Differences In Health Beliefs Research Articles

“Getting Moving” and Being “Active Fit”: Class Differences and Similarities in Health-promoting Parenting through Children's Organized Athletic Activities

Parents are held increasingly responsible for acting intensively to protect their children's health through everyday decisions and practices. We add to this scholarship by considering how organized athletic activities, an important part of the lives of many children, help parents fulfill their responsibility to protect their children's health. Through qualitative analysis of 92 in-depth interviews with parents, we attend to how parents' class shapes their articulation of the relationship between their children's health and their extracurricular involvement, considering literature on the ubiquity of intensive parenting expectations and the possibility that health behaviors and understandings constitute health-related cultural capital. Contrary to previous research, overall, we find similarities across class in parents' understandings of the health benefits of organized athletic activities. We find that parents believe organized athletic activities protect their children's health from inactivity, excess technology usage, and fatness. We do find some class distinctions. Middle-class parents, and not working-class parents, believe that their children's athletic activities will instill a passion for exercise and staying in shape and give children the experience and knowledge to control their body size and promote their well-being through their lives. This may signal a transformation in the relationship between health-related parenting and class that could maintain middle-class children's advantage if it contributes to differences in health beliefs, narratives, or practices that are differentially rewarded by important institutions such as schools, the workplace, or the medical system.

Specific health beliefs mediate sex differences in food choice.

Although sex differences in dietary habits are well documented, the etiology of those differences is still a focus of research. The present study examines the role of specific health beliefs regarding healthy amounts of food for food choice and its relation to sex, more specifically, the assumption that sex differences in food choices are mediated by differentiating health beliefs. 212 German participants (44.3% female) aged 18-70 answered an online self-report questionnaire on their dietary habits and health beliefs, based on the recommendations of the German Nutrition Society. Most of the anticipated sex differences in food choice and some differences in health beliefs were found. The mediation hypothesis was partly supported, as the relationship between sex and fruit, vegetable, and fish consumption was mediated by the respective health beliefs. However, no mediation effects were found for meat, egg, cereal, and milk product consumption. The support for the mediation hypothesis aligns with previous findings and indicates that health beliefs might be an important pathway to fostering healthier food choices, especially for men. Nonetheless, sex differences in food choice were only partially mediated by sex differences in specific health beliefs, indicating that future studies might benefit from parallel mediation analyses to reveal the impact of other relevant factors influencing sex differences in food choice.

Racial Disparities in Health Beliefs and Advance Care Planning Among Patients Receiving Maintenance Dialysis.

Among people receiving maintenance dialysis, little is known about racial disparities in the occurrence of prognostic discussions, beliefs about future health, and completion of advance care planning (ACP) documents. We examined whether Black patients receiving maintenance dialysis differ from White patients in prognostic discussions, beliefs about future health, and completion of ACP-related documents. We surveyed adult patients receiving maintenance dialysis from seven dialysis units in Cleveland, Ohio, and hospitalized patients at a tertiary care hospital in Cleveland. Of the 450 patients who were asked to participate in the study, 423 (94%) agreed. We restricted the current secondary analyses to include only Black (n=285) and White (n=114) patients. The survey assessed patients' knowledge of their kidney disease, attitudes toward chronic kidney disease (CKD) treatment, preferences for end-of-life (EoL) care, the patient-reported occurrence of prognostic discussions, experiences with kidney therapy decision making, sentiments of dialysis regret, beliefs about health over the next 12 months, and advance care planning. We used stepwise logistic regression to determine if race was associated with the occurrence of prognostic discussions, beliefs about future health, and completion of an ACP-related document, while controlling for potential confounders. We found no significant difference in the frequency of prognostic discussions between Black (11.9%) versus White patients (7%) (P=0.15). However, Black patients (19%) had lower odds of believing that their health would worsen over the next 12 months (OR 0.22, CI 0.12, 0.44) and reporting completion of any ACP-related document (OR 0.5, CI 0.32, 0.81) compared to White patients CONCLUSION: Racial differences exist in beliefs about future health and completion of ACP-related documents. Systemic efforts to investigate differences in health beliefs and address racial disparities in the completion of ACP-related documents are needed.

Differences in health beliefs and behavior compliance of the patients with chronic renal failure

Health belief is about a patient’s belief that vulnerability and treatment efficacy can affect health behavior decisions. This research investigated the difference in behavior compliance of patients with chronic renal failure based on gender and health beliefs' contribution to it. The sample of this research was 30 male and 30 female renal failure patients at Brigjend H. Hasan Basry Hospital. Data was collected by behavior compliance scale and health belief scale. Multivariate analysis was used to analyze the data. The results show a significant relationship between male and female patients' health beliefs and behavior compliance. The health belief of male patients is higher than female patients, while the behavior compliance of female patients is higher than males. It can be concluded that health and gender are factors affecting behavior compliance. Therefore, paramedics may increase patients' health beliefs to enhance behavior compliance, especially among female patients with chronic renal failure.

Comparison of Stroke Knowledge, Health Beliefs, and Stroke Prevention Behavior between Early and Middle-Aged Adults

Background: The onset age of stroke is decreasing, leading to social loss. As such, primary stroke prevention is important. This study aimed to compare the stroke knowledge, health beliefs, and stroke prevention behavior between early and middle-aged adults.Methods: In this cross-sectional descriptive study, a survey was conducted in three small cities in Korea from June to October 2020. The study used a structured self-report questionnaire that included items on stroke knowledge, including risk factors, warning signs, and urgent action, health beliefs, and stroke prevention behavior, as well as collected data on respondents’ demographic characteristics. The data were analyzed with descriptive statistics, t-test, <sup>2</sup> test, and Pearson’s correlation coefficients using IBM SPSS Statistics for Windows, Version 26.0.Results: The participants included 104 early adults (aged below 40 years) and 143 middle-aged adults (aged 40∼64 years). The two groups showed a significant difference in their health beliefs scores. By contrast, they did not show a significant difference in their scores for stroke prevention behavior. However, their scores for health responsibility (t=−2.00, p=.047), nutrition (t=4.24, p＜.001), and interpersonal relationships (t=2.04, p=.042) were significantly different.Conclusions: Early and middle-aged adults showed differences in health beliefs and the stroke prevention behavior subfactors of health responsibility, nutrition, and interpersonal relationships. The present findings may be used when planning interventions or education programs for primary stroke prevention.

An analytical study of gender differences in health beliefs among rural population

An analytical study of gender differences in health beliefs among rural population

Perceptions of Ecuadorian indigenous healers on their relationship with the formal health care system: barriers and opportunities

BackgroundThe new paradigm of intercultural policies focuses on rethinking the common public culture. In Ecuador, the “Buen Vivir” plan seeks to incorporate the ancestral medical knowledge, experience and beliefs of traditional healers into the formal health services. This study explores views on the formal health system from the perspective of the healers belonging to the Kichwa and Shuar ethnicities in the South of Ecuador.MethodsA qualitative study with a phenomenological approach was performed. Focus groups were conducted in three locations in Southern Ecuador. Shuar, Kichwa and Mestizo ethnic groups were included in the research.ResultsEleven focus groups with a total of 110 participants belonging to the Shuar, Kichwa and Mestizo ethnic groups participated in the study. Six themes were created through analysis: 1) conflicts with health professionals, 2) acceptance of traditional healers, 3) respect, 4) work as a team, 5) environment and patient care, and 6) salary and recognition.ConclusionThis study indicated the perceived barriers compromising respectful collaboration between health staff and traditional healers from an indigenous perspective. Power inequalities and a historically unidirectional relationship and, in addition, differences in health beliefs, seem to create misunderstandings regarding each other’s approach when faced with health and disease. However, insight in these barriers can create opportunities towards collaboration, which will have a positive effect on patient confidence in one or both systems and support continuity between traditional healers and the formal health system.

Global Imperative of Suicidal Ideation in 10 Countries Amid the COVID-19 Pandemic.

Background: The novel coronavirus (COVID-19) has had a detrimental impact on individuals' psychological well-being; however, a multi-country comparison on the prevalence of suicidal ideation due to the virus is still lacking.Objectives: To examine the prevalence and correlates of suicidal ideation among the general population across 10 countries during the COVID-19 pandemic.Materials and methods: This was a cross-sectional study which used convenience sampling and collected data by conducting an online survey. Participants were sourced from 10 Eastern and Western countries. The Patient Health Questionnaire (PHQ-9) was used to measure the outcome variable of suicidal ideation. Ordinal regression analysis was used to identify significant predictors associated with suicidal ideation.Results: A total of 25,053 participants (22.7% male) were recruited. Results from the analysis showed that the UK and Brazil had the lowest odds of suicidal ideation compared to Macau (p < 0.05). Furthermore, younger age, male, married, and differences in health beliefs were significantly associated with suicidal ideation (p < 0.05).Conclusions: The findings highlight the need for joint international collaboration to formulate effective suicide prevention strategies in a timely manner and the need to implement online mental health promotion platforms. In doing so, the potential global rising death rates by suicide during the pandemic can be reduced.

Black-white disparities in 2009 H1N1 vaccination among adults in the United States: A cautionary tale for the COVID-19 pandemic

BackgroundPrior research has highlighted racial and ethnic disparities in H1N1 vaccination in the United States. Our study adds to this literature by utilizing an intersectionality framework to examine the joint influence of race and sex on H1N1 vaccination beliefs and behaviors among non-Hispanic blacks and non-Hispanic whites (hereafter blacks and whites). MethodsUsing data from the National H1N1 Flu Survey of U.S. adults, we measured differences in beliefs about the safety and efficacy of the H1N1 vaccine among black women, black men, white women, and white men. We then estimated a series of nested logistic regression models to examine how race/sex vaccination disparities were influenced by health beliefs, socioeconomic status (SES), pre-existing conditions, and healthcare. ResultsBlack respondents were more likely than white respondents to express reservations about the safety and efficacy of the H1N1 vaccine. Consistent with those beliefs, white females reported the highest rate of H1N1 vaccination (28.4%), followed by white males (26.3%), black males (21.6%), and black females (17.5%). Differences in health beliefs, SES, pre-existing conditions, and healthcare explained lower odds of H1N1 vaccination among white men and black men, relative to white women. However, black women experienced 35–45% lower odds of vaccination than white women across all models, highlighting the intersectional nature of these associations. DiscussionThe 2009 H1N1 influenza pandemic provides a cautionary tale about the distribution of new vaccines across large populations with diverse racial, sex, and socioeconomic characteristics. Despite differences between the H1N1 and COVID-19 pandemics, our study warns that many black Americans will forego COVID-19 vaccines unless swift action is taken to address black-white disparities in access to vital resources. Public health stakeholders can also encourage widespread adoption of COVID-19 vaccines by tailoring health promotion messages for different groups of racial minorities, especially groups like black women who face intersecting disadvantages.

Characterizing Demographic and Geographical Differences in Health Beliefs and Dietary Habits Related to Colon Cancer Risk in US Adults.

Background: Colon cancer (CC) risk is increased by behavioral factors including a diet high in red meat (RM) and processed meat; excess adiposity has contributed to a rise in CC in younger adults. The willingness of at-risk adults to modify behaviors to reduce CC risk warrants further investigation.Methods: The previously validated Dietary Habits and Colon Cancer Beliefs Survey (DHCCBS) was used to assess attitudes and beliefs related to CC risk and diet behavior. An abbreviated food frequency questionnaire was included in the survey to quantify RM and green leafy vegetable (GLV) intake over the previous 30 days. Independent samples t-tests compared RM and GLV intake and DHCCBS responses. One-way analysis of variance with post-hoc LSD correction was completed to assess these differences within three age groups (<35, 35–44, and 45–54 years old) and between U.S. Census Bureau geographical regions.Results: Eight hundred and thirty eight survey responses were analyzed. Perceived severity of CC diagnosis was significantly lower in younger adults (<35) compared to older adults (35–44, p = 0.042; 45–54, p = 0.003). Furthermore, younger adults (<35) perceived fewer barriers (i.e., taste preference) to GLV consumption than their older adult counterparts (35–44, p = 0.019; 45–54, p = 0.002). Few regional differences in habitual RM consumption were observed, however, several disparities were observed with GLV.Conclusion: These findings from the DHCCBS indicate health beliefs toward CC risk are influenced by an individual's age and dietary habits. Additionally, regional differences in GLV consumption indicate opportunities for risk-reduction-focused health messages, particularly in the southern United States where CC incidence and mortality are highest.

Nurses' health beliefs about paper face masks in Japan, Australia and China: a qualitative descriptive study.

AimTo explore the health beliefs of clinical and academic nurses from Japan, Australia and China regarding wearing paper masks to protect themselves and others, and to identify differences in participants' health beliefs regarding masks.BackgroundThe correct use of face masks and consensus among health professionals across the globe is essential for containing pandemics, and nurses need to act according to policy to protect themselves, educate the public and preserve resources for frontline health workers. Paper masks are worn by health professionals and the general public to avoid the transmission of respiratory infections, such as COVID‐19, but there appear to be differences in health beliefs of nurses within and between countries regarding these.MethodsThis qualitative descriptive study used content analysis with a framework approach.FindingsThere were major differences in nurse participants’ beliefs between and within countries, including how nurses use paper masks and their understanding of their efficacy. In addition, there were cultural differences in the way that nurses use masks in their daily lives and nursing practice contexts.ConclusionNurses from different working environments, countries and areas of practice hold a variety of health beliefs about mask wearing at the personal and professional level.Implications for nursing policy and health policyThe COVID‐19 pandemic has sparked much discussion about the critical importance of masks for the safety of health professionals, and there has been considerable discussion and disagreement about health policies regarding mask use by the general public. Improper use of masks may have a role in creating mask shortages or transmitting infections. An evidence‐based global policy on mask use for respiratory illnesses for health professionals, including nurses, and the general public needs to be adopted and supported by a wide‐reaching education campaign.

Understanding Patients' Perspectives and Educational Needs by Type of Osteoporosis in Men and Women and People with Glucocorticosteroid-Induced Osteoporosis: A Qualitative Study to Improve Disease Management.

The aim of the study was to investigate similarities and differences in health beliefs, experiences and educational needs by type of osteoporosis (OP), particularly in people with glucocorticoid-induced OP (GIOP) and men. A qualitative study was conducted via focus groups involving post-menopausal women with or without osteoporotic fractures, osteoporotic men and people with GIOP. Fifty-three participants were included in eight groups. A wide range of health beliefs was found for all types of OP. Osteoporosis was considered a natural consequence of ageing except in men or conversely a serious disease associated with risk of new fractures and disability. GIOP patients had heterogeneous knowledge of OP and reported fewer prevention behaviours, and their quality of life was affected by the causal illness. Men had difficulties coping with the loss of their functional abilities and felt that OP was a "women's" disease. Beliefs about treatments ranged from confidence to fear of adverse effects or doubt about efficacy in all types of OP. Participants were interested in physical activity, fall prevention and diet, and preferred group sessions. GIOP patients and men had an interest in face-to-face education. Men were also interested in brief information including via the Internet. Patients' beliefs about OP differed by type of OP. Specific populations such as men or people with GIOP need particular care owing to experiences and needs. Offering group sessions in educational interventions is of interest to allow for sharing experiences and also face-to-face education for men and GIOP patients or the Internet for men.

Culturally competent healthcare - A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision.

BackgroundCulturally and linguistically diverse patients access healthcare services less than the host populations and are confronted with different barriers such as language barriers, legal restrictions or differences in health beliefs. In order to reduce these disparities, the promotion of cultural competence in healthcare organizations has been a political goal. This scoping review aims to collect components and strategies from evaluated interventions that provide culturally competent healthcare for culturally and linguistically diverse patients within healthcare organizations and to examine their effects on selected outcome measures. Thereafter, we aim to organize identified components into a model of culturally competent healthcare provisions.Methods and findingsA systematic literature search was carried out using three databases (Pubmed, PsycINFO and Web of Science) to identify studies which have implemented and evaluated cultural competence interventions in healthcare facilities. PICO criteria were adapted to formulate the research question and to systematically choose relevant search terms. Sixty-seven studies implementing culturally competent healthcare interventions were included in the final synthesis. Identified strategies and components of culturally competent healthcare extracted from these studies were clustered into twenty categories, which were organized in four groups: Components of culturally competent healthcare–Individual level; Components of culturally competent healthcare–Organizational level; Strategies to implement culturally competent healthcare and Strategies to provide access to culturally competent healthcare. A model integrating the results is proposed. The overall effects on patient outcomes and utilization rates of identified components or strategies were positive but often small or not significant. Qualitative data suggest that components and strategies of culturally competent healthcare were appreciated by patients and providers.ConclusionThis scoping review used a bottom-up approach to identify components and strategies of culturally competent healthcare interventions and synthesized the results in a model of culturally competent healthcare provision. Reported effects of single components or strategies are limited because most studies implemented a combination of different components and strategies simultaneously.

Characterizing Beliefs about Stroke and Walking for Exercise among Seniors from Four Racial/Ethnic Minority Communities.

We described and compared seniors' stroke-related health beliefs among four racial/ethnic communities to inform a culturally-tailored stroke prevention walking intervention. Specific attention was paid to how seniors combined pathophysiology-based biomedical beliefs with non-biomedical beliefs. We conducted twelve language-concordant, structured focus groups with African American, Chinese American, Korean American, and Latino seniors aged 60years and older with a history of hypertension (n= 132) to assess stroke-related health beliefs. Participants were asked their beliefs about stroke mechanism and prevention strategies in addition to questions corresponding to four constructs from the Health Belief Model: perceived susceptibility, perceived severity, and benefits and barriers to walking for exercise. Using thematic analysis, we iteratively reviewed and coded focus group transcripts to identify recurrent themes within and between racial/ethnic groups. Participants across all four racial/ethnic groups believed that blockages in brain arteries caused strokes. Factors believed to increase susceptibility to stroke were often similar to biomedical risk factors across racial/ethnic groups, but participants also endorsed non-biomedical factors such as strong emotions. The majority of participants perceived stroke as a serious condition requiring urgent medical attention, fearing paralysis or death, but few mentioned severe disability as a stroke consequence. Participants largely believed stroke to be preventable through physical activity, dietary changes, and medication adherence. Perceived benefits of walking for exercise included improved physical health, decreased bodily pain, and ease of participation. Perceived barriers to walking included limited mobility due to chronic medical conditions, increased bodily pain, and low motivation. While seniors' stroke-related health beliefs were often similar to biomedical beliefs across racial/ethnic groups, we also identified several non-biomedical beliefs that were shared across groups. These non-biomedical beliefs regarding perceived stroke susceptibility and severity may warrant further discussion in stroke education interventions. Patterns in non-biomedical beliefs that vary between groups may reflect cultural differences. Stroke education could potentially increase cultural relevancy and impact by addressing such differences in health beliefs as well as perceived benefits and barriers to walking for exercise that vary between different racial/ethnic groups.

Perceived treatment barriers and experiences in the use of services for obsessive-compulsive disorder across different ethnic groups: a thematic analysis.

Patients from ethnic minority backgrounds are underrepresented in clinical settings. Factors like cost of treatment, poor knowledge of the health system, geographic availability of services, lack of mental health literacy, differences in health beliefs, and social barriers have been identified as reasons for these inequalities. The aim of this study was to identify and compare barriers that parents from different ethnic groups face when accessing specialist services for obsessive-compulsive disorder (OCD) for their children. Ten parents from White backgrounds and 10 from ethnic minority backgrounds were recruited from the National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, London, United Kingdom. They were interviewed about their opinions and experiences when accessing treatment. Using thematic analysis, several common barriers for both groups were identified. These included a lack of knowledge of OCD, lack of resources within the health system, previous negative experiences, lack of trust in the mental health system, lack of time and financial issues, no support out of hours, bullying, and inconvenient location of services. In addition, there were several barriers that were endorsed by ethnic minority groups but not by the parents from White backgrounds, namely stigma and discrimination from within their communities, shame and denial, a general lack of trust in the health system by their cultural group, different beliefs about mental health issues, and discrimination from within the system. Policy-makers and clinicians should be aware of the additional barriers minority patients may face in accessing treatment and should support interventions designed to overcome them.

Latino Caregiver Coping With Children's Chronic Health Conditions: An Integrative Literature Review

In this study we examined research pertaining to how Latino caregivers cope with their children's chronic health conditions. An understanding of this topic could facilitate appropriate interventions by health care staff to promote optimal child health outcomes. In this integrative review we categorized 21 studies by publication characteristics, methodology, findings, and their focus on emotion-focused and/or problem-focused coping. Thirteen studies used a qualitative design. Five studies included fathers in the sample. Twelve studies investigated coping with child's asthma, primarily in Mexican or Puerto Rican families. Coping strategies utilizing religion/spirituality, alternate healing practices, family support, and education about the child's illness were identified. Language, cultural dissimilarities, receiving inadequate information about the child's health care, differences in health beliefs, and feeling disrespected by providers were frequently cited coping challenges. Addressing these barriers is imperative to enhance coping of caregivers. Inconsistencies in research samples regarding income, education, immigration, and acculturation histories make findings difficult to generalize; recommendations for further research are suggested.

Mental health problems of undocumented migrants in the Netherlands: A qualitative exploration of recognition, recording, and treatment by general practitioners

Objective. To explore the views and experiences of general practitioners (GPs) in relation to recognition, recording, and treatment of mental health problems of undocumented migrants (UMs), and to gain insight in the reasons for under-registration of mental health problems in the electronic medical records. Design. Qualitative study design with semi-structured interviews using a topic guide. Subjects and setting. Sixteen GPs in the Netherlands with clinical expertise in the care of UMs. Results. GPs recognized many mental health problems in UMs. Barriers that prevented them from recording these problems and from delivering appropriate care were their low consultation rates, physical presentation of mental health problems, high number of other problems, the UM’s lack of trust towards health care professionals, and cultural differences in health beliefs and language barriers. Referrals to mental health care organizations were often seen as problematic by GPs. To overcome these barriers, GPs provided personalized care as far as possible, referred to other primary care professionals such as social workers or mental health care nurses in their practice, and were a little less restrictive in prescribing psychotropics than guidelines recommended. Conclusions. GPs experienced a variety of barriers in engaging with UMs when identifying or suspecting mental health problems. This explains why there is a gap between the high recognition of mental health problems and the low recording of these problems in general practice files. It is recommended that GPs address mental health problems more actively, strive for continuity of care in order to gain trust of the UMs, and look for opportunities to provide mental care that is accessible and acceptable for UMs.

The refugee experience of acquiring a family doctor

Purpose – The purpose of this paper is to explore refugees’ experiences of the barriers and facilitators involved in finding a regular family doctor. Design/methodology/approach – Hermeneutic phenomenology was used to produce an integrated description sensitive to the lifeworlds of refugees who came from multiple cultural perspectives. Participants consisted of refugees from Iran, Afghanistan, Myanmar, Vietnam, and Latin America who arrived in Canada between 2005 and 2007. Texts for analysis came from first language focus group discussions and interviews with the interpreters for those groups. Findings – The principal themes that emerged from the experience of barriers were “futility,” “dependence,” and “relevance.” Themes related to the experience of facilitators were “inclusion,” “congruence,” and “benefit to family.” These themes provide key messages about sources of patient decisions to seek or not seek care, not comply, attend irregularly, and not disclose symptoms, which can be used by doctors and other health providers to enhance care planning. Practical implications – The factors that facilitate refugees’ access to a regular family doctor have implications for the development of culturally appropriate healthcare information, policies that support adequate interpreter services, and cultural sensitivity training for physicians. Originality/value – Previous research documents barriers such as lack of language access, differences in health beliefs, and lack of knowledge about western healthcare systems. However, little is known about how refugees experience these barriers, nor how they overcome them. This study contributes a rich and deeper understanding of how refugees experience these barriers and elucidates factors that facilitate their process of obtaining a regular family doctor.

Why do ethnic Chinese in the Netherlands underutilize mental health care services? Evidence from a qualitative study.

Chinese immigrants in the Netherlands are less likely than other ethnic groups to utilize mainstream mental health care services. This study investigated the experiences of Chinese with mental health problems, to inform measures to make services more responsive to the needs of this group. Qualitative methods of analysis were applied to interview data in order to explore ways of finding help, barriers to accessing mainstream mental health care, experiences in care, factors jeopardizing the quality of care, and views on mental health services among Chinese migrants in the Netherlands. Rather than recruiting individuals with mental health problems, an indirect method was used in which ethnic Chinese participants were invited to tell us about one or more Chinese individuals in their social environment whom they regarded as having (had) mental health problems (Symbol: see text). Although most Chinese regarded mainstream Dutch care as the appropriate resource for dealing with mental health problems, many barriers to access and threats to care quality were reported. In contrast to the widely accepted view that cultural differences in health beliefs underlie the low utilization of mental health services by Chinese in the West, the main obstacles identified in this study concerned practical issues such as communication problems and lack of knowledge of the health system. Respondents also described concerns about entitlement to care and discrimination (actual or anticipated). Measures suggested by respondents for improving care included increased use of interpreters and cultural mediators, encouraging migrants to increase their language proficiency, and better dissemination of information about the health system. The article concludes with a discussion of the policy implications of these findings.

Differences in Health Beliefs Across Stage of Adoption of Mammography in Iranian Women

Despite evidence that screening for breast cancer is effective, adherence with screening recommendations in Iranian women is low. The aims of this study were to (a) examine the relationships between related beliefs and (b) to determine to what extent women in stages of mammography adoption differ in their agreement of individual perceived health beliefs. A sample of 686 Iranian women completed a questionnaire including selected constructs of the Health Belief Model and stages of mammography adoption. Proportions of participants who were in the preadoption and adoption stages were 75% and 17.8%, respectively. Precontemplators showed significantly lower positive attitude and greater agreement for most of the barrier items than did those in other adoption stages. In terms of specific items, women in the relapse and maintenance stages endorsed greatest agreement for the barrier items "not knowing how to get a mammogram" and "forget to schedule," respectively. Common barriers for women in preadoption stages were being painful, taking much time, and embarrassing. Iranian women are less likely than other Asian women to be in the maintenance and action stages. Identifying the associations between perceived related beliefs items and stages of mammography adoption may provide detailed information to allow for future research and guide the development of interventions not only for Iranian women but also for similar cultural and immigrant groups that have been neglected to date in the breast cancer literature. Examining the interactions between perceived related beliefs items and other beliefs such as perceived control and self-efficacy to having a mammography is warranted.