Obese women’s barriers to mammography and Pap smear: The possible role of personality

Obese women are at increased risk of developing and dying from cancer, but are less likely than non-obese women to receive cancer screening examinations. Our qualitative study explores obese women’s barriers to Pap smears and mammograms in greater depth than previous research. We also seek to understand why some obese women undergo screening while others do not. A purposive sample of moderately to severely obese women over age 40 was recruited from community-based organizations, health clinics, and retail establishments. Semi-structured in-depth interviews (N=33) informed by the Theory of Care-Seeking Behavior and three prior focus groups of obese women (N=18) were recorded and transcribed. Qualitative analysis was iterative, using a grounded theory approach involving a series of immersion/crystallization cycles. Participants verified many barriers to cervical and breast cancer screening previously identified in the general population, including fear, modesty, competing demands, and low perceived risk. Participants also highlighted several weight-related barriers, including insensitive comments about weight, and equipment and gowns that could not accommodate them. Comparison of participants who were up-to-date with both Pap smears and mammograms with those not up-to-date with either screening showed no discernable differences in these barriers, however. Instead, we found that the participants who followed through on their cancer screenings may share certain personality traits, such as conscientiousness or self-regulatory ability, that allow them to complete difficult or feared tasks. Our research therefore suggests that personality may act as an important mediator in health behavior, and should be taken into account in future theoretical models and health behavior interventions, particularly for obese women.