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Social ecological predictors of prostate-specific antigen blood test and digital rectal examination in black American men

V Diane Woods, Susanne B Montgomery, R Patti Herring, Robert W Gardner, Daniel Stokols
Journal of the National Medical Association 2006, 98 (4): 492-504
16623061

BACKGROUND: Black American men continue to suffer disproportionately from epidemically higher rates of prostate cancer. We hypothesize that complex reasons for persistently higher death rates of prostate cancer in this group are steeped in social factors associated with health access.

METHODS: We utilized data from the It's All About U prostate cancer prevention study among black men to investigate: 1) what social ecological factors were predictive of prostate-specific antigen (PSA) testing and digital rectal examinations (DRE); 2) if black men were aware of prostate cancer screening and, if screening was available, would they take the PSA and DRE? Quantitative cross-sectional data from a cohort of 276 black men with no diagnosis of prostate cancer were analyzed to identify characteristics, beliefs, practices and attitudes of this group toward prostate cancer screening. We created a social ecological model to examine which social factors (i.e., environmental, personal, person/environment interplay, black culture and institutional policy) were predictive of PSA and DRE, PSA only and DRE only. To reduce data and identify data patterns, factor analyses (tested for reliability by calculating Cronbach alpha scores) were performed. Variables were standardized with Z scores and analyzed with predictive analytic software technology (SPSS, version 12). A multivariate binary logistic regression was conducted to identify predictors of PSA and DRE.

RESULTS: A significant predictor of both PSA and DRE was the physician's direct prostate cancer communication message (P<0.010). Significant correlations exist in PSA and DRE outcomes with a physician's engaging communication style (P<0.012), encouragement to screen (P<0.001) and sharing prostate cancer information (P<0.001); as was men understanding the serious risk of prostate cancer (P<0.001), culture (P<0.004), positive interaction with healthcare staff, significant other(s) and providers (P<0.001), and environmental dimensions (P<0.006). A profile of four major self-reported barriers to screening were identified (i.e., fear, internal locus of health, comfort level and external locus of health). Lastly, men who utilized health systems with a prostate cancer screening policy had high percentages of PSA and DRE (63.3%), PSA only (70.9%) and DRE only (81.7%).

CONCLUSION: A physician's aggressive, positive engagement in shared decision-making, tailored social influences promoting prostate cancer prevention among black men, as well as institutional screening policy, has the potential to increase early detection and reduce morbidity among this group.

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