Date Presented 4/17/2015
In this mixed-methods study, we identified disparities in breast and cervical cancer among women with disabilities, along with modifiable barriers to screening. By understanding and addressing these barriers, occupational therapy practitioners can be change agents at the provider and client levels.
Research Platform
SIGNIFICANCE: The impact of cancer screening on the reduction of cancer disparities is well documented. Accessibility of these services is woefully inadequate for women with disabilities. There is a critical need to understand the root causes of these disparities. Occupational therapy practitioners can serve as change agents at the client and consumer levels to promote access to cancer screening.
INNOVATION: Quantitative data from population-based surveys supplemented with personal stories are powerful advocacy tools and can support structural changes in health care policy and service provision. Women with disabilities are more than 55% less likely to receive Pap tests or mammograms compared with their peers without disabilities. There is limited understanding about the individual and social factors that influence cancer screening. The purpose of this mixed methods study was to document cancer screening disparities among women with disabilities and to examine the root causes of these disparities. Specifically, the research aims were to (1) compare cancer screening rates between women with and without disabilities while adjusting for individual traits and social factors using data from the 2008 and 2010 Illinois Behavioral Risk Factor Surveillance System (IL-BRFSS); and (2) identify barriers to breast and cervical cancer screening experienced by women with disabilities.
METHOD: This was a community-based participatory research study in which we used a mixed-methods approach. The setting occurred in community-based settings throughout Illinois. A convenience sample of community-dwelling women, aged 21 to 64 yr, with self-identified physical disabilities (N = 40) were recruited through local centers for independent living. We used secondary analysis of the 2008 and 2010 IL-BRFSS (n = 8,307) to determine the relative contributions that individual traits (race, age, and disability status) and social factors (income, education, social support, and access to health care) have on women’s use of mammography and Pap tests. We used six focus groups of women with physical disabilities to gain a nuanced understanding of barriers to cancer screening. We summarized IL-BRFSS data and compared the characteristics of women with and without disabilities. Logistic regression models were fit to examine factors associated with cancer screening. We used constructivist grounded theory with a two-phase analysis that proceeded from descriptive to conceptual coding.
RESULTS: Linear regression models indicate that disability status, low income, and lack of access to health care are predictive of not receiving breast and cervical cancer screenings. Qualitative data indicate that provider attitudes and referral patterns, health literacy, physical inaccessibility, and prior negative health care experiences are barriers to cancer screening among women with disabilities.
CONCLUSION: Women with disabilities face significant individual and social barriers to cancer screening. It is imperative that providers and policy makers address identified barriers to help reduce cancer screening disparities. Occupational therapy practitioners can serve as accessibility and accommodation consultants to cancer screening providers and can support women with disabilities through patient advocacy and health care system navigation training.
