Impact of breast cancer screening intervention on Korean-American women in Maryland

Dissemination and implementation science frameworks and strategies to increase breast cancer screening for at-risk women in the United States: A scoping review

Dissemination and implementation science (D&I) can help bridge the gap between research and practice by addressing how to facilitate and maintain pre-existing evidence-based interventions (EBIs) in various contexts within different fields, including that of breast cancer screening and treatment. Yet, despite the availability of D&I frameworks and strategies, there is a lack of studies exploring knowledge transfer dissemination and implementation models, strategies, and frameworks in the setting of breast cancer care. There is a need for studies that create guidelines and roadmaps built on theoretical foundations of D&I research to scale up successful D&I of strategies, frameworks, and protocols proven to cater to the needs of all breast cancer patients when seeking screening and treatment services. The Arksey and O'Malley (2005) York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; (5) collating, summarizing, and reporting results. Most cited barriers (n = 46) sorted into the category of "Recruitment, Measurement, and Delivery Challenges." The predominant ERIC strategy, featured in a noteworthy 84% of studies, was "Tailor strategies" (#16), which belongs to the "Adapt and tailor to context: culture, language, data analysis, collection" domain. This study can guide researchers, physicians, and community workers in improving accessibility, affordability, and quality of breast cancer screening and adequate follow-up opportunities through D&I strategies and models improving the reach and sustainability of evidence-based programs in at-risk female populations.

Breast Cancer Knowledge and Mammography Use Among Asian American Women Aged 40 and Older: Using the Transtheoretical Model Approach

Mammography screening rates remain low among Asian American women (AAW). The aims of our study were to: (a) assess breast cancer knowledge and mammography screening behaviors, and (b) identify the factors related to the transtheoretical model (TTM) stages of change in relation to mammography utilization among AAW aged 40 and older. Using a cross-sectional design, a convenience sample of 714 AAW completed a structured questionnaire in 2021. Participants demonstrated a moderate level of knowledge regarding breast cancer and mammography. Only 34.2% of the participants reported obtaining regular mammograms. The ordinal logistic regression indicated that age, birthplace, health perception, breast biopsy history, breast cancer knowledge, self-efficacy, and perceived barriers were correlated with TTM stages of change. Our results highlight the need for implementing effective interventions aimed at increasing knowledge and screening rates for breast cancer among AAW. Additional TTM studies with AAW are needed to determine the relationships among TTM constructs and develop theory-based programs to improve adherence to screening guidelines. Future research using a mixed-method design may provide opportunities to explore complex phenomena associated with breast cancer screening behaviors. Finally, further assessments of the Breast Cancer Knowledge Scale's psychometric properties are necessary to improve this instrument.

Development and Modification of a Culturally Tailored Education Program to Prevent Breast Cancer in Korean Immigrant Women in New York City

Breast cancer (BC) is the most common cancer in Korean American (KA) women. In view of its high prevalence in these women, their low screening rates, and the cultural influence of BC risk factors in their lifestyles, we developed a community-based culturally tailored BC prevention program, the Korean Breast Cancer Risk Reduction Program (KBCRRP). Guided by the PRECEDE-PROCEDE and health belief models, the KBCRRP was developed to achieve four goals: (1) healthy weight, (2) physically active lifestyle, (3) healthy diet, and (4) BC screening and adherence. KBCRRP combines effective multicomponent strategies for BC screening and a group-based lifestyle intervention incorporating traditional Korean health beliefs and is tailored for BC risk reduction. In this paper, we provide an overview of the program, the process of program development, implementation, and evaluation, and modification during the COVID-19 pandemic. The initial program involved 8 weeks of in-person group education sessions led by interdisciplinary healthcare professionals and 16 weeks of follow-up involving smartphone applications, phone calls, and text messaging from trained lifestyle coaches. Participants received opportunities to obtain free mammography during the program. After feasibility testing, the program was modified by incorporating participants' feedback. During the COVID-19 pandemic, we provided the program using the Zoom video platform. Participants' recruitment and retention during the pandemic was successful, reflecting the fact that virtual delivery of group-based education was a feasible and acceptable alternative to in-person sessions. Collaboration with community organizations serving the target population is the key to developing and sustaining a successful community-based educational program.

Effect of Educational Intervention Based on Theory of Planned Behavior (TPB) on Doing Breast Self-examination in a Sample of Iranian Women

Background

Breast self-examination (BSE) is an important part of health care for all women in every stage of life. This study aimed to investigate the effect of theory of planned behavior (TPB) on doing BSE in a sample of Iranian women.

Methods

A cross-sectional study was carried out to examine the factors affecting the BSE in 400 women. Then, a quasi-experimental study was conducted on 200 subjects (100 in experimental group and 100 in control group). The educational intervention for the experimental group consisted of 8 training sessions. A questionnaire including demographic characteristics, knowledge, and constructs of TPB was used to measure BSE performance before and 6 months after the intervention. Constructs of attitude, subjective norms, and perceived behavioral control predicted the intention to do the BSE.

Results

The mean age of the subjects was 31.65 ± 7.59 years. The studied variables predicted 38.7% of behavioral intention (P < .001, odds ratio = 0.387). Six months after the intervention, the experimental group showed a significant increase in the knowledge, attitude, perceived behavioral control, subjective norms, intention, and BSE performance compared with the control group (P < .001).

Conclusions

This study showed that educational intervention based on the TPB was effective in promoting breast cancer screening behavior such as BSE. Therefore, it is suggested that health educators and health care planners use educational texts based on these constructs of TPB to increase their influence on individuals via screening behavior for breast cancer.

Effect of educational program based on theory of planned behavior on osteoporosis preventive behaviors: a randomized clinical trial

Background

The prevalence of chronic diseases is increasing worldwide. Implementing educational programs is an important step in prevention of chronic diseases in the community setting. This study was conducted to assess the effect of educational program based on the Theory of Planned Behavior (TPB) on the osteoporosis preventive behaviors in middle-aged individuals.

Methods

A randomized clinical trial was conducted on 64 middle-aged individuals presenting to primary care centers. A researcher-made questionnaire developed according to “a guide for compiling and analyzing the questionnaire based on TPB” was used for data collection. Random block sampling was applied to assign participants to control and intervention groups after ensuring the validity and reliability. An educational program on osteoporosis prevention was conducted in six educational sessions based on the TPB constructs for the intervention group in primary care centers. Control group received routine education about lifestyle changes including osteoporosis by primary care centers. Eight weeks after the intervention, the questionnaires were completed again and the data were analyzed using the SPSS V16 software.

Results

Independent t-test found no significant difference in the mean score of knowledge, osteoporosis preventive behavior, attitude, subjective norms, perceived behavioral control and behavioral intention between intervention and control groups before intervention (p > 0.05). After the intervention, however, a significant difference was found in the mean score of knowledge, attitude, subjective norms, perceived behavioral control and behavioral intention between the cases in intervention and control groups (P < 0.05). In addition, based on repeated measurement ANOVA, the intervention had a significant effect on knowledge, preventive behaviors, attitude, subjective norms, perceived behavioral control, and behavioral intention (P < 0.05).

Conclusions

The results of the present study showed that implementation of an educational intervention based on the Theory of Planned Behavior significantly increased the knowledge along with all constructs of TPB in osteoporosis preventive behaviors.

Trial registration

This study was registered in the Iranian Registry of Clinical Trials IRCT2017081735647N2 (11/10/2017).

Factors Influencing Mammography Uptake Following a Screening Intervention among Asian American Women: A Systematic Review

Asian American women, both immigrant and US-born, are known to have low mammography screening rates. To reduce health disparities and address community health needs, we undertook a systematic review to identify factors that affect mammography uptake among Asian American women following a mammography screening intervention. Following the PRISMA guidelines, we searched four databases and selected 12 studies that met our inclusion criteria. We identified 22 relevant factors and developed a new conceptual model that comprehensively captures these sociodemographic; cultural; knowledge, attitude, and perception; health history; health care accessibility and availability; and intervention factors, including components and mode of intervention. This conceptual model can be used to guide development of interventions that effectively promote mammography screening. Future research should focus on the effect of acculturation on screening behaviors and the importance of culturally tailored intervention and information-sharing elements to improving mammography screening among Asian Americans.

The Effect of Educational Intervention Based on the Theory of Planned Behavior on Mammography Screening in Iranian Women

Mammography is the most special screening method for early diagnosis of breast cancer. The purpose of present research is investigating the effect of educational intervention based on theory of planned behavior on mammography screening of women in Fasa city, Fars province, Iran. In this quasi-experimental study, 400 subjects (200 subjects for experimental group and 200 subjects for control group) were selected in 2017-2018. Educational intervention for the experimental group included 8 educational sessions. A questionnaire used for evaluating demographic information and constructs of theory of planned behavior (knowledge, perceived behavioral control, subjective norms, and attitude) investigated mammography performance of women before and 6 months after intervention. Data were analyzed by using SPSS 22 through chi-square test, McNemar's test, and Wilcoxon-Mann-Whitney test at significance level of P < 0.05. The average age of subjects was 45.52 ± 6.76 years in the experimental group and 45.12 ± 6.64 years in the control group. Six months after intervention, the experimental group showed significant increase in knowledge, perceived behavioral control, subjective norms, and attitude compared to the control group and 174 people (78%) of the experimental group had intention for doing mammography and 148 people (74%) of the experimental group performed mammography. Also, 6 months after educational intervention, 38 people (19%) of the control group had intention for performing mammography and 14 people (7%) of the control group performed mammography.

Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States

To summarize the literature on barriers and facilitators to breast and cervical cancer screening among immigrants to the US. A literature review was conducted for studies on breast and cervical cancer screening among immigrant populations. A thematic analysis of 180 studies identified a variety of barriers and facilitators to screening at the personal and system levels. Personal barriers included lack of knowledge and insurance coverage, high cost of care, and immigration status. System barriers included poor access to services, lack of interpreter services, and insensitivity to patient needs. Facilitators to screening included knowledge of disease, access to information sources, physician recommendation, and social networks. Cultural norms and resource availability at the individual and system levels influence screening among immigrants. Health insurance coverage was found to be an important predictor of preventative screening use. Future research should seek to identify the best way to address this and other barriers to cancer screening among immigrants groups.

Evaluation of Health Belief Model-Based Intervention on Breast Cancer Screening Behaviors among Health Volunteers

Breast cancer is the most common cancer and the second leading cause of death among women. Regarding the lack of knowledge about the cause of breast cancer and considering the fact that all women are prone to this disease, training on methods of early diagnosis to reduce its complications is of great importance. Thus, this study aimed to determine the effect of education based on the health belief model on breast cancer screening behaviors in health volunteers of health centers in Isfahan. In this experimental study, 480 healthy volunteers were randomly divided into two groups: the case (n = 240) and control (n = 240). The training program was designed according to health belief model structures. Before the training interventional program, the Champion standard questionnaire and functional checklist were completed for both groups. A standard questionnaire was completed during three stages (before, immediately after, and 2 months after the training). The experimental group received the educational intervention during eight sessions, and the collected data was eventually analyzed using the SPSS statistical software version 16 with relevant statistical tests. Participation of all individuals in the present research was voluntary and with informed consent. The results showed that mean scores of knowledge, perceived susceptibility, severity, benefits, barriers, self-efficacy, and behavioral intention related to breast self-examination (BSE) and mammography in the intervention group significantly increased compared with those of the control group immediately after and 2 months after educational intervention. There was a significant difference between groups in BSE skill 2 months after the intervention, but there was no significant difference between the two groups in BSE behavior and mammography 2 months after the intervention. The results confirmed the efficiency and effectiveness of an educational intervention based on the health belief model on improving factors affecting breast cancer screening behaviors.

Cultural Appropriateness in Health Communication: A Review and A Revised Framework

A revised framework for cultural appropriateness is offered on the basis of a systematic review of operationalizations in 44 cancer screening interventions for Asian Americans. Studies commonly conveyed the epidemiological bases of the intervention (97.7%) and used the language of the population (95.5%). Less commonly reported were strategies central to health communication: cultural features of the intervention messages (77.3%) and the cultural beliefs and values that the intervention focused on (43.2%). Few used cultural tailoring (4.5%) and none aimed to address acculturation or cultural identity. The theoretical framework most frequently used was the health belief model (27.3%) which does not explain the role of culture. More studies focused on cultural barriers (20.5%) than cultural strengths (9.1%). Our revised framework comprises six cultural appropriateness strategies of cultural identity, linguistic, perceptual features, content, constituent-involving, and socioeconomic context-adaptive. It prioritizes cultural identity to recognize the dynamics within racial ethnic groups and to inform adaptive efforts for cultural appropriateness. It emphasizes examining cultural strengths that can facilitate change, as well as reducing cultural barriers. Future research and action should address the disparities in extant health disparities research in which theory and methods are underdeveloped and underutilized for Asian Americans.

Effect of an Intervention on the Breast Cancer Screening Behavior in Women: Application of Integrated Behavioral Model

BACKGROUND

Screening is the most important action in the early diagnosis of breast cancer. This study investigates the impact of educational intervention based on the integrated behavioral model on breast cancer screening behavior in women in Karaj City, 2016.

METHODS

This semi-experimental study was conducted on 138 women who were attended to health centers in Mohammad Shahr city. The samples were selected using cluster sampling and were randomly divided into two groups, experimental and control group. Data gathering tool was a four-part questionnaire (demographic characteristics, knowledge, Champion's Health Belief Scale, subjective norms). Two 50-min sessions were held for educational intervention in the experimental group. Training was presented through lecture, questioning and answering and group discussion. The data were completed in three steps (before, immediately after and 2 months after the intervention) and were analyzed using SPSS 16 software.

RESULTS

The results showed that the mean score of all structures except the perceived benefits of mammography and mammography behavior have a significant difference in the intervention group than the control group in 2 months after intervention (P < 0.001). In all the studied structures, except the perceived benefits of mammography (P = 0.083) and mammographic behavior (P = 0.156), there was a significant difference between the two groups before and immediately after the intervention (P < 0.001).

CONCLUSIONS

The finding of this study showed that the efficiency and effectiveness of an educational intervention based on health belief model along with subjective norms that emphasize the opinions of others about the behaviors of individuals also has a very dramatic effect on the promotion of breast cancer screening behaviors.

Access to Health Care, Beliefs, and Behaviors about Colorectal Cancer Screening among Korean Americans

Background: Colorectal cancer (CRC) is one of the most common cancers among Korean Americans (KAs) and their CRC screening rates are low. To raise the rates of CRC screening among KAs, it is necessary to improve our understanding of factors that influence their CRC screening behaviors. This study examined socio-demographics, access to health care, health and cultural beliefs, and behaviors about the fecal occult blood test (FOBT) for CRC screening among KAs aged 50 and older. Methods: Based on the health belief model, the cultural assessment model for health, and the Powe fatalism model, this study measured socio-demographics (age, gender, years in the U.S., marital status, education, employment, income, and acculturation), health care access (health insurance, having a regular doctor, physician recommendation, and trust in doctor), health beliefs (susceptibility, severity, benefits, barriers, and self-efficacy), and cultural beliefs (physical space, health temporal orientation, personal control, and fatalism) and FOBT. A cross-sectional survey (n=202) was conducted. Data analysis was conducted using descriptive analysis, Pearson correlation, and multivariate logistic regression. Results: This study found that physician recommendation was the strongest factor in lifetime FOBT utilization in KAs. The results also revealed a positive association among health temporal orientation, health fatalism, and lifetime FOBT among KAs, while previous research found a negative association between fatalism and cancer screening. Years in the U.S., employment, and having a regular doctor were significantly associated with having had a FOBT in the previous year. Conclusion: Study results suggested the need for public education programs to increase physician recommendation among KAs. Furthermore, the positive relationships among health temporal orientation, health fatalism, and FOBT utilization in KAs suggests that KAs have a desire to maintain health and find cancer early despite their fatalistic view on health.

Development and Evaluation of Culturally and Linguistically Tailored Mobile App to Promote Breast Cancer Screening

Background: While a significant breast cancer burden exists for Korean American immigrant women, their cancer screening behavior is strikingly poor, and few interventions have focused on this population. To promote breast cancer screening behavior in Korean American immigrant women, a mobile phone multimedia messaging intervention (mMammogram) was developed. Objective: The current study explores the impact of mMammogram on changes to study participants’ screening behavior and proposes suggestions for how the intervention can be improved for wide dissemination and implementation in the Korean American community. Material and Methods: Data were collected through qualitative research methods. Three focus groups were conducted with 14 Korean immigrant women who completed the mMammogram. Findings: Three themes emerged: (1) better understanding of breast cancer and screening through mMammogram (e.g., increased knowledge on breast cancer and screening methods, increased understanding of the importance of regular mammography, and reduced anxiety about mammography); (2) health navigators as a trigger to promote mammography (e.g., providing resources for free or low-cost mammograms and scheduling mammogram appointments); and (3) suggestions for mMammogram (e.g., technical issues and program period). Conclusions: Mobile app intervention that is culturally tailored, along with health navigation services, can be a feasible, effective, and acceptable tool to promote breast cancer screening behaviors in underserved immigrant women. A mobile app can cover a broad range of breast cancer health topics and the health navigator can further help women overcome barriers to screening. A health navigation service is critical in overcoming language, transportation, and health accessibility barriers and triggering a positive change in their health screening behavior, especially for newly arrived immigrant populations.

Mobile Phone Multilevel and Multimedia Messaging Intervention for Breast Cancer Screening: Pilot Randomized Controlled Trial

Background

Despite the increasing breast cancer incidence and mortality rates, Korean American immigrant women have one of the lowest rates of breast cancer screening across racial groups in the United States. Mobile health (mHealth), defined as the delivery of health care information or services through mobile communication devices, has been utilized to successfully improve a variety of health outcomes.

Objective

This study adapted the principles of mHealth to advance breast cancer prevention efforts among Korean American immigrant women, an underserved community.

Methods

Using a randomized controlled trial design, 120 Korean American women aged 40 to 77 years were recruited and randomly assigned to either the mMammogram intervention group (n=60) to receive culturally and personally tailored multilevel and multimedia messages through a mobile phone app along with health navigator services or the usual care control group (n=60) to receive a printed brochure. Outcome measures included knowledge, attitudes, and beliefs about breast cancer screening, readiness for mammography, and mammogram receipt. The feasibility and acceptability of the mMammogram intervention was also assessed.

Results

The intervention group showed significantly greater change on scores of knowledge of breast cancer and screening guidelines (P=.01). The intervention group also showed significantly greater readiness for mammography use after the intervention compared with the control group. A significantly higher proportion of women who received the mMammogram intervention (75%, 45/60) completed mammograms by the 6-month follow-up compared with the control group (30%, 18/60; P<.001). In addition, the intervention group rated satisfaction with the intervention (P=.003), effectiveness of the intervention (P<.001), and increase of knowledge on breast cancer and screenings (P=.001) significantly higher than the control group.

Conclusions

A mobile phone app–based intervention combined with health navigator service was a feasible, acceptable, and effective intervention mechanism to promote breast cancer screening in Korean American immigrant women. A flexible, easily tailored approach that relies on recent technological advancements can reach underserved and hard-to-recruit populations that bear disproportionate cancer burdens.

Trial Registration

Clinicaltrials.gov NCT01972048; https://clinicaltrials.gov/show/NCT01972048 (Archived by WebCite at https://clinicaltrials.gov/archive/NCT01972048/2013_10_29)

The Effects of Training on Knowledge and Beliefs About Breast Cancer and Early Diagnosis Methods Among Women

OBJECTIVE

Breast cancer (BC) is the most common female malignancy in the world and Turkey. Its prevalence and mortality are surprisingly increasing at a rapid rate. The objective of this study was to determine the effectiveness of training sessions on women's knowledge of relevant risk factors of BC and screening methods, screening behaviors and health beliefs among of healthy women in Turkey.

MATERIALS AND METHODS

In this study, in order to establish the efficiency of BC training, a semi-empirical single group pre-test & post-test research model was used. The data were collected by using a self-administered questionnaire and by using the Turkish version of Champion's health belief model scale (CHBMS). The pre-test was performed before the training and after one week of the training, post-test was performed with a questionnaire having the same content.

RESULTS

In total, 244 women participated in the study. The average age of the women was 39.44 (SD=1.06) years. The mean total knowledge score increased significantly (p<.001) from 9.05 in the pre-test to 16.53 in the post-test. The results showed that both mean knowledge scores and CHBMS subscales scores of the women were increased significantly (p<.001) from the pre-test to the post-test. In multiple linear regression analysis, BC screening knowledge of women with susceptibility, benefit, self-efficacy and health motivation subscales of CHBMS, breast self-examination (BSE) practice and self-efficacy were also significant in the post-test; in the pre- and post-tests, a significant relationship among the level of education of women, susceptibility and seriousness was found (p<.001).

CONCLUSION

The study showed that the training program had profound effects on BC knowledge, screening behaviors and health beliefs of women.

Web-Based Study for Improving Mammography Among Korean American Women

Web-based culture-specific interventions for Korean American (KA) women to improve mammography utilization are not available. An established intervention developed to improve mammography utilizations for Korean American (KA) women was tested via the Web for its efficacy, feasibility, and acceptability. A randomized controlled trial, with a pretest-posttest control group design, was conducted with 136 KA women and their spouses. Intention to have a mammogram within the next 12 months increased significantly in the intervention group compare to controls. Among women whose mammograms had not been updated, 22 % of women in the intervention and 13 % of women in the control group obtained a mammogram at 2-month post-baseline, even though the difference was not statistically significant. The Web-based study educating couples was feasible and could improve KA women's breast cancer screening intention and behaviors. Combining off-line contact for recruitment/data collection with online intervention material could decrease the attrition rate in the future study because the attrition rate in this study was higher than the original study.

Church-Based Recruitment to Reach Korean Immigrants: An Integrative Review

Although the Korean church has been frequently used to recruit Korean immigrants in research, little is known about the specific strategies and process. The purpose of this integrative review was to describe recruitment strategies in studies of Korean immigrants and to identify the process of Korean church-based recruitment. Thirty-three studies met inclusion criteria. Four stages of church-based recruitment were identified: initiation, endorsement, advertisement, and implementation. This review identified aspects of the church-based recruitment process in Korean immigrants, which are different from the Black and Hispanic literature, due to their hierarchical culture and language barriers. Getting permission from pastors and announcing the study by pastors at Sunday services were identified as the key components of the process. Using the church newsletter to advertise the study was the most effective strategy for the advertisement stage. Despite several limitations, church-based recruitment is a very feasible and effective way to recruit Korean immigrants.

Understanding breast cancer screening behaviors of Korean American women in sociocultural contexts

This study examines the breast cancer screening behaviors of Korean American women focusing on their cultural beliefs and access to health care. A total of 111 Korean American women participated in the cross-sectional survey research. Korean American women who felt embarrassed about breast cancer screenings were less likely to have received clinical breast exams or mammograms. Implications to culturally competent social work practice in promoting their breast cancer screening behaviors are discussed.

Barriers to Cervical Cancer Screening and Prevention in Young Korean Immigrant Women: Implications for Intervention Development

This study aimed to identify major barriers to Papanicolaou (Pap) test uptake and human papillomavirus (HPV) vaccine acceptability. Three focus groups with 16 young Korean immigrant women residing in a community in the Midwest were conducted. Braun and Clarke’s six phases of thematic analysis were used to develop themes. Three major themes emerged as barriers: (a) limited knowledge about cervical cancer and preventive behaviors, (b) culture-specific barriers, and (c) low accessibility to health care services. These themes were multifactorial and interrelated barriers to Pap test uptake and HPV vaccine acceptability among young Korean immigrant women. These findings indicate that culturally tailored cervical cancer education is needed to promote Pap test uptake and HPV vaccination in this underserved population.

Effect of education on knowledge, attitude and behavioral intention in family relative with colorectal cancer patients based on theory of planned behavior

BACKGROUND

Colorectal cancer is one of most common cancers in women and men and one of the major causes of death due to neoplasia. Colonoscopy is considered as the most accurate diagnostic procedure to detect colorectal cancer at the earlier stages.

OBJECTIVES

The current study aimed to evaluate the effects of an education program using the Theory of Planned Behavior on promoting behavioral intention among first degree relatives of colorectal cancer patients.

MATERIALS AND METHOD

A quasi-experimental study conducted to evaluate the effectiveness of an educational program to promote attitudinal factors associated with early detection of colorectal cancer in 99 first degree relatives of colorectal cancer patients aged more than 20 years in Yazd city, Iran. A researcher made questionnaire forwhich validity and reliability were confirmed by expert point of view and pilot testing was employed for data collection. Questionnaires were filled in before and after educational intervention. The registered data were transferred to SPSS 19 and analyzed by paired T-test, Man-Whitney and Wilcaxon.

RESULTS

Mean scores of knowledge, attitude, perceived behavioral control and intention regarding colorectal cancer increased after education significantly (P<0.05).

CONCLUSIONS

Application of the Theory of Planned Behavior has positive influence on promoting intention behavior. It is therefore recommended to apply educational programs to promote behavioral intention.

Effectiveness of an Ongoing, Community-Based Breast Cancer Prevention Program for Korean American Women

The study evaluates the effectiveness of an ongoing, community-based breast cancer prevention program offered by a local social services agency in the Washington, DC, metropolitan area. Korean American women who participated in this breast cancer prevention program were compared with those who did not participate in their knowledge, attitude, and screening behaviors. The study found that the intervention group was more knowledgeable on breast cancer and related services and reported more positive attitudes toward breast cancer screening services than the comparison group. The participants in the intervention group were also more likely to plan to receive a mammogram than those in the comparison group. However, significant differences were not observed in the two groups in their intention to receive a clinical breast examination. The study findings suggest that an ongoing, community-based breast cancer prevention program can be an effective method of addressing breast cancer prevention disparities observed among Korean American women.

Interventional Education Methods for Increasing Women's Participation in Breast Cancer Screening Program

The purpose of this study was to evaluate the impact of the three methods of education-individual, individual with an educational brochure for spouses, and group-on participation on breast cancer screening in Turkey. A total of 550 home visits were made and 446 women were interviewed to accrue 327 women for the study, 26.7% of whom reported receiving a screening mammogram within the past 2 years. Participants were divided into one of the three educational groups, and following the educational session, they were invited to attend a breast cancer screening program. The results indicated that the decision to have a screening mammogram was influenced by the method of education and the knowledge score. Women, who were educated, within a group scored the highest. These results demonstrate that group education is an effective method of increasing breast cancer knowledge and screening awareness.

Cultural Factors Associated with Breast and Cervical Cancer Screening in Korean American Women in the US: An Integrative Literature Review

PURPOSE

This study examined current research theories and methods, cultural factors, and culturally relevant interventions associated with breast and cervical cancer screening in Korean American (KA) women.

METHODS

Based on Ganong's guidelines, the literature on cultural factors associated with breast and cervical cancer screening in KA women was searched using MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Sixty-eight articles on breast cancer screening and 66 articles on cervical cancer screening were retrieved from both databases, and a total of 22 articles were included in the literature review based on the selection criteria.

RESULTS

Of the 22 studies reviewed, 14 (63.6%) were descriptive and 8 (36.4%) were interventional. Many studies have used individual focused cognitive theories such as health belief model and different types of operationalization for measures of cultural beliefs. Cultural factors associated with breast and cervical cancer screening in KA women that were identified in descriptive quantitative and qualitative studies included family, embarrassment, preventive health orientation, fatalism, and acculturation. Most culturally relevant interventional studies used education programs, and all education was conducted by bilingual and bicultural health educators at sociocultural sites for KA women.

CONCLUSIONS

Theories focusing on interpersonal relationships and standardized, reliable, and valid instruments to measure cultural concepts are needed to breast and cervical cancer screening research in KA women. Traditional cultural factors associated with cancer screening should be considered for practical implications and future research with KA women.

Photonovels: an innovative approach to address health disparities and sustainability

Medically underserved and underrepresented communities have high rates of health disparities. In the greater Tampa Bay area, communities of color are disproportionately affected by chronic diseases such as cancer. In response to these concerns and as part of a lay health advisory program being implemented by the Center for Equal Health, a University of South Florida/H. Lee Moffitt Cancer Center & Research Institute partnership, our group created a photonovel, an educational tool which explains topics using a graphic novel style. The photonovel was designed to educate community members about prostate cancer and was compared to standard cancer educational materials currently used for cancer outreach. We found that our photonovel served as an effective health education tool to address cancer health disparities in medically underserved and underrepresented populations in Tampa Bay.

Mobile phone text messaging intervention for cervical cancer screening: changes in knowledge and behavior pre-post intervention

Background

Cervical cancer poses a significant threat to Korean American women, who are reported to have one of the highest cervical cancer mortality rates in the United States. Studies consistently report that Korean American women have the lowest Pap test screening rates across US ethnic groups.

Objective

In response to the need to enhance cervical cancer screening in this vulnerable population, we developed and tested a 7-day mobile phone text message-based cervical cancer Screening (mScreening) intervention designed to promote the receipt of Pap tests by young Korean American women.

Methods

We developed and assessed the acceptability and feasibility of a 1-week mScreening intervention to increase knowledge of cervical cancer screening, intent to receive screening, and the receipt of a Pap test. Fogg’s Behavior Model was the conceptual framework that guided the development of the mScreening intervention. A series of focus groups were conducted to inform the development of the intervention. The messages were individually tailored for each participant and delivered to them for a 7-day period at each participant’s preferred time. A quasi-experimental research design of 30 Korean American women aged 21 to 29 years was utilized with baseline, post (1 week after the completion of mScreening), and follow-up (3 months after the completion of mScreening) testing.

Results

Findings revealed a significant increase in participants’ knowledge of cervical cancer (P<.001) and guidelines for cervical cancer screening (P=.006). A total of 23% (7/30) (95% CI 9.9-42.3) of the mScreening participants received a Pap test; 83% (25/30) of the participants expressed satisfaction with the intervention and 97% (29/30) reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention.

Conclusions

This study provides evidence of the effectiveness and feasibility of the mScreening intervention. Mobile technology is a promising tool to increase both knowledge and receipt of cervical cancer screening. Given the widespread usage of mobile phones among young adults, a mobile phone-based health intervention could be a low-cost and effective method of reaching populations with low cervical cancer screening rates, using individually tailored messages that cover broad content areas and overcome restrictions to place and time of delivery.

The effect of a couples intervention to increase breast cancer screening among korean americans

PURPOSE/OBJECTIVES

To assess the efficacy of Korean Immigrants and Mammography-Culture-Specific Health Intervention (KIM-CHI), an educational program for Korean American (KA) couples designed to improve mammography uptake among KA women.

DESIGN

A two-group cluster randomized, longitudinal, controlled design.

SETTING

50 KA religious organizations in the Chicago area.

SAMPLE

428 married KA women 40 years of age or older who had not had a mammogram in the past year. The women and their husbands were recruited from 50 KA religious organizations.

METHODS

Couples were randomly assigned to intervention or attention control groups. Those in the KIM-CHI program (n = 211 couples) were compared to an attention control group (n = 217 couples) at baseline, as well as at 6 and 15 months postintervention on mammogram uptake.

MAIN RESEARCH VARIABLES

Sociodemographic variables and mammography uptake were measured. Level of acculturation was measured using the Suinn-Lew Asian Self-Identity Acculturation Scale. Researchers asked questions about healthcare resources and use, health insurance status, usual source of care, physical examinations in the past two years, family history of breast cancer, and history of mammography.

FINDINGS

The KIM-CHI group showed statistically significant increases in mammography uptake compared to the attention control group at 6 months and 15 months postintervention.

CONCLUSIONS

The culturally targeted KIM-CHI program was effective in increasing mammogram uptake among nonadherent KA women.

IMPLICATIONS FOR NURSING

Nurses and healthcare providers should consider specific health beliefs as well as inclusion of husbands or significant others. They also should target education to be culturally relevant for KA women to effectively improve frequency of breast cancer screening.

Developing theoretically based and culturally appropriate interventions to promote hepatitis B testing in 4 Asian American populations, 2006-2011

Introduction

Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community.

Methods

Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities.

Results

Use of the Health Behavior Framework allowed a systematic approach to intervention development across populations, resulting in 4 different culturally appropriate interventions that addressed the same set of theoretical constructs.

Conclusions

The development of theory-based health promotion interventions for different populations will advance our understanding of which constructs are critical to modify specific health behaviors.

Culturally tailored interventions of chronic disease targeting Korean Americans: a systematic review

OBJECTIVE

Because little is known about promising interventions to prevent and control chronic disease in Korean Americans, we conducted a systematic literature review to investigate: (1) theoretical frameworks and strategies employed by interventions targeting Korean Americans; (2) cultural factors considered by these interventions; and (3) the extent of their success in engaging Korean participants and improving their health.

DESIGN

Following the PRISMA guidelines, PubMed, PsycInfo, and Web of Science were searched to identify primary research articles evaluating interventions to prevent or control chronic disease, tailored to Korean Americans, and published from 1980 through 2011. Of 238 articles identified, 21 articles describing16 unique intervention tests met inclusion criteria. These interventions targeted cancer (10), hypertension (2), diabetes (1), mental health (1), tobacco cessation (1), and general health (1).

RESULTS

All included studies were published since 2000, reflecting the relatively recent establishment of intervention research with Korean Americans. All 16 programs delivered linguistically appropriate messages and education. The 11 programs that realized significant intervention effects also provided or coordinated social support from culturally relevant and well-trained lay health workers, nurses, or family members during an intervention and/or follow-up period.

CONCLUSIONS

Culturally matched and linguistically appropriate messages and education may not be enough to prevent or control chronic disease among immigrant Korean Americans. Culturally sensitive and committed social support should be provided to catalyze behavioral changes and sustain the effect of the interventions.

The influences of immigration on health information seeking behaviors among Korean Americans and Native Koreans

Korean Americans (KAs) have low screening rates for cancer and are often not well informed about their chronic diseases. Reduced access to health-related information is one reason for gaps in knowledge and the widening health disparities among minority populations. However, little research exists about KAs' health information seeking behaviors. Guided by the Structural Influence Model, this study examines the influence of immigration status on KAs' trust in health information sources and health information seeking behaviors. Cross-sectional surveys were conducted in the Washington, D.C., metropolitan area as well as in the Gwangju metropolitan city in South Korea during 2006-2007. Two hundred and fifty-four KAs and 208 native Koreans who were 40 years of age or older completed the surveys. When comparing native Koreans to KAs, we found KAs were 3 times more likely to trust health information from newspapers or magazines (odds ratio [OR] = 3.13; 95% confidence interval [CI] = 1.49-6.54) and 11 times more likely to read the health sections of newspapers or magazines (OR = 11.35; 95% CI = 3.92-32.91) in multivariate adjusted models. However, they were less likely to look for health information from TV (OR = 0.29; 95% CI = 0.12-0.72) than native Koreans. Our results indicate that immigration status has profound influences on KAs' health information seeking behaviors. Increasing the availability of reliable and valid health information from printed Korean language magazines or newspapers could have a positive influence on increasing awareness and promoting screening behaviors among KAs.

Racial/ethnic differences in cancer prevention beliefs: applying the health belief model framework

PURPOSE

An understanding of each racial/ethnic group's beliefs about cancer prevention is important for designing/implementing interventions to reduce cancer-health disparities. The Health Belief Model was used to examine racial/ethnic differences in beliefs about cancer and cancer prevention.

DESIGN

The data were from the 2007 Health Information National Trends Survey, a biennial, cross-sectional survey using a random-digit-dial telephone frame and a mailing address frame.

SETTING

A weighted, nationally representative sample of American adults.

SUBJECTS

The sample consisted of 7452 individuals.

MEASURES

Model construct variables (perceived susceptibility; perceived severity; perceived benefits; perceived barriers; cues to action; self-efficacy) and race/ethnicity were assessed.

ANALYSIS

The Rao-Scott χ(2) test and multivariate logistic regression assessed racial/ethnic differences.

RESULTS

The constructs self-efficacy, perceived benefits, and perceived susceptibility were significantly associated with race/ethnicity. The remaining three constructs were not statistically significant. Multivariate analysis revealed Hispanics were less likely to believe they could lower their chances of getting cancer than did African-Americans and whites. Hispanics, Asians, and African-Americans were more likely to believe they had a lower chance of getting cancer in the future than did whites.

CONCLUSION

Culturally relevant health education/promotion interventions need to be developed and tailored to (1) empower Hispanics regarding their ability to prevent cancer and (2) educate racial/ethnic minorities about their susceptibility and risk perception for cancer.

Ethnic disparities in breast cancer

Breast cancer is the leading cause of cancer death for women worldwide. While breast cancer incidence is lower for many ethnic minority women than for white women, stage at diagnosis and survival are often worse. These disparities are most marked for African-American women, but are also present for Asians, Latinas, Native Americans and Hawaiians. The etiology of ethnic disparities in breast cancer is multifactorial, including differences in tumor characteristics, genetics, access to care and insurance, prevalence of risk factors, screening participation and processes of care, such as timeliness of diagnosis and quality of communication and treatment. This review will examine what is known regarding ethnic differences in all of these areas, what questions remain, and where researchers and policy makers should focus their future efforts.

A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women

Background

The Asian population is one of the fastest growing ethnic minority groups in western countries. However, cancer screening uptake is consistently lower in this group than in the native-born populations. As a first step towards developing an effective cancer screening intervention program targeting Asian women, we conducted a comprehensive systematic review, without geographic, language or date limitations, to update current knowledge on the effectiveness of existing intervention strategies to enhance breast and cervical screening uptake in Asian women.

Methods

This study systematically reviewed studies published as of January 2010 to synthesize knowledge about effectiveness of cancer screening interventions targeting Asian women. Fifteen multidisciplinary peer-reviewed and grey literature databases were searched to identify relevant studies.

Results

The results of our systematic review were reported in accordance with the PRISMA Statement. Of 37 selected intervention studies, only 18 studies included valid outcome measures (i.e. self-reported or recorded receipt of mammograms or Pap smear). 11 of the 18 intervention studies with valid outcome measures used multiple intervention strategies to target individuals in a specific Asian ethnic group. This observed pattern of intervention design supports the hypothesis that employing a combination of multiple strategies is more likely to be successful than single interventions. The effectiveness of community-based or workplace-based group education programs increases when additional supports, such as assistance in scheduling/attending screening and mobile screening services are provided. Combining cultural awareness training for health care professionals with outreach workers who can help healthcare professionals overcome language and cultural barriers is likely to improve cancer screening uptake. Media campaigns and mailed culturally sensitive print materials alone may be ineffective in increasing screening uptake. Intervention effectiveness appears to vary with ethnic population, methods of program delivery, and study setting.

Conclusions

Despite some limitations, our review has demonstrated that the effectiveness of existing interventions to promote breast and cervical cancer screening uptake in Asian women may hinge on a variety of factors, such as type of intervention and study population characteristics. While some studies demonstrated the effectiveness of certain intervention programs, the cost effectiveness and long-term sustainability of these programs remain questionable. When adopting an intervention program, it is important to consider the impacts of social-and cultural factors specific to the Asian population on cancer screening uptake. Future research is needed to develop new interventions and tools, and adopt vigorous study design and evaluation methodologies to increase cancer screening among Asian women to promote population health and health equity.

Efficacy of an educational material on second primary cancer screening practice for cancer survivors: a randomized controlled trial

BACKGROUND

Cancer surivors have limited knowledge about second primary cancer (SPC) screening and suboptimal rates of completion of screening practices for SPC. Our objective was to test the efficacy of an educational material on the knowledge, attitudes, and screening practices for SPC among cancer survivors.

METHODS

Randomized, controlled trial among 326 cancer survivors from 6 oncology care outpatient clinics in Korea. Patients were randomized to an intervention or an attention control group. The intervention was a photo-novel, culturally tailored to increase knowledge about SPC screening. Knowledge and attitudes regarding SPC screening were assessed two weeks after the intervention, and screening practices were assessed after one year.

RESULTS

At two weeks post-intervention, the average knowledge score was significantly higher in the intervention compared to the control group (0.81 vs. 0.75, P<0.01), with no significant difference in their attitude scores (2.64 vs. 2.57, P = 0.18). After 1 year of follow-up, the completion rate of all appropriate cancer screening was 47.2% in both intervention and control groups.

CONCLUSION

While the educational material was effective for increasing knowledge of SPC screening, it did not promote cancer screening practice among cancer survivors. More effective interventions are needed to increase SPC screening rates in this population.

TRIAL REGISTRATION

ClinicalTrial.gov NCT00948337.

Workplace-based breast cancer screening intervention in china

BACKGROUND

Breast cancer continues to be the primary cause of death among East and Southeast Asian women. Although China, the most populous country in the world, is experiencing unprecedented economic growth, its health care system has yet to benefit from the current economic prosperity. Indeed, studies have shown a consistent increase in breast cancer rates among Chinese women over the past two decades in the absence of breast cancer screening guidelines.

METHODS

The primary objective of this study was to examine the impact of a workplace intervention on increasing breast cancer screening rates. The study was implemented at eight worksites in Nanjing, four of which were assigned to the intervention group (n = 232) and four to the control group (n = 221). The intervention group received breast cancer education and screening navigation. The control group was provided with general cancer education and received a delayed intervention after completion of the study. Study measures were completed at pre- and postprogram and at 6-month follow-up to assess uptake of mammography.

RESULTS

Baseline mammography use was low among both intervention and control groups. However, exposure to the workplace intervention dramatically increased the uptake of mammography from 10.3% at baseline to 72.6% at 6-month follow-up in the intervention group (P < 0.001).

CONCLUSIONS

Findings provide preliminary evidence that the implementation of a comprehensive workplace breast cancer screening intervention program in China can lead to increased uptake of mammography. These data may help facilitate the development of theory-based workplace cancer prevention programs and screening guidelines in China.

IMPACT

A workplace-based multifaceted intervention could have a strong impact in breast cancer prevention and early detection among women in China.

Colorectal cancer screening disparities in Asian Americans and Pacific Islanders: which groups are most vulnerable?

BACKGROUND

Colorectal cancer (CRC) is a significant cause of mortality among Asian Americans and Pacific Islanders (AAPIs), yet studies have consistently reported lower CRC screening rates among AAPIs than among non-Latino Whites and African Americans. Moreover, existing research tends to aggregate AAPIs as one group when reporting CRC screening, masking the disproportionate burden in cancer screening that exists across AAPI groups.

METHODS

This study examines differences in CRC screening rates in both aggregated and disaggregated AAPI groups as compared with non-Latino Whites in order to identify the most vulnerable AAPI subgroups in terms of obtaining CRC screening. This study utilizes merged data from the 2001, 2003, and 2005 California Health Interview Survey (CHIS), specifically the data pertaining to adults aged 50 and older (n = 52,491) from seven AAPI groups (Chinese, Japanese, Korean, Filipino, South Asian, Vietnamese, and Pacific Islander) and non-Latino Whites. Andersen's Behavioral Model of Health Services Use was utilized to select potential confounders to racial/ethnic differences in CRC screening.

RESULTS

When AAPI groups were considered as an aggregate, their CRC screening rate (46.8%) was lower than that of non-Latino Whites (57.7%). When AAPI groups were disaggregated, further disparity was noted: Koreans (32.7%) showed the lowest CRC screening rate, whereas Japanese (59.8%) had the highest. When the influence of potential predisposing, enabling, and need confounders was adjusted, Koreans, Filipinos, and South Asians were found to have a lower likelihood than non-Latino Whites to undergo CRC screening. Comparisons among AAPI subgroups further revealed that Filipinos, Koreans, Pacific Islanders, and South Asians were less likely than Chinese, Japanese, and Vietnamese to receive CRC screening.

CONCLUSION

These results highlight the importance of identifying differences in CRC screening behavior among disaggregated AAPI subgroups in order to help health professionals and policy-makers prioritize which AAPI subgroups need the most urgent interventions in terms of CRC screening promotion.

The effects of an educational program on knowledge of breast cancer, early detection practices and health beliefs of nurses and midwives

AIM

To determine the effectiveness of an educational program concerning knowledge of breast cancer, early detection practices and health beliefs of nurses and midwives.

BACKGROUND

Educational programs play an important role in breast cancer preventive behaviour.

DESIGN

The study was designed as an experimental post-test only, control group design. The educational program was applied only to the experimental group. The study group included 157,134 nurses and midwives respectively in the experimental and the control group.

METHODS

Participants in the experimental group received an educational program on the breast cancer. One year after the educational program was delivered, data were collected from the two groups using a personal data form and the Turkish version of Champion's Health Belief Model Scale. Descriptive statistics, paired samples t-test, chi-square test and Fisher's exact test were conducted in the course of the data analyses.

RESULTS

The mean total knowledge score was significantly higher in the experimental group than in the control group. The application percentage of mammography and clinical breast examination was higher in the experimental group. There were no significant differences between two groups in performing breast self-examination. The experimental group was significantly more likely to feel confident and motivated, and their total score on the health belief scale was much better than that of the control group.

CONCLUSIONS

The results of this study showed that educational intervention had a positive impact on knowledge of breast cancer, on practices related to breast cancer, on early detection and on the health beliefs in the experimental group.

RELEVANCE TO CLINICAL PRACTICE

The educational programs, including techniques to increase the motivation and skills for early detection of breast cancer, should be made widespread in nursing and midwifery. Health beliefs should be considered in planning educational programs about breast cancer. Interventions should be designed to enhance nurses' and midwives' confidence and motivation.

Breast cancer screening interventions in selected counties across US regions

OBJECTIVES

To determine the types of, and the populations targeted by interventions implemented to increase breast cancer screening rates in counties with large African American populations across different US regions.

METHODS

A brief questionnaire was administered by e-mail to county representatives from 33 states from October 2008 through March 2009. Responses were obtained from 33% of 203 targeted counties.

RESULTS

Most counties (>80%) reported interventions for African American women and for women with low income. Women were exposed to different kinds of interventions depending on where they lived. Most counties in the Northeast (93%), Southwest (82%), and Midwest (100%) implemented interventions that provided free or low cost mammograms. Counties in the Southeast (83%) were more likely to report education interventions. Counties from the Southwest reported using a variety of interventions to encourage breast cancer screening.

CONCLUSION

In this selected group of counties, different types of interventions were used to increase breast cancer screening in minority and disadvantaged women. Interventions implemented were similar to those shown in the literature to be effective in increasing screening rates in specific populations. Future research should examine the use of screening interventions in a larger sample of US counties.

Increasing breast examinations among arab women using a tailored culture-based intervention

This study aimed to assess outcomes of a culture-specific intervention devised to reduce barriers to breast cancer screening among Arab women in Israel. Women in intervention (n = 42) and control (n = 24) groups answered breast examination performance and Arab culture-specific barriers and health beliefs questionnaires at pre- and postintervention. Women in the study group received tailored telephone intervention between the 2 interviews. Although the study and control groups did not differ in rate of attending clinical examinations and mammography at pre-intervention, at post-intervention, almost 48% of the intervention group and 12.5% of the control group scheduled or attended a clinical examination, and 38.5% of women in the intervention group and 21.4% of the control group attended or scheduled a mammography. Of the cultural barriers, a significant group x time effect was found for the cultural barriers of exposure, social barriers, and self-uneasiness with body, with a higher decrease in the intervention group. Of the health beliefs, a group x time effect was found for perceived vulnerability and perceived barriers to clinical examination and mammography, which significantly decreased in the intervention group, but not in the control group. The preliminary results showed that the culture-based intervention was effective in reducing barriers and increasing the rate of breast cancer examinations.

Relationships between decisional balance and stage of adopting mammography and Pap testing among Chinese American women

BACKGROUND

The Transtheoretical Model has not been applied to explain cancer screening behavior among a large sample of Chinese Americans. This study examines the stage of adopting mammography and Pap testing in relation to women's decisional balance of cancer screening.

METHODS

We surveyed a sample of 507 Chinese American women aged 50 and older in the DC area in 2003 and 2004. We categorized women into six screening stages (pre-contemplation, contemplation, action, relapse, risk of relapse, and maintenance) based on the frequency and regularity of past screening behaviors and future intentions. We measured women's attitudes toward mammography and Pap testing by 22 pro and con statements. Decisional balance was calculated by the mean difference between pro and con scores. Multinomial regression analyses were used to examine the associations between decisional balance and stage of adoption, controlling for sociodemographics, English fluency, and physician and family recommendations.

RESULTS

Maintenance was the largest group among six stages (45% for mammography; 44% for Pap testing). Women in the maintenance group had the highest decisional balance scores, indicating more positive attitudes toward screening. Decisional balance was significantly related to stages of adopting mammograms and Pap testing after adjusting for other covariates.

CONCLUSIONS

This study demonstrated that Chinese American women's cancer screening behavior was associated with decisional balance, as described in the Transtheoretical Model. Cancer screening messages should be tailored to the needs of women in different stages of adopting mammography and Pap testing.

Assess the effects of culturally relevant intervention on breast cancer knowledge, beliefs, and mammography use among Korean American women

A pre-post test, two-group study was conducted to examine the effects of a culturally competent targeted intervention titled GO EARLY Save Your Life on the breast cancer and early screening-related knowledge and beliefs and mammography use among 180 Korean American (KA) women aged 40 years or older who had not had mammograms within the past 12 months. The intervention group received an interactive education session focused on breast cancer, early screening guidelines, and beliefs (breast cancer-related and Korean cultural beliefs). The control group received no education. There was no statistically significant intervention effect on mammography use between the intervention (34%) and control groups (23%) at 24 weeks post baseline. The rates of mammography use for both groups significantly increased from 16 to 24 weeks post baseline. The education was effective in increasing breast cancer/early screening-related knowledge and modifying beliefs (decreasing barriers, fear, seriousness, and fatalism, and increasing preventive health orientation).

Impact of a print intervention to increase annual mammography screening among Korean American women enrolled in the National Breast and Cervical Cancer Early Detection Program

BACKGROUND

Although Korean American women have one of the lowest rates of mammography screening, only few interventions have been developed for them. We developed a theory-based Korean-language print intervention to increase annual mammography screening with the goal to disseminate it through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).

METHODS

Korean American staff and patients at a community clinic advised on the content and layout of the brochure. We pilot tested the intervention from July to September 2005 at a community clinic in Koreatown, Los Angeles County that provides free mammograms through the NBCCEDP. The proportion of Korean American women who received a repeat mammogram during the intervention period was compared to the pre-intervention period using a NBCCEDP database.

RESULTS

We found a non-significant 6 percentage point increase in repeat screening from 32% to 38%. A debriefing survey with a subsample of 59 women revealed that only 32% recalled receipt of the brochure and a subsequent investigation revealed that only about 60% had identical address information in the NBCCEDP records and in their charts.

CONCLUSIONS

Although dissemination of print information through NBCCEDP is very feasible, the reach and effectiveness of the intervention was limited due to incorrect or outdated address information.