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Devotta K, O’Campo P, Bender J, Lofters AK. Important and Feasible Actions to Address Cervical Screening Participation amongst South Asian Women in Ontario: A Concept Mapping Study with Service Users and Service Providers. Curr Oncol 2024; 31:4038-4051. [PMID: 39057173 PMCID: PMC11276223 DOI: 10.3390/curroncol31070301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Regular cervical screening can largely prevent the development of cervical cancer and innovative methods are needed to better engage people in screening. In Ontario, Canada, South Asian women have some of the lowest rates of screening in the province. In this study, we used concept mapping to engage two stakeholder groups-South Asian service users and service providers-to identify and prioritize points of intervention to encourage the uptake of cervical screening. After participants brainstormed a master list of statements, 45 participants rated the statements based off 'importance' and 'ease to address' in relation to encouraging cervical screening. A bivariate plot (X-Y graph) that shows the average rating values for each statement across the two rating variables (a 'go-zone' display) was produced to display priorities for implementation. Statements that were considered high priority to address reflected issues around education and awareness including understanding and communication related to cervical screening and preventative care, as well as the need for trusted sources of information. Statements that were considered high priority but challenging to implement were centered around fear, stigma, discomfort, family and personal priorities. This study highlighted that stigma, norms and social relations that impact the uptake of screening must be addressed in order for education and awareness raising to be effective and to move people from conviction around screening to action.
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Affiliation(s)
- Kimberly Devotta
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- Women’s College Hospital, Toronto, ON M5S1B2, Canada
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B1W8, Canada
| | - Jacqueline Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- University Health Network, Toronto, ON M5G2C4, Canada
| | - Aisha K. Lofters
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- Women’s College Hospital, Toronto, ON M5S1B2, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G1V7, Canada
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Devotta K, Vahabi M, Prakash V, Lofters A. Reach and effectiveness of an HPV self-sampling intervention for cervical screening amongst under- or never-screened women in Toronto, Ontario Canada. BMC Womens Health 2023; 23:36. [PMID: 36698140 PMCID: PMC9876406 DOI: 10.1186/s12905-023-02174-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cervical cancer is almost entirely preventable with appropriate and timely screening. In Ontario, Canada, South Asian, Middle Eastern and North African women have some of the lowest rates of screening and a suggested higher burden of cervical cancer. With increasing international evidence and adoption of HPV testing, many screening programs are making the move away from Pap tests and towards HPV testing with the option of HPV self-sampling seeming promising for under- or never-screened (UNS) women. Our study aimed to understand the uptake and acceptability of an HPV self-sampling intervention amongst these disproportionately UNS women in Peel region and surrounding areas in Ontario. METHODS A community -based mixed methods approach guided by the RE-AIM framework was used to recruit approximately 100 UNS racialized immigrant women aged 30-69, during the period of June 2018 to December 2019. The main recruitment strategy included community champions (i.e. trusted female members of communities) to engage people in our selected areas in Peel Region. Participants completed a study questionnaire about their knowledge, attitudes and practices around cervical cancer screening, self-selected whether to use the HPV self-sampling device and completed follow-up questions either about their experience with self-sampling or going to get a Pap test. RESULTS In total, 108 women participated in the study, with 69 opting to do self-sampling and 39 not. The majority of women followed through and used the device (n = 61) and found it 'user friendly.' The experience of some participants suggests that clearer instructions and/or more support once at home is needed. Survey and follow-up data suggest that privacy and comfort are common barriers for UNS women, and that self-sampling begins to address these concerns. Across both groups addressing misinformation and misconceptions is needed to convince some UNS women to be screened. Family, friends and peers also seemed to play a role in the decision-making process. CONCLUSIONS HPV self-sampling is viewed as an acceptable alternative to a Pap test for cervical screening, by some but not all UNS women. This method begins to address some of the barriers that often prevent women from being screened and is already being offered in some jurisdictions as an alternative to clinical cervical cancer screening.
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Affiliation(s)
- Kimberly Devotta
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - Mandana Vahabi
- grid.68312.3e0000 0004 1936 9422Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Vijayshree Prakash
- grid.68312.3e0000 0004 1936 9422WECAN Research Project, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Aisha Lofters
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7 Canada
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Kayser K, Washington A, Anderson G, Harris LM, Lee HY, LaJoie AS. Perceived Barriers and Facilitators in Accessing Cervical Cancer Screening: The Voices of Women in a Low-Income Urban Community. FAMILY & COMMUNITY HEALTH 2022; 45:46-57. [PMID: 34783690 DOI: 10.1097/fch.0000000000000312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although advancements in cervical cancer prevention have helped reduce the incidence, mortality, and prevalence, access to these preventive services has not been experienced equally by all women in the United States. The purpose of this study was to learn about the factors that affect access to preventive services in a low-income, primarily Black community. Using a community-based participatory research approach, women were recruited to participate in 7 focus groups, with 6 to 8 women per group (N = 45). Participants were mainly Black (64%), with a mean age of 46 years, and 60% reporting completing at least some college. The discussions were transcribed, and text data were organized using Dedoose software. Guided by qualitative content analysis, the data were analyzed through an iterative process of coding and condensing the codes into themes. Ten types of barriers and 11 facilitators relating to cervical cancer screening access were identified and grouped into 7 themes. Participants provided suggestions for promoting cervical cancer screening in their community. On the basis of the findings of the data, the researchers conceptualized and mapped culturally and geographically appropriate interventions to promote cervical cancer screening within the community of interest.
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Affiliation(s)
- Karen Kayser
- Kent School of Social Work (Drs Kayser, Washington, Harris, and Anderson) and School of Public Health and Information Sciences (Dr LaJoie), University of Louisville, Louisville, Kentucky; and School of Social Work, The University of Alabama, Tuscaloosa (Dr Lee)
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Understanding the Acceptability and Uptake of HPV Self-Sampling Amongst Women Under- or Never-Screened for Cervical Cancer in Toronto (Ontario, Canada): An Intervention Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179114. [PMID: 34501703 PMCID: PMC8430523 DOI: 10.3390/ijerph18179114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 11/21/2022]
Abstract
Cervical cancer remains a global public health concern, even though scientific advancements have made the disease almost entirely preventable. With the link between human papillomavirus (HPV) and cervical cancer, and the subsequent improvement in screening technology, there is potential to improve access and coverage of cervical screening with the introduction of HPV self-sampling. In Ontario, Canada, a province with a cytology-based screening program (i.e., Pap test), women who identify as South Asian, West Asian, Middle Eastern and North African have some of the lowest rates of screening, and research suggests they have a higher burden of cervical cancer. In this study, we will use both quantitative and qualitative methods to understand the acceptability and uptake of a take-home HPV self-sampling kit. Working with community champions—people with pre-existing connections with local groups—we will recruit women from these groups who are under- or never-screened for cervical cancer. Women will self-select whether they are in the group that tries HPV self-sampling or in the group that does not. We will aim for 100 women in each group. All participants will provide feedback on the feasibility, acceptability and preferences for cervical screening through a survey and phone follow-up. Women who self-select the HPV self-sampling group, will be followed up to find out if they followed through with self-sampling and to understand their experience using the device. Women who do not want to try self-sampling will be followed up to see if they went on to get a Pap test. The qualitative phase of this study consists of five focus groups with participants and semi-structured interviews with key informants in the community.
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Biddell CB, Spees LP, Smith JS, Brewer NT, Des Marais AC, Sanusi BO, Hudgens MG, Barclay L, Jackson S, Kent EE, Wheeler SB. Perceived Financial Barriers to Cervical Cancer Screening and Associated Cost Burden Among Low-Income, Under-Screened Women. J Womens Health (Larchmt) 2021; 30:1243-1252. [PMID: 33851854 DOI: 10.1089/jwh.2020.8807] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Despite screening's effectiveness in reducing cervical cancer incidence and mortality, disparities in cervical cancer screening uptake remain, with lower rates documented among uninsured and low-income individuals. We examined perceived financial barriers to, and the perceived cost burden of, cervical cancer screening. Materials and Methods: We surveyed 702 low-income, uninsured or publicly insured women ages 25-64 years in North Carolina, U.S., who were not up to date on cervical cancer screening according to national guidelines. Participants were asked about perceived financial barriers to screening and how much they perceived screening would cost. We used multivariable logistic regression to assess the sociodemographic predictors of perceived financial barriers. Results: Seventy-two percent of participants perceived financial barriers to screening. Screening appointment costs (71%) and follow-up/future treatment costs (44%) were most commonly reported, followed by lost pay due to time missed from work (6%) and transportation costs (5%). In multivariable analysis, being uninsured (vs. publicly insured), younger (25-34 vs. 50-64 years), White (vs. Black), and not reporting income data were associated with perceiving screening costs and future treatment costs as barriers to screening. Participants reported wide-ranging estimates of the perceived out-of-pocket cost of screening ($0-$1300), with a median expected cost of $245. Conclusions: The majority of our sample of low-income women perceived substantial financial barriers to screening, particularly related to screening appointment costs and potential follow-up/future treatment costs. Providing greater cost transparency and access to financial assistance may reduce perceived financial barriers to screening, potentially increasing screening uptake among this underserved population. Clinicaltrials.gov registration number NCT02651883.
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Affiliation(s)
- Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer S Smith
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Health Behavior and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrea C Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Busola O Sanusi
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael G Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lynn Barclay
- American Sexual Health Association, Research Triangle Park, North Carolina, USA
| | - Sarah Jackson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Yoon S, Wang K, Luo Y, Lee J, Neese J, Lee H. Cancer Screening Literacy among Vietnamese Population: Does Annual Checkup Improve Cancer Screening Literacy? Asian Pac J Cancer Prev 2021; 22:927-933. [PMID: 33773559 PMCID: PMC8286676 DOI: 10.31557/apjcp.2021.22.3.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Colorectal, breast, and cervical cancers disproportionately impact the Vietnamese population. However, research on cancer prevention among this population was very limited. The purpose of this study is to examine the cancer screening literacy levels for these three types of cancers among rural Vietnamese and investigate correlates of cancer screening literacy. METHODS A sample of 226 Vietnamese men and women aged 25-70 years old was recruited from rural Vietnam and finished a self-administered questionnaire. Andersen's Behavioral Model was used to guide this cross-sectional study to identify modifiable variables. Bivariate analysis was used to explore the relationship between demographic factors and cancer screening literacy levels. Multiple linear regressions were also used to identify significant factors for cancer literacy levels. RESULTS Cancer screening literacy levels of Vietnamese men and women were low regarding all three types of cancers, especially HPV symptom questions. Only about 24% of women answered correctly on "most people with genital HPV have no visible signs/symptoms" and less than 18% answered correctly on "I can transmit HPV to my partner(s) even if I have no HPV symptoms." Findings suggested that having an annual checkup was associated with higher colorectal (β=.15, p <.05), breast (β=.25, p <.001), and cervical (β=.18, p <.01) cancer screening literacy. CONCLUSIONS Public health efforts should focus on encouraging annual checkups in the Vietnamese population. During the annual checkup, health care professionals should educate patients about importance of cancer screening and provide recommendations for regular cancer screenings to reduce cancer health disparities.
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Affiliation(s)
| | - Kun Wang
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Yan Luo
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Jongwook Lee
- Department of Agricultural Economics and Rural Development, Seoul National University, Building, Seoul, Republic of Korea
| | - Jessica Neese
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Hee Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
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Zhang Z, Yin AT, Bian Y. Willingness to Receive Periodic Health Examination Based on the Health Belief Model Among the Elderly in Rural China: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:1347-1358. [PMID: 34188452 PMCID: PMC8232960 DOI: 10.2147/ppa.s312806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study aimed to explore factors affecting behavioral intention of receiving periodic health examinations (hereafter, BIE) among people aged 60 and over in rural China, namely, Shandong Province, using the extended health belief model (EHBM). PATIENTS AND METHODS Participants were selected using stratified multi-stage random sampling. Three cities were selected based on economic level. Subsequently, three counties and three villages were selected from each sample city and county. Finally, 30 respondents were selected from each sample village. Face-to-face surveys were conducted using a structured questionnaire between March and September 2017. Multiple linear regression was conducted to investigate the association between BIE and eight dimensions of EHBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues to action, health knowledge, and social support. RESULTS Of the 509 rural respondents aged 60 years and older, the average score of behavioral intention was 4.43±0.80. Multivariate linear regression analysis demonstrated poor BIE among participants who were men, were current smoker, were current drinker, were aged 70 years or over, had lower social support, and perceived lower self-efficacy, less benefits, and more barriers. Among them, barriers were found to have the strongest association with BIE (B'=-0.556; p<0.001). Qualitative interviews revealed that reasons for not receiving periodic health examinations (PHE) included pain, cost, difficulty in finding a health care provider, time and scheduling, potential lack of trust in the physician, and value of the PHE. CONCLUSION This study highlighted the importance of psychological variables in the acceptance of PHE among the elderly in rural China and provided insights for further intervention designs targeting identified groups and performed by general practitioners. Addressing medical mistrust, strengthening, and enhancing one's social support network and health communication channels, such as bulletin boards, may serve to facilitate BIE.
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Affiliation(s)
- Zhuo Zhang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, People’s Republic of China
| | - Ai-Tian Yin
- School of Health Care Management, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Ying Bian
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, People’s Republic of China
- Correspondence: Ying Bian Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Room 2055, N22 Building, Taipa, Macau SAR, People’s Republic of ChinaTel +853-66548926 Email
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9
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Jun J, Kim J, Choi M, Heo Y. Cancer Control Continuum in Korean American Community Newspapers: What Is the Association with Source Nationality-US vs. Korea? J Racial Ethn Health Disparities 2020; 7:1059-1070. [PMID: 32198697 DOI: 10.1007/s40615-020-00729-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/05/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
Prior research suggests that cancer information obtained from Korean American community media, which are the primary health information sources among the population, does not connect to Korean Americans' increased cancer knowledge or cancer protective/detective behavior. We aim to identify the reason by analyzing cancer type, cancer control continuum, and cancer topic presented in Korean American community newspapers. The nationality of news source, US and Korea, and its association with the cancer coverage were examined. We found that among articles that cited any source, nearly one third used a source from Korea. The source nationality was associated with cancer coverage. In particular, cancer risk factors and screening were more likely to be discussed when a US source was cited as compared to when no source was cited. Korean sources were never or rarely observed in articles focusing on a few cancer sites (e.g., breast and prostate, which Korean Americans have higher risks compared to native Koreans), cancer preventive behaviors (diet, physical activity, no smoking), and specific cancer detection methods (mammogram, pap-smear). We suggest Korean American media to reflect the cancer priority and information needs among Korean Americans, which are varied from native Koreans, and to acknowledge the differences in cancer prevention and detection guidelines between the U.S. and Korean healthcare system. Also, the U.S. government should disseminate cancer screening and prevention guidelines, customized to racial/ethnic groups' cancer prevalence and communication preference.
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Affiliation(s)
- Jungmi Jun
- School of Journalism and Mass Communications, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA.
| | - Joonkyoung Kim
- School of Journalism and Mass Communications, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA
| | - Minhee Choi
- School of Journalism and Mass Communications, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA
| | - Yujin Heo
- School of Journalism and Mass Communications, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA
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Gottschlich A, Ochoa P, Rivera-Andrade A, Alvarez CS, Mendoza Montano C, Camel C, Meza R. Barriers to cervical cancer screening in Guatemala: a quantitative analysis using data from the Guatemala Demographic and Health Surveys. Int J Public Health 2019; 65:217-226. [PMID: 31838575 PMCID: PMC7049547 DOI: 10.1007/s00038-019-01319-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/21/2019] [Accepted: 12/02/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Examine the association between commonly reported barriers to health care, including discordant spoken languages between patients and providers, and reported previous cervical cancer screening. METHODS Data from the nationally representative Guatemala National Maternal and Child Health Survey from the Demographic and Health Surveys Program were used to explore associations between barriers and screening rates nationwide and in high-risk populations, such as rural and indigenous communities. Negative binomial regressions were run accounting for survey sample weights to calculate prevalence ratios. RESULTS 64.0%, 57.5% and 47.5% of women reported ever screening, in the overall, indigenous, and rural populations, respectively. Overall, never screened for cervical cancer was associated with the following health barriers: needing permission, cost, distance, not wanting to go alone, and primary language not spoken by health providers, even after adjustment for age, ethnicity, and literacy. CONCLUSIONS Offering screening programs alone is not enough to reduce the burden of cervical cancer in Guatemala. Measures need to be taken to reduce barriers to health care, particularly in rural areas, where screening rates are lowest.
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Affiliation(s)
- Anna Gottschlich
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Alvaro Rivera-Andrade
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama-INCAP, Guatemala City, Guatemala
| | - Christian S Alvarez
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Carlos Mendoza Montano
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama-INCAP, Guatemala City, Guatemala
| | - Claudia Camel
- Guatemala Ministry of Health and Social Assistance (MSPAS), Guatemala City, Guatemala
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Development and Evaluation of Culturally and Linguistically Tailored Mobile App to Promote Breast Cancer Screening. J Clin Med 2018; 7:jcm7080181. [PMID: 30042291 PMCID: PMC6111615 DOI: 10.3390/jcm7080181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/02/2022] Open
Abstract
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.
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12
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Instrument Adaptation, Modification, and Validation for Cultural Beliefs About Colorectal Cancer Screening Among Korean Americans. Cancer Nurs 2018; 41:E38-E48. [DOI: 10.1097/ncc.0000000000000523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cultural Factors Influencing Osteoarthritis Care in Asian Communities: A Review of the Evidence. J Community Health 2018; 43:816-826. [PMID: 29468518 DOI: 10.1007/s10900-018-0470-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
With the prevalence of osteoarthritis (OA) increasing internationally, there is a need to study the impact of this disease on culturally diverse populations. Individuals of Asian descent make up more than 60% of the world population, yet comprehensive information on the cultural factors that impact OA care is not available. Scoping review methodology using directed content analysis was employed to identify and analyze existing research on OA care for Asians. A categorization matrix was developed using the six care areas from the OA clinical practice guidelines along with an additional three non-clinical areas (cross-cultural adaptation of clinical tools; psychological well-being; family systems and informal care) identified in an initial scan resulting in a total of nine OA care areas to guide initial coding. A full scoping review was conducted across five databases resulting in 656 abstracts screened. All text was coded using the categorization matrix and resulting subthemes were identified. A total of 74 articles were analyzed with 23 subthemes identified across the nine categories. Four new perspectives emerged to support OA care for Asian populations: (1) the importance of family and peer assistance, (2) the importance of culturally specific activities, (3) distrust in western medicine, and (4) impact of positive coping mechanisms on health appraisals. While Asians are more susceptible to knee and hand OA because of their cultural lifestyle factors (e.g. squatting for chores, hygiene and religious activities), and traditional beliefs on OA management (e.g. traditional diet, topical oils, physical therapy), many do not present themselves for conventional treatments (e.g. surgery) until all traditional treatments are exhausted. The results suggest that cultural factors influence the uptake of OA management practices among Asians. Greater awareness of these cultural factors may improve diagnosis, treatment, and management of OA among Asian patients.
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When, How and Why is Loss-Framing More Effective than Gain- and
Non-Gain-Framing in the Promotion of Detection Behaviors? INTERNATIONAL REVIEW OF SOCIAL PSYCHOLOGY 2017. [DOI: 10.5334/irsp.15] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Karimy M, Azarpira H, Araban M. Using Health Belief Model Constructs to Examine Differences
in Adherence to Pap Test Recommendations among Iranian
Women. Asian Pac J Cancer Prev 2017; 18:1389-1394. [PMID: 28612592 PMCID: PMC5555552 DOI: 10.22034/apjcp.2017.18.5.1389] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Despite documented successful Pap tests in routine care of women, screening levels are unfortunately often lower than recommended. This study aimed to assess differences in adherence to Pap test guidelines among a sample of Iranian women using the Health Belief Model (HBM). In this descriptive and analytical study, information was collected from a total of 305 women, (age range of 15-49) from Zarandieh health centers in Iran using a random multistage sampling method. The questionnaire covered demographic characteristics; health belief model constructs were gathered by a self-report method. The results were analyzed using the independent samples t test and logistic regression in SPSS-20. A total 32% of the subjects had a history of a Pap test and the score mean of the whole constructs model (knowledge, susceptibility, severity, benefits, barriers and self-efficacy) in these individuals was higher than those without a positive history. Among the predictive variables of HBM constructs, the highest weights were observed for perceived benefits ß)=0.36), perceived susceptibility =ß) 0.35) and self-efficacy ß)=0.29). Based on our finding of positive relationships for health belief model structures with performance of a pap smear test, designing educational interventions for changing the knowledge levels and beliefs of women is recommended.
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Affiliation(s)
- Mahmood Karimy
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
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16
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Andreassen T, Weiderpass E, Nicula F, Suteu O, Itu A, Bumbu M, Tincu A, Ursin G, Moen K. Controversies about cervical cancer screening: A qualitative study of Roma women's (non)participation in cervical cancer screening in Romania. Soc Sci Med 2017; 183:48-55. [PMID: 28460211 DOI: 10.1016/j.socscimed.2017.04.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/23/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
Romania has Europe's highest incidence and mortality of cervical cancer. While a free national cervical cancer-screening programme has been in operation since 2012, participation in the programme is low, particularly in minority populations. The aim of this study was to explore Roma women's (non)participation in the programme from women's own perspectives and those of healthcare providers and policy makers. We carried out fieldwork for a period of 125 days in 2015/16 involving 144 study participants in Cluj and Bucharest counties. Fieldwork entailed participant observation, qualitative interviewing and focus group discussions. A striking finding was that screening providers and Roma women had highly different takes on the national screening programme. We identified four fundamental questions about which there was considerable disagreement between them: whether a free national screening programme existed in the first place, whether Roma women were meant to be included in the programme if it did, whether Roma women wanted to take part in screening, and to what degree screening participation would really benefit women's health. On the background of insights from actor-network theory, the article discusses to what degree the programme could be said to speak to the interest of its intended Roma public, and considers the controversies in light of the literature on patient centred care and user involvement in health care. The paper contributes to the understanding of the health and health-related circumstances of the largest minority in Europe. It also problematizes the use of the concept of "barriers" in research into participation in cancer screening, and exemplifies how user involvement can potentially help transform and improve screening programmes.
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Affiliation(s)
- Trude Andreassen
- Cancer Registry of Norway, Oslo, Norway; Institute of Health and Society, University of Oslo, Norway.
| | - Elisabete Weiderpass
- Cancer Registry of Norway, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Florian Nicula
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania
| | - Ofelia Suteu
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania; "Iuliu Haţieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreea Itu
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania
| | - Minodora Bumbu
- The Oncology Institute "Prof. Dr. Ion Chiricuţă" of Cluj-Napoca, Romania
| | - Aida Tincu
- "Iuliu Haţieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Kåre Moen
- Institute of Health and Society, University of Oslo, Norway
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17
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Fatalism and health promoting behaviors in Chinese and Korean immigrants and Caucasians. J Immigr Minor Health 2016; 17:165-71. [PMID: 24072515 DOI: 10.1007/s10903-013-9922-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fatalism has been associated with non-adherence to health behavior in the past. This study compared fatalism of Chinese and Korean immigrants with native-born Caucasians (N = 309) and examined whether the relationship between fatalism and exercise, nutrition and medical screening would be moderated by ethnicity. Chinese reported higher fatalism than Caucasians and Koreans. Higher fatalism was associated with greater exercise among Chinese and Koreans, but less reported exercise among Caucasians. Caucasian participants had higher scores for nutrition and medical screening compared with Chinese and Korean immigrants. These findings indicate that fatalism is more prevalent among Chinese immigrants; however, there is no evidence of a detrimental effect of fatalism on exercise, nutrition or medical screening among the Asian immigrants. Caucasians with higher fatalism may be at greater risk of future illnesses, given the association between fatalism and sedentary behavior in this group. Differences between cultural groups in the adoption of health behavior justify the development and assessment of targeted interventions to optimize health promoting behaviors.
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Fang CY, Ma GX, Handorf EA, Feng Z, Tan Y, Rhee J, Miller SM, Kim C, Koh HS. Addressing multilevel barriers to cervical cancer screening in Korean American women: A randomized trial of a community-based intervention. Cancer 2016; 123:1018-1026. [PMID: 27869293 DOI: 10.1002/cncr.30391] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/23/2016] [Accepted: 09/21/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Korean American women have among the lowest rates of cervical cancer screening in the United States. The authors evaluated a multicomponent intervention combining community education with navigation services to reduce access barriers and increase screening rates in this underserved population. It was hypothesized that cervical cancer screening rates would be higher among women who received the intervention program compared with those in the control program. METHODS Korean American women (N = 705) were recruited from 22 churches. In this matched-pair, group-randomized design, 347 women received the intervention, which consisted of a culturally relevant cancer education program combined with provision of navigation services. The control group (N = 358) received general health education, including information about cervical cancer risk and screening and where to obtain low-cost or no-cost screening. Screening behavior was assessed 12 months after the program. RESULTS Screening behavior data were obtained from 588 women 12 months after the program. In both site-level and participant-level analyses, the intervention program contributed to significantly higher screening rates compared with the control program (odds ratio [OR], 25.9; 95% confidence interval [CI], 10.1-66.1; P < .001). In sensitivity analysis, the treatment effect remained highly significant (OR, 16.7; 95% CI, 8.1-34.4; P < .001). CONCLUSIONS A multicomponent intervention combining community cancer education with navigation services yielded significant increases in cervical cancer screening rates among underscreened Korean American women. Community-accessible programs that incorporate cancer education with the delivery of key navigation services can be highly effective in increasing cervical cancer screening rates in this underserved population. Cancer 2017;123:1018-26. © 2016 American Cancer Society.
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Affiliation(s)
- Carolyn Y Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Elizabeth A Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Ziding Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Joanne Rhee
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Suzanne M Miller
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Charles Kim
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Han Seung Koh
- First Korean United Methodist Church of Cherry Hill, Cherry Hill, New Jersey
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19
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Lee HY, Lee MH. Barriers to Cervical Cancer Screening and Prevention in Young Korean Immigrant Women: Implications for Intervention Development. J Transcult Nurs 2016; 28:353-362. [DOI: 10.1177/1043659616649670] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Hee Yun Lee
- University of Minnesota–Twin Cities, St. Paul, MN, USA
| | - Mi Hwa Lee
- University of Minnesota–Twin Cities, St. Paul, MN, USA
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20
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Islam RM, Bell RJ, Billah B, Hossain MB, Davis SR. Lack of Understanding of Cervical Cancer and Screening Is the Leading Barrier to Screening Uptake in Women at Midlife in Bangladesh: Population-Based Cross-Sectional Survey. Oncologist 2015; 20:1386-92. [PMID: 26590177 DOI: 10.1634/theoncologist.2015-0235] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/23/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cancer (CCa) is the second most common cancer among women in Bangladesh. The uptake of CCa screening was less than 10% in areas where screening has been offered, so we investigated the awareness of CCa and CCa screening, and factors associated with women's preparedness to be screened. METHODS A nationally representative, cross-sectional survey of women aged 30-59 years was conducted in 7 districts of the 7 divisions in Bangladesh, using a multistage cluster sampling technique. Factors associated with the awareness of CCa and screening uptake were investigated separately, using multivariable logistic regression. RESULTS On systematic questioning, 81.3% and 48.6% of the 1,590 participants, whose mean age was 42.3 (±8.0) years, had ever heard of CCa and CCa screening, respectively. Having heard of CCa was associated with living in a rural area (adjusted odds ratio [OR]: 0.42; 95% confidence interval [CI]: 0.26-0.67), being 40-49 years old (OR: 1.59; 95% CI: 1.15-2.0), having no education (OR: 0.25; 95% CI: 0.16-0.38), and being obese (OR: 2.04; 95% CI: 1.23-3.36). Of the 773 women who had ever heard of CCa screening, 86% reported that they had not been screened because they had no symptoms and 37% did not know screening was needed. Only 8.3% had ever been screened. Having been screened was associated with being 40-49 years old (OR: 2.17; 95% CI: 1.19-3.94) and employed outside the home (OR: 3.83; 95% CI: 1.65-8.9), and inversely associated with rural dwelling (OR: 0.54; 95% CI: 0.30-0.98) and having no education (OR: 0.29; 95% CI: 0.10-0.85). CONCLUSION Lack of awareness of CCa and of understanding of the concept of screening are the key barriers to screening uptake in women at midlife in Bangladesh. Targeted educational health programs are needed to increase screening in Bangladesh with the view to reducing mortality.
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Affiliation(s)
- Rakibul M Islam
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Baki Billah
- Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mohammad B Hossain
- Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Bahmani A, Baghianimoghadam MH, Enjezab B, Mazloomy Mahmoodabad SS, Askarshahi M. Factors Affecting Cervical Cancer Screening Behaviors Based On the Precaution Adoption Process Model: A Qualitative Study. Glob J Health Sci 2015; 8:211-8. [PMID: 26755465 PMCID: PMC4954902 DOI: 10.5539/gjhs.v8n6p211] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/25/2015] [Accepted: 11/17/2015] [Indexed: 11/12/2022] Open
Abstract
One of the most preventable cancers in women is cervical cancer. Pap smear test is an effective screening program; however, it is not conducted very frequently. The aim of this study is explaining the determinants affecting women's participation in the Pap smear test based on precaution adoption process model with a qualitative approach. This study was a qualitative approach using a Directed Content Analysis methodology which was conducted in 2014. Participants were 30 rural women who participated in this study voluntarily in sarvabad, Iran. Purposive sampling was initiated and continued until data saturation. Semi-structured interviews were the primary method of data collection. Data were analyzed using qualitative content analysis and continuous comparisons. Women`s information and awareness about cervical cancer and Pap smear is insufficient and most of them believed that they were not at risk; however, they perceived the severity of the disease. Some of them had no adequate understanding of the test benefits. They pointed to the lack of time, financial difficulties, fear of test result and lack of awareness as the main barriers against the Pap smear test; however, they did not say that they were not willing to do the test. Findings could help health policy makers to find the right area and purpose to facilitate the participation of women in the Pap smear test.
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Affiliation(s)
- Afshin Bahmani
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran..
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22
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Khani Jeihooni A, Kashfi SM, Bahmandost M, Kashfi SH. The Survey of Factors Affecting Pap Smears Based on Health Belief Model in Health Centers in Fasa, Fars Province, Iran. WOMEN’S HEALTH BULLETIN 2015. [DOI: 10.17795/whb-25565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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The effect of message framing and the nature of the targeted illness on individuals’ intention to participate in clinical trials. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY 2015. [DOI: 10.1016/j.erap.2015.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Lee SY. Cultural Factors Associated with Breast and Cervical Cancer Screening in Korean American Women in the US: An Integrative Literature Review. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:81-90. [PMID: 26160234 DOI: 10.1016/j.anr.2015.05.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 02/03/2015] [Accepted: 02/05/2015] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Shin-Young Lee
- Department of Nursing, Chosun University, Gwangju, South Korea.
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25
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Chawla N, Breen N, Liu B, Lee R, Kagawa-Singer M. Asian American women in California: a pooled analysis of predictors for breast and cervical cancer screening. Am J Public Health 2015; 105:e98-e109. [PMID: 25521898 DOI: 10.2105/ajph.2014.302250] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined patterns of cervical and breast cancer screening among Asian American women in California and assessed their screening trends over time. METHODS We pooled weighted data from 5 cycles of the California Health Interview Survey (2001, 2003, 2005, 2007, 2009) to examine breast and cervical cancer screening trends and predictors among 6 Asian nationalities. We calculated descriptive statistics, bivariate associations, multivariate logistic regressions, predictive margins, and 95% confidence intervals. RESULTS Multivariate analyses indicated that Papanicolaou test rates did not significantly change over time (77.9% in 2001 vs 81.2% in 2007), but mammography receipt increased among Asian American women overall (75.6% in 2001 vs 81.8% in 2009). Length of time in the United States was associated with increased breast and cervical cancer screening among all nationalities. Sociodemographic and health care access factors had varied effects, with education and insurance coverage significantly predicting screening for certain groups. Overall, we observed striking variation by nationality. CONCLUSIONS Our results underscore the need for intervention and policy efforts that are targeted to specific Asian nationalities, recent immigrants, and individuals without health care access to increase screening rates among Asian women in California.
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Affiliation(s)
- Neetu Chawla
- Neetu Chawla is with Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD. Nancy Breen is with Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute. Benmei Liu is with Statistical Methodology and Applications Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute. Richard Lee is with Information Management Services, Inc, Calverton, MD. Marjorie Kagawa-Singer is with UCLA School of Public Health and Asian American Studies Department, Los Angeles, CA
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26
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Decker KM, Singh H. Reducing inequities in colorectal cancer screening in North America. J Carcinog 2014; 13:12. [PMID: 25506266 PMCID: PMC4253036 DOI: 10.4103/1477-3163.144576] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 10/14/2014] [Indexed: 12/26/2022] Open
Abstract
Colorectal cancer (CRC) is an important cause of mortality and morbidity in North America. Screening using a fecal occult blood test, flexible sigmoidoscopy, or colonoscopy reduces CRC mortality through the detection and treatment of precancerous polyps and early stage CRC. Although CRC screening participation has increased in recent years, large inequities still exist. Minorities, new immigrants, and those with lower levels of education or income are much less likely to be screened. This review provides an overview of the commonly used tests for CRC screening, disparities in CRC screening, and promising methods at the individual, provider, and system levels to reduce these disparities. Overall, to achieve high CRC participation rates and reduce the burden of CRC in the population, a multi-faceted approach that uses strategies at all levels to reduce CRC screening disparities is urgently required.
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Affiliation(s)
- Kathleen M Decker
- Department of Community Health Sciences, University of Manitoba, Canada ; Screening Programs, Cancer Care Manitoba, Canada
| | - Harminder Singh
- Department of Community Health Sciences, University of Manitoba, Canada ; Department of Internal Medicine, University of Manitoba, Canada ; Department of Haematology and Medical Oncology, Cancer Care Manitoba, Canada
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Jeudin P, Liveright E, Del Carmen MG, Perkins RB. Race, ethnicity, and income factors impacting human papillomavirus vaccination rates. Clin Ther 2014; 36:24-37. [PMID: 24417783 DOI: 10.1016/j.clinthera.2013.11.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) infection and cervical cancer disproportionately affect low-income and minority women. HPV vaccines have the potential to either reduce or exacerbate racial disparities in HPV-related diseases and cervical cancers, depending on the equitability of vaccine uptake. OBJECTIVES This review aims to identify barriers and facilitators of equitable uptake of HPV vaccination among low-income and minority girls. This review discusses factors related to race, ethnicity, and income that are associated with initiation and completion rates of the 3-dose HPV vaccine series and presents targets for intervention. METHODS We reviewed relevant English-language literature to identify current vaccination rates and factors associated with vaccine uptake. Study findings related to race (black, Latino, Asian), and incomes were summarized. RESULTS Current trends in the United States indicate low uptake among all adolescents, and that rates stagnated between 2011 and 2012. Low-income and minority adolescents are equally or more likely to start the HPV vaccination series than are white and higher-income adolescents, but are less likely to complete all 3 shots. Provider recommendation is a key factor in HPV vaccination, and minorities are less likely to report receiving recommendations for HPV vaccination. CONCLUSIONS As black, Hispanic, and Asian populations continue to grow in the United States over the next several decades, it is imperative that we not only improve HPV vaccination rates overall, but also focus on high-risk populations to prevent an increase in cervical cancer disparities.
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Affiliation(s)
- Patricia Jeudin
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Elizabeth Liveright
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rebecca B Perkins
- Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts.
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Park H, Park MS. Cancer information-seeking behaviors and information needs among Korean Americans in the online community. J Community Health 2014; 39:213-20. [PMID: 24198135 DOI: 10.1007/s10900-013-9784-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Korean Americans tend to have less access to health service and cancer screening tests than all US population. It is necessary to understand their current cancer information-seeking behaviors and information needs to more effectively provide adequate cancer information. However, there is little known about their cancer information seeking behaviors and needs. The purpose of the study was to understand cancer information seeking behaviors and information needs among Korean Americans. Data were collected from MissyUSA, which is one of the biggest websites for the Korean community in the USA. A total of 393 free-texts from January to June 2013 were reviewed; 120 were deleted because the messages were not related to cancer health information. A total of 273 posted free-texts were analyzed for this study, using an open source text-mining software program called AntConc 3.2.4. The extracted terms were categorized based on coding systems, after linguistic variations were handled. Terms such as "surgery," "breast cancer," "examination," "cancer" (unspecified), "Korea," and "pain" were most frequently identified. Medical topics accounted for 71.4 % of the main topics of the postings. Treatment was the most frequently discussed in the medical topics while in the non-medical category, the most frequently discussed topic was recommendations for hospitals or doctors. In relation to types of cancer, breast cancer was the greatest concern, followed by cervical and liver cancer. The findings from this study can help in establishing more effective strategies to provide better cancer information among Korean Americans by assessing their cancer information seeking trends and information needs.
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Affiliation(s)
- Hyejin Park
- College of Nursing, Florida State University, 98 Varsity Way, PO Box 3064310, Tallahassee, FL, 32306-4310, USA,
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29
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Lee HY, Koopmeiners JS, Rhee TG, Raveis VH, Ahluwalia JS. Mobile phone text messaging intervention for cervical cancer screening: changes in knowledge and behavior pre-post intervention. J Med Internet Res 2014; 16:e196. [PMID: 25164545 PMCID: PMC4180333 DOI: 10.2196/jmir.3576] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/28/2014] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work and University of Minnesota Masonic Cancer Center, College of Education and Human Development, University of Minnesota, Twin Cities, St Paul, MN, United States.
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Sogukpinar N, Saydam BK, Can HO, Hadimli A, Bozkurt OD, Yucel U, Kocak YC, Akmese ZB, Demir D, Ceber E, Ozenturk G. Assessment of cervical cancer risk in women between 15 and 49 years of age: case of Izmir. Asian Pac J Cancer Prev 2014; 14:2119-25. [PMID: 23679329 DOI: 10.7314/apjcp.2013.14.3.2119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to determine risk factors for cervical cancer for women in Izmir. METHODS This cross-sectional, descriptive field covered a population of 4319 women of reproductive age (15-49) (household registration in the Mukhtar's office-2007). A total of 1,637 women were included in the sample given a four-part questionnaire through face-to-face interview by visiting the women in their homes in order to determine socio-demographic factors, obstetric history, genital hygiene and the use of family planning methods. In addition, during the data collection process, the women were given group training in order to raise awareness of cervical cancer. The number and percentage distributions of the data were calculated. RESULTS While the average age of the women was 31.9±9.77 (Min: 15.00-Max: 49.00), education level of 43.4% of them was elementary school only. It was determined that 70.3% of the women experienced at least one pregnancy, 71.0% had vaginal delivery and 75.9% used a contraceptive method. In the study it was determined that among the cervical cancer related risks vaginal delivery, vaginal lavage and having three or more pregnancies had the highest rates, while having sexual intercourse before 16 years of age and having more than one sexual partner constituted lower rates. The rate of the women who stated not having a smear in the last three years was 82.4%. CONCLUSIONS Considering the case in terms of having Pap smear test, women's awareness on the risk factors and early diagnosis of cervical cancer was found to be low. Due to this reason, awareness of women has to be raised through education.
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Affiliation(s)
- Neriman Sogukpinar
- Department of Midwifery, Ege University Izmir Ataturk School of Health, Bornova, Izmir, Turkey
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De Abreu C, Horsfall H, Learmonth D. Adherence barriers and facilitators for cervical screening amongst currently disadvantaged women in the greater Cape Town region of South Africa. Afr J Prim Health Care Fam Med 2013. [PMCID: PMC4709491 DOI: 10.4102/phcfm.v5i1.492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background In South Africa cervical cancer is the second most commonly occurring cancer amongst women, and black African women have the highest risk of developing this disease. Unfortunately, the majority of South African women do not adhere to recommended regular cervical screening. Objectives The purpose of this research was to explore the perceptions, experiences and knowledge regarding cervical screening of disadvantaged women in two informal settlements in South African urban areas. Method The Health Belief Model (HBM) provided a theoretical framework for this study. Four focus groups (n = 21) were conducted, using questions derived from the HBM, and thematic analysis was used to analyse the data. The ages of the women who participated ranged from 21 to 53 years. Results The analysis revealed lack of knowledge about screening as a key structural barrier to treatment. Other structural barriers were: time, age at which free screening is available, and health education. The psychosocial barriers that were identified included: fear of the screening procedure and of the stigmatisation in attending screening. The presence of physical symptoms, the perception that screening provides symptom relief, HIV status, and the desire to know one's physical health status were identified as facilitators of cervical screening adherence. Conclusion This knowledge has the potential to inform healthcare policy and services in South Africa. As globalisation persists and individuals continue to immigrate or seek refugee status in foreign countries, increased understanding and knowledge is required for successful acculturation and integration. Developed countries may therefore also benefit from research findings in developing countries.
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Affiliation(s)
| | - Hannah Horsfall
- Psychology Department, University of Cape Town, South Africa
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Korean Americans' Beliefs about Colorectal Cancer Screening. Asian Nurs Res (Korean Soc Nurs Sci) 2013; 7:45-52. [DOI: 10.1016/j.anr.2012.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 09/07/2012] [Accepted: 09/29/2012] [Indexed: 11/19/2022] Open
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Jeudin P, Liveright E, del Carmen MG, Perkins RB. Race, ethnicity and income as factors for HPV vaccine acceptance and use. Hum Vaccin Immunother 2013; 9:1413-20. [PMID: 23571170 DOI: 10.4161/hv.24422] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
If distributed equitably, Human Papillomavirus (HPV) vaccines have the potential to reduce racial disparities in HPV-related diseases and cervical cancers. However, current trends in the US indicate low uptake among all adolescents, with persistent disparities among minority and low-income adolescents despite largely positive views of vaccination among their parents. As Black, Hispanic, and Asian populations continue to grow in the US over the next 40 y, it is imperative that we not only improve HPV vaccination rates overall, but focus on high-risk populations to prevent an increase in cervical cancer disparities. This review discusses initiation and completion rates of the three-dose HPV vaccine series among adolescents in high-risk groups and describes cultural similarities and differences in motivation and barriers to vaccination. The goal of this review is to highlight factors leading to vaccination in different adolescent racial groups and to help guide the development of strategies to increase rates of vaccine initiation and completion among groups at the highest risk for developing cervical cancer.
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Affiliation(s)
- Patricia Jeudin
- Boston University School of Medicine; Boston Medical Center; Boston, MA USA
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Ma GX, Gao W, Fang CY, Tan Y, Feng Z, Ge S, Nguyen JA. Health beliefs associated with cervical cancer screening among Vietnamese Americans. J Womens Health (Larchmt) 2013; 22:276-88. [PMID: 23428284 DOI: 10.1089/jwh.2012.3587] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vietnamese American women represent one of the ethnic subgroups at great risk for cervical cancer in the United States. The underutilization of cervical cancer screening and the vulnerability of Vietnamese American women to cervical cancer may be compounded by their health beliefs. OBJECTIVE The objective of this study was to explore the associations between factors of the Health Belief Model (HBM) and cervical cancer screening among Vietnamese American women. METHODS Vietnamese American women (n=1,450) were enrolled into the randomized controlled trial (RCT) study who were recruited from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey. Participants completed baseline assessments of demographic and acculturation variables, health care access factors, and constructs of the HBM, as well as health behaviors in either English or Vietnamese. RESULTS The rate of those who had ever undergone cervical cancer screening was 53% (769/1450) among the participants. After adjusting for sociodemographic variables, the significant associated factors from HBM included: believing themselves at risk and more likely than average women to get cervical cancer; believing that cervical cancer changes life; believing a Pap test is important for staying healthy, not understanding what is done during a Pap test, being scared to know having cervical cancer; taking a Pap test is embarrassing; not being available by doctors at convenient times; having too much time for a test; believing no need for a Pap test when feeling well; and being confident in getting a test. CONCLUSION Understanding how health beliefs may be associated with cervical cancer screening among underserved Vietnamese American women is essential for identifying the subgroup of women who are most at risk for cervical cancer and would benefit from intervention programs to increase screening rates.
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Affiliation(s)
- Grace X Ma
- Department of Public Health, Center for Asian Health, Temple University, Philadelphia, Pennsylvania 19122, USA.
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Somanchi M, Juon HS, Rimal R. Predictors of screening mammography among Asian Indian American women: a cross-sectional study in the Baltimore-Washington metropolitan area. J Womens Health (Larchmt) 2013; 19:433-41. [PMID: 20141384 DOI: 10.1089/jwh.2008.0873] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess adherence to screening mammography guidelines and examine predictors of having a mammogram in the past 2 years among immigrant Asian Indian women (AIW) aged > or = 40 years. METHODS Face-to-face surveys of 418 AIW in the Baltimore-Washington metropolitan area were conducted. Subjects were recruited through Asian Indian (AI) religious and other community-based organizations. RESULTS Of the 418 AIW surveyed, 83% had ever had a mammogram, and 70% had obtained a mammogram within the past 2 years. AIW who had lived in the United States for > 10 years had a higher rate of obtaining a mammogram (75.4%) within the past 2 years than did those who had lived in the United States for < or = 10 years (24.6%). In multiple logistic regression analysis, length of stay in the United States, marital status, knowledge of mammogram guidelines, age, having health insurance, physician recommendations, and number of relatives who had a mammogram were positively associated with having a mammogram within the past 2 years. Physician ethnicity and not having a healthcare provider were negatively associated with having a mammogram within the past 2 years. CONCLUSIONS This study lays a foundation for designing guidelines for interventions to improve mammography screening behaviors among AIW women. Increasing the use of mammogram to the levels recommended by guidelines will require a two-pronged approach directed at both AIW and AI physicians.
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Affiliation(s)
- Meena Somanchi
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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Laranjeira CA. Portuguese women's knowledge and health beliefs about cervical cancer and its screening. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:150-157. [PMID: 23461350 DOI: 10.1080/19371918.2011.592042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Currently little is known about Portuguese women's knowledge and beliefs about cervical cancer screening, so this information is crucial to the success of cervical cancer screening programs. The intention of this study was to describe the knowledge and beliefs of women in Portugal. In-depth, face-to-face, individual interviews were conducted. Twenty-five females were recruited, the age range was 30 to 60. The results showed a lack of knowledge on cervical cancer and the Pap smear test. From a public policy point of view, it may be important to further explore the extent to which perceived barriers to screening will affect screening uptake when a national screening program is implemented.
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Why are women with cervical cancer not being diagnosed in preinvasive phase? An analysis of risk factors using a hierarchical model. Int J Gynecol Cancer 2012; 22:645-53. [PMID: 22343973 DOI: 10.1097/igc.0b013e318246a1af] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess the risk factors for delayed diagnosis of uterine cervical lesions. MATERIALS AND METHODS This is a case-control study that recruited 178 women at 2 Brazilian hospitals. The cases (n = 74) were composed of women with a late diagnosis of a lesion in the uterine cervix (invasive carcinoma in any stage). The controls (n = 104) were composed of women with cervical lesions diagnosed early on (low- or high-grade intraepithelial lesions). The analysis was performed by means of logistic regression model using a hierarchical model. The socioeconomic and demographic variables were included at level I (distal). Level II (intermediate) included the personal and family antecedents and knowledge about the Papanicolaou test and human papillomavirus. Level III (proximal) encompassed the variables relating to individuals' care for their own health, gynecologic symptoms, and variables relating to access to the health care system. RESULTS The risk factors for late diagnosis of uterine cervical lesions were age older than 40 years (odds ratio [OR] = 10.4; 95% confidence interval [CI], 2.3-48.4), not knowing the difference between the Papanicolaou test and gynecological pelvic examinations (OR, = 2.5; 95% CI, 1.3-4.9), not thinking that the Papanicolaou test was important (odds ratio [OR], 4.2; 95% CI, 1.3-13.4), and abnormal vaginal bleeding (OR, 15.0; 95% CI, 6.5-35.0). Previous treatment for sexually transmissible disease was a protective factor (OR, 0.3; 95% CI, 0.1-0.8) for delayed diagnosis. CONCLUSIONS Deficiencies in cervical cancer prevention programs in developing countries are not simply a matter of better provision and coverage of Papanicolaou tests. The misconception about the Papanicolaou test is a serious educational problem, as demonstrated by the present study.
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Armstrong N, James V, Dixon-Woods M. The role of primary care professionals in women's experiences of cervical cancer screening: a qualitative study. Fam Pract 2012; 29:462-6. [PMID: 22090193 DOI: 10.1093/fampra/cmr105] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The UK Cervical Screening Programme, delivered mostly through primary care, commands impressive levels of public support. However, considerable evidence suggests that women find the experience of screening problematic. OBJECTIVE To investigate this tension using women's accounts of cervical screening, with a view to informing practice to better meet their needs. METHODS A qualitative interview study with 34 participants focussed on their experiences and understandings of cervical cancer screening in the UK. Analysis was based on the constant comparative method. RESULTS The highly intimate and personal nature of the test is challenging, and many women report unsatisfactory experiences. Problematic issues include: embarrassment and discomfort (sometimes severe) in exposing an intimate and personal part of their body; surrendering control and finding the test painful, uncomfortable and personally threatening. Though there is an important role for primary health care professionals in easing discomfort and facilitating positive experiences, women often report feeling disappointed with how the procedure is conducted. Women suggest that practitioners' attempts to normalize the interaction and maintain a degree of detachment could have the perverse effect of making them feel more uncomfortable and that more personalization would be welcome. CONCLUSIONS This work identifies the ways in which women may find personal engagement with cervical screening difficult and demonstrates the important role of primary care practitioners in contributing to women's experiences of the encounter. We draw on Erving Goffman's work on the 'interaction order' to explain some of the problems reported by women and to help inform good practice in primary care.
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Affiliation(s)
- Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Oh KM, Kreps GL, Jun J, Chong E, Ramsey L. Examining the health information-seeking behaviors of Korean Americans. JOURNAL OF HEALTH COMMUNICATION 2012; 17:779-801. [PMID: 22642692 DOI: 10.1080/10810730.2011.650830] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Many Korean Americans suffer from high levels of cancer incidence and have low cancer screening rates. A significant number of Korean Americans lack adequate information about cancer screening tests. However, little is known about their health behaviors. This article examines exposure to mass media and health information-seeking behaviors for Korean Americans, and their associations with demographic characteristics influencing variations in exposure to the different health information and trust in health information sources. The authors gathered data for this study using a cross-sectional, community-based survey conducted in the Washington, DC, metropolitan area during 2006 and 2007. It was administered to 254 Korean Americans who were 40 years of age or older. This study is part of the first health-related program of research to study exposure to mass media, health and cancer information sources, and seeking preferences and experiences of Korean Americans. Results indicated that Korean ethnic media sources and Internet are important sources used regularly. Age, years of education completed, and English proficiency levels for Korean Americans significantly predicted the likelihood of their Internet use. Low-income Korean Americans with less education were more likely to seek health information in Korean ethnic magazines and newspapers, whereas Korean Americans with higher education and English proficiency were more likely to seek information online. The most trusted source of health information among respondents was from a doctor or other health care professional. Future research should be conducted to determine whether physicians are actually used as a primary source for health information.
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Affiliation(s)
- Kyeung Mi Oh
- School of Nursing, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA.
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Lu M, Moritz S, Lorenzetti D, Sykes L, Straus S, Quan H. A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women. BMC Public Health 2012; 12:413. [PMID: 22676147 PMCID: PMC3488494 DOI: 10.1186/1471-2458-12-413] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 05/12/2012] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Mingshan Lu
- Departments of Economics and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Salman KF. Health beliefs and practices related to cancer screening among Arab Muslim women in an urban community. Health Care Women Int 2012; 33:45-74. [PMID: 22150266 DOI: 10.1080/07399332.2011.610536] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In this exploratory study I investigated the participation status in breast and cervical cancer screening of a group of American immigrant Arab Muslim women (AMW). Perceived knowledge of and barriers to screening participation, relationships among demographic variables, health practice and beliefs, and self-reports of traditionalism and acculturation also are studied. Factors including religious and cultural beliefs, economic concerns, and modesty and embarrassment were considered. To reach the goals of Healthy People 2010 (HP 2010), an effective and meaningful educational initiative to raise awareness about breast and cervical cancer of AMW will require specific interventions consistent with their cultural and religious traditions.
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Affiliation(s)
- Khlood Faik Salman
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania 15282, USA.
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Lee EE, Eun Y, Lee SY, Nandy K. Age-related differences in health beliefs regarding cervical cancer screening among Korean American women. J Transcult Nurs 2012; 23:237-45. [PMID: 22477716 DOI: 10.1177/1043659612441015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cervical cancer screening rates among older Korean American (KA) women are much lower than the rates for younger KA women, even though the overall cancer screening rates in the population continue to have one of the lowest Papanicolaou (Pap) test adherence rates compared with non-Hispanic White women. Variables based on the Health Belief Model related to cervical cancer screening were compared by age group among KA women. A telephone survey was conducted with 189 KA women living in the midwestern United States. Perceived barriers to having a Pap test predicted the outcome variable of having had Pap tests in the preceding 3 years in older KA women who were 65 or older, but not in younger women who were between 40 and 64 years old. Having physical examinations without symptoms in the preceding 2 years predicted the outcome variable in both age groups. Intervention strategies for all KA women should focus on encouraging them to receive routine physical examinations. In addition, attempts should be made to reduce perception of barriers in older KA women to improve their cervical cancer screening behaviors.
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Affiliation(s)
- Eunice E Lee
- University of California, Los Angeles, Los Angeles, CA, USA.
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Yoo GJ, Le MN, Vong S, Lagman R, Lam AG. Cervical cancer screening: attitudes and behaviors of young Asian American women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2011; 26:740-6. [PMID: 21553330 PMCID: PMC3880118 DOI: 10.1007/s13187-011-0230-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Compared to other racial/ethnic groups, Korean, Filipino, and Vietnamese American women experience high incidence rates of cervical cancer but low rates of cervical cancer screenings. This study examines the behaviors and attitudes towards screening in young Korean, Filipino, and Vietnamese American women (n = 304) in the San Francisco Bay Area. Results indicated Vietnamese American (OR = 2.51) and Filipino American (OR = 2.31) women had greater odds of ever having a Pap test than Korean American women. Those older (OR = 1.55), born in the USA (OR = 2.64), and those comfortable with the test (OR = 3.41) also had greater odds of ever having a Pap test. Correct knowledge of cervical cancer and the human papillomavirus did not significantly affect the odds of having a Pap test. Interventions to increase Pap testing in these populations should focus on increasing levels of comfort and should target those younger and foreign born.
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Affiliation(s)
- Grace J Yoo
- Asian American Studies Department, San Francisco State University, San Francisco, CA 94132-4252, USA.
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Park MJ, Park EC, Choi KS, Jun JK, Lee HY. Sociodemographic gradients in breast and cervical cancer screening in Korea: the Korean National Cancer Screening Survey (KNCSS) 2005-2009. BMC Cancer 2011; 11:257. [PMID: 21682886 PMCID: PMC3144456 DOI: 10.1186/1471-2407-11-257] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 06/17/2011] [Indexed: 11/25/2022] Open
Abstract
Background Cancer screening rates in Korea for five cancer types have increased steadily since 2002. With regard to the life-time cancer screening rates in 2009 according to cancer sites, the second highest was breast cancer (78.1%) and the third highest was cervical cancer (76.1%). Despite overall increases in the screening rate, disparities in breast and cervical cancer screening, based on sociodemographic characteristics, still exist. Methods Data from 4,139 women aged 40 to74 years from the 2005 to 2009 Korea National Cancer Screening Survey were used to analyze the relationship between sociodemographic characteristics and receiving mammograms and Pap smears. The main outcome measures were ever having had a mammogram and ever having had a Pap smear. Using these items of information, we classified women into those who had had both types of screening, only one screening type, and neither screening type. We used logistic regression to investigate relationships between screening history and sociodemographic characteristics of the women. Results Being married, having a higher education, a rural residence, and private health insurance were significantly associated with higher rates of breast and cervical cancer screening after adjusting for age and sociodemographic factors. Household income was not significantly associated with mammograms or Pap smears after adjusting for age and sociodemographic factors. Conclusions Disparities in breast and cervical cancer screening associated with low sociodemographic status persist in Korea.
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Affiliation(s)
- Mi Jin Park
- National Cancer Control Institute, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Korea.
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Oh KM, Kreps GL, Jun J, Ramsey L. Cancer information seeking and awareness of cancer information sources among Korean Americans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2011; 26:355-364. [PMID: 21210270 DOI: 10.1007/s13187-010-0191-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Many Korean Americans (KAs) suffer high cancer incidence levels and have low cancer screening rates. A significant number of KAs lack adequate information about cancer screening tests. However, little is known about the health information seeking behaviors of KAs. This study examines the types of cancer information searched for, the cancer information seeking experiences, and the awareness of major cancer information sources, such as the National Cancer Institutes (NCI) and the NCI's Cancer Information Service, among KAs. It also examines associations with demographic characteristics and media use influencing variations in the awareness of cancer information sources. Data for this study were gathered with a cross-sectional, community-based survey (254 KAs). The survey results indicated that KA's involvement in cancer information seeking is relatively low, and they have somewhat negative experiences in seeking cancer information. In addition, their awareness of cancer information sources was limited. Despite of the heavy use of Korean ethnic media, it did not connect to cancer information source awareness. Rather, use of US mainstream media was significantly related with awareness. Campaigns using the Korean language through partnerships with Korean ethnic media to inform KAs about credible sources of health information appear to be warranted by our findings.
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Affiliation(s)
- Kyeung Mi Oh
- School of Nursing, George Mason University, Fairfax, Virginia, VA 22030, USA.
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Mosavel M. Health promotion and cervical cancer in South Africa: why adolescent daughters can teach their mothers about early detection. Health Promot Int 2011; 27:157-66. [PMID: 21421580 DOI: 10.1093/heapro/dar014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The notion that adolescent daughters can provide their mothers with health information that could actually impact the mothers' behavior is a novel area of health promotion research. The goal of this study is to explore the reasons why adolescent daughters would give their mothers cervical cancer information, and why mothers would have the intent to listen to advice to obtain a Pap smear. We randomly selected and interviewed 157 mother and daughter dyads in Cape Town, South Africa. Almost one-fourth of mothers (22%) indicated never having had a Pap smear, while 92% of their daughters said their mother has never talked to them about cervical cancer or a Pap smear. Willingness of daughters to ask their mothers to obtain a Pap smear was high (80%). Motivations included the important health benefit and the sense of responsibility to share life saving information. Most mothers said they would definitely obtain a Pap smear when advised by their daughter (74%), while 25% said they would have to think about it and 1% said they would not listen. Mothers' main motivations included the direct health benefit and a strong sense of duty and responsibility to listen to her daughter. This study provides important information about the reasons why an upward (child to parent) health intervention may be feasible. The values of duty and responsibility, especially as it manifests within the family, hold promise for informing health promotion interventions directed at multiple generations.
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Affiliation(s)
- Maghboeba Mosavel
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, McGuire Hall Annex, 1st Floor, 1112 East Clay Street, PO Box 980149, Richmond, VA 23298-0149, USA.
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Fang CY, Ma GX, Tan Y. Overcoming Barriers to Cervical Cancer Screening Among Asian American Women. ACTA ACUST UNITED AC 2011; 4:77-83. [PMID: 21687826 DOI: 10.7156/v4i2p077] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Significant disparities in cervical cancer incidence and mortality exist among ethnic minority women, and in particular, among Asian American women. These disparities have been attributed primarily to differences in screening rates across ethnic/racial groups. Asian American women have one of the lowest rates of screening compared to other ethnic/racial groups. Yet Asian Americans, who comprise one of the fastest growing populations in the United States, have received the least attention in cancer control research. Studies suggest that various factors, including lack of knowledge, psychosocial and cultural beliefs, and access barriers, are associated with cervical cancer screening behaviors among Asian American women. Indeed, the few interventions that have been developed for Asian American women demonstrate that targeting these factors can yield significant increases in screening rates. It is important to note, however, that the effectiveness of educational interventions is often attenuated if access barriers are not adequately addressed. Hence, interventions that include key essential components, such as the use of community individuals as lay health workers, culturally-tailored and linguistically-appropriate educational materials, and navigation assistance to overcome access barriers, are more likely to be successful in enhancing screening rates. As the benefits of community-based cervical cancer prevention programs become more apparent, it will be essential to identify effective approaches for disseminating such programs more broadly. In conclusion, community-based cervical cancer screening programs have demonstrated promise in addressing existing cervical cancer disparities by increasing awareness and knowledge and promoting recommended screening behaviors. These findings will be instrumental in guiding future community-based programs to reduce cervical cancer health disparities among Asian American women.
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Affiliation(s)
- Carolyn Y Fang
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Robert C. Young Pavilion, 4 Floor, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111, Tel: 215-728-4062, ,
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Tran JH, Mouttapa M, Ichinose TY, Pang JK, Ueda D, Tanjasiri SP. Sources of information that promote breast and cervical cancer knowledge and screening among native Hawaiians in Southern California. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2010; 25:588-94. [PMID: 20237883 PMCID: PMC3709576 DOI: 10.1007/s13187-010-0078-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Breast and cervical cancers are the second and fourth leading causes of cancer death among Asian and Pacific Islander women. Despite screening exams that can detect these cancers early and increase survival, racial and ethnic populations continue to be disproportionately affected. This study examined the sources of information and their impacts on cancer screening compliance among native Hawaiians in Orange County, California. A community-based participatory research approach was used to conceive, design, implement, and analyze data. A relatively small proportion of the study's native Hawaiian women were compliant with recommended breast and cervical cancer screenings, and their screening rates were below the national Healthy People 2010 standards. Knowledge of screening procedures, seeking advice from a doctor, and obtaining information from internet medical sites were associated with higher rates of compliance with cancer-screening procedures.
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Affiliation(s)
- Jacqueline H Tran
- Orange County Asian and Pacific Islander Community Alliance, 12900 Garden Grove Blvd., Suite 214A, Garden Grove, CA 92843, USA.
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Lee HY, Vang S. Barriers to cancer screening in Hmong Americans: the influence of health care accessibility, culture, and cancer literacy. J Community Health 2010; 35:302-14. [PMID: 20140486 DOI: 10.1007/s10900-010-9228-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Hmong Americans face high cancer mortality rates even in comparison to their Asian American counterparts, and report low utilization of cancer screenings. To date, no study has been conducted on the cultural barriers this population faces in undergoing cancer screenings. A systematic review of the literature was conducted to examine the existing knowledge regarding the barriers to cancer screening for Hmong Americans. Potential barriers were identified from this examination to include: health access factors (type of health insurance, ethnicity of provider, low English proficiency, and years spent in the U.S.); cultural factors (belief in the spiritual etiology of diseases, patriarchal values, modesty, and mistrust of the western medical system); and cancer literacy factors (cancer and prevention illiteracy). Based on this review, potential cultural and ethnic group-specific prevention strategies and cancer health policies are discussed to address these barriers and enhance screening behavior among the Hmong.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, Saint Paul, MN 55108, USA.
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50
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Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt) 2010; 19:463-9. [PMID: 20156089 PMCID: PMC2867551 DOI: 10.1089/jwh.2009.1422] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The primary objective of the present study was to evaluate the effects of a community-based pilot intervention that combined cervical cancer education with patient navigation on cervical cancer screening behaviors among Chinese American women residing in New York City. METHODS Chinese women (n = 134) who had not had a Pap test within the previous 12 months were recruited from four Asian community-based organizations (CBOs). Women from two of the CBOs received the intervention (n = 80) consisting of education, interaction with a Chinese physician, and navigation assistance, including help in identifying and accessing free or low-cost screening services. The control group (n = 54) received education delivered by Chinese community health educators and written materials on general health and cancer screening, including cervical cancer, the Pap test, and information about sites that provided free screening. Study assessments were obtained in-person at baseline and postintervention. Screening behavior was self-reported at 12-month postintervention and verified by medical staff. RESULTS In the 12-month interval following the program, screening rates were significantly higher in the intervention group (70%) compared to the control group (11.1%). Hierarchical logistic regression analyses indicated that screening behavior was associated with older age (OR = 1.08, 95% CI = 1.01-1.15, p < .05). In addition, women with poorer English language fluency (OR = 0.30, 95% CI = 0.10-0.89, p < .05) and who did not have health insurance were less likely to obtain screening (OR = 0.15, 95% CI = 0.02-0.96, p < .05). Among health beliefs, greater perceived severity of disease was positively associated with screening behavior (OR = 4.26, 95% CI = 1.01-18.04, p < .05). CONCLUSIONS Community-based programs that provide combined education and patient navigation may be effective in overcoming the extensive linguistic and access barriers to screening faced by Chinese American women.
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Affiliation(s)
- Xingjie Wang
- Center for Asian Health, Department of Public Health, College of Health Professions, Temple University, Philadelphia, Pennsylvania
- Chinese Community Clinic, Flushing, New York
| | - Carolyn Fang
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Yin Tan
- Center for Asian Health, Department of Public Health, College of Health Professions, Temple University, Philadelphia, Pennsylvania
| | - Andy Liu
- Chinese American Community Business Network, New York, New York
| | - Grace X. Ma
- Center for Asian Health, Department of Public Health, College of Health Professions, Temple University, Philadelphia, Pennsylvania
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