This study investigated the influences of an array of socioeconomic, health care utilization, breast cancer awareness and cultural belief factors on rural women's intentions to seek breast health care if they were to detect a breast lump. The underlying conceptual schema was an ecological perspective that provided a framework for the multiple levels of predisposing, reinforcing and enabling influences on women's perceptions about breast cancer and subsequent decision-making. -- A secondary analysis of survey data was conducted from a random sample of 853 White and African women aged 18 to 99 years residing in two counties in rural eastern North Carolina. Bivariate analyses revealed that older African American women, compared to their younger and White counterparts, were the least likely to know or worry about breast cancer and its risks, or to talk to their physicians about the need for screening, or to have been screened, and more likely to subscribe to cultural beliefs that were barriers to seeking breast health care. Yet, older African American women were more predisposed to pursuing health care and physician recommendations than the other subgroups. -- A multi-stage, multivariate logistic regression analysis revealed that socioeconomic characteristics, breast health care utilization, breast cancer awareness, and cultural beliefs influenced intentions, but could not account for racial and age differences. Findings indicated that past screening behavior predicts future screening intention, prior use of the health care system predicts future use if a health problem is detected, breast cancer cultural beliefs that are consistent with mainstream medical knowledge reinforce the use of medical care and screening, and physician communication about breast cancer risk and religious beliefs about God's role in curing cancer are highly influential on women's intentions to watch the lump for changes and to pray. -- Findings highlight the need for public health programs that incorporate information related to women's use of the medical system and their cultural beliefs about breast cancer. Provider-oriented interventions should focus on the relevance of these beliefs for optimal health care and the importance of early detection. Study findings also justify advocacy for community partnerships that promote breast cancer screening for at-risk women
