Learning What Research Could Mean to Me

By Alyssa Ammerman

Research Story Competition, Highlighted Story.
Undergraduate Research Opportunities Conference, 2022

When you are a college student, you read a lot of different research papers. There are endless ways to contribute to the world of research, but for years, I was convinced that I would not be able to do research if I was not ready to do things like slice rat brains or mess with Petri dishes. I was so fixated on this idea of what premed students are supposed to do that I stopped myself from exploring other areas of research interest. I thought that I just was not research-minded and that I would have to find my premed niche elsewhere. It was not until my health communication professor, Dr. Yangsun Hong, asked us to write about a healthcare problem that impacts a certain population that I realized what “research” could mean to me. I spent a day or two trying to brainstorm a topic, but I quickly realized (to my surprise) that there was an area of interest that had been lingering in the back of my mind.

Outside of school, I help manage outpatient referrals for One Hope Centro de Vida Health Center (OHCV) in Albuquerque’s International District. I have been at the clinic since I was in high school, so I have become very familiar with the referral forms and procedures. One of the most common referrals that we send out are screening and diagnostic mammogram referrals. Because OHCV serves primarily Spanish-speaking individuals who are low-income or uninsured, we receive funds from the Breast and Cervical Cancer Early Detection Program (BCC). The program covers the costs of screening and diagnostic mammograms for patients who qualify based on their age, income, and insurance status. Even though the clinic can send BCC referrals, I noticed that some older Hispanic patients still declined breast exams.

I had originally dismissed the breast exam refusals because I had assumed that the patients were concerned about the costs of radiology testing, but that clearly wasn’t the case. I then wondered if it isn’t about financial concerns, were there other financial or cultural barriers that were limiting mammogram testing in Hispanic patients? And the moment that that question popped into my mind, I knew I had found my project subject. I started reviewing as many scholarly articles on the subject as I could find. I discovered that Hispanic women face disproportionately high rates of death from breast cancer and have lower rates of mammogram testing when compared to white non-Hispanic women. Once I discovered those statistics (and many other concerning figures), I knew that my research subject would be especially relevant to states like New Mexico where we have such a large Hispanic population and where we pride ourselves on working diligently to reduce healthcare inequalities.

I began my research into specific barriers to mammogram testing by looking into the financial challenges that many Hispanic patients face. Hispanic women often receive more delayed diagnoses and less testing because many immigrants are ineligible for medical insurance from the government or are unable to obtain medical benefits from their employers due to their citizenship status. Without medical insurance and other benefits, many families struggle to find the money to pay for the inevitable healthcare costs that all Americans face. As a result, things like preventative care are put on the back burner in many Hispanic households. While the financial barriers were of great concern to me, it was the information on cultural stigmas that limited mammogram testing in Hispanic women that really got to me.

I suspected that some of the cultural stigmas towards women’s reproductive health have roots in the conservative influences of the Catholic and Christian church, as over eighty percent of Hispanics identify as Christian and over fifty percent identify as Catholic. The Catholic church is known for its historical reluctance towards educating its parishioners on reproductive health and for its rigid stance on a wide variety of women’s health issues. Several studies that I read did suggest that many Hispanic women grow up without adequate knowledge of their bodies and their medical rights because of the conservative nature of the Catholic culture. This substantial knowledge gap continues long after the women reach the United States because there are very few educational campaigns geared towards them that are readily accessible and in Spanish.

I also found that one of the most widespread beliefs surrounding women’s reproductive healthcare in Hispanic culture is that it is not culturally acceptable to have a male OB-GYN perform intimate exams. While many women prefer female OB-GYNs over males, the fears associated with having male doctors in reproductive care settings are far more prevalent in minorities and non-English speaking populations. This is likely due to the lack of adequate communication and quality care that many patients with language barriers have experienced in the past. The reluctance is further reinforced by many patients’ husbands having negative attitudes towards their wives receiving health services from male practitioners. However, some patients still refuse breast exams even when the physicians are female, which can still prevent them from having key symptoms of breast cancer diagnosed in a timely manner. One of the other cultural beliefs surrounding reproductive healthcare that I had not heard before was that many women in minority groups are hesitant to have mammograms performed because they believe that breast cancer is always a death sentence. This is likely due to the limited healthcare information available and accessible to non-English speaking citizens and because of the misinformation that can spread in homogenous social networks. Fortunately, the social networks of female Hispanic patients can have positive impacts on preventative care usage as well, which can be used to help lessen the inequalities in mammography usage among Hispanic women.

In addition to utilizing the strong female-female relationships in the Hispanic community, there are a variety of other ways that we can work to increase mammogram testing rates in Hispanic women. This includes allocating more resources and funding to programs like the BCC.

New Mexico healthcare centers also need to make English-Spanish translation services readily available for all patients. I think it would also be prudent for the department of health to invest in an educational campaign geared towards Spanish-speaking women in New Mexico to inform them of the importance of early detection in breast cancer and to combat the misconception that breast cancer is always a death sentence.

In order to help patients be more comfortable during physician visits, I think that doctors and other medical providers should work to ensure that patients understand their rights when it comes to intimate exams like breast exams and pap smears. Patients should be aware that the doctors have certain guidelines that they should be following every time they perform an intimate exam. The patients will then know to pay attention to things like whether or not the doctor is wearing gloves, whether another staff member is in the room during the exam, and whether or not the physician has taken the time to explain the procedure and obtain consent before it begins. This will help to empower the patients because they will be equipped with the background knowledge required to recognize true red flags instead of just culturally-embedded misconceptions. With older Hispanic patients, utilizing the strong social support from their younger relatives (daughters, granddaughters, etc) is very important because they may be especially reluctant to have breast exams and mammograms performed. The bonds between female family members and female friends in Hispanic communities have been shown to have a significant positive effect on health-seeking behavior, even when other social and cultural factors threaten to curb efforts towards health promotion. That is why any community-level intervention aimed at improving mammogram testing rates in Hispanic women has to include a broad spectrum of ages and utilize the incredibly powerful bonds that the women in the community have with each other.

While I have yet to share my formalized findings with my colleagues at the clinic, I hope that the information I have found will be useful for patient advocates and other medical providers who work with Hispanic populations. Because I am still very new to the research world, I was not sure how to best share my ideas, but I am happy to be able to spread awareness through my participation in UROC this year. I think that just raising awareness of the fact that there are cultural stigmas that impact mammogram testing rates is important because the subject is not well known. I am especially hopeful about the practical use of this information for patient advocates because they are in the best position to work with patients on recognizing and overcoming these stigmas. In the future, I would like to develop or promote educational campaigns that are geared towards educating patients on their medical rights so that patients are more comfortable in healthcare settings. In the end, I am incredibly thankful for having gotten even a small taste of the research experience because it lead me to information that will help my community and it opened my eyes to all the possibilities that research has to offer.