Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Morton Wagenfeld


Even with access to well-known breast cancer treatment centers, older African American women continue to have higher breast cancer mortality compared to their European American counterparts. Researchers have theorized relationships among diagnostic delay, socioeconomic status (SES) factors, beliefs, culture, and breast cancer mortality in African American women ages 40 to 64, but these same relationships among African American women ages 65 to 80 have not been investigated. The purpose of this qualitative study was to describe older African American women's experiences with abnormal mammograms. The quality-caring model and critical race theory were used through narration to show the association of structure and process within the context of race. Purposeful, criterion-based sampling was used to select and interview 12 African American women ages 65 to 80 who had an abnormal mammogram result after breast cancer screening (BCS) within the previous 2 years. Through narrative analysis with triangulation it was demonstrated that clinical and social systems within the process of BCS affected the women's perceptions of providers and outcome. Their independence, motivation, health outlook, and spiritualistic beliefs kept them adherent to BCS and longterm follow-up. Health promotion activities were supported by family, friends, and spirituality. Variations in mammography practices and poor provider communication were obstacles to health maintenance. Positive social change is supported through health care providers' understanding of the barriers that impede older African American women's follow-up of abnormal mammogram results. Removing these barriers may assist in the reduction of breast cancer mortality.