Health care systems do not exist in isolation, but rather, as part of the larger social and cultural mosaic. In particular, perceived attitudes are major obstacles in health promotion exercises. This problem is especially true for non-white populations where little is known about the prevailing social and cultural perceptions towards western biomedical prescriptions. To further our understanding of Asian women's acceptance of mammograms, three attitudinal indexes are conceptualised, constructed and validated. Data fi om a prospective survey showed the significance of fatalistic attitudes, perceived barriers and perceived efficacy of early detection in predicting women's acceptance of a free mammogram at the National Breast Screening Project. In addition, findings reinforced the importance of social support from the family in the promotion of breast screening among Asian women. (C) 2000 Elsevier Science Ltd. All rights reserved.