Nurse practioners' prioritization of breast health promotion among marginalized women: a pilot study from the east Tennessee region

The purpose of this study was to examine the prioritization nurse practitioners place on breast health knowledge among marginalized women. A voluntary convenience sample (N=167) of nurse practitioners currently working in the east Tennessee region of the United States were sent questionnaires containing five vignettes describing marginalized women.Twelve education topics (immunizations, nutritional concerns, importance of regular exercise, smoking cessation, weight reduction, heart disease prevention, osteoporosis prevention, mental health screenings, annual pap smears, monthly breast examination, annual clinical breast examination, and mammography) followed each vignette and nurse practitioners prioritized teaching according to the vignette.

Results of the study showed no significant difference between the promotion of breast self examination and mammography among nurse practitioners working in the public (n=36) or private (n=113) clinic settings. However, statistically significant difference (p=0.03) between the public and private clinic nurse practitioners in regard to promoting clinical breast examination was discovered.Public clinic nurse practitioners more highly promote the importance of this screening.

Next, a comparison between practice specialties was conducted with a sample of family health (n=106) and women's health (n=30) nurse practitioners. There was no significant difference between the groups in the promotion of breast self-examination and mammography. However, there was a significant difference in the promotion of clinical breast examination.The women's health nurse practitioners were more likely to promote this health teaching (p < 0.05).

A comparison of the responses by all the nurse practitioners revealed a disparity among the prioritization of breast health among the vignettes.In a pairwise comparison it is found that nurse practitioners were more likely to promote breast health teaching in the vignettes describing low socioeconomic women who were African-American,Latina,and lesbian. The nurse practitioners were least likely to promote breast health teaching in the vignettes describing women who were homeless and/or HIV positive.

Nurse practitioners who work in public health settings more highly rank the importance of an annual clinical breast examination than private setting nursepractitioners.Public health nurse practitioners often minister to women who are transient; the promotion of an annual examination may convince women to seek care so that other necessary annual screenings may be carried out such as Pap smears or colon cancer screenings. Since the women portrayed in the vignettes were of limited financial means,nurse practitioners may be aware that these women are least likely to receive annual breast examinations.

Women who are homeless or HIV positive have many needs in regard to health teaching. Since nurse practitioners reported a lower priority with this aggregate of homeless or HIV positive women it may be assumed that nurse practitioners will prioritize various necessary health teaching according to specific identifying factors. The implications for nursing practice suggest extension of appointment time allotments for these marginalized women to ensure breast health teaching according to American Cancer Society guidelines.