Background: Breast cancer is an important public health issue within the American Indian (AI) community in Oklahoma; however, there is limited information to explain the low screening mammography rates among AI women. Purpose: To identify the motivational factors affecting an AI woman's decision to obtain a mammogram. Methods: Through the use of the Theory of Planned Behavior, 24 elicitation interviews were conducted with eligible for mammography AI women obtaining services at an Oklahoma-based tribal clinic. Results: Most women had mixed attitudes toward screening mammography. Environmental-related factors also were cited as barriers in getting a screening mammogram and women recommended improved accessibility to mammography screening. Participants identified family members, friends and their personal physician as critical social referents. No specific culturally related beliefs or taboos were noted. Discussion: This study provides new theoretically guided insights into the motivation of AI women to obtain screening mammography. Future interventions to promote mammography screening among AI women may yield more effective results if key social referents are included in the decision-making process. Translation to Health Education Practice: Public health practitioners need to incorporate a socio-ecological approach to the design of a related intervention, and acknowledge the diversity in terms of cultural affiliation and beliefs within the AI population they serve. (Contains 2 tables and 1 figure.)