How African American Men Decide Whether or Not to Get Prostate Cancer Screening

Randy A. Jones, PhD, RN; Richard Steeves, PhD, RN, FAAN; Ishan Williams, PhD


Cancer Nurs. 2009;32(2):166-172. 

In This Article

Health-Seeking Behaviors Among Rural African American Men

Although prostate cancer is a significant problem for African American men, few studies have focused directly on rural African American men's decision making or views that may keep them from receiving testing. A few studies have identified barriers to undergoing prostate screening examinations for African American men, including distrust, poverty, lack of knowledge, low social standing, fear of possible hospitalization, and negative attitudes toward white healthcare providers.[3,4,19] There may be other reasons as well. For instance, Mcdougall and colleagues[20] had 19 African American men complete a prostate cancer screening questionnaire to examine perceived barriers to screening. The researchers found that barriers to prostate cancer screening by African American men included personal beliefs such as lower value placed on health and inadequate time, lack of money, and fear of test results. Although one limitation to this study was the small sample size, it revealed other possible explanations to the problem. Some men may avoid involving their closest family members and friends in cancer screening and treatment decisions because of shame, guilt, and fear. Some men may not feel comfortable talking about their situation with relatives and friends although they may feel more relaxed when speaking with other men who have gone through similar experiences. There is some evidence that African Americans who have strong social support and pleasant experiences with healthcare providers are more likely to express commitment to their health and follow-up appointments than those who do not feel supported by providers.[21] One study[21] that examined factors associated with the intention to obtain prostate cancer screening among 154 African American men found a positive association between prostate cancer screening intention and strong social support and a trusting healthcare provider-patient relationship.

It has been noted that individuals, particularly low-income African Americans, who live in rural communities in the southern regions of the United States have less access to healthcare screenings than their urban counterparts. In this current study's catchment area, central rural Virginia, several hospitals and agencies provide free prostate cancer screenings at least once a year, and there are other opportunities to obtain prostate cancer screenings. Usually, these free screenings occur near or at major medical centers such as the University of Virginia Medical Center. Also, Virginia is one of the states that have enacted laws requiring insurers to include coverage for prostate cancer screenings. However, in rural areas, individuals may not be aware of free prostate cancer screenings, or it may be difficult to get to a screening because of distance; furthermore, individuals may not be aware of the risk of prostate cancer. There is little information on what prostate cancer screening means to rural African American men and why they do or do not participate in screening. This study therefore examined the meaning of prostate cancer screening for rural African American men. Understanding African American men's beliefs about prostate screening may lead to more effective interventions to get these men into screening earlier and possibly decrease mortality in this population.


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