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Keim-Malpass J, Vavolizza RD, Cohn WF, Kennedy EM, Showalter SL. Cancer Screening and Treatment Delays During the COVID-19 Pandemic and the Role of Health Literacy in Care Re-engagement: Findings from an NCI-Designated Comprehensive Cancer Center sample. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1405-1412. [PMID: 37202597 PMCID: PMC10195653 DOI: 10.1007/s13187-023-02312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
The COVID-19 pandemic has led to numerous delays in cancer-related care and cancer-specific screening, but the extent is not fully understood. For those that experience a delay or disruption in care, health related self-management is required to re-engage in care pathways and the role of health literacy in this pathway has not been explored. The purpose of this analysis is to (1) report the frequency of self-reported delays in cancer treatment and preventative screening services at an academic, NCI-designated center during the COVID-19 pandemic and (2) investigate cancer-related care and screening delays among those with adequate and limited health literacy. A cross-sectional survey was administered from an NCI-designated Cancer Center with a rural catchment area during November 2020 through March 2021. A total of 1,533 participants completed the survey, and nearly 19 percent of participants were categorized as having limited health literacy. Twenty percent of those with a cancer diagnosis reported a delay in cancer-related care; and 23-30% of the sample reported a delay in cancer screening. In general, the proportions of delays among those with adequate and limited health literacy were similar with the exception of colorectal cancer screening. There was also a notable difference in the ability to re-engage in cervical cancer screening among those with adequate and limited health literacy. Thus, there is a role for those engaged in cancer-related education and outreach to offer additional navigation resources for those at risk to cancer-related care and screening disruptions. Future study is warranted to investigate the role of health literacy on cancer care engagement.
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Affiliation(s)
- Jessica Keim-Malpass
- Department of Pediatrics, Division of Hematology-Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Rick D Vavolizza
- Department of Surgery, Division of Surgical Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Erin M Kennedy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Shayna L Showalter
- Department of Surgery, Division of Surgical Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA
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Sun Y, Moyer A, White JH. How Can Framed Mammography Screening Messages Be Optimally Persuasive for Foreign-Born Chinese American Women? Cancer Nurs 2023; 46:344-353. [PMID: 37607370 DOI: 10.1097/ncc.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Foreign-born Chinese American women (FBCAW) have the lowest mammography rates compared with other racial groups despite the overwhelming evidence of the benefits of screening. Message framing based on the prospect theory has shown significant but inconsistent effects on mammogram screening among ethnic minority groups. OBJECTIVE Using data from a randomized controlled trial, this secondary analysis aims to identify factors that interact with message framing to improve mammography screening in FBCAW. METHODS In the parent study, participants were randomized to receive either a gain- or loss-framed brochure that encouraged mammography screening. Data were collected at baseline and 2 months using validated questionnaires. For this secondary analysis, ordinal logistic regression was performed to identify moderation effects using both per-protocol and intention-to-treat principles. RESULTS Participants predominantly had low income, a low level of English proficiency, and no insurance. Lack of access to mammography services, knowledge of making a mammogram appointment, knowledge of insurance coverage for breast cancer treatment, education levels, and mammogram history were significant moderators of the framing effects. Overall, the moderation effects were larger when using per-protocol analysis. Some moderation results under intention-to-treat analysis were different from those using per-protocol analysis. CONCLUSIONS The persuasive effects of the loss- or gain-framed messages depend on the characteristics of FBCAW. Future studies can identify algorithms to select tailored messages that match individual FBCAW's characteristics to optimize the effects of framed messages. IMPLICATIONS FOR PRACTICE Findings of this study can guide healthcare providers, especially nurses, to choose different wording when communicating with their clients.
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Affiliation(s)
- Yiyuan Sun
- Author Affiliations: College of Nursing and Public Health, Adelphi University (Drs Sun and White), Garden City; and Social and Health Psychology, Stony Brook University (Dr Moyer), New York
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Cataneo JL, Meidl H, Ore AS, Raicu A, Schwarzova K, Cruz CG. The Impact of Limited Language Proficiency in Screening for Breast Cancer. Clin Breast Cancer 2023; 23:181-188. [PMID: 36635166 DOI: 10.1016/j.clbc.2022.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 10/13/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prevalence of a culturally diverse population in the United States continues to grow. Nevertheless, the national impact of limited English proficiency (LEP) in breast cancer screening is still unknown. METHODS A retrospective review of the 2015 sample of the National Health Interview Survey database was performed. The cohort included women with and without LEP between 40 and 75 years. We evaluated differences in screening rates, baseline, socioeconomic, access to healthcare, and breast cancer risk factors with univariate and multivariate regression analyses. RESULTS The prevalence of LEP was 5.7% (N = 1825, weighted counts 3936,081). LEP women showed a statistically significant lower rate of overall screening mammograms (78% vs. 90%), fewer benign lumps removed (6.4% vs. 17%) and lower rates of access to healthcare variables. They showed a higher rate of nonprivate insurance and living below the poverty line, a lower rate of hormone replacement therapy (1.8% vs. 5.6%), older menarche (12.97 vs. 12.75) and a higher rate of current menstruation (36% vs. 24). LEP women were associated with a lower probability of having a screening mammogram in multivariate analysis (OR: 0.67, 95% CI: 0.51-0.87). When LEP was subdivided into Spanish and "other" languages, Spanish speakers were associated with a lower probability of a screening mammogram (OR 0.67, 95% CI 0.49-0.90) while controlling for the same covariates. CONCLUSION The results from our study showed that LEP women are associated with a lower probability of having a screening mammogram. Particularly, the Spanish speakers were found as a vulnerable subgroup.
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Affiliation(s)
- Jose L Cataneo
- University of Illinois at Chicago/Metropolitan Group Hospitals, Advocate Illinois Masonic Medical Center, Department of Surgery, Chicago IL.
| | - Hanna Meidl
- University of Illinois at Chicago/Metropolitan Group Hospitals, Advocate Illinois Masonic Medical Center, Department of Surgery, Chicago IL
| | - Ana Sofia Ore
- Beth Israel Deaconess Medical Center/Harvard Medical School. Department of Surgery, Boston, MA
| | - Andreea Raicu
- University of Illinois at Chicago/Metropolitan Group Hospitals, Advocate Illinois Masonic Medical Center, Department of Surgery, Chicago IL
| | | | - Celeste G Cruz
- Advocate Illinois Masonic Medical Center, Department of Surgery, Chicago, IL
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Cobb S, Ekwegh T, Adinkrah E, Ameli H, Dillard A, Kibe LW, Bazargan M. Examining colorectal cancer screening uptake and health provider recommendations among underserved middle aged and older African Americans. Health Promot Perspect 2022; 12:399-409. [PMID: 36852204 PMCID: PMC9958235 DOI: 10.34172/hpp.2022.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 02/22/2023] Open
Abstract
Background: The purpose of this study is to determine whether underserved middle-aged and older African Americans are receiving a colorectal cancer (CRC) screening test (sigmoidoscopy or colonoscopy) and if recommended by their provider. Additionally, we examined correlates of both provider recommendation and uptake of CRC screening. Methods: Seven hundred forty African American individuals, aged 55 and older, participated in this local community cross-sectional survey. We used a multivariate technique of logistic regression. Results: One out of three participants reported that they never received a sigmoidoscopy or colonoscopy for CRC screening. More than 31% indicted that their providers never suggested CRC testing. However, participants who indicated that their providers recommended sigmoidoscopy/colonoscopy were almost 49 times (odds ratio [OR]: 48.9, 95% confidence interval [CI]: 29.5-81.2) more likely to obtain it compared to their counterparts who were not advised to have these procedures. Our data suggest that African American men were significantly less likely than women to receive recommendations from their providers (OR: 0.70, 95% CI: 0.50-0.91). Furthermore, controlling for other variables, the following factors: 1) living arrangement (OR: 1.44, 95% CI: 1.02-2.04), 2) health maintenance organization (HMO) membership (OR: 1.84, 95% CI: 1.28-2.67), 3) number of providers (OR: 1.15, 95% CI: 1.01-1.32), 4) satisfaction with access to and quality of care (OR: 1.24, 95% CI: 1.03-1.51), 5) depressive symptoms (OR: 0.92, 95% CI: 0.86-0.98), and 6) gastrointestinal conditions (OR: 1.73, 95% CI: 1.16-2.58) were associated with obtaining a sigmoidoscopy or colonoscopy test. Conclusion: Our findings suggest that the absence of a provider recommendation is the primary barrier preventing underserved older African Americans from obtaining CRC screening. In addition, our data revealed significant association between obtaining CRC screening and some of the predisposing characteristics of participants, satisfaction with access to and quality of care, and physical and mental health. These findings are consistent with this notion that disparities in health care for African Americans can be traced back to four primary factors: patients, healthcare providers, the healthcare system, and society as a whole, and emphasize the need for establishing theory-driven, culturally-sensitive, and cost-effective CRC screening interventions that recognize and address the constraints to cancer screening experienced by this segment of population.
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Affiliation(s)
- Sharon Cobb
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science (CDU), CA, USA
| | - Tavonia Ekwegh
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science (CDU), CA, USA
| | - Edward Adinkrah
- Department of Public Health, College of Science & Health, CDU, CA, USA
| | | | - Attallah Dillard
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science (CDU), CA, USA
| | - Lucy W. Kibe
- Physician Assistant Program, College of Science & Health, CDU, CA, USA
| | - Mohsen Bazargan
- Department of Family Medicine, College of Medicine, CDU, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, CA, USA
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Gong Q, Bharj K. A qualitative study of the utilisation of digital resources in pregnant Chinese migrant women's maternity care in northern England. Midwifery 2022; 115:103493. [DOI: 10.1016/j.midw.2022.103493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/15/2022] [Accepted: 09/23/2022] [Indexed: 10/14/2022]
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6
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Cataneo JL, Kim TD, Park JJ, Marecik S, Kochar K. Disparities in Screening for Colorectal Cancer Based on Limited Language Proficiency. Am Surg 2022; 88:2737-2744. [PMID: 35642266 DOI: 10.1177/00031348221105596] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study analyzes the association between limited language proficiency and screening for colorectal cancer. METHODS This is a retrospective cohort study from the 2015 sample of the National Health Interview Survey database utilizing univariate and multivariate regression analysis. The study population includes subjects between 50 and 75 years of age. The main outcome analyzed was rates of screening colonoscopies between limited English-language proficiency (LEP) subjects and those fluent in English. Secondary outcomes included analysis of baseline, socioeconomic, access to health care variables, and other modalities for colorectal cancer screening between the groups. RESULTS Incidence of limited language proficiency was 4.8% (n = 1978, count = 4 453 599). They reported lower rates of screening colonoscopies (61% vs 34%, P < .001), less physician recommendation for a colonoscopy (87 vs 60%, P < .001), fewer polyps removed in the previous 3 years (24% vs 9.1%; P < .001), and fewer fecal occult blood samples overall (P < .001). Additionally, Hispanic non-LEP subjects have higher rates of colonoscopies compared to those with language barriers (50% vs 33%, P < .001). On multivariate analysis, LEP was associated with a lower likelihood to have a screening colonoscopy (OR .67 95% CI .49-.91). A second regression model with "Spanish language" and "other language" variables included, associated Spanish speakers with a lower likelihood for a screening colonoscopy (OR .71 95% CI .52-.97) when controlling for baseline, socioeconomic, and access to health care covariates. DISCUSSION Patients with limited English-language proficiency are associated with lower rates of screening for colorectal cancer, in particular the Spanish speaking subgroup.
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Affiliation(s)
- Jose L Cataneo
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Tae David Kim
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - John J Park
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | | | - Kunal Kochar
- 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
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Sungur H, van den Muijsenbergh METC, van Weert JCM, Schouten BC. Caring for older culturally and linguistically diverse patients with Cancer: Healthcare Providers' perceived barriers to communication. J Geriatr Oncol 2022; 13:862-870. [PMID: 35589543 DOI: 10.1016/j.jgo.2022.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to various socio-cultural and language related factors, healthcare providers experience barriers when communicating with older culturally and linguistically diverse (CALD) patients with cancer, which can lower the quality of care received by patients and negatively impact healthcare providers. Studies focusing on communication barriers of older CALD patients with cancer and a systematic comparison of those barriers between different healthcare providers have been largely missing. OBJECTIVES In order to lay out the healthcare providers' perceived barriers to communication, the present study identified and compared communication barriers among different healthcare providers when caring for older CALD patients with cancer. METHODS An online survey was conducted among healthcare providers in the Netherlands who identified as being involved in the care of CALD patients with cancer (N = 191), specifically; GPs (NGPs = 54), specialists (Nspecialists = 29), oncology nurses (Nnurses = 77), and pharmacists (Npharmacists = 31). Providers assessed twelve pre-specified factors on (i) importance and (ii) frequency of these factors as barriers to communication. A composite score by employing the QUOTE (Quality Of care Through the patients' Eyes) methodology was used to rank, and classify factors as either potential or influential barriers. RESULTS AND CONCLUSION Overall, low Dutch language proficiency of older CALD patients with cancer, family interpreters providing inadequate translations, not knowing the extent of patients' informational needs, cultural differences in views about healthcare (i.e., illnesses and treatments) and family members blocking communication were found to be influential communication barriers. Healthcare providers showed several differences in what they perceived to be a potential or an influential barrier: Cultural differences in views about healthcare and patients getting treatment in their home countries were important barriers for GPs, while not knowing the patient's contact person was for pharmacists. Nurses perceived the highest number of influential barriers, while specialists perceived the least. We conclude that specific interventions that address differences in perceived barriers among providers are needed, and we highlight potential interventions that involve digital communication tools, such as the Conversation Starter.
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Affiliation(s)
- Hande Sungur
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| | - Maria E T C van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; Prevention and care Programme, Pharos, National Centre of Expertise on Health Disparities, Utrecht, the Netherlands.
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| | - Barbara C Schouten
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
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Wang L, Mackenzie L, Hossain Z. Breast cancer screening practices and associated factors among Chinese-Australian women living in Sydney: A cross-sectional survey study. Nurs Health Sci 2022; 24:293-303. [PMID: 35106873 PMCID: PMC9305288 DOI: 10.1111/nhs.12925] [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: 11/09/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/27/2022]
Abstract
This study aimed to investigate breast cancer screening practices and associated factors among Chinese‐Australian women. A cross‐sectional quantitative survey method including convenience and snowball sampling was used to recruit 115 Chinese‐Australian women living in Sydney, using a self‐administered survey. In all, 69.8% of participants reported recent clinical breast examinations and 73.3% had mammograms. Age, religion, employment status, and length of residence were associated with having a clinical breast examination. Income was related to having a mammogram. Associations between knowledge of breast cancer, cancer‐related beliefs, and screening participation were found. Length of residence in Australia was the strongest predictor of having a clinical breast examination and mammogram. The most common barrier to mammography was if women felt that doctors did not recommend it to them. Chinese‐Australian women need to be educated about awareness of their usual breast health to be aware of any changes, especially if women are not eligible for mammography or have difficulty in accessing health services. Tailored programs, improving screening experiences, and minimizing perceived barriers are needed to promote early detection of breast cancer among Chinese–Australian women.
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Affiliation(s)
- Lei Wang
- School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Zakia Hossain
- School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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Jamal J, MacMillan F, McBride KA. Barriers and Facilitators of Breast Cancer Screening amongst Culturally and Linguistically Diverse Women in South Western Sydney: A Qualitative Explorative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179129. [PMID: 34501723 PMCID: PMC8430955 DOI: 10.3390/ijerph18179129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/04/2022]
Abstract
Breast cancer is the most common cause of cancer amongst Australian women and the second most common cause of cancer mortality. Despite the proven effectiveness of early intervention, screening rates remain subpar across many regions in New South Wales (NSW). Screening rates are particularly low within the culturally and linguistically diverse (CALD) area of South Western Sydney (SWS). The objective of this study was to qualitatively explore barriers and facilitators to breast screening from the perspectives of CALD women from SWS. CALD women aged ≥40 who resided in SWS were invited to participate in a semi-structured interview to explore barriers and facilitators to breast cancer screening. Interviews were recorded, transcribed verbatim and analysed thematically to identify recurring patterns in the data. Sixteen women from CALD backgrounds participated. Women in this study reported absence of symptoms, fatalistic beliefs and embarrassment during the procedure to be the primary reasons for reluctance to screen. Lack of general practitioner (GP) endorsement, transport issues and pain associated with the procedure were also reported as additional barriers to screening. Common facilitators to screening included encouragement from family and friends, family history of cancer and media adverts. CALD women have distinctive barriers to mammography, which lead to poor breast screening participation rates. Opportunistic health promotion in this area is warranted and may lead to better health outcomes amongst this population.
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Affiliation(s)
- Javeria Jamal
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia;
| | - Freya MacMillan
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia;
- School of Health Science, Western Sydney University, Sydney, NSW 2560, Australia
| | - Kate A. McBride
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia;
- School of Health Science, Western Sydney University, Sydney, NSW 2560, Australia
- Correspondence:
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Ferreira CS, Rodrigues J, Moreira S, Ribeiro F, Longatto-Filho A. Breast cancer screening adherence rates and barriers of implementation in ethnic, cultural and religious minorities: A systematic review. Mol Clin Oncol 2021; 15:139. [PMID: 34055354 PMCID: PMC8145341 DOI: 10.3892/mco.2021.2301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
Breast cancer is the most common cancer affecting women worldwide. Adherence to breast cancer screening guidelines is frequently lower in racial, ethnic and cultural minority populations and is affected by potential inequities or barriers to screening that these minorities face. Therefore, the aim of the present study was to collect information from different minority groups worldwide, assess adherence to breast cancer screening and evaluate barriers or limitations causing non-adherence, which should facilitate the development of effective interventions. A search was conducted through PubMed and Web of Science. Studies were considered as eligible if they met the following criteria: i) Female patients; ii) breast cancer screening program implemented in the country; iii) minority groups; iv) asymptomatic; v) report written in Portuguese or English; vi) study published from 2015 onwards. The Critical Appraisal Skills Programme checklist was used for qualitative studies and the Strengthening The Reporting of Observational Studies in Epidemiology checklist for cross-sectional studies. From the 348 initial articles, 86 were removed due to duplication and 19 were selected, analyzed and summarized, accordingly. Of the 19 studies included, 5.3% were classified as high quality, 52.6% as moderate to high and 42.1% as moderate. A total of 15 studies were cross-sectional and 4 were qualitative, collectively including 250,733 women. The rate of adherence to mammogram in different minorities was evaluated, obtaining a mean value of 49.7% in the last 2 years, and statistically significant barriers were selected and divided into sociodemographic; personal; ethnic, cultural and religious; and external factors. The characteristics of each population play a major role in the population's breast health practices. If the population, adherence rates, barriers and inequities are carefully studied, screening models may be customized and participation to breast cancer screening can be optimized, thereby reducing the high breast cancer-associated mortality.
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Affiliation(s)
| | - Joana Rodrigues
- School of Medicine, University of Minho, Braga, Minho 4710-057, Portugal
| | - Stefanie Moreira
- School of Medicine, University of Minho, Braga, Minho 4710-057, Portugal
| | - Filipa Ribeiro
- School of Medicine, University of Minho, Braga, Minho 4710-057, Portugal.,Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Minho 4710-057, Portugal
| | - Adhemar Longatto-Filho
- School of Medicine, University of Minho, Braga, Minho 4710-057, Portugal.,Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Minho 4710-057, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães 4710-057, Portugal.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP 14784-400, Brazil.,Medical Laboratory of Medical Investigation (LIM) 14, Department of Pathology, Medical School, University of São Paulo, SP 01246-903, Brazil
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11
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Liu D, Schuchard H, Burston B, Yamashita T, Albert S. Interventions to Reduce Healthcare Disparities in Cancer Screening Among Minority Adults: a Systematic Review. J Racial Ethn Health Disparities 2021; 8:107-126. [PMID: 32415578 DOI: 10.1007/s40615-020-00763-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/16/2019] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Racial minority populations face an increased burden relative to cancer interventions. Compared with Caucasians, the cancer screening rate is substantially lower among African American, Asian American, Latinx American, and American Indian/Alaska Native populations. Barriers such as low health literacy, lack of health insurance, and miscommunication between patients and providers have been identified as important factors that result in low screening rates among minority adults. This study was designed to identify interventions targeting racial minority adults 40 years of age or older that were effective in increasing cancer screening uptake rates. METHODS A systematic review of articles published in and after January 2009 was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Twenty-six published studies of cancer screening intervention tested with minority adults were identified through the searches of CINAHL, Global Health, PsycINFO, PubMed, and Scopus databases. RESULTS Thirteen (50%) of the studies utilized lay community health workers to increase cancer awareness and knowledge and to encourage screening. These methods took place over the telephone, at community education sessions, or within the context of personalized patient navigation support. The intervention programs utilized culturally relevant materials as well as spoken and written information in the targeted population's native language. Various intervention designs resulted in statistically significant increases in cancer screening adherence. However, we found no intervention that consistently elevated cancer screening rates across all racial/ethnic minority adults. CONCLUSIONS The finding suggests that highly segmented interventions are needed in order to improve cancer screening among various racial/ethnic minority adults.
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Affiliation(s)
- Darren Liu
- Department of Public Health, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA.
| | - Hayley Schuchard
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA, USA
| | - Betty Burston
- Department of Health Care Administration and Policy, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Takashi Yamashita
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Steven Albert
- Department of Behavioral & Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Assefa AA, Abera G, Geta M. Breast Cancer Screening Practice and Associated Factors Among Women Aged 20-70 Years in Urban Settings of SNNPR, Ethiopia. BREAST CANCER-TARGETS AND THERAPY 2021; 13:9-19. [PMID: 33447077 PMCID: PMC7802910 DOI: 10.2147/bctt.s286441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/07/2020] [Indexed: 01/22/2023]
Abstract
Background Breast cancer is the leading cause of morbidity and mortality among women in many countries around the globe. Early detection of breast cancer plays a great role in cancer prevention and treatment by potentially decreasing mortality. However, evidence is sparse on breast cancer screening practice among women in southern Ethiopia. Therefore, the aim of this study was to assess breast cancer screening practice and associated factors among women 20–70 years of age in an urban setting in SNNPR, Ethiopia. Methods A community-based cross-sectional study was conducted from March to April 2020. Multistage sampling technique was applied to select the study participants. Data were collected by using a pretested interviewer-administered structured questionnaire. Bivariable and multivariable logistic regression was done to confirm association between dependent variable and covariates. Results From the total study participants, 83 (13.6%; 95%CI: 10.8, 16.4%), have regularly engaged in at least one breast cancer screening method. Women with a favorable attitude towards breast cancer and its screening (AOR=3.0; 95%CI: 1.63–5.56), educational status of college and above (AOR=3.8; 95%CI: 1.25– 11.48), family history of breast cancer (AOR=3.7; 95%CI: 1.73–7.96), awareness about breast cancer screening methods (AOR=3.0; 95%CI: 1.46–6.22), knowing someone screened for breast cancer (AOR=2.2; 95%CI: 1.10–4.38), and recommendation by health professionals for BCS (AOR=5.0; 95%CI: 2.35–10.68) were variables significantly associated with BCS practice. Conclusion Breast cancer screening practice is low. Women with college and above education level, favorable attitude towards breast cancer and its screening, awareness about breast cancer screening methods, family history of breast cancer, having a recommendation from health professionals and knowing someone who screened for breast cancer were associated with BCS practice. Therefore, this finding implies the need to intervene upon those factors.
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Affiliation(s)
- Abiyu Ayalew Assefa
- Department of Public Health, Hawassa College of Health Science, Hawassa, Ethiopia
| | - Geleta Abera
- Department of Public Health, Hawassa College of Health Science, Hawassa, Ethiopia
| | - Medhin Geta
- Department of Public Health, Hawassa College of Health Science, Hawassa, Ethiopia
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13
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Ferdous M, Goopy S, Yang H, Rumana N, Abedin T, Turin TC. Barriers to Breast Cancer Screening Among Immigrant Populations in Canada. J Immigr Minor Health 2021; 22:410-420. [PMID: 31346839 DOI: 10.1007/s10903-019-00916-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective of this study is to summarize the current knowledge about barriers to breast cancer screening among immigrant and ethnic women and to determine future research opportunities in this area. A scoping review of the literature was conducted following a five-stage framework. Electronic databases of peer-reviewed articles and grey literature were searched based on comprehensive sets of key words, without restricting the time period or language. Barriers were classified into six themes: socioeconomic, cultural, communication, healthcare-system-related, knowledge-related, and personal barriers. Lack of education, lack of physicians' recommendation, a preference for female physicians, the inability to speak one of the official languages, and embarrassment were some of the common barriers identified. The reported barriers can be used as a source of information for policymakers, healthcare providers, and researchers to decide the future direction of research in this field.
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Affiliation(s)
- Mahzabin Ferdous
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Suzanne Goopy
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | | | - Nahid Rumana
- Sleep Center, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Tasnima Abedin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Family Medicine, Health Sciences Center, Room G012F, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada.
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14
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Kcomt L, Gorey KM. Chinese enclave protections among married Chinese American women: exploratory secondary analysis of colon cancer survival. ETHNICITY & HEALTH 2020; 25:1089-1102. [PMID: 29945459 DOI: 10.1080/13557858.2018.1493432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 06/06/2018] [Indexed: 06/08/2023]
Abstract
Objective: Like the barrio advantage theory related to Mexican Americans, a theory about the protective effects of Chinese American enclaves is developing. Such protections were examined among socioeconomically vulnerable people with colon cancer. Design: A colon cancer cohort established in California between 1995 and 2000, and followed until the enactment of the Affordable Care Act was utilized in this study. Secondary analysis was conducted on the 5-year survival among 127 Chinese Americans and 4524 other Americans (3810 non-Hispanic white and 714 Hispanic people). A third of the original cohort was selected from high poverty neighborhoods. Chinese American enclaves were neighborhoods where typically 25% or more of the residents were Chinese Americans. Effects were tested with Cox regressions and group differences described with age and stage-standardized survival rate ratios (RR). Results: Though they were less adequately insured, Chinese American women residing in Chinese American enclaves (63%) were more likely to survive than were other Americans (50%, RR = 1.26). The protective effect of being married was also larger for Chinese Americans (RR = 1.31) than for others (RR = 1.17). Chinese American women (61%) were more likely than men (46%) to live in such enclaves and a large enclave survival advantage was observed among Chinese American women only (RR = 1.59). Conclusions: There is consistent evidence of the relatively protected status of Chinese American women, particularly those who were married and resided in Chinese American enclaves. Mechanisms that explain their apparent advantages are not yet well understood, though relatively large, kin-based social networks seem instrumental. Research on the influence of social networks as well as the possible effects of acculturation is needed. This study also exposed structural inequities related to the institutions of marriage, health care and communities that disadvantage others. Policy makers ought to be aware of them as future reforms of American health care are considered.
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Affiliation(s)
- Luisa Kcomt
- School of Social Work, University of Windsor, Windsor, Canada
| | - Kevin M Gorey
- School of Social Work, University of Windsor, Windsor, Canada
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15
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Herbach EL, Weeks KS, O'Rorke M, Novak NL, Schweizer ML. Disparities in breast cancer stage at diagnosis between immigrant and native-born women: A meta-analysis. Ann Epidemiol 2020; 54:64-72.e7. [PMID: 32950654 DOI: 10.1016/j.annepidem.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/10/2020] [Accepted: 09/13/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To synthesize existing observational evidence to identify disparities in stage at breast cancer diagnosis between foreign- and native-born women. We hypothesized immigrant women would be less likely than natives to be diagnosed at a localized stage. METHODS Systematic searches for studies detailing stage at breast cancer diagnosis by birthplace in PubMed, Embase, and Web of Science yielded 11 relevant cohort studies from six countries. Odds ratios were pooled using random effects models. RESULTS Foreign-born women were 12% less likely to be diagnosed with breast cancer at a localized stage than natives (OR 0.88, 95% CI 0.82-0.95). A similar disadvantage was observed in immigrants from Asia, Eastern Europe, Latin America and the Caribbean, and developing or in transition nations; immigrants from developed countries experienced the least disparity. CONCLUSIONS This meta-analysis confirmed the presence of significant differences in breast cancer stage at diagnosis as per nativity. Across diverse immigrant groups and host countries, foreign-born women were significantly less likely to be diagnosed with localized breast cancer than native women; the magnitude of the disparity varied by region and economic condition of immigrants' birthplace.
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Affiliation(s)
- Emma L Herbach
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
| | - Kristin S Weeks
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Michael O'Rorke
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Nicole L Novak
- Department of Community and Behavioral Health, University of Iowa, Iowa City
| | - Marin L Schweizer
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City; Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA
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16
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Parker PD, Heiney SP, Adams SA, Friedman DB, Dawson RM. Factors influencing chemotherapy knowledge in women with breast cancer. Appl Nurs Res 2020; 56:151335. [PMID: 32739071 DOI: 10.1016/j.apnr.2020.151335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/17/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chemotherapy knowledge is linked to managing side effects, reducing exposure to potential infection, and adjusting lifestyle behaviors while going through treatment. However, no research exists regarding the influence of patients' personal attributes on chemotherapy knowledge. Aim The aim of this study was to describe the relationships of health literacy and demographics on chemotherapy knowledge among women with breast cancer undergoing treatment. METHOD We used a descriptive, exploratory design with convenience sampling of women with breast cancer receiving intravenous chemotherapy who completed one mandatory education session. Participants completed a demographic questionnaire and three instruments: 1) Rapid Estimate of Adult Literacy - Short Form (REALM-SF); 2) Shortened Test of Functional Health Literacy in Adults (S-TOFHLA); and 3) Leuven Questionnaire on Patient Knowledge of Chemotherapy (L-PaKC). We used univariate linear regression and ANOVA to identify how health literacy and demographics influenced chemotherapy knowledge. RESULTS The REALM-SF (p = .022) and S-TOFHLA (p = .023) scores were significantly associated with chemotherapy knowledge. Chemotherapy knowledge scores were affected by marital status (p = .018) and income (p < .001) where married women had significantly higher chemotherapy knowledge scores (M = 92.6, SD = 6.6) than women who were divorced (M = 83.3, SD = 16.7) with a knowledge score difference of -9.3 between the groups (p = .02). Comparisons showed significant differences of chemotherapy knowledge between women with differing income levels. CONCLUSIONS This study highlights the relevance of considering patients' health literacy and personal attributes such as marital status and income when teaching about chemotherapy.
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Affiliation(s)
- Pearman D Parker
- University of South Carolina, College of Nursing, 1601 Greene Street, Columbia 29208, SC, USA.
| | - Sue P Heiney
- University of South Carolina, College of Nursing, 1601 Greene Street, Columbia 29208, SC, USA.
| | - Swann Arp Adams
- University of South Carolina, College of Nursing, 1601 Greene Street, Columbia 29208, SC, USA; University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, 915 Greene Street, Columbia 29208, SC, USA.
| | - Daniela B Friedman
- University of South Carolina, Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, 915 Greene Street, Columbia 29208, SC, USA.
| | - Robin M Dawson
- University of South Carolina, College of Nursing, 1601 Greene Street, Columbia 29208, SC, USA.
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17
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Abstract
RÉSUMÉLe vieillissement et l’immigration ont significativement transformé la composition démographique au Canada, et les immigrants y représentent une proportion croissante de la population adulte plus âgée. L’accès adéquat aux services de santé est essentiel au bien-être et à l’inclusion sociale de cette population. Cet examen de la portée porte sur les connaissances actuelles concernant l’accès des immigrants d’âge avancé aux médecins omnipraticiens et à leur consultation, considérant que ces médecins jouent un rôle central dans la prestation de soins de première ligne, dans les soins préventifs et les soins de santé mentale. Le modèle en 5 étapes d’Arksey et O’Malley a été utilisé pour effectuer des recherches dans une grande variété de bases de données pour des articles publiés en anglais dans des revues avec comité de pairs concernant ce sujet dans le contexte canadien. Un total de 31 articles répondant aux critères d’inclusion ont été examinés en détail. Ces articles ont été classés en fonction de l’information disponible sur leurs auteurs, la population à l’étude, la méthodologie, le domaine de la santé et les obstacles mentionnés. Trois thèmes principaux ont émergé de cet examen de portée : l’accès et l’utilisation des soins de première ligne, la promotion de la santé et le dépistage du cancer, ainsi que l’utilisation des services de santé mentale. Les immigrants d’âge avancé font face à des obstacles en termes d’accès aux soins et ceux-ci seraient liés à la littératie en santé, à la langue, à la culture, aux croyances en matière de santé, aux inégalités spatiales et à des circonstances structurelles. L’examen de la portée présente de manière détaillée l’accès aux soins des personnes âgées immigrantes au Canada, et permet de dériver des implications sur les politiques qui permettraient de répondre à leurs besoins qui sont non comblés dans le domaine de la santé.
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18
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Papadakos JK, Hasan SM, Barnsley J, Berta W, Fazelzad R, Papadakos CJ, Giuliani ME, Howell D. Health literacy and cancer self-management behaviors: A scoping review. Cancer 2018; 124:4202-4210. [DOI: 10.1002/cncr.31733] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/04/2018] [Accepted: 07/30/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Janet K. Papadakos
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Patient Education; Cancer Care Ontario Toronto Ontario Canada
| | - Salwa M. Hasan
- Undergraduate Medical Education, Faculty of Medicine; University of Toronto; Toronto Ontario Canada
| | - Jan Barnsley
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Whitney Berta
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Rouhi Fazelzad
- Library and Information Services; Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Christine J. Papadakos
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Patient Education; Cancer Care Ontario Toronto Ontario Canada
| | - Meredith E. Giuliani
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Radiation Medicine Program; Princess Margaret Cancer Centre Toronto Ontario Canada
- Department of Radiation Oncology, Faculty of Medicine; University of Toronto; Toronto Ontario Canada
| | - Doris Howell
- Division of Psychosocial Oncology and Palliative Care; Ontario Cancer Institute; Princess Margaret Cancer Centre Toronto Ontario Canada
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19
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Segmenting women eligible for cervical cancer screening using demographic, behavioural and attitudinal characteristics. Prev Med 2018; 114:134-139. [PMID: 29940291 DOI: 10.1016/j.ypmed.2018.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/14/2018] [Accepted: 06/21/2018] [Indexed: 11/23/2022]
Abstract
The best ways to communicate effectively to under-screened women about cervical cancer screening are unknown. Segmentation techniques create homogeneous segments of women in the population that are different from one another, and help to determine on whom communication efforts should be focused and how messaging should be tailored. We used segmentation techniques to better understand the demographics, attitudes and behaviours of women eligible for cervical screening. We developed a brief online questionnaire that consisted of demographic characteristics, attitudes toward health, and cervical screening behaviour. Simple descriptive statistics were used to describe the study population and principal components analysis was used to define the segments. The study sample consisted of 615 women living in Ontario, 508 from the general population and 107 from South Asia; 63.1% reported regular screening. We defined four segments that represented the sample: i) Proactive, ii) Family First, iii) Social and Stylish, and iv) Faith-Driven. South Asians were represented in all segments. Women who were in the Family First and Faith-Driven segments were least likely to have regular Pap tests and were least likely to know about human papilloma virus (HPV)'s role in cervical cancer. The Internet was very popular among women in all segments as a source of health information, particularly among Faith-Driven women. Only 69.2% of Family First women listed their family physician as a source of health information vs. 91.1% of Proactive women. Future research should focus on how to most effectively reach women who meet the Family First and Faith-Driven profiles, and through which communication media.
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20
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Karimi SE, Rafiey H, Sajjadi H, Nosrati Nejad F. Identifying the Social Determinants of Breast Health Behavior: a Qualitative Content Analysis. Asian Pac J Cancer Prev 2018; 19:1867-1877. [PMID: 30049199 PMCID: PMC6165651 DOI: 10.22034/apjcp.2018.19.7.1867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 06/08/2018] [Indexed: 11/27/2022] Open
Abstract
Background: Prevention, early diagnosis and reduction of mortality caused by breast cancer are the priorities of the world health systems. The aim of this study was to identify the social factors that affect the women’s breast health behavior based on the social determinants model of the World Health Organization (WHO). Materials and Method: This qualitative study was conducted and analyzed using content analysis approach. The data were collected from 32 participants by semi-structured interviews and focused group discussion. The participants comprised of breast surgeons, radiologists, health care providers and women over 35 years of age in Tehran who were selected through purposeful sampling. The interviews continued until data saturation was reached. Results: Based on the experiences of the participants, three themes were obtained from the data that shaped the women’s breast health behavior, including 1) the context of health policy, 2) socioeconomic status, and 3) cultural, psychological, and behavioral factors. Conclusion: A better understanding of social determinants related to breast health behavior can be effective in designing and applying of appropriate theories and models of education and intervention, so that, by early diagnosis of breast cancer and timely treatment of patients, the disease complications and mortality would be reduced.
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Affiliation(s)
- Salah Eddin Karimi
- Social welfare management department, University of social Welfare and Rehabilitation Sciences, Tehran, Iran.
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21
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Hashimoto H, Yanagisawa S. Development of health literacy scale among Brazilian mothers in Japan. Health Promot Int 2018; 32:1034-1040. [PMID: 27209049 DOI: 10.1093/heapro/daw040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Japanese-Brazilians were the third largest immigrant group in Japan in 2011. Their health issues have caused concern, as their limited language made them vulnerable by hindering access to health services. Upon considering child health, mothers' health literacy (HL) is very important. This study aimed to develop a health literacy scale among Brazilian mothers (HLSBM) in Japan. Questionnaires in Portuguese were distributed to 1474 mothers from December 2011 to March 2012. Among 698 collected, 558 questionnaires were analyzed. We prepared 29 candidate items for HLSBM based on Nutbeam's concept of functional, interactive and critical literacy. The dimensional structure was determined statistically using confirmatory factor analysis. Validity was also analyzed by Pearson's correlation with Ishikawa's scale and Kendall's coefficient of concordance among researchers. Cronbach's α coefficients were calculated to examine internal consistency. The confirmatory factor analysis revealed a two-factor model (five items for basic literacy and five items for critical literacy) with sufficient goodness of fit (GFI 969, AGFI 945, NFI 959, CFI 972, RMSEA 060). The internal consistency values of the total score, basic and critical literacy sub-scales were 0.819, 0.889 and 0.667, respectively. Kendall's coefficient of concordance showed good agreement of researchers (p < 0.001). Pearson's correlation coefficients with Ishikawa's scale were 0.554 for total score, 0.446 for basic literacy and 0.472 for critical literacy. The HLSBM consisting of two factors was confirmed to be valid and reliable. The HLSBM must be useful for understanding this vulnerable group's health literacy and its associated factors.
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Affiliation(s)
- Hidemi Hashimoto
- Faculty of Nursing, Doshisha Women's College of Liberal Arts, Kyotanabe, Kyoto, Japan
| | - Satoko Yanagisawa
- School of Nursing and Health, Aichi Prefectural University, Nagoya, Aichi, Japan
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22
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Shen SC, Lofters A, Tinmouth J, Paszat L, Rabeneck L, Glazier RH. Predictors of non-adherence to colorectal cancer screening among immigrants to Ontario, Canada: a population-based study. Prev Med 2018; 111:180-189. [PMID: 29548788 DOI: 10.1016/j.ypmed.2018.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/01/2018] [Accepted: 03/09/2018] [Indexed: 12/22/2022]
Abstract
Though colorectal cancer (CRC) screening rates have increased over time in Ontario, Canada, immigrants continue to have lower rates of screening. This study examines the association between non-adherence to CRC screening and immigration, socio-demographic, healthcare utilization, and primary care physician characteristics among immigrants to Ontario. This is a population-based retrospective cross-sectional study that uses healthcare administrative databases housed at the Institute for Clinical Evaluative Sciences. Our cohort comprised immigrants aged 60 to 74 years who lived in Ontario on March 31, 2015 and who had been eligible for the Ontario Health Insurance Plan for at least 10 years. The outcome was lack of adherence to CRC screening with any modality (fecal occult blood test, flexible sigmoidoscopy, colonoscopy) on March 31, 2015. Our cohort contained 182,949 immigrants. Overall 70,134 (38%) individuals were not adherent to screening. Risk of non-adherence to CRC screening was higher among immigrants who were from low (adjusted relative risk [ARR] 1.35, 95%CI 1.28-1.42) or low-middle (ARR 1.27, 95%CI 1.24-1.30, population-attributable risk [PAR] 9.8%) income countries and refugees (ARR 1.09, 95%CI 1.06-1.11). Compared to those from the United States, Australia, and New Zealand, immigrants from most other world regions, particularly Eastern Europe and Central Asia (ARR 1.28, 95%CI 1.21-1.37), had higher risks of non-adherence. Non-immigration factors such as low healthcare use and lack of primary care enrolment also increased the risk of non-adherence to screening. These findings can be used to inform future efforts to improve uptake of CRC screening among immigrant groups.
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Affiliation(s)
| | - Aisha Lofters
- Dalla Lana School of Public Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jill Tinmouth
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Lawrence Paszat
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Richard H Glazier
- Dalla Lana School of Public Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
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23
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Hippman C, Moshrefzadeh A, Lohn Z, Hodgson ZG, Dewar K, Lam M, Albert AYK, Kwong J. Breast Cancer and Mammography Screening: Knowledge, Beliefs and Predictors for Asian Immigrant Women Attending a Specialized Clinic in British Columbia, Canada. J Immigr Minor Health 2018; 18:1441-1448. [PMID: 26706472 DOI: 10.1007/s10903-015-0332-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Screening mammography (MMG) reduces breast cancer mortality; however, Asian immigrant women underutilize MMG. The Asian Women's Health Clinic (AWHC) was established to promote women's cancer screening amongst this population. This study evaluated the rate, and predictors, of MMG amongst women attending the AWHC. Women (N = 98) attending the AWHC completed a questionnaire. Descriptive statistics and multivariable logistic regression evaluated rate and predictors of MMG. Most participants (87 %, n = 85) reported having had a mammogram. Significant MMG predictors were: lower perceived MMG barriers [lifetime: OR (CI) 1.19 (1.01-1.49); past 2 years: OR (CI) 1.11 (1.01-1.25)], and knowing someone with breast cancer [past year: OR (CI) 3.42 (1.25-9.85); past 2 years: OR (CI) 4.91 (1.32-2.13)]. Even amongst women using preventive medicine, 13 % report never having had a mammogram. More research is needed into innovative interventions, e.g. the AWHC, and breast cancer-related outcomes amongst Asian immigrant women.
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Affiliation(s)
- Catriona Hippman
- Women's Health Research Institute, Women's Hospital and Health Centre, Vancouver, BC, Canada. .,Department of Psychiatry, University of British Columbia, Translational Research Building, 3rd Floor-938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada. .,BC Mental Health and Addictions Research Institute, BC Mental Health and Substance Use Services, Vancouver, BC, Canada.
| | - Arezu Moshrefzadeh
- Women's Health Research Institute, Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Zoe Lohn
- Women's Health Research Institute, Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Zoë G Hodgson
- Women's Health Research Institute, Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Kathryn Dewar
- Women's Health Research Institute, Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Melanie Lam
- Women's Health Research Institute, Women's Hospital and Health Centre, Vancouver, BC, Canada.,Asian Women's Health Clinic, Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Arianne Y K Albert
- Women's Health Research Institute, Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Juliet Kwong
- Asian Women's Health Clinic, Women's Hospital and Health Centre, Vancouver, BC, Canada
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24
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Vahabi M, Lofters A, Kim E, Wong JPH, Ellison L, Graves E, Glazier RH. Breast cancer screening utilization among women from Muslim majority countries in Ontario, Canada. Prev Med 2017; 105:176-183. [PMID: 28916289 DOI: 10.1016/j.ypmed.2017.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/11/2017] [Accepted: 09/04/2017] [Indexed: 01/26/2023]
Abstract
Breast cancer screening disparities continue to prevail with immigrant women being at the forefront of the under screened population. There is a paucity of knowledge about the role of religious affiliation or cultural orientation on immigrant women's cancer screening uptake. This study examined differences in uptake of breast cancer screening among women from Muslim and non- Muslim majority countries in Ontario, Canada. A cohort of 1,851,834 screening-eligible women living in Ontario during April 1, 2013 to March 31, 2015 was created using linked health and social administrative databases. The study found that being born in a Muslim majority country was associated with lower breast cancer screening uptake after adjusting for region of origin, neighbourhood income, and primary care-related factors. However, screening uptake in Muslim majority countries varied by world region with the greatest differences found in Sub-Saharan Africa and South Asia. Screening uptake was lower for women who had no primary care provider, were in a traditional fee-for service model of primary care, had a male physician, had an internationally trained physician, resided in a low income neighbourhood, and entered Canada under the family class of immigration. Religion may play a role in screening uptake, however, the variation in rates by regions of origin, immigration class, and access to primary care providers alludes to confluence of socio-demographic, cultural beliefs and practices, immigration trajectories and system level factors. Facilitating access for immigrant women to regular primary care providers, particularly female providers and enrollment in primary care models could enhance screening uptake.
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Affiliation(s)
- Mandana Vahabi
- Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, Canada; Graduate Program in Immigration and Settlement Studies, Ryerson University, Canada; Ryerson Centre for Global Health and Health Equity, Canada.
| | - Aisha Lofters
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Canada; Department of Family and Community Medicine, University of Toronto, Canada; Department of Family and Community Medicine, St. Michael Hospital, Canada; Institute for Clinical Evaluative Sciences, Canada; Dalla Lana School of Public Health, University of Toronto, Canada.
| | - Eliane Kim
- Institute for Clinical Evaluative Sciences, Canada.
| | - Josephine Pui-Hing Wong
- Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, Canada.
| | - Lisa Ellison
- Institute for Clinical Evaluative Sciences, Canada.
| | - Erin Graves
- Institute for Clinical Evaluative Sciences, Canada.
| | - Richard H Glazier
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Canada; Department of Family and Community Medicine, University of Toronto, Canada; Department of Family and Community Medicine, St. Michael Hospital, Canada; Institute for Clinical Evaluative Sciences, Canada; Dalla Lana School of Public Health, University of Toronto, Canada.
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25
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Simon MA, Tom LS, Dong X. Breast Cancer Screening Beliefs Among Older Chinese Women in Chicago's Chinatown. J Gerontol A Biol Sci Med Sci 2017; 72:S32-S40. [PMID: 28575263 PMCID: PMC5458426 DOI: 10.1093/gerona/glw247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 11/29/2016] [Indexed: 12/15/2022] Open
Abstract
Background Chicago's Chinatown is home to a sizeable community of first-generation Chinese American immigrants. This qualitative study seeks to describe the attitudes toward, and barriers and facilitators of, breast cancer screening among Chinese women in Chicago's Chinatown to inform strategies for future interventions. Methods We conducted six focus groups among Chinese-speaking adult women aged 45 and older. Focus groups were transcribed, coded, and analyzed for emergent themes. Results Forty-seven women participated in focus groups; 10 (21%) had received a breast cancer diagnosis in their lifetime, all participants were foreign-born, and 80% have resided in the United States for over 10 years. Participants expressed a range of breast cancer beliefs, attitudes toward screening, barriers encountered, and facilitators. Some differences were noted between women with cancer and those without. Barriers described include language, time, not wanting to burden their adult children, and transportation. Navigation services and physician recommendation were suggested facilitators to screening. Conclusions Our findings have important implications for development of interventions and policies to bolster breast cancer screening among Chinese women. We highlight the need to connect Chinese older adults with resources to navigate the health care system and present opportunities for community stakeholders, researchers, health professionals, and policy makers to improve the health of Chinese Americans.
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Affiliation(s)
- Melissa A Simon
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.,Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Laura S Tom
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - XinQi Dong
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
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Ogunkorode A, Holtslander L, Anonson J, Maree J. An integrative review of the Literature on the determinants of health outcomes of women living with breast cancer in Canada and Nigeria from 1990 to 2014: A comparative study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Peterson EB, Ostroff JS, DuHamel KN, D'Agostino TA, Hernandez M, Canzona MR, Bylund CL. Impact of provider-patient communication on cancer screening adherence: A systematic review. Prev Med 2016; 93:96-105. [PMID: 27687535 PMCID: PMC5518612 DOI: 10.1016/j.ypmed.2016.09.034] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/17/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022]
Abstract
Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a person's decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence.
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Affiliation(s)
- Emily B Peterson
- George Mason University, 4400 University Drive, MSN 3D6, Fairfax, VA 22031, United States.
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Katherine N DuHamel
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Thomas A D'Agostino
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Marisol Hernandez
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Mollie R Canzona
- Wake Forest University, P.O. Box 7347, Winston-Salem, NC 27109, United States; Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - Carma L Bylund
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States; Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar
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Kwok C, Lim D. Evaluation of a Culturally Tailored Education to Promote Breast and Cervical Cancer Screening Among Chinese-Australian Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:595-601. [PMID: 25985961 DOI: 10.1007/s13187-015-0859-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED This paper aims to evaluate the impact of the culturally sensitive and linguistically appropriate education program on the following: (i) awareness of screening practices (breast awareness, mammogram, and Pap smear test); (ii) screening intention within the next six months; and (iii) knowledge about breast and cervical cancer among Chinese-Australian women. Titled "Happy and Healthy Life in Sydney," this was a quasi-experimental study with both pre- and post-test design. A convenience sample of 288 Chinese women was recruited through Chinese organizations such as churches and community centers. Participants completed the questionnaires before and after the educational program. The results show that the program was effective in promoting awareness of breast and cervical cancer screening and resulted in increased participative intentions in both mammogram and Pap smear testing within the next 6 months. Results also indicate that knowledge and belief scores were significantly increased. CONCLUSION Our study supports that educational programs which use culturally sensitive and linguistically appropriate strategies are effective in improving both knowledge of breast and cervical cancer and awareness of their early detection practices among Chinese-Australian women.
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Affiliation(s)
- Cannas Kwok
- School of Nursing & Midwifery, University of Western Sydney, Sydney, Australia.
| | - Danforn Lim
- University of Technology Sydney, Sydney, Australia
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Gilmore AK, Granato HF, Wilson SM, George WH. Sexual Assault and Heavy Episodic Drinking Among Women of Asian/Pacific Islander Ancestry and Women of European Ancestry. PSYCHOLOGY OF WOMEN QUARTERLY 2016. [DOI: 10.1177/0361684316648312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amanda K. Gilmore
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Hollie F. Granato
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Sarah M. Wilson
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - William H. George
- Department of Psychology, University of Washington, Seattle, WA, USA
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Leung DYP, Chow KM, Lo SWS, So WKW, Chan CWH. Contributing Factors to Colorectal Cancer Screening among Chinese People: A Review of Quantitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13050506. [PMID: 27196920 PMCID: PMC4881131 DOI: 10.3390/ijerph13050506] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/02/2016] [Accepted: 05/11/2016] [Indexed: 02/01/2023]
Abstract
Colorectal cancer (CRC) is a major health problem in Asia. It has been reported that the Chinese are more susceptible to CRC than many other ethnic groups. Screening for CRC is a cost-effective prevention and control strategy; however, the screening rates among the Chinese are sub-optimal. We conducted a review to identify the factors associated with CRC screening participation among Chinese people. Twenty-two studies that examined the factors related to CRC screening behaviors among the Chinese were identified through five databases. Seven factors were consistently reported to influence CRC screening behaviors in at least one of the studies: socio-demographic characteristics (educational level, health insurance, and knowledge about CRC and its screening); psychological factors (perceived severity of CRC, susceptibility of having CRC, and barriers to screening); and contact with medical provider (physician recommendation). The evidence base for many of these relationships is quite limited. Furthermore, the associations of many factors, including age, gender, income, cancer worry/fear, and self-efficacy with CRC screening behaviors, were mixed or inconsistent across these studies, thereby indicating that more studies are needed in this area.
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Affiliation(s)
- Doris Y P Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Sally W S Lo
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
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Leung DYP, Wong EML, Chan CWH. Determinants of participation in colorectal cancer screening among community-dwelling Chinese older people: Testing a comprehensive model using a descriptive correlational study. Eur J Oncol Nurs 2016; 21:17-23. [PMID: 26952674 DOI: 10.1016/j.ejon.2015.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 11/18/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The prevalence of colorectal cancer (CRC) among older people is high. Screening for CRC presents a cost-effective secondary prevention and control strategy which results in a significant reduction in mortality. This study aims to describe the prevalence of CRC screening and examine its risk factors among Chinese community-dwelling older people guided by a comprehensive model combining Health Belief Model and Extended Parallel Processing Model. METHODS A descriptive correlational study was conducted. A convenience sample of 240 community-dwelling adults aged ≥60 was recruited in May-July in 2012 in Hong Kong. Participants were asked to complete a questionnaire which collected information on demographic variables, CRC-related psychosocial variables and whether they had a CRC screening in the past 10 years. RESULTS Among the participants, 25.4% reported having a CRC screening test. Results of logistic regression analyses indicated that participants with a higher level in cue to action, and lower perceived knowledge barriers and severity-fear were significantly associated with participation in CRC screening. But there were no significant associations between fatalism and cancer fear with screening. CONCLUSIONS The prevalence of CRC screening was low in Hong Kong Chinese community-dwelling elders. A number of modifiable factors associated with CRC screening were identified which provides specific targets for interventions. This study also adds to the knowledge regarding the associations between fatalism and fear with CRC screening behaviors among Chinese older people.
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Affiliation(s)
- Doris Y P Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Esther Lee Building, Shatin, Hong Kong.
| | - Eliza M L Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Esther Lee Building, Shatin, Hong Kong.
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Esther Lee Building, Shatin, Hong Kong.
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Health Status and Health Determinants of Older Immigrant Women in Canada: A Scoping Review. J Aging Res 2015; 2015:393761. [PMID: 26273480 PMCID: PMC4530267 DOI: 10.1155/2015/393761] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 07/01/2015] [Indexed: 11/17/2022] Open
Abstract
Increasing international migration in the context of aging populations makes a comprehensive understanding of older immigrant women's health status and determinants of their health particularly urgent. Using Arksey and O'Malley's framework, we conducted a scoping review to examine the available literature on the health of older immigrant women in Canada. We searched CINAHL, PsycINFO, Embase, Medline, and Cochrane databases for the period of 1990 to 2014 for Canadian-based, peer-reviewed studies on the topic. A total of 20 articles met the inclusion criteria. These articles were divided into six areas of focus: physical health; mental health; abuse; health promotion and chronic disease prevention; barriers to healthcare access and utilization; and health beliefs, behaviours, and practices. Our results show that the health of older immigrant women is affected by the interplay of various social determinants of health including the physical and social environment; economic conditions; cultural beliefs; gendered norms; and the healthcare delivery system. Our results also revealed that older immigrant women tend to have more health problems, underutilize preventive services, such as cancer screening, and experience more difficulties in accessing healthcare services.
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Vahabi M, Lofters A, Kumar M, Glazier RH. Breast cancer screening disparities among urban immigrants: a population-based study in Ontario, Canada. BMC Public Health 2015; 15:679. [PMID: 26194189 PMCID: PMC4508905 DOI: 10.1186/s12889-015-2050-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 07/10/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Breast cancer is one of the leading cause of mortality and morbidity in Canada. Screening is the most promising approach in identification and treatment of the disease at early stage of its development. Research shows higher rate of breast cancer mortality among ethno-racial immigrant women despite their lower incidence which suggests disparities in mammography screening. This study aimed to compare the prevalence of appropriate mammography screening among immigrant and native borne women and determine predicators of low mammography screening. METHODS We conducted secondary data analyses on Ontario linked social and health databases to determine the proportion of women who were screened during the two-year period of 2010-2012 among 1.4 million screening-eligible women living in urban centres in Ontario. We used multivariate Poisson regression to adjust for various socio-demographic, health care-related and migration related variables. RESULTS 64% of eligible women were appropriately screened. Screening rates were lowest among new and recent immigrants compared to referent group (Canadian-born women and immigrant who arrived before 1985) (Adjusted Rate Ratio (ARR) (0.87, 95% CI 0.85-0.88 for new immigrants and 0.90, 95% CI 0.89-0.91 for recent immigrants. Factors that were associated with lower rates of screening included living in low-income neighborhoods, having a male physician, having internationally-trained physician and not being enrolled in primary care patient enrolment models. Those not enrolled were 22% less likely to be screened compared to those who were (ARR 0.78, 95% CI 0.77-0.79). CONCLUSION To enhance immigrant women screening rates efforts should made to increase their access to primary care patient enrolment models and preferably female health professionals. Support should be provided to interventions that address screening barriers like language, acculturation limitations and knowledge deficit. Health professionals need to be educated and take an active role in offering screening guidelines during health encounters.
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Affiliation(s)
- Mandana Vahabi
- Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
- Immigration and Settlement Studies, Ryerson University, Toronto, Canada.
- Ryerson Centre for Global Health and Health Equity, Toronto, Canada.
| | - Aisha Lofters
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Matthew Kumar
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Richard H Glazier
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
- Dalla, Lana School of Public Health, University of Toronto, Toronto, Canada.
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Abstract
BACKGROUND Although the incidence rates of breast cancer have been increasing remarkably in Hong Kong over the last 2 decades, little is known on breast cancer screening practices among this group of women. OBJECTIVES This study aimed to report breast cancer screening practices among Hong Kong Chinese women and to examine the relationship between (1) demographic factors and (2) the modified Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) score and women's breast screening behaviors. METHODS A descriptive and cross-sectional method was used. Both English and Chinese versions of the modified CBCSB were administered. Of 946 Hong Kong Chinese women older than 18 years and invited to participate in the study, 753 (79.6%) completed and returned the questionnaire. RESULTS The majority of participants (70%-90%) had heard of breast self-examination (BSE), clinical breast examination (CBE), and mammograms. Only 33.3% performed a BSE monthly; 37.8% and 32.7% of women within the targeted age group had a CBE annually and had a mammogram every 2 years, respectively. Being married and part-time employment were positively associated with women who performed BSE as recommended. In terms of modified CBCSB score, women who had BSE, CBE, and mammogram as recommended had significantly higher scores on the subscale attitudes to health check-up. CONCLUSION Attitudes toward health check-up was influential in compliance with breast cancer screening practices among Chinese-Australian women. IMPLICATIONS FOR PRACTICE Effort should be focused on specific subgroups of Hong Kong Chinese women, to fully understand the barriers involved in participating in breast cancer screening practices.
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Tu SP, Chun A, Yasui Y, Kuniyuki A, Yip MP, Taylor V, Bastani R. Adaptation of an evidence-based intervention to promote colorectal cancer screening: a quasi-experimental study. Implement Sci 2014; 9:85. [PMID: 24989083 PMCID: PMC4226971 DOI: 10.1186/1748-5908-9-85] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 06/23/2014] [Indexed: 02/07/2023] Open
Abstract
Background To accelerate the translation of research findings into practice for underserved populations, we investigated the adaptation of an evidence-based intervention (EBI), designed to increase colorectal cancer (CRC) screening in one limited English-proficient (LEP) population (Chinese), for another LEP group (Vietnamese) with overlapping cultural and health beliefs. Methods Guided by Diffusion of Innovations Theory, we adapted the EBI to achieve greater reach. Core elements of the adapted intervention included: small media (a DVD and pamphlet) translated into Vietnamese from Chinese; medical assistants distributing the small media instead of a health educator; and presentations on CRC screening to the medical assistants. A quasi-experimental study examined CRC screening adherence among eligible Vietnamese patients at the intervention and control clinics, before and after the 24-month intervention. The proportion of the adherence was assessed using generalized linear mixed models that account for clustering under primary care providers and also within-patient correlation between baseline and follow up. Results Our study included two cross-sectional samples: 1,016 at baseline (604 in the intervention clinic and 412 in the control clinic) and 1,260 post-intervention (746 in the intervention and 514 in the control clinic), including appreciable overlaps between the two time points. Pre-post change in CRC screening over time, expressed as an odds ratio (OR) of CRC screening adherence by time, showed a marginally-significant greater increase in CRC screening adherence at the intervention clinic compared to the control clinic (the ratio of the two ORs = 1.42; 95% CI 0.95, 2.15). In the sample of patients who were non-adherent to CRC screening at baseline, compared to the control clinic, the intervention clinic had marginally-significant greater increase in FOBT (adjusted OR = 1.77; 95% CI 0.98, 3.18) and a statistically-significantly greater increase in CRC screening adherence (adjusted OR = 1.70; 95% CI 1.05, 2.75). Conclusions Theoretically guided adaptations of EBIs may accelerate the translation of research into practice. Adaptation has the potential to mitigate health disparities for hard-to-reach populations in a timely manner.
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Affiliation(s)
- Shin-Ping Tu
- Department of Medicine, Virginia Commonwealth University, 1201 East Marshall Street, Richmond, VA 23298, USA.
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Oldach BR, Katz ML. Health literacy and cancer screening: a systematic review. PATIENT EDUCATION AND COUNSELING 2014; 94:149-57. [PMID: 24207115 PMCID: PMC3946869 DOI: 10.1016/j.pec.2013.10.001] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 08/12/2013] [Accepted: 10/05/2013] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To evaluate published evidence about health literacy and cancer screening. METHODS Seven databases were searched for English language articles measuring health literacy and cancer screening published in 1990-2011. Articles meeting inclusion criteria were independently reviewed by two investigators using a standardized data abstraction form. Abstracts (n=932) were reviewed and full text retrieved for 83 articles. Ten articles with 14 comparisons of health literacy and cancer screening according to recommended medical guidelines were included in the analysis. RESULTS Most articles measured health literacy using the S-TOFHLA instrument and documented cancer screening by self-report. There is a trend for an association of inadequate health literacy and lower cancer screening rates, however, the evidence is mixed and limited by study design and measurement issues. CONCLUSION A patient's health literacy may be a contributing factor to being within recommended cancer screening guidelines. PRACTICE IMPLICATIONS Future research should: be conducted using validated health literacy instruments; describe the population included in the study; document cancer screening test completion according to recommended guidelines; verify the completion of cancer screening tests by medical record review; adjust for confounding factors; and report effect size of the association of health literacy and cancer screening.
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Affiliation(s)
- Benjamin R Oldach
- Comprehensive Cancer Center, The Ohio State University, Columbus, USA
| | - Mira L Katz
- Comprehensive Cancer Center, The Ohio State University, Columbus, USA; Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, USA.
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Tsai HM, Cheng CY, Chang SC, Yang YM, Wang HH. Health Literacy and Health-Promoting Behaviors among Multiethnic Groups of Women in Taiwan. J Obstet Gynecol Neonatal Nurs 2014; 43:117-129. [DOI: 10.1111/1552-6909.12269] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ryu SY, Crespi CM, Maxwell AE. What factors explain disparities in mammography rates among Asian-American immigrant women? A population-based study in California. Womens Health Issues 2013; 23:e403-10. [PMID: 24183415 PMCID: PMC3833860 DOI: 10.1016/j.whi.2013.08.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/30/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to compare rates of screening mammography among immigrant women in five Asian-American ethnic groups in California, and ascertain the extent to which differences in mammography rates among these groups are attributable to differences in known correlates of cancer screening. METHODS Using 2009 data from the California Health Interview Survey, we compared the rates of mammography among Chinese, Filipino, Japanese, Korean, and Vietnamese immigrants 40 years and older. To assess the impact of Asian ethnicity on participation in screening, we performed multiple logistic regression analysis with models that progressively adjusted for acculturation, sociodemographic characteristics, access to health care, and breast cancer risk factors, and examined the predicted probabilities of screening after adjusting for these factors. FINDINGS Participation in screening mammography differed according to ethnicity, with Filipina and Vietnamese Americans having the highest rates and Korean Americans having the lowest rates of lifetime and recent (past 2 years) screening. These differences decreased substantially after adjusting for acculturation, sociodemographic factors, and risk factors of breast cancer, but differences remained, most notably for Korean Americans, who continued to have the lowest predicted probability of screening even after adjustment for these factors. CONCLUSIONS This analysis draws attention to low mammography screening rates among Asian-American immigrants, especially recent immigrants who lack health insurance. Given that their breast cancer incidence is rising with length of stay in the United States, it is important to increase regular mammography screening in these groups.
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Affiliation(s)
- So Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, 309 Pilmun-daero, Dong-gu, Gwangju, 501-759, Korea; Tel:+82-62-230-6483;
| | - Catherine M. Crespi
- University of California, Los Angeles, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Room A2-125, CHS, Los Angeles, CA 90095, USA; Tel:+1-310-206-9364;
| | - Annette E. Maxwell
- University of California, Los Angeles, Fielding School of Public Health, Department of Health Policy and Management & Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Room A2-125, CHS, Los Angeles, CA 90095, USA; Tel:+1-310-794-9282;
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Abstract
BACKGROUND Our objectives were to: (1) compare colorectal cancer screening (CRCS) among US born citizens (USBs), naturalized citizens (NACs), and noncitizens (NOCs) and (2) evaluate clinical factors and potential barriers associated with CRCS in these populations. METHODS Screening-eligible patients were identified from the 2007 California Health Interview Survey. Up-to-date CRCS was defined as a fecal occult blood test within 1 year, a sigmoidoscopy within 5 years, or a colonoscopy within 10 years. Using logistic regression, we determined the effects of immigrant status on CRCS. Stratified analyses based on location of residence, health insurance status, and English proficiency were conducted. RESULTS A total of 30,434 average-risk adults aged 50 years or older completed the survey. Only 67% of USBs, 61% of NACs, and 46% of NOCs underwent CRCS. Advanced age, male sex, high-income earners, nonsmokers, and those who were married or visited their physicians frequently were more likely to receive CRCS (all P < 0.05). Compared with USBs, both NACs and NOCs showed decreased odds of CRCS (odds ratio 0.88, 95% confidence interval, 0.74-1.06 and odds ratio 0.68, 95% confidence interval, 0.53-0.88, respectively; P = 0.011). Stratified analyses revealed that the associations between immigrants and decreased CRCS were more prominent for those who lived in rural areas, lacked insurance, or were not English proficient. CONCLUSIONS CRCS remains suboptimal, especially in new US immigrants. Improving health care access and mitigating language barriers may minimize this disparity.
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Guvenc I, Guvenc G, Tastan S, Akyuz A. Identifying women's knowledge about risk factors of breast cancer and reasons for having mammography. Asian Pac J Cancer Prev 2013; 13:4191-7. [PMID: 23098429 DOI: 10.7314/apjcp.2012.13.8.4191] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The aim of this study was to identify breast cancer risk factors and reasons for having mammography of the women who applied for mammography, as well as to determine their level of knowledge about risk factors and level of risk perception, and anxiety concerning breast cancer. This cross-sectional descriptive study was conducted from June 15, 2010 through September 10, 2010, in a university hospital in Ankara, Turkey. A questionnaire prepared by the researchers was used to collect the data. The mean age of the women was 52.1 ± 9.98 years. Sixteen percent of the women had a family history of breast cancer. The majority of participants had mammograms (75.8%) before and had gained knowledge about breast cancer and its screening (73.7%). The leading source of information about breast cancer was physicians (46.2%). Physician recommendations, having breast-related complaints, and family history of breast cancer were important reasons to obtain mammography. The mean knowledge score about risk factors of breast cancer was 4.15 ± 2.73 and the mean anxiety score was 1.65 ± 1.61. It was found that some socio-demographic and obstetrical characteristics of women, their family history, and risk perceptions about breast cancer affect their knowledge and anxiety scores about breast cancer. In conclusion, the present study identified a number of factors affecting mammography participation for women. The results of this study can be helpful in promoting screening for breast cancer.
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Affiliation(s)
- Inanc Guvenc
- Department of Radiology, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
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Kwok C, Fethney J, White K. Breast cancer screening practices among Chinese-Australian women. Eur J Oncol Nurs 2012; 16:247-52. [DOI: 10.1016/j.ejon.2011.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/07/2011] [Accepted: 06/12/2011] [Indexed: 11/25/2022]
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Kwok C, Fethney J, White K. Mammographic Screening Practices Among Chinese-Australian Women. J Nurs Scholarsh 2011; 44:11-8. [DOI: 10.1111/j.1547-5069.2011.01429.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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McWhirter JE, Todd LE, Hoffman-Goetz L. Beliefs about causes of colon cancer by English-as-a-Second-Language Chinese immigrant women to Canada. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2011; 26:734-739. [PMID: 21800045 DOI: 10.1007/s13187-011-0258-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Colon cancer is the second leading cause of cancer death for Canadians. Immigrants underutilize screening and may be at greater risk of late stage diagnosis and death from the disease. This mixed-methods study investigated the self-reported causes of colon cancer by 66 English-as-a-Second-Language Chinese immigrant women to Canada after reading a fact sheet which listed two causes of colon cancer (polyps and cause unknown) and six ways to help prevent colon cancer (lifestyle, diet, weight, smoking, alcohol, and screening). Women correctly named or described both causes (6.1%) or one cause (22.7%), could not name or describe either cause (19.7%), or named or described causes not included on the fact sheet (54.5%). The most common causes reported by participants were "risk factors": diet (53.0%), family history (28.8%), and lifestyle (22.7%). Women confused cause with risk factor and infrequently mentioned screening. Possible reasons for their reported beliefs are discussed.
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Affiliation(s)
- Jennifer Elizabeth McWhirter
- Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada, N2L 3G1
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McWhirter J, Todd L, Hoffman-Goetz L. Comparing written and oral measures of comprehension of cancer information by English-as-a-Second-Language Chinese immigrant women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2011; 26:484-489. [PMID: 21445682 DOI: 10.1007/s13187-011-0219-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Short Test of Functional Health Literacy for Adults (S-TOFHLA) and Cloze test are commonly used tools to measure comprehension of health information (i.e., health literacy); however, little is known about their use in English-as-a-Second-Language (ESL) populations. In this study, we compared written (Cloze test) and oral (Teach Back) measures of colon cancer information comprehension among ESL Chinese immigrant women to Canada. Performances on colon cancer-specific measures were compared to a general measure of health literacy (S-TOFHLA). On the S-TOFHLA, Cloze, and Teach Back, respectively, the following percentage of participants had adequate comprehension: 62.1%, 14.8%, and 89.7%. Correlation between performance on the Cloze and Teach Back was significant albeit weakly so (r = 0.38, p = 0.04); performances on the S-TOFHLA and Teach Back were not correlated. Measures of health literacy skill that require written English language skills may not be appropriate for measuring understanding of health information for ESL populations.
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Affiliation(s)
- Jennifer McWhirter
- Department of Health Studies and Gerontology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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