BUFFALO, N.Y. – Clinicians, social workers and medical
professionals should be aware of how cultural factors influence
whether individuals choose to receive preventative health care
measures, according to new research from the University at
Louanne Bakk, an assistant professor in the UB School of Social
Work, is the coauthor of the study that explores low rates of
breast cancer screening in the older Hispanic population.
The research provides evidence that could help frame breast
cancer screening interventions in order to increase participation.
A broader sweeping patient assessment, for instance, that includes
cultural considerations with other relevant health data can improve
intake communication and better inform practitioners of their
patients’ desires and needs.
“It’s asking the right questions within that initial
screening instrument that can help explain to a provider why
someone may or may not be taking advantage of a particular
preventative health service,” says Bakk.
The findings have specific relevance given the ongoing
conversations regarding possible repeal of the Affordable Care Act,
which has provisions for no-cost preventative health screenings and
services for older Medicare and Medicaid beneficiaries.
“If this benefit is repealed, it can further diminish
older Hispanics’ ability to afford and obtain preventative
health care,” says Bakk. “It is imperative to consider
the current systematic factors that involve socioeconomic status as
well as cultural considerations to address inequities.”
Tamara Cadet, an assistant professor at the Simmons College
School of Social Work, led the study with Bakk and Simmons’
colleagues Kathleen Stewart and Peter Maramaldi.
The results are published in the Journal of Ethnic &
Cultural Diversity in Social Work.
The researchers analyzed time orientation – the extent to
which a society places importance on the future instead of the past
or present – and uncertainty avoidance – how
individuals deal with uncertainty – two cultural dimensions
that can be measured relative to other cultures to determine what
might be contributing to 29 percent of older Hispanic women in
their sample reporting not having a mammogram in the last two
Breast cancer is the leading cause of cancer death among
Hispanic women. Diagnosis of late stage cancer in this population
is greater than other groups partly because of underutilized
While many studies have looked at racial differences when it
comes to accessing preventative health, the influence of culture is
not as widely studied.
Developing the questions Bakk mentions is critical. Demographers
project the Hispanic population will reach 17.5 million people by
2050, making it the largest older minority group in the United
States. Furthermore, there is great diversity within that
population, which is represented by many parts of the world,
including Mexico, the Dominican Republic, Puerto Rico, Cuba and
Central and South American countries.
“I find this in my own work involving benefits access,
like Medicare,” says Bakk, an expert in health care
disparities and director of UB’s Institute on Aging Policy
and Practice. “We often don’t consider ethnicity when
it comes to receiving some of these benefits.”
The researchers drew their sample from the Health and Retirement
Study, a longitudinal study administered by the Institute for
Social Research at the University of Michigan.
As the research team expected, future-time-oriented Hispanic
women were more likely to participate in breast cancer screening,
but their analysis also suggests that Hispanic women with a higher
ability to manage uncertainty may be less concerned about
Bakk says clinicians should evaluate this outlook to determine
patients’ views on breast cancer screening.
“We need to be aware of these cultural factors that can
impact breast cancer screening among older Hispanic women, in
particular,” says Bakk.
“It is important to remember that each patient brings
unique perspectives to their care,” says Cadet.
And while the focus in the study was Hispanics, Cadet suggests
that providers should consider what cultural factors affect other