• mammography screening;
  • adherence;
  • older adults;
  • minority women;
  • provider-patient communication

Objectives: To identify predictors of varying levels of nonadherence to mammography screening in older women.

Design: Cross-sectional survey.

Setting: Sixty community-based sites where seniors gather.

Participants: Consecutive volunteer sample of 499 women aged 60 to 84 who had not received a mammogram within the previous year.

Measurements: Three levels of nonadherence (never had a mammogram (never), mammogram more than 2 years before (lapsed), and mammogram in the past 1 to 2 years (due/reference group)). These were based on a Transtheoretical Model and incorporated into the Adherence Model. Bivariate and multivariate multinomial logistic regression analysis was used for variables obtained.

Results: Two risk factors, having difficulty getting to a facility and not intending to ask a health provider for a mammogram, were predictive of the never and lapsed levels. Distinct risk factors for being in the never compared with the due level of nonadherence included being concerned about pain, not being enrolled in a health maintenance organization, not getting preventive checkups, and being only somewhat (versus very) likely to ask a physician for mammogram. In contrast, distinct risk factors for the lapsed compared with the due level of nonadherence included perceiving that no friends have routine mammograms and not having a provider referral.

Conclusion: Some risk factors for not being up to date with mammography vary by the level of nonadherence. Interventions should be individualized to women's level of nonadherence and include common core strategies that encourage women to ask for a mammogram and to lessen the difficulty of getting to a screening facility.