Transformative Learning Theory: Facilitating Mammography Screening in Rural Women

PURPOSE/OBJECTIVES: To use transformative learning to investigate what experiences serve as catalysts for mammography screening, the cognitive and affective responses that result from the catalyst, and how screening behavior is impacted. RESEARCH APPROACH: A descriptive qualitative study. SETTING: Southeastern Wyoming. PARTICIPANTS: 25 low-income, rural women aged 40 years and older. METHODOLOGIC APPROACH: Four focus group interviews. FINDINGS: Cancer experiences triggered universal responses of fear by screeners and nonscreeners. The manner in which that fear response was interpreted was a critical factor in the facilitation of, or impedance to, screening. Dichotomous interpretations of fear responses provided the context for screening behavior. Immobilizing and isolating experiences were associated with nonscreening behavior, whereas motivation and self-efficacy were associated with screening behavior. CONCLUSIONS: Transformative learning theory is a useful framework from which to explain differences in mammography screening behavior. Creating opportunities that facilitate dialogue and critical reflection hold the potential to change immobilizing and isolating frames of reference in nonscreening women. INTERPRETATION: To help women transcend their fear and become self-efficacious, nurses can assess how cancer and the screening experience is viewed and, if indicated, move beyond standard education and offer opportunities for dialogue and critical reflection.