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Understanding Knowledge and Attitudes About Breast CancerA Cultural Analysis
Leo R. Chavez, PhD;
F. Allan Hubbell, MD, MSPH;
Juliet M. McMullin, MA;
Rebecca G. Martinez, MA;
Shiraz I. Mishra, MD, PhD
Arch Fam Med. 1995;4(2):145-152.
Abstract
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Objective
To evaluate knowledge and attitudes about breast cancer risk factors among Latinas, Anglo-American women, and physicians.
Design
Ethnographic interviews employing systematic data collection methods.
Participants
Twenty-eight Salvadoran immigrants, 39 Mexican immigrants, 27 Chicanas, and 27 Anglo-American women selected through an organizationbased network sampling and a convenience sample of 30 primary care physicians in Orange County, Calif.
Main Outcome Measures and Results
Data analysis using qualitative content analysis and quantitative cultural consensus analysis, a mathematical technique that determines the degree of shared knowledge within groups and estimates "culturally correct" answers (cultural models), was employed. The content analysis revealed different beliefs about breast cancer risk factors, particularly between the Latinas and the physicians. The cultural consensus analysis found two broad cultural models (defined as groups with ratios between the first and second eigenvalues of  3 and no negative competency scores). A Latina model (ratio=3.4), formed by the Salvadorans, Mexicans, and Chicanas, emphasized breast trauma and "bad" behaviors, including drinking alcohol and using illegal drugs as risk factors. A biomedical model (ratio=3.0), embraced by physicians and Anglo-American women, emphasized risk factors described in the medical literature, such as family history and age. Within these broad models, each group of respondents also differed enough in their beliefs to form their own, often stronger, cultural models.
Conclusions
Ethnography can provide important insights about culturally based knowledge and attitudes about disease. An understanding of the distinctive cultural models regarding breast cancer risk factors will aid future cancer control interventions.
Author Affiliations
From the Departments of Anthropology (Dr Chavez) and Medicine (Drs Hubbell and Mishra), the School of Social Ecology (Drs Hubbell and Mishra), the Program in Social Relations (Mss McMullin and Martinez), and the Center for Health Policy and Research (Drs Chavez, Hubbell, and Mishra), University of California, Irvine.
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