Racialized gender images may contribute to poor breast cancer outcomes in minority women

A new study from the University of Illinois at Chicago highlights the need for patient navigators and other health care providers to understand the unique experiences of minority women and how those experiences affect their interactions with care providers.

Published in Cancer, a journal of the American Cancer Society, the study used data from the Patient Navigation in Medically Underserved Areas clinical trial to analyze the rates at which women randomized to the trial’s intervention group, who received patient navigation, reported barriers to care. Of the 3,754 women who received the patient navigation intervention, which provided the option for help overcoming financial, interpersonal or psychosocial barriers to obtaining a mammogram, only 14 percent identified barriers to care. Those women who reported barriers were more likely to obtain a mammogram.

“Regardless of whether women are aware of obstacles to screening and treatment, barriers tend to interfere with timely follow-up of abnormal test results, delaying diagnosis and treatment,” said Sage Kim, associate professor of health policy and administration in the UIC School of Public Health and study author. “While patient navigation is effective, care providers need to recognize that not all women interact the same with patient navigators and other care providers.”

Kim, who is a member of the University of Illinois Cancer Center, and her colleagues found that black women, women living in poverty and women who reported high levels of distrust in the health care system were the least likely to describe barriers and, thus, less likely to receive additional support that could help with early diagnosis and survival.

The researchers suggest that racialized gender images of the ideal women and distrust of the health care system affect how minority women, particularly those living in poverty, engage with the health care system.

Kim said one example is the prevalence of the “super woman” ideal among minority women, particularly black women.

“Minority women living in poverty always have been the source of social support for others,” Kim said, “However, with regard to health care access, they may be disadvantaged because of their role as caretakers.”

“Health care providers need to be aware of the social and historical conditions that may affect the effectiveness of interventions, including patient navigation, for minority women,” Kim said. “The way we train patient navigators and other health care providers needs to be reengineered.”

“We need to shift the focus away from how women report barriers to how structural factors affect women’s care utilization and interactions with care providers,” Kim said. “Inequality can be produced and reproduced by health care systems, interventions and care providers. In designing interventions, we need to think more about structural barriers and our findings highlight a somewhat unexpected area for improvement.”

Co-authors on the paper are Anne Glassgow, Karriem Watson and Yamile Molina of UIC and Elizabeth Calhoun of the University of Arizona. The research was supported in part by a grant from the National Institute of Minority Health and Health Disparities (3P60 MD003424-03S1).