Critique of Theoretical Manuscript Assignment

HPE 7040
Brittany Luipold
Article Reviewed
Deavenport, A., Modeste, N., Marshak, H. H., Neish, C. (2010). Heath beliefs of low-income
Hispanic women: A disparity in mammogram use. American Journal of Health Studies, 25,
92-101.
Indictor
Summary of article with
brief description of public
health issues (including the
social, behavioral,
environmental and
biological factors),
population/community,
assets, resources and deficits
in the community, and the
theory used.

Response
The American Cancer Society states that breast cancer is the
most commonly diagnosed cancer for women and also the
most common cause of death for women in 2009 (Cancer Facts
and figures for Hispanics/Latinos 2009-2011). This is
consistent with the statistics from 2006. Overall, the use of
mammograms for Hispanic women has continued to decline
for all Hispanic women (Deavenport, Modeste, Marshak,
Neish, 2010). The study used focus groups in order to get a
richer data in the understanding behind the lack of getting
breast cancer screenings. The reasoning for this study was to
examine why this is occurring and ways to overcome this
barrier. During the study, the health beliefs of the Hispanic
women are examined, but there was also a part that helped
women to see what their risk of getting breast cancer. Seeing
the risk was used in order to determine if the perceived risk
and the actual risk are the same. At the end of the study, there
was an incentive of a fruit basket, a breast cancer pin, and a
brochure about getting a yearly mammogram (Deavenport et
al., 2010). The social factors that exist understand the risk for
Hispanic women. There have been campaigns, but they are
not suited for the demographic. (Deavenport et al., 2010). The
campaigns are a valuable idea, but it was not properly suited
toward Hispanic women in California. The behavioral factors
that are expressed are understanding what is going to happen
with a mammogram and any pain that may be associated with
it. Another aspect is the priorities that women have when
looking at their own health (Deavenport et al., 2010).
When looking at the environmental factors a major component
was the lack of health insurance and the affordability of
actually getting a mammogram. If women are unable to get a
mammogram because of things that are out of their control,
then addressing these challenges is important to do first.
Looking at the women in this study, one barrier that is faced is
the lack affordability. These women have other ideas of how

to spend their money, rather than on a mammogram where

they cannot see the benefits right away. The biological factor
would be not being familiar with what screening for breast
cancer is and what is involved in it (Deavenport et al., 2010).
This could be the result of the lack of communication within
the community or communication from mother to daughter
about the importance of getting a mammogram. These
conversations may not have taken place if it is not something
that is seen important in a womans life and that it is not of a
high priority.
The participants are twelve Hispanic women who attended a
clinic in California and are over the age of 40 that spoke either
English or Spanish. There is not information provided about
the assets, resources, and deficits in the community
(Deavenport et al., 2010).

Critical evaluation of theory

used to address the health
issue in the article and
rationale for the argument.

The Health Belief Model (HBM) is a theory that examines the

values of outcomes. The constructs of this theory are
susceptibility, severity, benefits, barriers, cues to action, and
self-efficacy (Edberg, 2015). Each construct is touched on by
this study, which is why this study is an important contribution
to the field because it takes in all the different areas of the
HBM. Covering all aspects of the HBM is rare because of the
amount that is involved (Deavenport et al., 2010). Grounded
Theory is another theory that provides more guidelines to
follow about a concept that is being studied (Goodson, 2010).
Grounded Theory is used in order to show the relationship
between the women and their beliefs. The theory follows a
strict set of requirements to stay with the focus of
mammogram screenings decreasing.
Looking at this study, I believe that the Health Belief Model is
a good choice to look at the beliefs of Hispanic women and the
screening process. The HBM provided an outline for the
researchers to go through in order to make conclusive
qualitative research. Previously, there have been campaigns in
the study area that did not work. The HBM provided some
insight in understanding the many different aspects that go
within the screenings for breast cancer (Deavenport et al.,
2010). The rationale behind using the HBM is that there are
six constructs each which contain a different topic that
provides unique information about a specific population.
Since this study went through all of the constructs of the HBM
it strengthened the research findings because it shows that the
lack of screenings with Hispanic women is a multilevel
approach (Edberg, 2015).

Critical evaluation of theory

applied to the
population/community in
the article and rationale for
argument.

Insight about theory used in

the article.

Grounded Theory is another theory that is used in this study.

According to Dr. Barney Glaser (2010), Grounded Theory is
the study of the constructs and the patterns that exist within
something. The rationale in using Grounded Theory is that it
is a way to explain and strengthen the HBM constructs. Since
Grounded Theory only focuses on the concepts, it is important
to validate the concepts that are part of the HBM (Glaser,
2010). Grounded Theory is an extra level of strengthening the
study because it helps to explain the patterns that are seen
within screening practices in Hispanic women. In the end, I
think that that the HBM and Grounded Theory worked well
together in order to effectively explain the lack screening
practices among a small group of Hispanic women at a
California clinic.
I believe that the HBM and Grounded Theory are appropriate
for the evaluation of Hispanic womens screenings for breast
cancer. The use of focus groups allowed for a specific insight
about how women understand screenings and exploring their
misconceptions about what is going to happen during a
screening. The rationale behind this is that to better
understand a specific populations beliefs about screening, it is
important to understand the logic that exists behind not getting
screened (Deavenport et al., 2010). The use of the HBM and
Grounded Theory in focus groups helped women to better
understand the screening process. I think that if surveys are
used instead of focus groups, but kept the same theories, the
results of study would not be as strong as what the current
study suggested. Overall, I think that the study is well
developed and focused on a specific population, but it is not a
topic that can be generalized because of the sample that is used
and the way that the sample is obtained (Deavenport et al.,
2010).
The HBM provided a set of guidelines to be used during the
focus groups. This theory is a good starting point because it is
one of the few studies that have been conducted using all of
the constructs of the HBM (Deavenport et al., 2010). After
reading this study, I found it interesting that this is one of the
only studies that have been completed in this area using all
constructs of the HBM. This helped me to see that the HBM is
very time consuming and there are a variety of steps that need
to be included in order to get a successful study. I found that
in this case, the HBM is a good theory to use because of the
implications that it has on the larger society (Edberg, 2015).
Even though this study only focused on a small group of lowincome Hispanic women, it shows me that it is possible to do a
focus group using all areas of the HBM and come out with

Critique of theory used in

the article.

qualitative results (Deavenport et al., 2010). I think that

Grounded Theory is a good strengthening theory, but should
not be used on its own. Since Grounded Theory only studies
the concepts, another theory would also have to be used in
order to get the concepts (Glaser, 2010).
I think that examining the constructs of the HBM and to
further evaluate the situations could strengthen this study. One
example is looking at the lack of knowledge about
mammograms (Deavenport et al., 2010). This study focused
on not having screenings for a variety of reasons, but did not
talk about how to overcome these issues. I think that there is a
societal problem that needs to be addressed that the HBM does
not focus on. The HBM focus on the individual is important
because of the one on one idea, but with screenings of
Hispanic women, there needs to be a societal approach in
addition to the individual approach (Edberg, 2015). Grounded
Theory helped some in the evaluation of the HBM, but it does
not examine much of the concepts in the study, which I think
that a stronger discussion is needed (Glaser, 2009). Overall, I
think that the theories used in this study are well chosen when
looking at the individual level to understand why Hispanic
women think the way that they do. I think that another study is
needed to look at the societal level concerns for low-income
Hispanic women.
A theory that could be added is Vygostskys Sociocultural
Theory and his zone of proximal development. I think that this
aspect is important to consider because it looks at what women
know and how much they can learn with assistance and then
topics that are unreachable at a certain point in time (Berger,
2009). I think that layering this learning theory with the HBM
and Grounded Theory, then another dimension is added to this
study and it could show the importance of teaching to the
individual at a level that is understood (Berger, 2009).
Although this study did not specifically address the findings
about overcoming the concerns that are presented in each
aspect of the HBM, it is something that can be evaluated in a
future study. I would have liked to see what is going to be
done with this information about low-income Hispanic women
and the decline in mammogram screenings. I think a two-part
study could be done in order to examine the same population.
Part one would look at all of the HBM constructs and the
explanation of each one, and then in part two, based on the
findings from part one, apply what is learned to the
community. This would be done using the Sociocultural
Theory to ensure that the information is being taught in a way
that is fully understood (Berger, 2009). The HBM would also

References (in APA

Citation)

be used to make sure that all of the constructs are addressed

(Edberg, 2015).
American Cancer Society. (2009). Cancer facts and figures for
Hispanics and Latinos 2009-2011. Retrieved October 7,
2014, from American Cancer Society:
http://www.cancer.org/acs/groups/content/@nho/
documents/document/ffhispanicslatinos20092011.pdf.
Berger, K. S. (2009). The developing person: Through
childhood and adolescence. New York, NY: Worth
Publishers.
Deavenport, A., Modeste, N., Marshak, H. H., & Neish, C.
(2010). Health beliefs of low-income Hispanic women: A
disparity in mammogram use. American Journal of
Health Studies, 92-101.
Edberg, B. (2015). Essentials of health behavior: Social and
behavioral theory in public health. Burlington, MA: Jones
and Bartlett Learning.
Glaser, B. (2010). Grounded theory is the study of a concept!
Retrieved from http://www.youtube.com/watch?
v=OcpxaLQDnLk.
Glaser, B. (2009). What is grounded theory? Retrieved
October 7, 2014, from Grounded Theory Online;
Supporting GT Researchers:
http://www.groundedtheoryonline.com/what-is-groundedtheory.
Goodson, P. (2010). Theory in health promotion research
and practice: Thinking outside the box. Sudbury, MA:
Jones and Bartlett Publishers.