By Kara McGinnis
Article: Lende, D. & Lachiondo, A. (2009). Embodiment and breast cancer among African American women. Qualitative Health Research 19(2): 216-228.
Lende and Lachiondo present their research on why African American women remain a population that underutilizes breast cancer screening methods. Framing their study within the theoretical concept of embodiment, they explain why traditional examinations of poor screening practices have only slightly improved screening outcomes, and conclude by offering six recommendations for including embodiment in screening initiatives.
African American women have low breast cancer morbidity when compared to White women, and yet their rates of mortality are much higher. Lende and Lachiondo explain that traditionally researchers have examined why African American women do not regularly or timely screen for health issues by focusing on structural causes, deficit approaches, and cultural beliefs. Structural barriers to screening have included cost, access, and discrimination. Deficit approaches take an individual perspective that claims lack of knowledge or fear of the unknown are the barriers women must overcome to get screened. Finally, cultural beliefs such as, screening might bring the disease or God’s Will determines sickness, are used to explain why women are dissuaded from getting screened, and create an argument for culturally competent care.
While Lende and Lachiondo recognize that these perspectives have offered solutions for some of the barriers that individuals face, they point out that those perspectives remain limited in explaining why African American women continue to put off screening and be diagnosed with breast cancer at later stages.
Lende and Lachiondo propose that to truly understand why African American women are not getting screened, public health practitioners must account for how women feel about their bodies, and how screening personalizes and illuminates those feelings. They argue that approaching the topic from an embodiment framework allows researchers to fill in the gaps left by the three traditional approaches. They contend that the embodied approach works because it focuses on three specific concepts including, 1) an emphasis on subjective experiences; 2) the recognition that screening is an “embodied practice” that directly impacts a specific body part; and 3) the acknowledgement that a body is not just an object, but something that has a history and is meaningful (p.217-218).
Using participant observation in screening clinics and semi-structured interviews with fifteen women from the clinics and from a local church community, Lende and Lachiondo designed a qualitative study that reflected beliefs from women along the screening spectrum (from never screened to consistently screens). Special attention was paid to nonverbal cues and body language, and grounded theory and compare-and-contrast methods were used to analyze the data.
In regards to the traditional barriers affecting screening, Lende and Lachiondo found that women already knew where they could get screened, were already knowledgeable about screening options and the significance of cancer, and already knew that they should get screened. Lende and Lachiondo use this to argue that because the traditional barriers had already resulted in successful public health campaigns to overcome them, the fact women were still not getting screened justifies the need for a new theoretical approach to understand why women are not utilizing screening methods earlier.
Significant findings from Lende and Lachiondo include that women were not making their decisions based on “rational” reasons, but the “irrational” reasons of morality and beauty. Having to touch one’s body, or having a provider touch one’s body, evoked internal dialogues where women had to reassure themselves these touches were in fact appropriate and not sexually motivated. Additionally, screening for cancer made the possibility of the consequences of getting chemotherapy or breast removal surgery a closer reality, and women responded negatively to the thoughts of having these body-altering treatments.
Finally, Lende and Lachiondo uncovered a dislike of distant, “professional” style of many providers. Personally dealing with the exams, which revealed the discomfort women had with their own bodies, sexuality, and potential realities of becoming a cancer patient, was harder when women were forced to become the passive objects of the professional provider. In fact, women who were regularly receiving screening spoke of feeling the responsibility of their health as something they could actually control and manage, not something they were told to do.
This personal responsibility arose when they felt that their providers treated them as capable individuals, and recognized that this was an emotional and loaded screening, not an insignificant exam. Women repeatedly mentioned hugs from their provider as helping to move them from passive to empowered patient. Lende and Lachiondo described the transformation of one woman who began screening regularly after developing a good relationship with her provider, deciding to learn more on her own, and hearing other women’s testimonies, concluding with, “she had a personal, and thus embodied, sense of why she had to screen, not simply abstract pronouncements about risk or a doctor telling her she should” (p. 223).
To summarize the study’s findings, African American women feel the implications of screening through the objectification of their body personally, socially, and medically, whether they can articulate their discomfort or not. These embodied understandings can hinder screening, or be recognized by providers, friends, and self as important feelings with complex social and personal implications, thus empowering women to screen. With these findings, Lende and Lachiondo offer six ways that health care providers can incorporate embodiment into current interventions.
First, it is necessary to design good practices that include discussions of the implications of screening and actual screening demonstrations. Second, researchers must discover how to effectively frame the reasons to screen for specific populations. Third, interventions need to have appropriate messages that resonate with women. Fourth, narratives that recognize women’s embodied experiences as important and meaningful need to be shared. Fifth, utilizing social ties such as women’s testimonies and encouraging providers to acknowledge women’s emotional struggles with getting screened can be used to help women feel more comfortable. Sixth, it may be effective to use motivational interviewing to help women find important personal reasons that would motivate them to screen.
In conclusion, Lende and Lachiondo insist that traditional studies of African American women’s barriers to breast cancer screening have been limited in scope. They argue that utilizing an embodied approach can assess the personal and “irrational” meanings that prevent women from accessing care. They assert that validating these feelings and trying to uncover the personal and social understandings of screening that women embody can ultimately motivate women to include screening in their regular healthcare routines.
Editor’s Note: Kara McGinnis is an MA/MPH student in anthropology at the University of South Florida. This post emerged from a class assignment to summarize an article we had read for my graduate medical anthropology class. For more on students and blogging, see Students and Neuroanthropology: The Power of the Post.
Previous posts on breast cancer research:
Article Abstract: Lende, D. & Lachiondo, A. (2009). Embodiment and breast cancer among African American women. Qualitative Health Research 19(2): 216-228.
African American women have historically been screened for breast cancer less than other women, contributing to higher mortality rates. Previous research has focused on social and cultural factors, such as discrimination and religiosity, as shaping African American women’s screening practices. This article extends this research by (a) examining the decisions and justifications of African American women with regard to screening practices, and (b) using a theoretical focus on embodiment to better understand women in relation to their own bodies. Ethnographic research consisted of 5 months of participant observation at an Indiana (USA) breast cancer care center, and 15 in-depth, semi-structured interviews along the continuum of screening practices. The results showed that embodied understandings of the body, personal (rather than biomedical) considerations of screening and treatment, and the quality of doctor/patient interactions all play a significant role in women’s decisions about whether to screen for breast cancer or not. Based on these results and a review of the literature, six ways to include embodiment in public health initiatives are outlined.