Barriers to cancer screening in Hmong Americans: the influence of health care accessibility, culture, and cancer literacy

Chronic disease self-management and health literacy in four ethnic groups

Research from several fields has explored health literacy as a multidimensional construct. The authors' multimethod study, "The Impact of Cultural Differences on Health Literacy and Chronic Disease Outcomes," assessed health literacy and chronic disease self-management among 296 patients from four ethnic groups (Vietnamese, African American, White, Latino) at a Massachusetts community health center between 2006 and 2010. Health literacy was assessed using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Adult Literacy in Medicine (REALM), and the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA) measures. Qualitative research methods, including in-depth interviews (n = 34), home visits (n = 12), chronic disease diaries (n = 15), and focus groups (n = 47), were completed with a subset of participants. Qualitative interviews indicated a wide range of interpretations of S-TOFHLA questions in which participants substituted their own illness or health care experiences for the abstract examples offered in the instrument, at times leading to incorrect responses. Situating these responses in a broader social and cultural context, this article describes examples of the wide range of chronic disease self-management abilities among participants with limited education and/or low health literacy. It also discusses the culturally variable health beliefs identified among participants interviewed that may play important roles in their chronic disease self-management practices.

Access to health care and quality of life for underserved men with prostate cancer

OBJECTIVES

To explore links between access to care and quality of life for underserved men with prostate cancer through a literature review.

DATA SOURCES

Articles published from 2000 to present based on a PubMed search using the key words access, quality of life, health care access, underserved, low-income, health literacy, and prostate cancer.

CONCLUSION

There is not one reason that adequately explains factors affecting access, health-related quality of life (HRQOL), or the potential relationships between the two for underserved men with prostate cancer. Socioeconomic factors contribute to accessibility and HRQOL, but not consistently, suggesting that there is still much work to be done in identifying factors and relationships that connect access to care and HRQOL for underserved men with prostate cancer.

IMPLICATIONS FOR NURSING PRACTICE

Particularly important is to develop intervention strategies to address the disparities in access to care and prostate cancer treatment outcomes (including HRQOL) for this vulnerable population. Based on findings from studies, nurses need to be actively involved in the development and implementation of programs that address multiple barriers including socioeconomic status, minority status, health literacy, insurance, and language.

English proficiency, symptoms, and quality of life in Vietnamese- and Chinese-American breast cancer survivors

CONTEXT

In the United States, limited English proficiency has been shown to have a negative influence on effective functioning in the health care environment. Minority immigrant populations, therefore, may be especially vulnerable to poorer symptom management and quality of life (QOL) during and after cancer treatment, given their limited language skills. Breast cancer is the most prevalent cancer in Asian-American women but little is known about its adverse consequences in this population.

OBJECTIVES

We examined the extent to which English proficiency was associated with symptoms and QOL in Chinese- (n = 72) and Vietnamese-American (n = 25) breast cancer survivors in Houston, Texas.

METHODS

Data were collected through face-to-face interviews. Symptoms and QOL were assessed using the Edmonton Symptom Assessment Scale and the Quality of Life Instrument-Breast Cancer Patient Version (QOL-BC), respectively.

RESULTS

The most commonly reported severe symptoms (≥ 7 on a 0-10 scale) were lack of well-being (38%), fatigue (26%), pain (18%), lack of appetite (14%), anxiety (14%), and feeling depressed (14%). For the QOL-BC, the physical (mean = 6.78; standard deviation [SD] = 1.28) and spiritual subscales (mean = 6.01; SD = 2.18) had the highest and lowest mean scores, respectively. Of the whole sample, 33% reported having the ability to understand, read, speak, and write in English very well. English proficiency was significantly associated with symptom distress (coefficient = -0.257; P = 0.011) and QOL (coefficient = -0.390; P = 0.002).

CONCLUSION

English proficiency has a significant impact on symptom distress and QOL. These findings may help the development of services to meet the unique needs of Vietnamese- and Chinese-American breast cancer survivors.