Ethnicity Shapes How Women Translate Health Knowledge Into Breast Cancer Prevention

Breast cancer remains the most commonly diagnosed cancer among women worldwide, and yet the behaviors that can catch it early—breast self-examination, clinical breast examination, and attention to warning signs—are far from evenly practiced across populations. A new study from southeastern Türkiye offers a striking illustration of just how unevenly these behaviors are distributed, and why. Researchers surveyed 403 women from four distinct ethnic groups in the city of Mardin and found that ethnicity was woven through nearly every measure they examined: levels of health anxiety, degrees of health literacy, and the practical steps women took to protect themselves from breast cancer. The findings, published in BMC Psychology, suggest that closing screening gaps will require far more than handing out leaflets; it will require understanding how culture shapes the journey from knowing about a disease to acting against it.

The study was led by Gülhan Yiğitalp of Dicle University, together with Kadriye Olğaç Ak and Vasfiye Bayram Değer of Mardin Artuklu University. Mardin was an ideal setting for such an investigation. The city sits in a region where Kurdish, Arab, Turkish, and Assyrian communities have lived side by side for centuries, often maintaining distinct languages, religious traditions, and health practices despite sharing the same streets and the same health care system. By sampling women aged 20 to 69 from all four groups, the researchers could ask a question that single-community studies cannot answer: when the health system is nominally the same for everyone, why do prevention behaviors differ so dramatically between ethnic groups?

The team designed the work as a descriptive, cross-sectional survey, and they took the statistical groundwork seriously. Before recruiting a single participant, they performed an a priori power analysis using G*Power 3.1 software, calculating how many women would be needed to detect meaningful effects in a multiple linear regression framework. That calculation settled on 403 participants. Each woman completed a personal information form along with three validated instruments: the Health Anxiety Scale, which measures worry and vigilance about illness; the Health Literacy Scale, which captures the ability to find, understand, and apply health information; and the ASSISTS scale, formally known as the Scale to Determine Factors Affecting Women’s Breast Cancer Prevention Behaviors. The data were analyzed in SPSS 22.0 using chi-square tests, analysis of variance with post-hoc comparisons, Pearson correlations, and linear regression.

The headline result concerned clinical breast examinations, in which a trained health professional checks the breasts for lumps or other changes. Women of Assyrian origin underwent these examinations most frequently, with 64.0 percent reporting the practice. At the other end of the spectrum, only 22.8 percent of women of Kurdish origin had undergone a clinical breast examination—a gap of more than forty percentage points between two communities living in the same city. Because clinical breast examination is a frontline tool for detecting breast cancer at earlier, more treatable stages, a disparity of that magnitude is not a statistical curiosity. It represents a real difference in the odds that a tumor will be found in time, and it points to barriers—whether informational, cultural, or structural—that fall unevenly across ethnic lines.

Health anxiety told a more nuanced story. Women of Assyrian and Arab origin reported significantly higher levels of anxiety about their health than women of Turkish origin, a difference that reached statistical significance at p = 0.002. At first glance, elevated anxiety might seem purely negative, a source of distress to be reduced. But in the context of cancer prevention, the relationship between worry and action is complicated. A moderate degree of health concern can motivate women to seek examinations and pay attention to their bodies, while too little concern can breed complacency. The study’s pattern—higher anxiety in the group that also screened most often—hints that emotional engagement with health may be one of the engines driving preventive behavior, though the authors are careful to frame this as a relationship to be explored rather than a simple prescription.

Health literacy, by contrast, peaked in a different community. Women of Turkish origin scored significantly higher than women of the other three groups on total health literacy and on two of its most sophisticated dimensions: interactive literacy, the ability to communicate with health providers and extract useful information from them, and critical literacy, the capacity to evaluate health information and apply it to one’s own circumstances. The difference was robust, with p values below 0.001. This matters because critical health literacy in particular is what turns a pamphlet or a television segment into a personal decision. A woman can memorize the fact that breast screening exists, but unless she can judge that information as relevant to her own life and act on it, the knowledge stays inert. The Turkish-origin group’s advantage on precisely these higher-order dimensions may help explain other behavioral differences the study recorded.

When the researchers turned to the ASSISTS scale, which measures the factors that support women’s breast cancer prevention behaviors, the overall scores were remarkably similar across all four ethnic groups, with no statistically significant difference in the total score. Yet one subscale broke the pattern: stress management was significantly higher among women of Turkish origin than among the others, at p = 0.004. In other words, the raw motivation and general orientation toward prevention were comparable everywhere, but the specific psychological resources that sustain preventive habits were not. This is perhaps the study’s most subtle finding. It suggests that the ethnic differences in screening rates documented earlier in the paper are not simply a matter of one group caring about breast cancer and another not caring. Something else—something closer to the machinery of daily self-care—differs between the communities.

That interpretation gained strength from the regression analyses. Health literacy significantly predicted breast cancer prevention behaviors among women of Assyrian, Kurdish, and Arab origin, with standardized beta coefficients of 0.236, 0.505, and 0.384 respectively, and p values ranging from 0.021 to below 0.001. The strongest effect appeared in the Kurdish-origin group, where health literacy explained a substantial share of the variation in prevention behavior. Notably, the authors report that the total ASSISTS score itself did not differ significantly by ethnicity, which sharpens the implication: the same level of preventive orientation can translate into very different actual behaviors depending on how well a woman can access, understand, and critically use health information. Literacy, in this sense, is the bridge between intention and action—and the bridge is stronger in some communities than in others.

The authors draw a conclusion that reaches well beyond Mardin. Ethnic differences in breast cancer prevention behaviors, they argue, are related not only to the level of knowledge women possess but to how that knowledge translates into behavior. Awareness training and behavioral models, they write, should be planned and implemented with local opinion leaders and community representatives at the table, taking ethnic and cultural characteristics into account. This is a practical prescription with real logic behind it. A health message delivered in the wrong language, by an outsider, through a channel a community does not trust, will fail even if its content is scientifically impeccable. Conversely, a message carried by a trusted local figure, framed in familiar cultural terms, can move a community where generic campaigns stall. The study’s evidence that motivation is similar across groups while translation of motivation into action differs makes this community-embedded approach especially promising.

For a global audience, the study is a reminder that health inequities are rarely as simple as access to a clinic. All 403 women lived in the same city and were nominally served by the same health system, yet their screening rates, anxiety levels, and literacy profiles diverged along ethnic lines in ways that statistics could clearly detect. Breast cancer prevention, the findings imply, is not a single intervention but a chain of psychological and social steps—feeling that health matters, understanding information, judging it relevant, and converting it into a clinic visit or a monthly self-exam—and each link can be forged differently in different cultural settings. As screening programs worldwide confront persistent gaps among minority and ethnic communities, the Mardin data offer both a warning and a template: measure the differences honestly, respect the cultures involved, and build prevention from the community outward rather than from the campaign inward.

Subject of Research: Ethnic differences in health anxiety, health literacy, and breast cancer prevention behaviors among women

Article Title: Identifying factors influencing health anxiety, health literacy, and breast cancer prevention behaviors of women from different ethnic groups

Article References: Yiğitalp, G., Olğaç Ak, K., & Bayram Değer, V. (2026). Identifying factors influencing health anxiety, health literacy, and breast cancer prevention behaviors of women from different ethnic groups. BMC Psychology. https://doi.org/10.1186/s40359-026-05594-z

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05594-z

Keywords: breast cancer, health literacy, health anxiety, ethnicity, cancer prevention, women's health, screening, clinical breast examination, health behavior, cultural differences, Türkiye, public health