Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Lisa Kennedy Sheldon

Second Advisor

Jerry Cromwell

Third Advisor

Laura Hayman


Breast cancer is the second leading causes of mortality among women living in the United States. The American Cancer Society recommends yearly mammograms for women starting at the age of 40. Minority women are less apt to follow breast cancer screening recommendations. Among Black ethnic groups, Haitian immigrants have the lowest screening rates. There are many identified barriers to breast cancer screening including embarrassment and fear associated with screening, poor knowledge about breast cancer screening, language barriers, and level of acculturation.

The purpose of this study was to examine if there is an association between the level of acculturation and mammography use by Haitian immigrant women residing in Massachusetts.

Eighty percent of the women interviewed reported having had a mammography at least once (n = 80), seventy three percent (n = 58) of those women reported to have had two to three mammograms in the last three years as recommended by ACS. Traditional Haitian health belief (THHB) scores were significantly associated with ‘ever’ mammography use. Contrary to what was predicted, the association was positive. Women who first turned to prayer were more likely to report ever mammography use, and women with fatalistic views and lack of trust were less likely to report ‘ever’ mammography, which supported the hypothesis of this study.

There was a significant association between ‘ever’ mammography use and Language, Identity, and Behavior (LIB) acculturation scores, but that association disappeared when health knowledge and health insurance were added to the model, thus showing that health knowledge and health insurance were mediators of the effects of LIB acculturation scores and ‘ever’ mammography use.

In addition, age, health knowledge, and insurance were all positively associated with mammography adherence. Women with higher health knowledge scores were three times more likely to report at least 2 mammograms in the last three years.

Interventions to improve adherence to mammography guidelines should focused on increasing health knowledge and improving access to health insurance. Nurses play key roles in influencing health behavior and increasing health knowledge about breast cancer and breast cancer screening in this immigrant group through patient education.


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