1
|
Pellegrin KL, Hales S, O'Neil P, Wongwiwatthananukit S, Jongrungruangchok S, Songsak T, Lozano AJ, Miller K, Mnatzaganian CL, Fricovsky E, Nigg CR, Tagorda-Kama M, Hanlon AL. Community Culture Survey - Revised: Measuring neighborhood culture and exploring geographic, socioeconomic, and cultural determinants of health in samples across the United States and in Thailand. PUBLIC HEALTH IN PRACTICE 2024; 7:100512. [PMID: 38846106 PMCID: PMC11153899 DOI: 10.1016/j.puhip.2024.100512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 06/09/2024] Open
Abstract
Objectives Research on links between social, geographic, and cultural determinants of health has been thwarted by inadequate measures of culture. The purpose of this study was to improve the measurement of community culture, defined as shared patterns of attitudes and behaviors among people within a neighborhood that distinguish it from others, and to examine dimensions of culture, independent of socioeconomic and demographic factors, and their relationships with health. Study design A survey research design with correlational analyses was used. Methods A survey packet including the Community Culture Survey - Revised (CCS-R), demographic, health, and other individual-level measures was administered through convenience sampling across the United States (US) and to a sample in Thailand from 2016 to 2018. US county-level variables were obtained from zip codes. Results 1930 participants from 49 US states (n = 1592) and Thailand (n = 338) completed all CCS-R items, from which 12 subscales were derived: Social Support & Connectedness, Responsibility for Self & Others, Family Ties & Duties, Social Distress, Urban Diversity, Discontinuity, Church-Engaged, External Resource-Seeking, Locally Owned Business-Active, Power Deference, Next Generation Focus, and Self-Reliance. Neighborhood culture subscale scores varied more by geography than by participant's demographics. All subscales predicted one or more health indicator, and some of these relationships were significant after adjusting for participant age and county-level socioeconomic variables. Most of the significant differences on subscales by race/ethnicity were no longer significant after adjusting for participant's age and county-level socioeconomic variables. Most rural/urban and regional differences in culture within the US persisted after these adjustments. Based on correlational analyses, Social Support & Connectedness and Responsibility for Self & Others were the best predictors of participants' overall health and quality of life, and Responsibility for Self & Others was the best predictor (inversely) of the CDC's measures of social vulnerability. Conclusions Neighborhood culture is measurable, multi-dimensional, distinct from race/ethnicity, and related to health even after controlling for age and socioeconomic factors. The CCS-R is useful for advancing research and practice addressing the complex interactions between individuals, their neighborhood communities, and health outcomes.
Collapse
Affiliation(s)
- Karen L. Pellegrin
- Center for Rural Health Science, Daniel K. Inouye College of Pharmacy, University of Hawaiʻi at Hilo, USA
| | - Sarah Hales
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick O'Neil
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - Alicia J. Lozano
- Center for Biostatistics and Health Data Science (CBHDS), Department of Statistics, Virginia Tech, USA
| | - Katharine Miller
- Statistical Applications and Innovations Group (SAIG), Department of Statistics, Virginia Tech, USA
| | | | - Eduardo Fricovsky
- University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, USA
| | - Claudio R. Nigg
- Department of Health Science, Institute of Sport Science, University of Bern, Switzerland
| | | | - Alexandra L. Hanlon
- Center for Biostatistics and Health Data Science (CBHDS), Department of Statistics, Virginia Tech, USA
| |
Collapse
|
2
|
Ðoàn LN, Chau MM, Ahmed N, Cao J, Chan SWC, Yi SS. Turning the Health Equity Lens to Diversity in Asian American Health Profiles. Annu Rev Public Health 2024; 45:169-193. [PMID: 38134402 DOI: 10.1146/annurev-publhealth-060222-023852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
The monolithic misrepresentation of Asian American (AsAm) populations has maintained assumptions that AsAm people are not burdened by health disparities and social and economic inequities. However, the story is more nuanced. We critically review AsAm health research to present knowledge of AsAm health profiles from the past two decades and present findings and opportunities across three topical domains: (a) general descriptive knowledge, (b) factors affecting health care uptake, and (c) effective interventions. Much of the literature emphasized underutilization of health care services; low knowledge and awareness among AsAms about health-related risk factors, prevention, diagnosis, and treatment; inadequate efforts by health systems to improve language access, provider-patient communication, and trust; and the critical roles of community- and faith-based organizations and leaders in health promotion initiatives. Future opportunities for AsAm health research will require adoption of and significant investment in community-engaged research infrastructure to increase representation, funding, and research innovation for AsAm communities.
Collapse
Affiliation(s)
- Lan N Ðoàn
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA;
| | - Michelle M Chau
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA;
| | - Naheed Ahmed
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Jiepin Cao
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA;
| | - Sze Wan Celine Chan
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA;
| | - Stella S Yi
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA;
| |
Collapse
|
3
|
Walker MR, Lor K, Lor KB, Vidri RJ, Hampton JM, Maldonado C, Schiefelbein AM, LoConte NK. Survival of the Hmong population diagnosed with colon and rectal cancers in the United States. Cancer Med 2024; 13:e7087. [PMID: 38466018 PMCID: PMC10926880 DOI: 10.1002/cam4.7087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/08/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The Hmong population constitutes an independent ethnic group historically dispersed throughout Southeast Asia; fallout from the Vietnam War led to their forced migration to the United States as refugees. This study seeks to investigate characteristics of the Hmong population diagnosed with in colorectal cancer (CRC) as well as survival within this population. METHODS Cases of colon and rectal adenocarcinoma diagnosed between 2004 and 2017 were identified from the National Cancer Database (NCDB). Summary statistics of demographic, clinical, socioeconomic, and treatment variables were generated with emphasis on age and stage at the time of diagnosis. Cox-proportional hazard models were constructed for survival analysis. RESULTS Of 881,243 total CRC cases within the NCDB, 120 were classified as Hmong. The average age of Hmong individuals at diagnosis was 58.9 years compared 68.7 years for Non-Hispanic White (NHW) individuals (p < 0.01). The distribution of analytic stage differed between the Hmong population and the reference NHW population, with 61.8% of Hmong individuals compared to 45.8% of NHW individuals with known stage being diagnosed at stage III or IV CRC compared to 0, I, or II (p = 0.001). However, there was no difference in OS when adjusting for potential confounders (HR 1.00 [0.77-1.33]; p = 0.998). CONCLUSIONS Hmong individuals are nearly a decade younger at the time of diagnosis of CRC compared to the NHW individuals. However, these data do not suggest an association between Hmong ethnicity and overall survival, when compared to the NHW population.
Collapse
Affiliation(s)
- Margaret R. Walker
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Kha Lor
- University of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Kajua B. Lor
- Medical College of Wisconsin School of PharmacyMilwaukeeWisconsinUSA
| | - Roberto J. Vidri
- Division of Surgical Oncology, Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - John M. Hampton
- University of Wisconsin Carbone Cancer CenterMadisonWisconsinUSA
| | | | | | - Noelle K. LoConte
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- University of Wisconsin Carbone Cancer CenterMadisonWisconsinUSA
| |
Collapse
|
4
|
Lee HY, Xiong S, Sur A, Khang T, Vue B, Culhane-Pera KA, Pergament S, Torres MB, Koopmeiners JS, Desai J. Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study. JMIR Form Res 2023; 7:e38388. [PMID: 37338961 PMCID: PMC10337404 DOI: 10.2196/38388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. OBJECTIVE We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. METHODS Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website's effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. RESULTS Participants' HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents' average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers' self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website's content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders. CONCLUSIONS This theory-driven, community-based participatory action research-designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents' and adolescents' knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website's impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools).
Collapse
Affiliation(s)
- Hee Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Serena Xiong
- School of Medicine, Washington University in St Louis, St Louis, MO, United States
| | - Aparajita Sur
- School of Public Health, University of Minnesota, Twin Cities, MN, United States
| | - Tounhia Khang
- SoLaHmo Partnership for Health & Wellness, Community University Health Care Center, Minneapolis, MN, United States
| | - Bai Vue
- SoLaHmo Partnership for Health & Wellness, Community University Health Care Center, Minneapolis, MN, United States
| | - Kathleen A Culhane-Pera
- SoLaHmo Partnership for Health & Wellness, Community University Health Care Center, Minneapolis, MN, United States
| | - Shannon Pergament
- SoLaHmo Partnership for Health & Wellness, Community University Health Care Center, Minneapolis, MN, United States
| | - M Beatriz Torres
- Department of Public Health, Mercyhurst University, Erie, PA, United States
| | - Joseph S Koopmeiners
- School of Public Health, University of Minnesota, Twin Cities, MN, United States
| | - Jay Desai
- Minnesota Department of Health, Saint Paul, MN, United States
| |
Collapse
|
5
|
Vang KKK, Catz S, Drake C, Baker D, Garcia L. COVID-19 mitigation behaviors among English-Speaking Hmong Americans. BMC Public Health 2023; 23:487. [PMID: 36918836 PMCID: PMC10011763 DOI: 10.1186/s12889-023-15354-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/01/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND COVID-19 mitigation strategies such as masking, social distancing, avoiding group gatherings, and vaccination uptake are crucial interventions to preventing the spread of COVID-19. At present, COVID-19 data are aggregated and fail to identify subgroup variation in Asian American communities such as Hmong Americans. To understand the acceptance, adoption, and adherence to COVID-19 mitigation behaviors, an investigation of Hmong Americans' contextual and personal characteristics was conducted. METHODS This study aims to describe COVID-19 mitigation behaviors among Hmong Americans and the contextual and personal characteristics that influence these behaviors. A cross-sectional online survey was conducted from April 8 till June 1, 2021, with Hmong Americans aged 18 and over. Descriptive statistics were used to summarize the overall characteristics and COVID-19 related behaviors of Hmong Americans. Chi-square and Fisher's Exact Test were computed to describe COVID-19 mitigation behaviors by gender and generational status (a marker of acculturation). RESULTS The sample included 507 participants who completed the survey. A majority of the Hmong American participants in our study reported masking (449/505, 88.9%), social distancing (270/496, 55.3%), avoiding group gatherings (345/505, 68.3%), avoiding public spaces (366/506, 72.3%), and obtaining the COVID-19 vaccination (350/506, 69.2%) to stay safe from COVID-19. Women were more likely to socially distance (P = .005), and avoid family (P = .005), and social gatherings (P = .009) compared to men. Social influence patterns related to mitigation behaviors varied by sex. Men were more likely compared to women to be influenced by Hmong community leaders to participate in family and group gatherings (P = .026), masking (P = .029), social distancing (P = .022), and vaccination uptake (P = .037), whereas healthcare providers and government officials were social influencers for social distancing and masking for women. Patterns of social distancing and group gatherings were also influenced by generational status. CONCLUSION Contextual and personal characteristics influence COVID-19 mitigation behaviors among English speaking Hmong Americans. These findings have implications for identifying and implementing culturally appropriate health messages, future public health interventions, policy development, and ongoing research with this population.
Collapse
Affiliation(s)
- Kao Kang Kue Vang
- Betty Irene Moore School of Nursing, University of California Davis, 2570 48th Street, 95817, Sacramento, CA, United States of America
| | - Sheryl Catz
- Betty Irene Moore School of Nursing, University of California Davis, 2570 48th Street, 95817, Sacramento, CA, United States of America.
| | - Christiana Drake
- Department of Statistics, University of California Davis, Sacramento, CA, United States of America
| | - Dian Baker
- School of Nursing, California State University, Sacramento, CA, United States of America
| | - Lorena Garcia
- Department of Public Health Sciences-Division of Epidemiology, University of California Davis, Sacramento, CA, United States of America
| |
Collapse
|
6
|
Foster S, Carvallo M, Wenske M, Lee J. Damaged Masculinity: How Honor Endorsement Can Influence Prostate Cancer Screening Decision-Making and Prostate Cancer Mortality Rates. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2023; 49:296-308. [PMID: 34964413 DOI: 10.1177/01461672211065293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Prior research has established factors that contribute to the likelihood that men seek out prostate cancer screenings. The current study addresses how endorsing the ideology found in cultures of honor may serve as a barrier to prostate cancer screenings. Two studies were conducted which analyzed the impact of stigma on men's decisions to seek out prostate cancer screenings (Study 1) as well as how prostate cancer deaths may be higher in the culture of honor regions due to men's reticence to seek out screenings (Study 2). Results suggest that older, honor-endorsing men are less likely to have ever sought out a prostate cancer screening due to screening stigma and that an honor-oriented region (southern and western United States) displays higher rates of prostate cancer death than a non-honor-oriented region (northern United States). These findings suggest that honor may be a cultural framework to consider when practitioners address patients' screening-related concerns.
Collapse
Affiliation(s)
| | | | | | - Jongwon Lee
- The University of New Mexico, Albuquerque, USA
| |
Collapse
|
7
|
Sun B, Yew PY, Wen YF, Chi CL, Straka RJ. Comparison of the Warfarin Dosing and Outcomes in Hmong Versus East Asians Patients: Real-World Data From an Integrated Healthcare System. Cureus 2022; 14:e28905. [PMID: 36249660 PMCID: PMC9549258 DOI: 10.7759/cureus.28905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Previous research predicted that Hmong, an understudied East Asian subpopulation, might require significantly lower warfarin doses than East Asian patients partially due to their unique genetic and clinical factors. However, such findings have not been corroborated using real-world data. Methods This was a retrospective cohort study of Hmong and East Asian patients receiving warfarin. Warfarin stable doses (WSD) and time to the composite outcome, including international normalized ratio (INR) greater than four incidences or major bleeding within six months of warfarin initiation, were compared. Results This cohort study included 55 Hmong and 100 East Asian patients. Compared to East Asian patients, Hmong had a lower mean WSD (14.5 vs. 20.4 mg/week, p<0.05). In addition, Hmong had a 3.1-fold (95% CI: 1.1-9.3, p<0.05) higher hazard of the composite outcome. Conclusion Using real-world data, significant differences in warfarin dosing and hazard for the composite outcome of INR>4 and major bleeding were observed between Hmong and East Asian patients. These observations further underscore the importance of recognizing subpopulation-based differences in warfarin dosing and outcomes.
Collapse
|
8
|
Taparra K, Dee EC, Dao D, Patel R, Santos P, Chino F. Disaggregation of Asian American and Pacific Islander Women With Stage 0-II Breast Cancer Unmasks Disparities in Survival and Surgery-to-Radiation Intervals: A National Cancer Database Analysis From 2004 to 2017. JCO Oncol Pract 2022; 18:e1255-e1264. [PMID: 35594493 PMCID: PMC9377694 DOI: 10.1200/op.22.00001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Aggregation of Asian Americans (AAs) with Native Hawaiians and Other Pacific Islanders (NHPIs) masks significant health disparities. We evaluated overall survival (OS) and surgery-to-radiation intervals (STRIs) among AA and NHPI women with early-stage breast cancer. METHODS This National Cancer Database study included women with stage 0-II breast cancer diagnosed between 2004 and 2017. STRI was defined as days from surgery to radiation. Patients were stratified by adjuvant treatment. AAs were disaggregated into geographically relevant subpopulations: East, South, and Southeast Asians. Kaplan-Meier estimates and log-rank tests assessed survival. Cox proportional hazard and linear regression were adjusted for clinical and sociodemographic factors. RESULTS In total, 578,927 women were included (median age 61 years, median follow-up 65 months, and 10-year OS 83%). AA and NHPI 10-year OS was 91% overall; subpopulation 10-year OS was 92% for East Asian, 90% for South Asian, 90% for Southeast Asian, and 83% for NHPI. On multivariable analysis, compared with non-Hispanic White, NHPI women had worse survival (adjusted hazard ratio [aHR] = 1.38; 95% CI, 1.09 to 1.77); all AA subpopulations had improved survival: East Asian (aHR = 0.57; 95% CI, 0.48 to 0.69), South Asian (aHR = 0.66; 95% CI, 0.51 to 0.84), and Southeast Asian (aHR = 0.78; 95% CI, 0.65 to 0.94). The AA and NHPI median STRI for was 73 days overall; the disaggregated median STRI was 68 days for East Asian, 80 days for South Asian, 77 days for Southeast Asians, and 81 days for NHPI. On adjusted analysis, compared with non-Hispanic White, Southeast Asians and NHPI had longer STRI by 6.6 (95% CI, 4.3 to 8.9) and 10.0 (95% CI, 5.8 to 14) days, respectively. CONCLUSION Breast cancer disparities exist among disaggregated AA and NHPI subpopulations. Data disaggregation insights may lead to interventions to overcome these disparities, such as optimizing time-to-treatment for select populations.
Collapse
Affiliation(s)
- Kekoa Taparra
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Dyda Dao
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Rohan Patel
- Department of Internal Medicine, SUNY Downstate Medical Center, Brooklyn, NY
| | - Patricia Santos
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY
| |
Collapse
|
9
|
Yoon S, Wang K, Luo Y, Lee J, Neese J, Lee H. Cancer Screening Literacy among Vietnamese Population: Does Annual Checkup Improve Cancer Screening Literacy? Asian Pac J Cancer Prev 2021; 22:927-933. [PMID: 33773559 PMCID: PMC8286676 DOI: 10.31557/apjcp.2021.22.3.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Colorectal, breast, and cervical cancers disproportionately impact the Vietnamese population. However, research on cancer prevention among this population was very limited. The purpose of this study is to examine the cancer screening literacy levels for these three types of cancers among rural Vietnamese and investigate correlates of cancer screening literacy. METHODS A sample of 226 Vietnamese men and women aged 25-70 years old was recruited from rural Vietnam and finished a self-administered questionnaire. Andersen's Behavioral Model was used to guide this cross-sectional study to identify modifiable variables. Bivariate analysis was used to explore the relationship between demographic factors and cancer screening literacy levels. Multiple linear regressions were also used to identify significant factors for cancer literacy levels. RESULTS Cancer screening literacy levels of Vietnamese men and women were low regarding all three types of cancers, especially HPV symptom questions. Only about 24% of women answered correctly on "most people with genital HPV have no visible signs/symptoms" and less than 18% answered correctly on "I can transmit HPV to my partner(s) even if I have no HPV symptoms." Findings suggested that having an annual checkup was associated with higher colorectal (β=.15, p <.05), breast (β=.25, p <.001), and cervical (β=.18, p <.01) cancer screening literacy. CONCLUSIONS Public health efforts should focus on encouraging annual checkups in the Vietnamese population. During the annual checkup, health care professionals should educate patients about importance of cancer screening and provide recommendations for regular cancer screenings to reduce cancer health disparities.
Collapse
Affiliation(s)
| | - Kun Wang
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Yan Luo
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Jongwook Lee
- Department of Agricultural Economics and Rural Development, Seoul National University, Building, Seoul, Republic of Korea
| | - Jessica Neese
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Hee Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| |
Collapse
|
10
|
Vu M, Berg CJ, Escoffery C, Jang HM, Nguyen TT, Travis L, Bednarczyk RA. A systematic review of practice-, provider-, and patient-level determinants impacting Asian-Americans' human papillomavirus vaccine intention and uptake. Vaccine 2020; 38:6388-6401. [PMID: 32829979 PMCID: PMC7505643 DOI: 10.1016/j.vaccine.2020.07.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Asian-Americans have been documented to have low human papillomavirus (HPV) vaccine initiation and completion. No research has attempted to examine underlying mechanisms of HPV vaccine uptake disparities among Asian-Americans. Using the P3 (practice, provider, and patient) model, this study aimed to identify practice-, provider-, and patient-level determinants of Asian-Americans' HPV vaccine intention and uptake. METHODS We conducted a systematic review of published literature regarding practice-, provider- and patient-level determinants of vaccine intention (e.g., intention, willingness, or acceptability) and uptake (e.g., initiation or completion). Eligible studies were those presenting empirical/original data, focusing on Asian populations in the U.S., including outcomes related to HPV vaccine intention and uptake, and analyzing data on factors associated with these outcomes separately for Asian groups. RESULTS Twenty-six studies (19 quantitative and 7 qualitative studies) were included in the review. Most commonly studied subgroups were Koreans (n = 9), Chinese (n = 6), and Cambodians (n = 5). Studies showed varied prevalence across subgroups (intention: 23.4%-72%; initiation: 14%-67%; completion: 9%-63%). Only 3 studies included measurements of practice-level determinants (language services, insurance policy). Twelve studies measured provider-level determinants (most commonly documented: HPV vaccine recommendation). All studies measured patient-level determinants (most commonly documented: HPV and HPV vaccine knowledge, perceived safety, perceived susceptibility, and perceived relationship between HPV vaccine and sexual activity). CONCLUSIONS Existing research on determinants of HPV vaccine intention and uptake among Asian-Americans currently lacks measurements of practice-level constructs and perspectives of clinic staff and providers, which are needed to guide system-level interventions and provider training. Data regarding patient-level determinants suggest that interventions for Asian-American populations can focus on providing educational information in culturally-appropriate manners, leveraging familial influences, and attending to access-related or cultural beliefs about HPV vaccine. Interventions should take into account varied vaccine intention and uptake prevalence in different Asian subgroups.
Collapse
Affiliation(s)
- Milkie Vu
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States; George Washington Cancer Center, George Washington University, Washington, DC, United States
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Hyun M Jang
- Emory College of Arts & Science, Emory University, Atlanta, GA, United States
| | - Tien T Nguyen
- Hanoi-Amsterdam High School for the Gifted, Hanoi, Viet Nam
| | - Lisa Travis
- Woodruff Health Sciences Center Library, Emory University, Atlanta, GA, United States
| | - Robert A Bednarczyk
- Winship Cancer Institute, Emory University, Atlanta, GA, United States; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA United States
| |
Collapse
|
11
|
Cheah YK, Meltzer D. Ethnic Differences in Participation in Medical Check-ups Among the Elderly: Evidence from Malaysia. J Gen Intern Med 2020; 35:2680-2686. [PMID: 32185659 PMCID: PMC7459043 DOI: 10.1007/s11606-020-05766-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND There were ethnic differences in the prevalence of non-communicable diseases among the elderly in Malaysia. OBJECTIVE To examine ethnic differences in participation in medical check-ups among the elderly. DESIGN A nationally representative data set was employed. Multiple logistic regressions were utilised to examine the relationship between ethnicity and the likelihood of undergoing medical check-ups. The regressions were stratified by age, income, marital status, gender, household location, insurance access and health status. These variables were also controlled for in the regressions (including stratified regressions). PARTICIPANTS The respondents were required to be residents of Malaysia and not be institutionalised. Overall, 30,806 individuals were selected to be interviewed, but only 28,650 were actually interviewed, equivalent to a 93% response rate. Of those, only 2248 were used in the analyses, because 26,402 were others or below aged 60. MAIN MEASURES The dependent variable was participation in a medical check-up. The main independent variables were the three major ethnic groups in Malaysia (Malay, Chinese, Indian). KEY RESULTS Among the elderly aged 70-79 years, Chinese (aOR 1.89; 95% CI 1.28, 2.81) and Indians (aOR 2.39; 95% CI 1.20, 4.74) were more likely to undergo medical check-ups than Malays. Among the elderly with monthly incomes of ≤ RM999, Chinese (aOR 1.44; 95% CI 1.12, 1.85) and Indians (aOR 1.50; 95% CI 0.99, 2.28) were more likely to undergo medical check-ups than Malays. Indian males were more likely to undergo medical check-ups than Malay males (aOR 2.32; 95% CI 1.15, 4.67). Chinese with hypercholesterolaemia (aOR 1.45; 95% CI 1.07, 1.98) and hypertension (aOR 1.32; 95% CI 1.02, 1.72) were more likely to undergo medical check-ups than Malays. CONCLUSIONS There were ethnic differences in participation in medical check-ups among the elderly. These ethnic differences varied across age, income, marital status, gender, household location, insurance access and health status.
Collapse
Affiliation(s)
- Yong Kang Cheah
- School of Economics, Finance and Banking, College of Business, Universiti Utara Malaysia, Sintok, Kedah Darul Aman, Malaysia.
| | - David Meltzer
- Department of Medicine, University of Chicago, Chicago, IL, USA
| |
Collapse
|
12
|
Luft H, Perzan M, Mitchell R, Schmidt A. An integrative literature review of barriers and facilitators to cervical cancer screening among refugee women in the United States. Health Care Women Int 2020; 42:992-1012. [PMID: 32814006 DOI: 10.1080/07399332.2020.1803872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Refugee women experience disproportionally high cervical cancer-related mortality. In this integrative review, we identify and discuss factors related to cervical cancer screening among refugee women in the US according to the Social Ecological Model. Two qualitative and three quantitative studies met inclusion criteria. Individual-level factors include English-language ability, availability, and individual knowledge, attitudes, and beliefs. Interpersonal-level factors include interactions with family/friends, provider, and community health worker. Community-, organization-, and policy-level factors include sociocultural values, transportation, ability to navigate the healthcare system, and health insurance. We discuss findings in the context of related reviews and applicability to other global settings.
Collapse
Affiliation(s)
- Heidi Luft
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Mireille Perzan
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Rita Mitchell
- Advocate Aurora Library Network, Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - Austin Schmidt
- Milwaukee Global Health Consortium, Milwaukee, Wisconsin, USA
| |
Collapse
|
13
|
Lee HY, Beltran R, Kim NK, Lee DK. Racial Disparities in Cervical Cancer Screening: Implications for Relieving Cervical Cancer Burden in Asian American Pacific Islander Women. Cancer Nurs 2020; 42:458-467. [PMID: 30624249 DOI: 10.1097/ncc.0000000000000642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While cervical cancer is considered preventable and the overall Papanicolaou (Pap) test utilization rate has gradually increased in the United States, certain Asian American Pacific Islander (AAPI) women consistently rate lower in Pap test receipt compared with non-Latina whites (NLWs), leading to a higher cervical cancer mortality rate for various AAPI women. Few studies, however, have focused on female AAPI college students' cervical cancer screening behavior in comparison with NLW students. OBJECTIVE This study aimed to investigate cervical cancer screening behaviors among college-aged females by (1) determining AAPIs' and NLWs' screening rates, (2) assessing their knowledge about Pap tests, and (3) discovering factors associated with Pap test receipt. Andersen's Health Behavioral Model was used as a theoretical framework. METHODS Using a simple random sampling strategy, 2270 female students (15% AAPIs, 85% NLWs) completed an online health survey. RESULTS Results indicate AAPI students had significantly lower Pap test knowledge and Pap test receipt rate compared with NLW students. Age, nativity, human papillomavirus vaccination completion, frequency of obstetrician/gynecologist (OB/GYN) visits, and the number of sexual partners were associated with AAPI students' lower rate of Pap test receipt, whereas the Pap test receipt rate for NLW students was influenced by the same factors with the addition of having increased prior knowledge about Pap tests. CONCLUSION Results show the importance of OB/GYN visits in obtaining Pap tests for AAPI and NLW students. IMPLICATION FOR PRACTICE Health practitioners should pay attention to students' race/ethnicity in their practice and provide corresponding ethnic group-specific preventive care.
Collapse
Affiliation(s)
- Hee Yun Lee
- Author Affiliations: School of Social Work, University of Alabama, Tuscaloosa (Dr Lee); and School of Social Work (Ms Beltran), Department of Educational Psychology (Mr Kim), and School of Medicine (Mr Lee), University of Minnesota, Twin Cities
| | | | | | | |
Collapse
|
14
|
Zhang L, Ding D, Fethney J, Neubeck L, Gallagher R. Tools to measure health literacy among Chinese speakers: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:888-897. [PMID: 31837896 DOI: 10.1016/j.pec.2019.11.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Health literacy measurement can identify healthcare consumers' needs and help inform healthcare service delivery. The objective of this review is to identify and evaluate tools to measure health literacy among Chinese speakers. METHODS A systematic literature search was undertaken in nine databases, both English and Chinese, on articles published from the databases' inception to May 2018, addressing health literacy among Chinese speakers. RESULTS Ten health literacy instruments in the Chinese language were reported in 17 studies, of which ten were published in English and seven in Chinese. Of the 17 studies, six reported on a new instrument, while the remainder reported on derivative instruments. All, except for one, are self-administered. These studies applied various implicit or explicit conceptual or operational health literacy definitions. The psychometric strength varied across the instruments. CONCLUSIONS A number of instruments are available for assessing health literacy among Chinese speakers. Careful selection is recommended, given the variation in components and psychometric properties assessed. PRACTICE IMPLICATIONS This review can be used by healthcare providers and researchers to select effective health literacy tools to examine patients' ability to understand and apply health information so that services can be more appropriately tailored to Chinese speaking patients.
Collapse
Affiliation(s)
- Ling Zhang
- Susan Wakil School of Nursing and Midwifery / Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, Australia.
| | - Ding Ding
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia; Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Judith Fethney
- Susan Wakil School of Nursing and Midwifery / Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Lis Neubeck
- Susan Wakil School of Nursing and Midwifery / Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, Australia; School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery / Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| |
Collapse
|
15
|
Ly MYN, Kim KK, Stewart SL. Assessing the performance of the Asian/Pacific islander identification algorithm to infer Hmong ethnicity from electronic health records in California. BMJ Open 2019; 9:e031646. [PMID: 31831538 PMCID: PMC6924723 DOI: 10.1136/bmjopen-2019-031646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study assesses the performance of the North American Association of Central Cancer Registries Asian/Pacific Islander Identification Algorithm (NAPIIA) to infer Hmong ethnicity. DESIGN AND SETTING Analyses of electronic health records (EHRs) from 1 January 2011 to 1 October 2015. The NAPIIA was applied to the EHR data, and self-reported Hmong ethnicity from a questionnaire was used as the gold standard. Sensitivity, specificity, positive (PPV) and negative predictive values (NPVs) were calculated comparing the source data ethnicity inferred by the algorithm with the self-reported ethnicity from the questionnaire. PARTICIPANTS EHRs indicating Hmong, Chinese, Vietnamese and Korean ethnicity who met the original study inclusion criteria were analysed. RESULTS The NAPIIA had a sensitivity of 78%, a specificity of 99.9%, a PPV of 96% and an NPV of 99%. The prevalence of Hmong population in the sample was 3.9%. CONCLUSION The high sensitivity of the NAPIIA indicates its effectiveness in detecting Hmong ethnicity. The applicability of the NAPIIA to a multitude of Asian subgroups can advance Asian health disparity research by enabling researchers to disaggregate Asian data and unmask health challenges of different Asian subgroups.
Collapse
Affiliation(s)
- May Ying N Ly
- Metropolitan Studies, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, University of California Davis, Davis, California, USA
| | - Susan L Stewart
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento, California, USA
| |
Collapse
|
16
|
Tsoh JY, Tong EK, Sy AU, Stewart SL, Gildengorin GL, Nguyen TT. Knowledge of colorectal cancer screening guidelines and intention to obtain screening among nonadherent Filipino, Hmong, and Korean Americans. Cancer 2019; 124 Suppl 7:1560-1567. [PMID: 29578604 DOI: 10.1002/cncr.31097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/10/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Nonadherence to colorectal cancer (CRC) screening among Asian Americans is high but not well understood. This study examined correlates of screening intention among Filipino, Hmong, and Korean Americans who were nonadherent to CRC screening. METHODS Using cross-sectional, preintervention survey data from 504 Asian Americans (115 Filipinos, 185 Hmong, and 204 Koreans) aged 50-75 years who were enrolled in a multisite cluster randomized controlled trial of lay health educator intervention, we analyzed correlates of self-reported CRC screening nonadherence, which was defined as not being up-to-date for fecal occult blood test, sigmoidoscopy, or colonoscopy. RESULTS Only 26.8% of participants indicated intention to obtain screening within 6 months (Hmong: 12.4%; Korean: 30.8%; and Filipino: 42.6%; P < .001). Only one third of participants had undergone a prior screening, and a majority did not know that screening is a method of CRC prevention method (61.3%) or had any knowledge of CRC screening guidelines (53.4%). Multivariable analyses revealed that patient-provider ethnicity concordance, provider's recommendation of screening, participants' prior CRC screening, perceived severity and susceptibility of CRC, and knowledge of guidelines were positively associated with screening intention. Specifically, knowing one or more screening guidelines doubled the odds of screening intention (adjusted odds ratio, 2.38; 95% confidence interval, 1.32-4.28). Hmong were less likely to have screening intention than Filipinos, which was unexplained by socio-demographics, health care factors, perceived needs for CRC screening, or knowledge of screening guidelines. CONCLUSION CRC screening intention among nonadherent Filipino, Hmong, and Korean Americans was low. Targeting knowledge of CRC screening guidelines may be effective strategies for increasing CRC screening intention among nonadherent Asian Americans. Cancer 2018;124:1560-7. © 2018 American Cancer Society.
Collapse
Affiliation(s)
- Janice Y Tsoh
- Department of Psychiatry, University of California San Francisco, San Francisco, California.,Asian American Research Center on Health, San Francisco, California
| | - Elisa K Tong
- Asian American Research Center on Health, San Francisco, California.,Department of Internal Medicine, University of California Davis, Davis, California
| | - Angela U Sy
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Susan L Stewart
- Department of Public Health Sciences, University of California Davis, Davis, California
| | - Ginny L Gildengorin
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California
| | - Tung T Nguyen
- Asian American Research Center on Health, San Francisco, California.,Division of General Internal Medicine, University of California San Francisco, San Francisco, California
| |
Collapse
|
17
|
Fang DM, Stewart SL. Social-cultural, traditional beliefs, and health system barriers of hepatitis B screening among Hmong Americans: A case study. Cancer 2019; 124 Suppl 7:1576-1582. [PMID: 29578596 DOI: 10.1002/cncr.31096] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/10/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND The incidence of liver cancer in Hmong Americans is 5 times higher than that of non-Hispanic whites, and there is a low hepatitis B screening rate (24%) among Hmong adults compared with other Asian American populations. The purpose of this study was to examine the Hmong's perceptions on social-cultural determinants, traditional health beliefs, and health care system barriers that influenced community-based hepatitis B screening interventions. METHODS A qualitative method was used, integrating a collective case study research design. In-depth interviews were used to collect data from 20 Hmong adults from the greater Sacramento area. A pattern matching analytic technique was used to analyze the data. The main core elements of Culture Care Theory were used to capture the key themes presented by the participants. RESULTS Protecting a family's reputation; fear of doctors, medical procedures, and test results; lack of trust in medical doctors and medical care services; and using Hmong herbal medicines and practicing spiritual healing were identified as social-cultural and traditional health belief barriers to obtaining HBV screening. Health care costs, perceived discrimination, lack of transportation, linguistic discordance, and poor quality of care were identified as barriers to accessing high-quality health care services and obtaining hepatitis B screening. CONCLUSION Providers, health policy makers, researchers, and community-based organizations will need to work together to develop intervention strategies to address the social-cultural factors, traditional health beliefs, and health care challenges that influence obtaining hepatitis B screening in the Hmong community. Cancer 2018;124:1576-82. © 2018 American Cancer Society.
Collapse
Affiliation(s)
| | - Susan L Stewart
- Department of Public Health Sciences, University of California, Davis, California
| |
Collapse
|
18
|
Yalim AC, Kim W, Kim I. Challenges in health-care service use among Burmese refugees: A grounded theory approach. SOCIAL WORK IN HEALTH CARE 2019; 58:665-684. [PMID: 31120371 DOI: 10.1080/00981389.2019.1616244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/28/2019] [Accepted: 05/01/2019] [Indexed: 06/09/2023]
Abstract
The timely use of health-care services is essential to achieve the best health outcomes. We explore barriers to health-care access among refugees from Burma through interviews with key community informants who serve their community as interpreters, health-care professionals, paraprofessionals, and/or representatives. The interviews with a convenience sampling of 11 leaders from Burmese and Karen ethnic communities revealed three stages of health-care use (i.e., before, during, and after doctor's appointments), in which their community members encounter difficulties in accessing health-care services. Using grounded theory analysis approach, specific difficulties and cultural considerations for each stage were emerged. This study suggests that training programs for health-care providers on refugee populations' needs, cultural expectations, attitudes, and health behaviors may ease the process for refugees during each of these three stages. Interpreters as cultural brokers have an important role in facilitating cross-cultural communications not only before and during the appointment but also after doctor's visits, such as in the pharmacy and labs.
Collapse
Affiliation(s)
- Asli Cennet Yalim
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Wooksoo Kim
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Isok Kim
- a School of Social Work , University at Buffalo, The State University of New York , Buffalo , NY , USA
| |
Collapse
|
19
|
Wagner T. Incorporating Health Literacy Into English as a Second Language Classes. Health Lit Res Pract 2019; 3:S37-S41. [PMID: 31773086 PMCID: PMC6857769 DOI: 10.3928/24748307-20190405-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/05/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Teresa Wagner
- Address correspondence to Teresa Wagner, DrPH, MS, CPH, RDN/LD, CHWI, University of North Texas, Health Science Center, School of Public Health, 3500 Camp Bowie Boulevard, EAD 746, Fort Worth, TX 76107-2699;
| |
Collapse
|
20
|
Odegard M, Serrano OK, Peterson K, Mongin SJ, Berglund D, Vock DM, Chinnakotla S, Dunn TB, Finger EB, Kandaswamy R, Pruett TL, Matas AJ. Delivery of transplant care among Hmong kidney transplant recipients: Outcomes from a single institution. Clin Transplant 2019; 33:e13539. [DOI: 10.1111/ctr.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Marjorie Odegard
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Oscar K. Serrano
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Kent Peterson
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Steven J. Mongin
- Biostatistical Design and Analysis Center Clinical and Translational Science Institute Minneapolis Minnesota
| | - Danielle Berglund
- Informatics Services for Research and Reporting, Fairview Minneapolis Minnesota
| | - David M. Vock
- Division of Biostatistics, School of Public Health University of Minnesota Minneapolis Minnesota
| | | | - Ty B. Dunn
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Erik B. Finger
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Raja Kandaswamy
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Timothy L. Pruett
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Arthur J. Matas
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| |
Collapse
|
21
|
Padela AI, Nageeb S, Vu M, Quinn MT. The Development and Validation of a Modesty Measure for Diverse Muslim Populations. JOURNAL OF RELIGION AND HEALTH 2019; 58:408-425. [PMID: 30465264 DOI: 10.1007/s10943-018-0734-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper reports on the multi-phase development of an English-language modesty measure for use among Muslim populations. The process yielded a 10-item measure that has high levels of internal consistency reliability (Cronbach's α of 0.83), and has acceptable discriminant and predictive validity. Specifically although our modesty measure for Muslim women was found to be significantly correlated with measures of positive and negative religious (Islamic) coping, it was not significantly correlated with religious practice-based religiosity (discriminant validity). Further logistic modeling revealed higher modesty levels positively associated with forgoing mammography because of concerns about lack of same-sex providers (predictive validity).
Collapse
Affiliation(s)
- Aasim I Padela
- Initiative on Islam and Medicine, Program on Medicine and Religion, Department of Medicine, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
- Section of Emergency Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA.
- Section of General Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA.
| | - Shaheen Nageeb
- Initiative on Islam and Medicine, Program on Medicine and Religion, Department of Medicine, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
- Section of Emergency Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Milkie Vu
- Initiative on Islam and Medicine, Program on Medicine and Religion, Department of Medicine, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
- Section of Emergency Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Michael T Quinn
- Section of General Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
22
|
Gathirua-Mwangi W, Cohee A, Tarver WL, Marley A, Biederman E, Stump T, Monahan P, Rawl S, Skinner CS, Champion VL. Factors Associated with Adherence to Mammography Screening Among Insured Women Differ by Income Levels. Womens Health Issues 2018; 28:462-469. [DOI: 10.1016/j.whi.2018.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 12/11/2022]
|
23
|
Jun J, Nan X. Determinants of Cancer Screening Disparities Among Asian Americans: A Systematic Review of Public Health Surveys. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:757-768. [PMID: 28378200 DOI: 10.1007/s13187-017-1211-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We conducted a systematic analysis of 24 peer-reviewed literary works that examined Asian Americans' breast, cervical, and colon cancer screening, focusing on empirical findings from large-scale public health surveys (i.e., NHIS, CHIS, HINTS, BRFSS). We provide an overview of relevant research in terms of study characteristics, samples, predictor/covariate of cancer screenings, and key findings. Our analysis indicates that Asian Americans' cancer screening rates are lower than for non-Hispanic Whites for all cancer types in four large-scale public health surveys throughout 17 study years. Acculturation and healthcare access were two significant factors in explaining Asian Americans' cancer screening rates. Cancer fatalism and family cancer history emerged as potential factors that may account for more variances. However, the screening disparities between Asian Americans and whites persist even after adjusting all covariates, including SES, acculturation, healthcare access, health status, and health perception/literacy. More individual and cultural factors should be identified to address these disparities.
Collapse
Affiliation(s)
- Jungmi Jun
- The Department of Communication, University of Maryland, College Park, MD, USA.
| | - Xiaoli Nan
- The Department of Communication, University of Maryland, College Park, MD, USA
| |
Collapse
|
24
|
Oyenuga M, Yang JK, Prizment AE, Bushhouse S, Demerath EW, Spector LG. Cancer patterns in Hmong in Minnesota, 2000 to 2012. Cancer 2018; 124:3560-3566. [DOI: 10.1002/cncr.31592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/11/2018] [Accepted: 05/16/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Mosunmoluwa Oyenuga
- Division of Epidemiology and Community Health; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - John K. Yang
- Division of Epidemiology and Community Health; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Anna E. Prizment
- Division of Epidemiology and Community Health; University of Minnesota School of Public Health; Minneapolis Minnesota
- Masonic Cancer Center; University of Minnesota; Minneapolis Minnesota
| | - Sally Bushhouse
- Minnesota Cancer Reporting System, Minnesota Department of Health; St. Paul Minnesota
| | - Ellen W. Demerath
- Division of Epidemiology and Community Health; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Logan G. Spector
- Masonic Cancer Center; University of Minnesota; Minneapolis Minnesota
- Division of Pediatric Epidemiology and Clinical Research; Department of Pediatrics, University of Minnesota; Minneapolis Minnesota
| |
Collapse
|
25
|
Suwankhong D, Liamputtong P. Early Detection of Breast Cancer and Barrier to Screening Programmes amongst Thai Migrant Women in Australia: A Qualitative Study. Asian Pac J Cancer Prev 2018; 19:1089-1097. [PMID: 29699369 PMCID: PMC6031773 DOI: 10.22034/apjcp.2018.19.4.1089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Breast cancer screening programme is seen as the best practice to detect breast cancer early. However, there are circumstances that can prevent immigrant women from attending screening programmes. Little is known about Thai migrants and the barriers to their seeking breast cancer screening when living in a new homeland. This paper aimed to discuss the barriers to attending screening services among Thai migrant women living in Australia. Methods: This study adopted qualitative approach. Semi-structured in-depth interviewing and drawing methods were employed as data collection technique with 25 Thai migrant women who had not experienced breast cancer and were living in Metropolitan Melbourne, Australia. Thematic analysis method was employed to analyse the data. Results: Basing on the Health Belief Model, most Thai migrant women did not perceive that they were at risk of breast cancer. Despite seeing a breast cancer screening programme as important, the women rarely paid attention to breast cancer screening and used the mammography services provided by the Australian health care system. The barriers included the location of the services, unfamiliar patterns of health care provision, and language difficulties. Conclusions: There are many barriers that that they encountered in Australia that prevent Thai migrant women living in Melbourne Australia to pay attention to mammographic screening service provided by Australia health system. Our findings suggest that health services and interventions need to be designed more sensitive to the needs and socio-cultural context of migrant women in general and Thai migrant women in particular.
Collapse
Affiliation(s)
- Dusanee Suwankhong
- Department of Public Health, Faculty of Health and Sports Science, Thaksin University, Phatthalung, Thailand.
| | | |
Collapse
|
26
|
Tran MT, Jeong MB, Nguyen VV, Sharp MT, Yu EP, Yu F, Tong EK, Kagawa-Singer M, Cuaresma CF, Sy AU, Tsoh JY, Gildengorin GL, Stewart SL, Nguyen TT. Colorectal cancer beliefs, knowledge, and screening among Filipino, Hmong, and Korean Americans. Cancer 2018; 124 Suppl 7:1552-1559. [PMID: 29578600 PMCID: PMC5875724 DOI: 10.1002/cncr.31216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/22/2017] [Accepted: 12/13/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND To the authors' knowledge, there are few studies to date regarding colorectal cancer (CRC) beliefs, knowledge, and screening among multiple Asian American populations, who are reported to have lower CRC screening rates compared with white individuals. The current study was performed to assess knowledge and beliefs regarding the causes of CRC, its prevention, and factors associated with CRC screening among 3 Asian American groups. METHODS The authors conducted an in-language survey with Filipino (Honolulu, Hawaii), Hmong (Sacramento, California), and Korean (Los Angeles, California) Americans aged 50 to 75 years who were sampled through social networks. Bivariate and multivariable analyses were conducted to assess factors associated with CRC screening. RESULTS The sample of 981 participants was 78.3% female and 73.8% reported limited proficiency in English. Few of the participants were aware that age (17.7%) or family history (36.3%) were risk factors for CRC; 6.2% believed fate caused CRC. Only 46.4% of participants knew that screening prevented CRC (74.3% of Filipino, 10.6% of Hmong, and 55.8% of Korean participants; P<.001). Approximately two-thirds of participants reported ever having undergone CRC screening (76.0% of Filipino, 72.0% of Hmong, and 51.4% of Korean participants; P<.001) and 48.6% were up to date for screening (62.2% of Filipino, 43.8% of Hmong, and 41.4% of Korean participants; P<.001). Factors found to be significantly associated with ever screening were being Korean (compared with Filipino), having a family history of CRC, having health insurance or a regular source of health care, and knowing that a fatty diet caused CRC. Believing that fate caused CRC and that praying prevented it were found to be negatively associated with ever screening. Factors associated with being up to date for CRC screening included being born in the United States, having a family history of CRC, and having access to health care. CONCLUSIONS Knowledge regarding the causes of CRC and its prevention among Filipino, Hmong, and Korean individuals is low. However, health care access, not knowledge or beliefs, was found to be a key determinant of CRC screening. Cancer 2018;124:1552-9. © 2018 American Cancer Society.
Collapse
Affiliation(s)
- Mi T Tran
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Matthew B Jeong
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Vickie V Nguyen
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Michael T Sharp
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Edgar P Yu
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Filmer Yu
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Elisa K Tong
- Department of General Internal Medicine, University of California at Davis, Davis, California
| | - Marjorie Kagawa-Singer
- Department of Community Health Sciences, Los Angeles Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Charlene F Cuaresma
- Department of Public Health, University of Hawai'i at Manoa, Honolulu, Hawaii
| | - Angela U Sy
- Department of Public Health, University of Hawai'i at Manoa, Honolulu, Hawaii
| | - Janice Y Tsoh
- Department of Psychiatry, University of California at San Francisco, San Francisco, California
| | - Ginny L Gildengorin
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Susan L Stewart
- Department of Public Health Sciences, University of California at Davis, Davis, California
| | - Tung T Nguyen
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California
| |
Collapse
|
27
|
Beltran R, Simms T, Lee HY, Kwon M. HPV Literacy and Associated Factors Among Hmong American Immigrants: Implications for Reducing Cervical Cancer Disparity. J Community Health 2018; 41:603-11. [PMID: 26696118 DOI: 10.1007/s10900-015-0135-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previous studies show that certain minority and ethnic communities experience low human papillomavirus (HPV) vaccination rates despite a higher cervical cancer burden. HPV is known to be responsible for almost all cervical cancer cases. Hmong Americans, a growing Asian American population, appear to be at increased risk. The cervical cancer incidence rate among Hmong American women is three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites. Despite such alarming statistics, there is limited research focusing on HPV literacy and its associated factors in the Hmong American community. This study's objectives are to investigate: (1) the level of HPV knowledge among Hmong Americans; (2) HPV vaccination initiation and completion rates of Hmong Americans; and (3) factors associated with HPV literacy in the Hmong American community. Andersen's Behavioral Model of Health Services Use was used as the study's theoretical framework. A self-administered paper and online health survey was completed by192 Hmong Americans living in a major metropolitan area in Minnesota. Results revealed a mean score of 4.76 (SD 1.67) for the 7-item questionnaire measuring HPV knowledge. The HPV vaccination initiation rate was 46.3 % (n = 56), with 32.7 % completing the recommended three doses. Multiple regression analysis found that participants' level of education, number of doctor visits, and cervical cancer screening literacy were significantly associated with HPV knowledge. This study's results indicate the important role of health providers in educating Hmong Americans patients about HPV and cervical cancer prevention to decrease the cervical cancer burden in this high-risk population.
Collapse
Affiliation(s)
- Raiza Beltran
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA.
| | - Tina Simms
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA
| | - Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA
| | - Melissa Kwon
- Asian American Studies, University of Minnesota, Twin Cities, 778 Social Sciences Building 267 - 19th Avenue South, Minneapolis, MN, 55455, USA
| |
Collapse
|
28
|
Differences in Spontaneous Intracerebral Hemorrhage Cases between Urban and Rural Regions of Taiwan: Big Data Analytics of Government Open Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121548. [PMID: 29232864 PMCID: PMC5750966 DOI: 10.3390/ijerph14121548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 11/21/2022]
Abstract
This study evaluated the differences in spontaneous intracerebral hemorrhage (sICH) between rural and urban areas of Taiwan with big data analysis. We used big data analytics and visualization tools to examine government open data, which included the residents’ health medical administrative data, economic status, educational status, and relevant information. The study subjects included sICH patients of Taipei region (29,741 cases) and Eastern Taiwan (4565 cases). The incidence of sICH per 100,000 population per year in Eastern Taiwan (71.3 cases) was significantly higher than that of the Taipei region (42.3 cases). The mean coverage area per hospital in Eastern Taiwan (452.4 km2) was significantly larger than the Taipei region (24 km2). The residents educational level in the Taipei region was significantly higher than that in Eastern Taiwan. The mean hospital length of stay in the Taipei region (17.9 days) was significantly greater than that in Eastern Taiwan (16.3 days) (p < 0.001). There were no significant differences in other medical profiles between two areas. Distance and educational barriers were two possible reasons for the higher incidence of sICH in the rural area of Eastern Taiwan. Further studies are necessary in order to understand these phenomena in greater depth.
Collapse
|
29
|
Krieger M, Agather A, Douglass K, Reiser CA, Petty EM. Working with the Hmong Population in a Genetics Setting: an Interpreter Perspective. J Genet Couns 2017; 27:565-573. [PMID: 28942494 DOI: 10.1007/s10897-017-0153-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/31/2017] [Indexed: 11/27/2022]
Abstract
The aim of this pilot qualitative study was to describe the experiences and beliefs of medical interpreters when working with genetic counselors and other genetic providers caring for Hmong patients who are not native English speakers. Specific goals were to identify interpreters' thoughts and perceptions on (a) their roles during sessions, (b) unique challenges in a genetics session, (c) knowledge genetics providers need when working with Hmong patients and interpreters, and (d) supports and training needed to effectively interpret in a genetics setting. Hmong medical interpreters from Wisconsin and Minnesota were invited by email to participate in the study. Six were interviewed by telephone. Participants had worked with a variety of providers including geneticists, genetic counselors, primary care physicians, and oncologists. Factors identified by Hmong interpreters that made interpretation of content difficult in clinical genetics sessions included: time constraints, technical terms, and unique cultural perspectives of Hmong patients. While all respondents felt their primary role was to interpret session content as close to verbatim as possible, there was notable variation in the description of their interpretation style and other perceived roles in the genetic counseling session. Cultural issues genetics providers could consider when working with Hmong patients and different style issues when working with Hmong interpreters are discussed. Ideas for future studies and suggestions to improve communication with Hmong patients are explored.
Collapse
Affiliation(s)
- Meghan Krieger
- University of Wisconsin School of Medicine and Public Health, Rm 333 Waisman Center, 1500 Highland Avenue, Madison, WI, 53703, USA.
| | - Aime Agather
- Medstar Washington Hospital Center, Washington, DC, USA
| | | | - Catherine A Reiser
- University of Wisconsin School of Medicine and Public Health, Rm 333 Waisman Center, 1500 Highland Avenue, Madison, WI, 53703, USA
| | - Elizabeth M Petty
- University of Wisconsin School of Medicine and Public Health, Rm 333 Waisman Center, 1500 Highland Avenue, Madison, WI, 53703, USA
| |
Collapse
|
30
|
Lee M, Zhu L, Wang MQ, Wei Z, Tan Y, Nguyen MT, Ogunwobi OO, Ma GX. Psychosocial Predictors of HBV Screening Behavior among Vietnamese Americans. Am J Health Behav 2017; 41:561-570. [PMID: 28760178 PMCID: PMC5633084 DOI: 10.5993/ajhb.41.5.5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We evaluated the influence of psychosocial factors on HBV screening. METHODS Sample consisted of 1716 Vietnamese participants in our previous HBV intervention trial, recruited from 36 community-based organizations in Pennsylvania, New Jersey, and New York City between 2009 and 2014. Using the Health Belief Model and Social Cognitive Theory, we measured self-efficacy, knowledge, perceived barriers, perceived benefits, perceived severity, and risk susceptibility. Analysis of covariance was used to compare pre- and post-intervention changes of psychosocial variables. Structural equation modeling was used to explore the direct and indirect effects of the psychosocial variables on HBV screening. RESULTS Knowledge, self-efficacy, perceived benefits, and perceived barriers were directly associated with HBV screening; knowledge had the strongest effect. Perceived severity and risk susceptibility had indirect association with HBV screening through other variables. Indirect paths among the 6 psychosocial variables were also identified. CONCLUSION To promote HBV screening among Vietnamese Americans, intervention efforts should focus on increasing knowledge, self-efficacy, and perceived benefits, decreasing perceived barriers, and accounting for the dynamic cognitive processing.
Collapse
Affiliation(s)
- Minsun Lee
- Postdoctoral Associate, Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Lin Zhu
- Postdoctoral Associate, Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Min Qi Wang
- Professor, Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD
| | - Zhengyu Wei
- Research Associate, Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | | | - Minhhuyen T Nguyen
- Director, Section of Clinical Gastroenterology, Department of Medicine, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Olorunseun O Ogunwobi
- Associate Professor, Department of Biological Sciences, Hunter College of the City University of New York, New York, NY
| | - Grace X Ma
- Associate Dean for Health Disparities, Director, Center for Asian Health, Laura H. Carnell Professor and Professor in Clinical Sciences, Lewis Katz School of Medicine, Temple University Philadelphia, PA;,
| |
Collapse
|
31
|
Khuu BP, Lee HY, Zhou AQ. Health Literacy and Associated Factors Among Hmong American Immigrants: Addressing the Health Disparities. J Community Health 2017; 43:11-18. [PMID: 28528527 DOI: 10.1007/s10900-017-0381-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hmong Americans face a disproportionate health burden ranging from the high prevalence of diabetes to depressive disorders. Little research attention has been paid toward exploring contributing factors to this disparity. As such, the present study seeks to fill the gap in the literature by examining the health literacy levels in Hmong Americans and its associated factors. The present study employed Andersen's behavioral model of health service as the theoretical framework. A cross-sectional survey research design was used and information was gathered from 168 Hmong American immigrants. Participants were recruited using a purposive sampling strategy. A multiple regression analysis was conducted to identify the factors linked to health literacy. Approximately half of the participants had low health literacy and reported that they did not understand health information well. Health literacy levels were found to differ significantly based on the number of years participants have lived in the U.S., their social or religious group attendance, health status, and whether they had difficulties with activities of daily living. Our exploratory findings could be used prompt more research to help inform the development of interventions aiming to improve health literacy levels and address the health disparities in Hmong American Population.
Collapse
Affiliation(s)
- Belle P Khuu
- School of Social Work, University of Minnesota, Twin Cities, MN, USA.
| | - Hee Y Lee
- School of Social Work, University of Minnesota, Twin Cities, MN, USA
| | - Anne Q Zhou
- Department of Psychology, University of Minnesota, Twin Cities, MN, USA
| |
Collapse
|
32
|
Healey P, Stager ML, Woodmass K, Dettlaff AJ, Vergara A, Janke R, Wells SJ. Cultural adaptations to augment health and mental health services: a systematic review. BMC Health Serv Res 2017; 17:8. [PMID: 28056967 PMCID: PMC5217593 DOI: 10.1186/s12913-016-1953-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 12/15/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Membership in diverse racial, ethnic, and cultural groups is often associated with inequitable health and mental health outcomes for diverse populations. Yet, little is known about how cultural adaptations of standard services affect health and mental health outcomes for service recipients. This systematic review identified extant themes in the research regarding cultural adaptations across a broad range of health and mental health services and synthesized the most rigorous experimental research available to isolate and evaluate potential efficacy gains of cultural adaptations to service delivery. METHODS MEDLINE, PsycINFO, CINAHL, EMBASE, and grey literature sources were searched for English-language studies published between January 1955 and January 2015. Cultural adaptations to any aspect of a service delivery were considered. Outcomes of interest included changes in service provider behavior or changes in the behavioral, medical, or self-reported experience of recipients. RESULTS Thirty-one studies met the inclusion criteria. The most frequently tested adaptation occurred in preventive services and consisted of modifying the content of materials or services delivered. None of the included studies focused on making changes in the provider's behavior. Many different populations were studied but most research was concerned with the experiences and outcomes of African Americans. Seventeen of the 31 retained studies observed at least one significant effect in favor of a culturally adapted service. However there were also findings that favored the control group or showed no difference. Researchers did not find consistent evidence supporting implementation of any specific type of adaptation nor increased efficacy with any particular cultural group. CONCLUSIONS Conceptual frameworks to classify cultural adaptations and their resultant health/mental health outcomes were developed and applied in a variety of ways. This review synthesizes the most rigorous research in the field and identifies implications for policy, practice, and research, including individualization, cost considerations, and patient or client satisfaction, among others.
Collapse
Affiliation(s)
- Priscilla Healey
- Centre for the Study of Services to Children and Families, University of British Columbia, ASC 453, 3187 University Way, Kelowna, BC V1V 1V7 Canada
| | - Megan L. Stager
- Centre for the Study of Services to Children and Families, University of British Columbia, ASC 453, 3187 University Way, Kelowna, BC V1V 1V7 Canada
| | - Kyler Woodmass
- Centre for the Study of Services to Children and Families, University of British Columbia, ASC 453, 3187 University Way, Kelowna, BC V1V 1V7 Canada
| | - Alan J. Dettlaff
- University of Houston Graduate College of Social Work, 3511 Cullen Blvd Room 110HA, Houston, TX 77204-4013 USA
| | - Andrew Vergara
- Centre for the Study of Services to Children and Families, University of British Columbia, ASC 453, 3187 University Way, Kelowna, BC V1V 1V7 Canada
| | - Robert Janke
- University of British Columbia, Okanagan Campus Library, LIB 241, 3287 University Way, Kelowna, BC V1V 1V7 Canada
| | - Susan J. Wells
- Centre for the Study of Services to Children and Families, University of British Columbia, ASC 453, 3187 University Way, Kelowna, BC V1V 1V7 Canada
| |
Collapse
|
33
|
Truong M, Gibbs L, Paradies Y, Priest N, Tadic M. Cultural competence in the community health context: ‘we don’t have to reinvent the wheel’. Aust J Prim Health 2017; 23:342-347. [DOI: 10.1071/py16073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 05/01/2017] [Indexed: 11/23/2022]
Abstract
Health and social service agencies need to be responsive to the healthcare requirements of culturally and linguistically diverse (CALD) groups in the community. This is a challenging proposition, particularly due to shifting demographics in developed Western countries such as Australia. Organisations that strive for cultural competence can potentially reduce the barriers associated with inequitable access to services by CALD groups. Community health services play a vital role in the provision of culturally competent health services to people from CALD groups. Additional research related to cultural competence in the community health context is needed. Thus, the aim of this paper is to explore the positioning of cultural competence within community health from multiple perspectives using a qualitative case study of a community health service located in Victoria, Australia. The findings suggest that if the essential needs of clients are met, regardless of cultural background (e.g. able to communicate with staff, trust and a respectful and caring environment), then issues related to cultural background may be of less significance for some clients.
Collapse
|
34
|
Lee HY, Rhee TG, Kim NK. Cancer literacy as a mediator for cancer screening behaviour in Korean adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:e34-e42. [PMID: 25975449 DOI: 10.1111/hsc.12243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 06/04/2023]
Abstract
This study investigates the cancer literacy level in Korean adults and examines whether cancer literacy plays a mediating role in the relationship between population characteristics and cancer screening behaviours. We collected data from 585 community-dwelling adults in Korea using self-administered surveys and face-to-face interviews from October to December in 2009. Guided by Andersen's behavioural model, we used a structural equation model to estimate the effect of cancer literacy as a mediator and found that cancer literacy mediated cancer screening behaviour. In the individual path analysis models, cancer literacy played a significant mediating role for the use of eastern medicine, fatalism, health status and the number of chronic diseases. When controlling for other relevant covariates, we found that in the optimal path model, cancer literacy played a mediating role in the relationship between the use of eastern medicine and self-rated health status as well as cancer screening behaviour. Thus, developing community-based cancer education programmes and training clinical practitioners in eastern medicine clinics about the importance of informing their patients about regular cancer screening may be an option to boost cancer literacy and screening behaviour in Korea.
Collapse
Affiliation(s)
- Hee Yun Lee
- School of Social Work, College of Education and Human Development, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
| | - Taeho Greg Rhee
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| | - Nam Keol Kim
- Department of Educational Psychology, College of Education and Human Development, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| |
Collapse
|
35
|
Tong EK, Nguyen TT, Lo P, Stewart SL, Gildengorin GL, Tsoh JY, Jo AM, Kagawa-Singer ML, Sy AU, Cuaresma C, Lam HT, Wong C, Tran MT, Chen MS. Lay health educators increase colorectal cancer screening among Hmong Americans: A cluster randomized controlled trial. Cancer 2016; 123:98-106. [PMID: 27564924 DOI: 10.1002/cncr.30265] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/05/2016] [Accepted: 07/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Asian Americans have lower colorectal cancer (CRC) screening rates than non-Hispanic white individuals. Hmong Americans have limited socioeconomic resources and literacy. The current randomized controlled trial was conducted to determine whether bilingual/bicultural lay health educator (LHE) education could increase CRC screening among Hmong Americans. METHODS A cluster randomized controlled trial was conducted among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by an LHE. The control group received education regarding nutrition and physical activity delivered by a health educator. The outcomes were changes in self-reported ever-screening and up-to-date CRC screening after 6 months. RESULTS All 329 participants were foreign-born with mostly no formal education, limited English proficiency, and no employment. The majority of the participants were insured and had a regular source of health care. The intervention group experienced greater changes after the intervention than the control group for ever-screening (P = .068) and being up-to-date with screening (P<.0001). In multivariable regression analyses, the intervention group demonstrated a greater increase than the control group in reporting ever-screening (adjusted odds ratio, 1.73; 95% confidence interval, 1.07-2.79) and being up-to-date with screening (adjusted odds ratio, 1.71; 95% confidence interval, 1.26-2.32). Individuals who had health insurance were found to have >4 times the odds of receiving screening, both ever-screening and up-to-date screening. A higher CRC knowledge score mediated the intervention effect for both screening outcomes. CONCLUSIONS A culturally and linguistically appropriate educational intervention delivered by trained LHEs was found to increase CRC screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Cancer 2017;98-106. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Elisa K Tong
- Department of Internal Medicine, University of California at Davis, Sacramento, California
| | - Tung T Nguyen
- Department of Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Penny Lo
- Hmong Women's Heritage Association, Sacramento, California
| | - Susan L Stewart
- Department of Public Health Sciences, University of California at Davis, Sacramento, California
| | - Ginny L Gildengorin
- Department of Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Janice Y Tsoh
- Department of Psychiatry, University of California at San Francisco, San Francisco, California
| | - Angela M Jo
- University of New Mexico at Albuquerque, Albuquerque, New Mexico
| | - Marjorie L Kagawa-Singer
- Fielding School of Public Health and Asian American Studies Center, University of California at Los Angeles, Los Angeles, California
| | - Angela U Sy
- University of Hawai'i at Manoa, Manoa, Hawaii
| | | | - Hy T Lam
- Department of Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Ching Wong
- Department of Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Mi T Tran
- Department of Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Moon S Chen
- Department of Internal Medicine, University of California at Davis, Sacramento, California
| |
Collapse
|
36
|
Abstract
Access to healthcare is derived from a complex mix of personal beliefs, cultural norms, and social structure, combined with available individual and community resources. This article reviews the concept of access to care and its evolution since the 1960s. The difference between potential and realized access and the question of social justice as it relates to access to care also are explored.
Collapse
|
37
|
Haji-Jama S, Gorey KM, Luginaah IN, Zou G, Hamm C, Holowaty EJ. Disparities Report: Disparities Among Minority Women With Breast Cancer Living in Impoverished Areas of California. Cancer Control 2016; 23:157-62. [PMID: 27218793 PMCID: PMC4882162 DOI: 10.1177/107327481602300210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Interaction effects of poverty and health care insurance coverage on overall survival rates of breast cancer among women of color and non-Hispanic white women were explored. METHODS We analyzed California registry data for 2,024 women of color (black, Hispanic, Asian, Pacific Islander, American Indian, or other ethnicity) and 4,276 non-Hispanic white women (Anglo-European ancestries and no Hispanic-Latin ethnic backgrounds) diagnosed with breast cancer between the years 1996 and 2000 who were then followed until 2011. The 2000 US census categorized rates of neighborhood poverty. Health care insurance coverage was either private, Medicare, Medicaid, or none. Cox regression was used to model rates of survival. RESULTS A 3-way interaction between ethnicity, health care insurance coverage, and poverty was observed. Women of color inadequately insured and living in poor or near-poor neighborhoods in California were the most disadvantaged. Women of color adequately insured and who lived in such neighborhoods in California were also disadvantaged. The incomes of such women of color were typically lower than the incomes of non-Hispanic white women. CONCLUSIONS Women of color with or without insurance coverage are disadvantaged in poor and near-poor neighborhoods of California. Such women may be less able to bare the indirect, direct, or uncovered costs of health care for breast cancer treatment.
Collapse
Affiliation(s)
- Sundus Haji-Jama
- School of Social Work, University of Windsor, Ontario, Canada N9B 3P4.
| | | | | | | | | | | |
Collapse
|
38
|
Engaging in Culturally Informed Nursing Care With Hmong Children and Their Families. J Pediatr Nurs 2016; 31:102-6. [PMID: 26413994 DOI: 10.1016/j.pedn.2015.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/29/2015] [Accepted: 08/27/2015] [Indexed: 11/21/2022]
Abstract
The Hmong are an ethnic hill tribe group originally from Southern China with concentrated populations throughout Southeast Asia, especially the mountains of northern Laos. Following the Vietnam War, the Hmong started immigrating to the United States in waves to escape prosecution for fighting communism alongside the United States. Today, the Hmong population in the United States is growing rapidly, with a median age of 20.4 years. As the Hmong move and redistribute themselves across the country to be with family or pursue new opportunities, it is more and more likely that nurses everywhere will interact with Hmong children and their families. Historically medically underserved, the Hmong community continues to face barriers to healthcare as a result of culture, language, and lack of access. Nurses who are informed about cultural values and norms of the Hmong and their family and social structures, as well as their spiritual and traditional practices, will be able to establish trust with their pediatric patients and their caregivers. Utilizing strategies including interpretive services, asking detailed social and physical histories, providing extra appointment time, asking open ended questions, and employing teach back methods can help improve communication as well as provide higher quality care that addresses the specific needs of this population.
Collapse
|
39
|
Kue J, Thorburn S, Keon KL. Research challenges and lessons learned from conducting community-based research with the Hmong community. Health Promot Pract 2014; 16:411-8. [PMID: 25445983 DOI: 10.1177/1524839914561515] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conducting research with underserved communities with little exposure to research presents a number of challenges and opportunities. Our study used a community-based approach to better understand factors that influence breast and cervical cancer screening among Hmong women. OBJECTIVE This article shares lessons learned during the process of developing and conducting qualitative research with a Hmong community with limited experience with research. METHOD We conducted 17 key informant and 84 in-depth interviews with Hmong women and men. Research team discussions, insights from Hmong research team members, input from our Community Advisory Committee, and project documents were sources of information about the process of conducting research in this community. RESULTS Lessons learned concern including a cultural insider as an investigator; building community partnerships and support; establishing and working with a community advisory committee; hiring and training bilingual, bicultural staff; and using culturally appropriate materials and methods in a small, kinship-based community. We used multiple strategies to ensure that this study was conducted in a culturally appropriate manner. CONCLUSION The lessons learned from our experiences can provide guidance to researchers on methodological and practical issues in conducting research with the Hmong and can inform future research with the Hmong and other similar underserved populations.
Collapse
|
40
|
Arriaza P, Nedjat-Haiem F, Lee HY, Martin SS. Guidelines for conducting rigorous health care psychosocial cross-cultural/language qualitative research. SOCIAL WORK IN PUBLIC HEALTH 2014; 30:75-87. [PMID: 25375998 DOI: 10.1080/19371918.2014.938394] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this article is to synthesize and chronicle the authors' experiences as four bilingual and bicultural researchers, each experienced in conducting cross-cultural/cross-language qualitative research. Through narrative descriptions of experiences with Latinos, Iranians, and Hmong refugees, the authors discuss their rewards, challenges, and methods of enhancing rigor, trustworthiness, and transparency when conducting cross-cultural/cross-language research. The authors discuss and explore how to effectively manage cross-cultural qualitative data, how to effectively use interpreters and translators, how to identify best methods of transcribing data, and the role of creating strong community relationships. The authors provide guidelines for health care professionals to consider when engaging in cross-cultural qualitative research.
Collapse
Affiliation(s)
- Pablo Arriaza
- a School of Social Work and Human Services, Walden University , Minneapolis , Minnesota , USA
| | | | | | | |
Collapse
|
41
|
Fehniger J, Livaudais-Toman J, Karliner L, Kerlikowske K, Tice JA, Quinn J, Ozanne E, Kaplan CP. Perceived versus objective breast cancer risk in diverse women. J Womens Health (Larchmt) 2013; 23:420-7. [PMID: 24372085 DOI: 10.1089/jwh.2013.4516] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prior research suggests that women do not accurately estimate their risk for breast cancer. Estimating and informing women of their risk is essential for tailoring appropriate screening and risk reduction strategies. METHODS Data were collected for BreastCARE, a randomized controlled trial designed to evaluate a PC-tablet based intervention providing multiethnic women and their primary care physicians with tailored information about breast cancer risk. We included women ages 40-74 visiting general internal medicine primary care clinics at one academic practice and one safety net practice who spoke English, Spanish, or Cantonese, and had no personal history of breast cancer. We collected baseline information regarding risk perception and concern. Women were categorized as high risk (vs. average risk) if their family history met criteria for referral to genetic counseling or if they were in the top 5% of risk for their age based on the Gail or Breast Cancer Surveillance Consortium Model (BCSC) breast cancer risk model. RESULTS Of 1,261 participants, 25% (N=314) were classified as high risk. More average risk than high risk women had correct risk perception (72% vs. 18%); 25% of both average and high risk women reported being very concerned about breast cancer. Average risk women with correct risk perception were less likely to be concerned about breast cancer (odds ratio [OR]=0.3; 95% confidence interval [CI]=0.2-0.4) while high risk women with correct risk perception were more likely to be concerned about breast cancer (OR=5.1; 95%CI=2.7-9.6). CONCLUSIONS Many women did not accurately perceive their risk for breast cancer. Women with accurate risk perception had an appropriate level of concern about breast cancer. Improved methods of assessing and informing women of their breast cancer risk could motivate high risk women to apply appropriate prevention strategies and allay unnecessary concern among average risk women.
Collapse
Affiliation(s)
- Julia Fehniger
- 1 Department of Medicine, Division of General Internal Medicine, University of California , San Francisco, California
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Thorburn S, Keon KL, Kue J. Sources of breast and cervical cancer information for Hmong women and men. Women Health 2013; 53:468-78. [PMID: 23879458 DOI: 10.1080/03630242.2013.796305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite low breast and cervical cancer screening levels among Hmong women in the United States reported in the literature, understanding of the barriers to screening for Hmong women is limited. Health literacy issues may influence screening behavior for this population. This qualitative study explored sources of information about breast and cervical cancer, including screening, and identified barriers to seeking such information for Hmong women and men. Researchers conducted semi-structured, in-depth interviews with 84 Hmong women and men living in Oregon. Interviews were audio-recorded and transcribed. Transcripts of 83 usable interviews were analyzed using content analysis. Health care providers and the Internet were the most frequently cited sources of information about breast and cervical cancer, including screening. Other sources were family, friends, and other media. Over half of the participants indicated that nothing would prevent them from seeking information about these topics. These findings suggested that health care providers and the Internet may be important sources of information about breast and cervical cancer screening for Hmong women. Additional research is needed to examine further Hmong women's health literacy needs and preferences with regards to breast and cervical cancer screening.
Collapse
Affiliation(s)
- Sheryl Thorburn
- School of Social and Behavioral Health Sciences, Oregon State University, Corvallis, OR 97331, USA.
| | | | | |
Collapse
|
43
|
Thorburn S, Kue J, Keon KL, Zukoski A. "We don't talk about it" and other interpersonal influences on Hmong women's breast and cervical cancer screening decisions. HEALTH EDUCATION RESEARCH 2013; 28:760-71. [PMID: 23221592 PMCID: PMC3772328 DOI: 10.1093/her/cys115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 10/25/2012] [Indexed: 06/01/2023]
Abstract
Hmong women in the United States have low rates of breast and cervical cancer screening, and the factors that influence screening in this population are not well understood. This qualitative study explored family and clan influences on Hmong women's breast and cervical cancer screening attitudes and behavior. We conducted in-depth interviews with Hmong women and men living in Oregon. Interviews were audio-recorded and transcribed. Transcripts of 83 interviews were analysed using content analysis. We identified four key themes. First, Hmong women make decisions about breast and cervical cancer screening independently. Second, Hmong families do not discuss breast and cervical cancer screening. For some, not talking about breast and cervical cancer screening was seen as a way that family and clan influence attitudes. Third, Hmong families can provide encouragement and support for screening. Although women make their own decisions, about one-half of participants reported that family encouraged or supported them or women in their family to get screened. Fourth, some family members, especially elders, may actively discourage screening. This study contributes to knowledge about potential barriers and facilitators to breast and cervical cancer screening for Hmong women. Findings expand our understanding of clan and male family member's influence over Hmong women's screening behavior.
Collapse
Affiliation(s)
- Sheryl Thorburn
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, Formerly with College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA, Independent Consultant, Corvallis, OR, USA and Rainbow Research, 621 West Lake St., Ste. 300, Minneapolis, MN 55408, USA
| | - Jennifer Kue
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, Formerly with College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA, Independent Consultant, Corvallis, OR, USA and Rainbow Research, 621 West Lake St., Ste. 300, Minneapolis, MN 55408, USA
| | - Karen Levy Keon
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, Formerly with College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA, Independent Consultant, Corvallis, OR, USA and Rainbow Research, 621 West Lake St., Ste. 300, Minneapolis, MN 55408, USA
| | - Ann Zukoski
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, Formerly with College of Public Health and Human Sciences, 401 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, USA, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA, Independent Consultant, Corvallis, OR, USA and Rainbow Research, 621 West Lake St., Ste. 300, Minneapolis, MN 55408, USA
| |
Collapse
|
44
|
Lee HY, Vang S. Cultural beliefs and clinical breast examination in Hmong American women: the crucial role of modesty. J Immigr Minor Health 2013; 17:746-55. [PMID: 23943016 DOI: 10.1007/s10903-013-9890-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite grave cancer disparities in Hmong American women, investigation of the group's breast cancer screening behavior is sparse. This study examined how cultural factors are associated with breast cancer screening utilization, specifically clinical breast exam (CBE), in this population. One hundred and sixty-four Hmong American women between ages 18 and 67 were recruited from a large Midwestern metropolitan area with a median age of 28.0 years. Logistic regression was used to assess the association of cultural variables with receipt of CBE. Roughly 73% of Hmong American women reported ever having had a CBE. Logistic regression revealed that endorsing more modest views was the greatest barrier to ever having had a CBE. Age and language preference were also found to be significant predictors of past CBE use. Cultural factors should be considered in developing interventions aimed at promoting breast cancer screening in this population. In particular, Hmong American women who have less English proficiency and are relatively younger should be targeted in breast cancer screening efforts.
Collapse
Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, Minneapolis-Saint Paul, MN, 55108, USA,
| | | |
Collapse
|
45
|
Christy SM, Rawl SM. Shared decision-making about colorectal cancer screening: a conceptual framework to guide research. PATIENT EDUCATION AND COUNSELING 2013; 91:310-7. [PMID: 23419327 PMCID: PMC3756595 DOI: 10.1016/j.pec.2013.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 12/27/2012] [Accepted: 01/11/2013] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To develop a conceptual framework to guide research on shared decision-making about colorectal cancer (CRC) screening among persons at average risk and their providers. METHODS Based upon a comprehensive review of empirical literature and relevant theories, a conceptual framework was developed that incorporated patient characteristics, cultural beliefs, provider/health care system variables, health belief/knowledge/stage of adoption variables, and shared decision-making between patients and providers that may predict behavior. Relationships among concepts in the framework, shared decision-making process and outcomes, and CRC screening behavior were proposed. Directions for future research were presented. RESULTS Many of the concepts in the proposed framework have been examined in prior research. However, these elements have not been combined previously to explain shared decision-making about CRC screening. CONCLUSION Research is needed to test the proposed relationships and hypotheses and to refine the framework. PRACTICE IMPLICATIONS Findings from future research guided by the proposed framework may inform clinical practice to facilitate shared decision-making about CRC screening.
Collapse
Affiliation(s)
- Shannon M Christy
- Purdue School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, USA.
| | | |
Collapse
|
46
|
Chen MS, Fang DM, Stewart SL, Ly MY, Lee S, Dang JHT, Nguyen TT, Maxwell AE, Bowlus CL, Bastani R, Nguyen TT. Increasing hepatitis B screening for hmong adults: results from a randomized controlled community-based study. Cancer Epidemiol Biomarkers Prev 2013; 38:546-53. [PMID: 23613027 DOI: 10.1007/s10900-012-9649-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk. METHODS Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation. RESULTS Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P = 0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P = 0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3-9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02-1.7), female gender (OR 5.3; 95% CI 1.7-16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3-17.6). The most often cited reason for testing was a doctor's recommendation. CONCLUSIONS LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing. IMPACT LHWs can significantly increase HBV screening rates for Hmong but their doctors' recommendation is highly influential and should be pursued.
Collapse
Affiliation(s)
- Moon S Chen
- University of California Davis Comprehensive Cancer Center, 4800 2nd Avenue, Suite 2200, Sacramento, CA 95817, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Chen MS, Fang DM, Stewart SL, Ly MY, Lee S, Dang JHT, Nguyen TT, Maxwell AE, Bowlus CL, Bastani R, Nguyen TT. Increasing hepatitis B screening for hmong adults: results from a randomized controlled community-based study. Cancer Epidemiol Biomarkers Prev 2013; 22:782-91. [PMID: 23613027 DOI: 10.1158/1055-9965.epi-12-1399] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk. METHODS Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation. RESULTS Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P = 0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P = 0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3-9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02-1.7), female gender (OR 5.3; 95% CI 1.7-16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3-17.6). The most often cited reason for testing was a doctor's recommendation. CONCLUSIONS LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing. IMPACT LHWs can significantly increase HBV screening rates for Hmong but their doctors' recommendation is highly influential and should be pursued.
Collapse
Affiliation(s)
- Moon S Chen
- University of California Davis Comprehensive Cancer Center, 4800 2nd Avenue, Suite 2200, Sacramento, CA 95817, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Lor M, Khang PY, Xiong P, Moua KF, Lauver D. Understanding Hmong women's beliefs, feelings, norms, and external conditions about breast and cervical cancer screening. Public Health Nurs 2013; 30:420-8. [PMID: 24000914 DOI: 10.1111/phn.12043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the beliefs, feelings, norms, and external conditions regarding breast and cervical cancer screening in a sample of Hmong women. DESIGN AND SAMPLE In a descriptive design, female Hmong researchers recruited 16 Hmong women (ages 24-73) at a community center. Guided by the Theory of Care Seeking Behavior (TCSB), researchers asked participants semi-structured questions about their beliefs, feelings, norms, and external conditions in a group setting. Researchers documented responses in writing and audio recordings. Guided by theory, we used directed content analysis to categorize responses. RESULTS Participants' beliefs' about screening included uncertainty about causes of breast and cervical cancer, uncertainty about Western forms of treatments, and terminal illness as outcomes of such cancer. Many felt embarrassed about breast and cervical cancer screening. Their cultural norms about undressing for an exam and listening to authority figures were different from Western norms. External conditions that influenced participants' for screenings included difficulties in communicating with interpreters and clinicians. CONCLUSIONS Consistent with the TCSB, Hmong women's beliefs, affect, cultural norms and external conditions helped to understand their use of breast and cervical screening. Findings could guide nursing and public health interventions to improve culturally sensitive, cancer screening for Hmong women.
Collapse
Affiliation(s)
- Maichou Lor
- University of Wisconsin-Madison, Clinical Science Center, School of Nursing, Madison, Wisconsin 53792, USA.
| | | | | | | | | |
Collapse
|
49
|
Thorburn S, Kue J, Keon KL, Lo P. Medical mistrust and discrimination in health care: a qualitative study of Hmong women and men. J Community Health 2012; 37:822-9. [PMID: 22116737 DOI: 10.1007/s10900-011-9516-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Low rates of breast and cervical cancer screening among Hmong women have been documented. Mistrust of Western medicine and the health care system, as well as experiences of discrimination in health care, may be barriers to seeking health care for this population. In this study, we explored medical mistrust among Hmong women and men, their experiences with discrimination in health care, and how these factors may influence Hmong women's breast and cervical cancer screening behavior. We conducted semi-structured, in-depth interviews with women and men who were members of the Hmong community in Oregon. Transcripts of 83 interviews were analyzed using content analysis. Despite personally trusting Western medicine and the health care system, participants shared reasons that some Hmong people feel mistrust including lack of understanding or familiarity, culture, and tradition. Although mistrust was thought to result in delaying or avoiding breast or cervical cancer screening, more frequently trust was described as positively influencing screening. In addition, few participants reported being treated differently during breast or cervical cancer screening because they were Hmong. When discussing health care more broadly, however, some participants described differential (e.g., disrespectful or rude) treatment. Such experiences led to feelings such as anger and sadness and affected behavior, including willingness to seek care and choice of provider. Medical mistrust and perceived discrimination were not major barriers to breast and cervical cancer screening in this study. Additional studies are needed to assess whether our findings reflect the experiences of other Hmong.
Collapse
Affiliation(s)
- Sheryl Thorburn
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331-6406, USA.
| | | | | | | |
Collapse
|
50
|
Shaw SJ, Armin J, Torres CH, Orzech KM, Vivian J. Chronic disease self-management and health literacy in four ethnic groups. JOURNAL OF HEALTH COMMUNICATION 2012; 17 Suppl 3:67-81. [PMID: 23030562 PMCID: PMC3615891 DOI: 10.1080/10810730.2012.712623] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
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.
Collapse
Affiliation(s)
- Susan J Shaw
- School of Anthropology, PO Box 210030, University of Arizona, Tucson, AZ 85721-0030, USA.
| | | | | | | | | |
Collapse
|