Psychological Well-Being and Preventive Care Use in Midlife African-American Women

Preventive care is underutilized in the U.S., resulting in increased morbidity, lost lives, and inefficient use of healthcare dollars. African-American women (AAW) are particularly at risk for deleterious health outcomes that might be mitigated through increased preventive care use. Psychological well-being (PWB) may provide an important target for interventions aimed at increasing timely utilization of preventive services. The objective of this study was to explore midlife (aged 40 to 64) AAW’s perceptions and experiences of PWB and how these experiences affect their utilization of past and anticipated well-woman visits, flu vaccines, and mammograms. This mixed methods study was conducted with women from the Service Employees International Union - Healthcare Illinois Indiana headquartered in Chicago. Women participated in an online survey (n=124) that assessed their use of preventive services and well-woman visits, barriers and facilitators of preventive care use, and women’s degree of PWB. One-on-one, in-depth, semi-structured interviews were conducted with a subsample of participants (n=19) that assessed the same constructs. Data were collected May to October 2016. Mixed methods results showed that community violence was a major threat to women’s well-being and that emotional support and helping others greatly contributed to women’s well-being. Spiritual beliefs and practices, as well as positive reframing of challenges were coping mechanisms that women employed to deal with stress. More knowledge of preventive care was associated with greater use of preventive care services and access to affordable insurance and positive provider relationships also facilitated women’s use of preventive care. Influenza vaccine was the most misunderstood and least utilized preventive service. Findings from this study help elucidate a better understanding of the factors that impact the relationship between midlife African-American women’s psychological well-being and use of preventive services. These findings may inform strategies to increase utilization, which will in turn positively impact disease and disability as this group of at-risk women age.