breast cancer [5].

Understanding factors that facilitate and impede Latinas’ participation in breast-cancer screening programs is crucial to developing culturally relevant patient-centered interventions. We sought to identify these factors in order to develop an effective intervention to improve mammography screening in Latinas in a Federally Qualified Health Center (FQHC).



We conducted eight focus groups (38 participants) from April through October 2010 at four Latino-serving FQHC clinic sites in Washington State. These FQHCs provide comprehensive health and human services and specializes in serving low income and Hispanic populations. In 2010, about 93% of their clients had incomes below 200% of the federal poverty level, and about 91% were either uninsured or publicly insured. Through the clinics, patients have access to screening mammography on-site or through referrals to a nearby breast center. To pay for these services, patients may have access to the breast, cervical, and colon health program (BCCHP). BCCHP is a federal program that provides free breast, cervical, and colon cancer screening services for income- and age-eligible individuals in Washington State [6]. Patients who do not qualify for this program may be eligible for charity care, a sliding fee scale, or care through their own insurance programs.

Study procedures

Eligible participants were Latinas aged 40 to 74 who had had a clinic visit within 5 yearsand who had not had a mammogram in the past 2 years. Study staff held two focus groups at each site, one for women aged 40 – 49 and one for women aged 50 – 74. Two bilingual project investigators moderated focus groups using an openended guide with questions regarding attitudes and beliefs about mammography screening. Participants received a $10 gift card for their time. Focus groups were conducted in Spanish, recorded, and transcribed verbatim. Transcripts were coded using Atlas ti 6.2. We used the data, existing behavioral theory, and available literature to develop codes and modify them through an iterative process to arrive at the themes. Each transcript was coded by at least two independent coders and checked for reliability. Discordances in the assignment of codes were resolved by consensus.

This study was approved by the Institutional Review Board at the Fred Hutchinson Cancer Research Center in Seattle, WA. IRB number: 7124.

Data analysis

We analyzed the data using a thematic network [7]. Using this approach, we separated the data into codes that were specific and discrete enough to portray details within the data but broad enough to include many different segments of the text. Then, we aggregated the codes into common meaningful themes (basic themes) that we further organized into broader and more complex themes (organizing themes) and finally into global themes that encompass the main points in the text. We then constructed our thematic networks and proceeded to explore, describe, and summarize the data through them.

Conceptual framework

Environmental, cultural, and community characteristics determine health outcomes as much as biological and personal factors. Werneke et al propose a population approach to health disparities that includes population determinants of health as well as individual risk factors for disease [8]. Using this model, we analyzed the data to identify factors on multiple levels that were associated with Latinas’ attitudes towards mammography screening (Figure 1).

Citation:Martinez-Gutierrez J, Jhingan E, Black LE, Hayes Constant T and Coronado GD. Toward Patient- Centered Care: Understanding Latina Patients’ Perceptions of Screening Mammography. J Fam Med. 2016; 3(6): 1071. ISSN : 2380-0658