Differentiation of health behavior patterns related to prostate cancer screening among African-American men in military settings

The purposes of this study were to (a) identify, describe and classify African-American men in military settings according to the frequency with which they engage in screening practices for prostate cancer, and (b) to identify a linear combination of predictor variables that verifies the obtained classification and that can be used as a model to predict future group membership. The Health Belief Model and Arthur Kleinman's Model of the Health Care System were used to guide this study. This study incorporated a descriptive correlational method as well as qualitative inquiry to obtain data pertaining to overall health, prostate cancer, and prostate cancer screening practices among African-American men in military settings located in an urban area of northeast United States. One hundred and forty-seven African-American men 40 years of age and older, who were beneficiaries of military health care participated in the study by completing self-reporting questionnaires developed by the researcher and proven to be valid and reliable from a previous pilot study. To confirm, validate, and provide comprehensiveness to the quantitative data, the researcher additionally used a semistructured focus interview guide to interview ten men. All quantitative data were analyzed using descriptive and inferential statistics including ANOVA and discriminant analysis functions. Quantitative data were further analyzed with the qualitative data utilizing a mixed parallel/simultaneous approach described by Tashakkori and Teddlie. The results of the study revealed that most African-American men have an overall "good" to "excellent" view of health. Most of the men (85%) reported having screened for prostate cancer and over 54% of them reported screening annually for the disease. Age, education, perceived benefits of the digital rectal examination (DRE) and prostatic specific antigen (PSA) test, and perceived threats were statistically related to screening practices among the men (p < .05). However, data using discriminant analysis revealed that only age, education, and perceived benefits of the DRE and PSA predicted frequency of screening behavior among the men. The discriminant function was able to predict group membership by 67%. Qualitative data analysis compared with the quantitative data revealed five themes and three major categories dealing with the men's overall health, perceptions of prostate cancer and screening. Two major themes were formed from the data: "intrinsic" and "extrinsic" health behaviors. Intrinsic behaviors reflected the men's self-efficacy and personal control regarding their overall health as defined by lifestyle behaviors. Extrinsic behaviors included the men's attitudes, beliefs, and perceptions that affected their use of external resources, including the professional sector of the health care system, that affected their prostate cancer screening practices. The study revealed that there are significant factors, particularly educating men on the benefits and efficacy of the PSA and DRE, that may predict and influence screening practices for prostate cancer. Healthy People 2000 noted the importance of assessing and assuring preventive health care services for racial and ethnic minority groups. Health care providers, particularly nurses can play an impact in educating African-American men on prostate cancer and prostate cancer screening.