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Ruksakulpiwat S, Schiltz NK, Irani E, Josephson RA, Adams J, Still CH. Medication Adherence of Older Adults with Hypertension: A Systematic Review. Patient Prefer Adherence 2024; 18:957-975. [PMID: 38737487 PMCID: PMC11088410 DOI: 10.2147/ppa.s459678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024] Open
Abstract
Objective Hypertension (HTN) significantly increases the risk of stroke and heart disease, which are the leading causes of death and disability globally, particularly among older adults. Antihypertensive medication is a proven treatment for blood pressure control and preventing complications. However, medication adherence rates in older adults with HTN are low. In this review, we systematically identified factors influencing medication adherence in older adults with HTN. Methods We applied the PRISMA guidelines and conducted systematic searches on PubMed, MEDLINE, and Google Scholar in July 2022 to identify preliminary studies reporting factors influencing medication adherence among older adults with HTN. The convergent integrated analysis framework suggested by the Joanna Briggs Institute for systematic reviews was adopted for data synthesis. Results Initially, 448 articles were identified, and after title and abstract screening, 16 articles qualified for full-text review. During this phase, three articles were excluded for reporting on irrelevant populations or focusing on issues beyond the review's aim, leaving thirteen studies in the final review. After data synthesis, fifteen themes were extracted from the key findings of the included studies. The most prevalent themes included the number of medications used (53.9%, n=7 studies), financial status (38.5%, n=5), sex (38.5%, n=5), age (30.1%, n=4), duration of disease (23.1%, n=3), comorbidities (23.1%, n=3), and health compliance (23.1%, n=3). Other themes, such as education, health literacy, health belief, medication belief, perception of illness, patient-physician relationship, self-efficacy, and social support, were also identified. Conclusion The findings of this review highlight critical areas for developing innovative, evidence-based programs to improve medication adherence in hypertensive older adults. Insights from this review can contribute to improving medication adherence and preventing future health complications.
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Affiliation(s)
- Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Nicholas K Schiltz
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Jon Adams
- School of Public Health, The University of Technology Sydney, Sydney, Australia
| | - Carolyn Harmon Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Sun Y, Moyer A, White JH. How Can Framed Mammography Screening Messages Be Optimally Persuasive for Foreign-Born Chinese American Women? Cancer Nurs 2023; 46:344-353. [PMID: 37607370 DOI: 10.1097/ncc.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Foreign-born Chinese American women (FBCAW) have the lowest mammography rates compared with other racial groups despite the overwhelming evidence of the benefits of screening. Message framing based on the prospect theory has shown significant but inconsistent effects on mammogram screening among ethnic minority groups. OBJECTIVE Using data from a randomized controlled trial, this secondary analysis aims to identify factors that interact with message framing to improve mammography screening in FBCAW. METHODS In the parent study, participants were randomized to receive either a gain- or loss-framed brochure that encouraged mammography screening. Data were collected at baseline and 2 months using validated questionnaires. For this secondary analysis, ordinal logistic regression was performed to identify moderation effects using both per-protocol and intention-to-treat principles. RESULTS Participants predominantly had low income, a low level of English proficiency, and no insurance. Lack of access to mammography services, knowledge of making a mammogram appointment, knowledge of insurance coverage for breast cancer treatment, education levels, and mammogram history were significant moderators of the framing effects. Overall, the moderation effects were larger when using per-protocol analysis. Some moderation results under intention-to-treat analysis were different from those using per-protocol analysis. CONCLUSIONS The persuasive effects of the loss- or gain-framed messages depend on the characteristics of FBCAW. Future studies can identify algorithms to select tailored messages that match individual FBCAW's characteristics to optimize the effects of framed messages. IMPLICATIONS FOR PRACTICE Findings of this study can guide healthcare providers, especially nurses, to choose different wording when communicating with their clients.
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Affiliation(s)
- Yiyuan Sun
- Author Affiliations: College of Nursing and Public Health, Adelphi University (Drs Sun and White), Garden City; and Social and Health Psychology, Stony Brook University (Dr Moyer), New York
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Tran NH, Almodallal Y, Batheja M, Martin NA, Le-Rademacher J, Ridgeway JL, Sia IG, Jatoi A. Social determinants of health: a need for better data capture in Asian American patients with hepatocellular cancer. Support Care Cancer 2023; 31:543. [PMID: 37646853 DOI: 10.1007/s00520-023-08016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Social determinants of health lead to better cancer care. This multi-site, single-institution study sought to capture data on social determinants of health data in Asian Americans with hepatocellular carcinoma; this group constitutes 60% of patients with this malignancy and are often undertreated or not treated at all. METHODS This study took advantage of an institutional initiative designed to capture and integrate social determinants of health data into the electronic medical record for all patients. Medical records of Asian Americans with hepatocellular cancer were reviewed to acquire data on housing instability, lack of transportation, financial concerns, and social isolation; a score of 1 indicated poor social determinants of health. RESULTS Of 112 adult Asian American patients with hepatocellular cancer, 22 (20%) were Southeast Asian, and 74 (67%) described English proficiency/preference. Total noncompletion per domain (no question answered within that domain) was observed in 90 patients (80%) for housing instability; 90 (80%) for lack of transportation; 92 (82%) for financial hardship; and 90 (80%) for social isolation. A score of 1 (highest risk) was observed in 1 patient (0.9%) for housing instability; 1 (0.9%) lack of transportation; no patient for financial hardship; and 1 (0.9%) for social isolation. Of note, institution-wide benchmark total noncompletion rates were 0.3%, 0.3%, 47%, and 39% for these respective domains. CONCLUSION High total noncompletion rates make social determinants of health data challenging to interpret and underscore the need for evidence-based guidelines on how best to capture such data in underserved patients.
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Affiliation(s)
- Nguyen H Tran
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Yahya Almodallal
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mashal Batheja
- Division of Gastroenterology, Mayo Clinic, Phoenix, AZ, USA
| | - Nichole A Martin
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Poon PKM, Tam KW, Lam T, Luk AKC, Chu WCW, Cheung P, Wong SYS, Sung JJY. Poor health literacy associated with stronger perceived barriers to breast cancer screening and overestimated breast cancer risk. Front Oncol 2023; 12:1053698. [PMID: 36686831 PMCID: PMC9850080 DOI: 10.3389/fonc.2022.1053698] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
Background Low health literacy (HL) is negatively associated with mammography screening uptake. However, evidence of the links between poor HL and low mammography screening participation is scarce. Methods We conducted a cross-sectional questionnaire survey among participants of a cancer screening program. We measured HL using a validated Chinese instrument. We assessed breast cancer screening-related beliefs using the Health Belief Model and the accuracy of risk perception. We used multivariable regression models to estimate the relationship between HL and the outcomes. Results A total of 821 females were included. 264 (32.2%) had excellent or sufficient, 353 (43.0%) had problematic, and 204 (24.8%) had inadequate health literacy (IHL). Women with IHL were more likely to agree that high price (β = -0.211, 95% CI -0.354 to -0.069), lack of time (β = -0.219, 95% CI -0.351 to -0.088), inconvenient service time (β = -0.291, 95% CI -0.421 to -0.160), long waiting time (β = -0.305, 95% CI -0.447 to -0.164), fear of positive results (β = -0.200, 95% CI -0.342 to -0.058), embarrassment (β = -0.225, 95% CI -0.364 to -0.086), fear of pain (β = -0.154, 95% CI -0.298 to -0.010), fear of radiation (β = -0.177, 95% CI -0.298 to -0.056), lack of knowledge on service location (β = -0.475, 95% CI -0.615 to -0.335), and lack of knowledge on mammography (β = -0.360, 95% CI -0.492 to -0.228) were barriers. They were also less likely to have an accurate breast cancer risk perception (aOR 0.572, 95% CI 0.341 to 0.956). Conclusion Women with lower HL could have stronger perceived barriers to BC screening and an over-estimation of their breast cancer risk. Tackling emotional and knowledge barriers, financial and logistical assistance, and guidance on risk perception are needed to increase their breast cancer screening uptake.
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Affiliation(s)
- Paul K. M. Poon
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Paul K. M. Poon,
| | - King Wa Tam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Thomas Lam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Arthur K. C. Luk
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Polly Cheung
- Hong Kong Breast Cancer Foundation, Hong Kong, Hong Kong SAR, China
| | - Samuel Y. S. Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Joseph J. Y. Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Guo S, Dang Y, She B, Li Y. Sharing intention of electronic health records in online health communities: Patients' behavioral decisions in the context of privacy protection measures. Front Psychol 2022; 13:1047980. [PMID: 36619135 PMCID: PMC9813434 DOI: 10.3389/fpsyg.2022.1047980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Online health communities (OHCs) have become more important to people's daily lives on the foundation of the voluntary sharing of electronic health records (EHRs). However, no in-depth investigation has been conducted concerning the influence of the perceptions of privacy protection among patients on their willingness to share EHRs. To fill the knowledge gap, by combining and modifying the theory of planned behavior (TPB) and the health belief model in the context of the privacy protection models implemented by OHCs, an empirical research method using a questionnaire approach is conducted to validate the hypotheses. The results indicate that the more positive a patient's attitude toward medical information sharing behavior is, the higher that patient's level of perceived behavioral control; in addition, the greater the social rewards obtained from this process, the more willing the patient is to share his or her EHRs after privacy protection measures are implemented by OHCs. Meanwhile, the effects of past positive experiences and disease severity have also been tested. The findings of this study can be used to promote patients' full participation in OHCs from a privacy perspective and offer theoretical and practical suggestions to promote the development of OHCs.
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Affiliation(s)
- Shanshan Guo
- School of Business and Management, Shanghai International Studies University, Shanghai, China
| | - Yuanyuan Dang
- School of Business Administration, South China University of Technology, Guangzhou, China,*Correspondence: Yuanyuan Dang,
| | - Bofei She
- School of Business Administration, South China University of Technology, Guangzhou, China
| | - Yugang Li
- School of Management, Harbin Institute of Technology, Harbin, Heilongjiang, China
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Noman S, Shahar HK, Rahman HA, Ismail S, Aljaberi MA, Abdulrahman MN. Factor structure and internal reliability of breast cancer screening Champion's Health Belief Model Scale in Yemeni women in Malaysia: a cross-sectional study. BMC Womens Health 2021; 21:437. [PMID: 34965865 PMCID: PMC8715606 DOI: 10.1186/s12905-021-01543-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The reliability and validity of the Champion's Health Belief Model Scale (CHBMS) used in assessing the belief of women regarding breast cancer (BC) and breast cancer screening (BCS) have been examined on various populations. However, the use of this tool has not been adequately assessed for its validity in ethnic minorities. This study assessed the validity and reliability of CHBMS by analyzing the factor structure and internal reliability of the factors among Yemeni women in Malaysia. METHODS A survey was conducted among 103 female teachers from 10 schools. SPSS version 22.0 was utilized in analyzing the data. Descriptive statistics were computed for the socio-demographic characteristics. The Cronbach's alpha coefficients were used in assessing the internal reliability. The Exploratory Factor Analysis (EFA) was used to analyze the factor structure of the translated items. Parallel analysis was performed to determine the number of factors accurately. RESULTS The alpha coefficients of the factors had acceptable values ranging between 0.76 and 0.87. The factor analysis yielded six and five factors for breast self-examination (BSE) and mammography (MMG), with a total explained variance of 47.69% and 52.63%, respectively. The Kaiser-Meyer-Olkin (KMO) index values of 0.64 and 0.72, and the Bartlett's Test of Sphericity (P = 0.0001) for BSE and MMG, respectively, verified the normality distribution and the adequacy of the sample size for EFA. All the items on each factor were from the same construct that were consistent with the number of factors obtained in the scale development study. The items achieved adequate factor loadings that ranged between 0.47 and 0.88. CONCLUSIONS The translated version of the CHBMS is a validated scale used in assessing the beliefs related to BC and BCS among Yemeni women living in Malaysia. Healthcare workers could use the scales to assess women's beliefs on BC and BCS. This instrument could be used to test the effectiveness of the intervention programs.
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Affiliation(s)
- Sarah Noman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia.
- Faculty of Medicine and Health Sciences, Taiz University, Taiz, Yemen.
| | - Hayati Kadir Shahar
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia
- Malaysian Research Institute of Ageing (MyAgeing), 43400, Serdang, Malaysia
| | - Hejar Abdul Rahman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia
| | - Suriani Ismail
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia
| | - Musheer A Aljaberi
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia
- Faculty of Medicine and Health Sciences, Taiz University, Taiz, Yemen
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Chu HY, Huang HC, Huang CY, Chu CC, Su CT, Tsai IL, Hu HLS, Guo SL. A predictive model for identifying low medication adherence among older adults with hypertension: A classification and regression tree model. Geriatr Nurs 2021; 42:1309-1315. [PMID: 34560525 DOI: 10.1016/j.gerinurse.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
Various individual characteristics may affect medication adherence; however, few studies have investigated the effect of interrelationships among these various individual characteristics on medication adherence. This cross-sectional study explored the interrelationships among risk factors for medication adherence and established a predictive model of low medication adherence among older adults with hypertension. Convenience sampling was used to recruit 300 older adults with hypertension. The following parameters were recorded: demographic and disease characteristics, health beliefs, self-efficacy, social support, and medication adherence of antihypertensive drugs. Classification and regression tree (CART) analysis was performed to develop a predictive model of low medication adherence. The CART model revealed that health belief, disease duration, self-efficacy, and social support interacted to contribute to various pathways of low medication adherence. The predicted accuracy of the model was validated with a low misclassification rate of 26%. The proposed classification model can help identify risk cases with low medication adherence. Suitable health education programs based on these risk factors to manage and improve medication adherence for older adults with hypertension could be considered.
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Affiliation(s)
- Han-Yu Chu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Chi Chu
- Department of Cardiology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Chien-Tien Su
- Department of Family Medicine, Taipei Medical University Hospital, Taipei Taiwan; School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - I-Lin Tsai
- Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Huey-Lan Sophia Hu
- School of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Liu Guo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.
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Moreira CB, Dahinten VS, Howard AF, Fernandes AFC. The Revised Champion's Health Belief Model Scale: Predictive Validity Among Brazilian Women. SAGE Open Nurs 2021; 6:2377960820940551. [PMID: 33415294 PMCID: PMC7774489 DOI: 10.1177/2377960820940551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/26/2020] [Accepted: 06/13/2020] [Indexed: 11/25/2022] Open
Abstract
Mammography screening is provided free of charge for the recommended target
population in Brazil but participation rates have remained low, and breast
cancer mortality has continued to increase. Thus, it is important to
identify factors that are associated with poor participation in mammography
screening so that service providers can target health promotion messages and
screening programs more effectively. Objective: To evaluate the
predictive validity of the Revised Champion’s Health Belief Model scale
(RCHBMS) for identifying women at high risk of not adhering to national
guidelines for mammography screening in Brazil. Methods: We
used a longitudinal survey design with a 1-year follow-up data from 194
women living in northeastern Brazil, in the city of Fortaleza, Ceará,
participants completed the RCHBMS at baseline, and mammography uptake was
measured 1 year later. Hierarchical logistic regression was used to
determine the predictive validity of the RCHBMS for identifying women who
had not adhered to recommendations for mammography screening, after
accounting for the women’s sociodemographic and clinical characteristics.
The sensitivity and specificity of various cut-off points were calculated to
determine the optimal cut-off point for identifying women at high risk of
not adhering to mammography screening guidelines. Results: Two
subscales of the RCHBMS uniquely predicted nonadherence: susceptibility and
barriers, along with race and family history of cancer. The total scale
score (with barriers reverse coded) was also highly predictive. For our
sample, using only the RCHBMS with a cutoff of ≤ 3.67 (out of a total
possible range of 1–5) yielded a high sensitivity and specificity for
predicting nonadherence. Conclusion: Study findings support the
validity and clinical utility of the RCHBM for identifying women at risk of
not adhering to national guidelines for mammography screening in Brazil.
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Miller BC, Sarma EA, Sun Y, Messina CR, Moyer A. Psychosocial predictors of mammography history among Chinese American women without a recent mammogram. ETHNICITY & HEALTH 2020; 25:862-873. [PMID: 29506393 DOI: 10.1080/13557858.2018.1447653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
Chinese American women have lower rates of mammography screening compared with non-Hispanic White women. Although the extent of perceived barriers, as conceptualized by the Health Belief Model, have been shown to distinguish between currently non-adherent Chinese American women who have ever and never had a mammogram, it is less clear which types of perceived barriers differentiate them. One hundred twenty-eight Chinese American women in the New York metropolitan area who had not had a mammogram in the past year completed baseline assessments for a mammography framing intervention study. Demographics, medical access variables, and perceived barriers to mammography (lack of access, lack of need for screening, and modesty) were used to predict mammography history (ever versus never screened). Fifty-five women (43%) reported having been screened at least once. A sequential logistic regression showed that English speaking ability and having health insurance significantly predicted mammography history. However, these control variables became non-significant when the three barrier factors were included in the final model. Women who reported a greater lack of access (OR = 0.36, p < .05) and greater lack of need (OR = 0.27, p < .01) were less likely to be ever screeners. Unexpectedly, women who reported greater modesty were more likely to be ever screeners (OR = 4.78, p < .001). The results suggest that interventions for Chinese American women should identify and target specific perceived barriers with consideration of previous adherence.
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Affiliation(s)
| | | | - Yiyuan Sun
- Stony Brook University, Stony Brook, NY, USA
| | | | - Anne Moyer
- Stony Brook University, Stony Brook, NY, USA
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Didarloo A, Akhgar M, Moghaddam-Tabrizi F, Gharaaghaji R, Sheikhi S. Psychometric Properties of the Iranian version of Champion's Revised Health Belief Model Scale for Breast Cancer screening. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:146-153. [PMID: 32195161 PMCID: PMC7055179 DOI: 10.4103/ijnmr.ijnmr_220_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 11/11/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022]
Abstract
Background: Women's beliefs regarding breast cancer and its screening approaches were considered antecedents of their behavioral changes. Understanding of these beliefs in women requires a valid and reliable instrument. The present study seeks to translate the English version of the Champion's Revised Health Belief Model Scale (CRHBMS) into the Persian language and assess its psychometric properties. Materials and Methods: The study was conducted on 334 students at Urmia University of Medical Sciences, Iran, 2016. The 57-item CRHBMS was translated to Persian language, back translated, and tested. To test the face and content validity of the Persian version; item analysis, Content Validity Ratio (CVR), and Content Validity Index (CVI) were applied, respectively. Construct validity of the Persian scale was performed by Exploratory and Confirmatory Factor Analyses (EFA, CFA) using Kaiser-Meyer-Olkin and Bartlett's tests in SPSS 16 and LISREL8.72 software. The reliability of the translated scale was evaluated using Cronbach's alpha and test-retest approaches. Results: In the EFA, eight factors were extracted concerning breast cancer screening, and each item was loaded on its specific factor. These factors were self-efficacy, health motivation, benefits-mammography, benefits-Breast Self-Examination (BSE), barriers-mammography, barriers-BSE, susceptibility, and severity. The final 42-item scale was confirmed by the CFA, and all goodness of fit indices showed a proper fit of the model. Cronbach's alpha coefficient and test-retest correlation of the subscales ranged from 0.72–0.89 and 0.67–0.93, respectively. Conclusions: The study suggests that the Persian version of CRHBMS is a feasible scale for evaluating women's health beliefs regarding breast cancer and its screening behaviors.
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Affiliation(s)
- Alireza Didarloo
- Social Determinants of Health Research Center, Department of Public Health, Faculty of Health Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Masoumeh Akhgar
- Solid Tumor Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Rasool Gharaaghaji
- Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Siamak Sheikhi
- Department of Psychiatry, Urmia University of Medical Sciences, Urmia, Iran
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Barriers to mammography screening among racial and ethnic minority women. Soc Sci Med 2019; 239:112494. [PMID: 31513931 DOI: 10.1016/j.socscimed.2019.112494] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 07/04/2019] [Accepted: 08/13/2019] [Indexed: 11/21/2022]
Abstract
RATIONALE Breast cancer is the second leading cause of cancer death among women. Disparities in breast cancer mortality rates adversely affect racial/ethnic minority women. Mammography screening is the most effective early detection method and means of reducing mortality rates. Yet, barriers prevent racial/ethnic minority women from participating in regular screening. OBJECTIVE This review aimed to summarize self-reported barriers to mammography screening in racial/ethnic minority women in studies using open-ended assessments and closed-ended assessments. METHOD Literature searches were conducted in two databases, PsycINFO and PubMed. Barriers were detailed in full by barrier type (psychological/knowledge-related, logistical, cultural/immigration-related, and social/interpersonal) and summarized briefly by race/ethnicity (African American/Black, Asian/Pacific Islander, Hispanic, American Indian/Native American, and Middle Eastern). RESULTS Twenty-two open-ended and six closed-ended studies were identified as eligible for this review. Overall, racial/ethnic minority women identified common logistical and psychological/knowledge-related barriers. Additionally, women reported cultural/immigration-related and social/interpersonal barriers that were closely tied to their racial/ethnic identities. CONCLUSIONS It was concluded that cultural/immigration-related barriers may be the only barrier type that is unique to racial/ethnic minority women. Thus, designing studies of barriers around race and ethnicity is not always appropriate, and other demographic factors are sometimes a more important focus. The variability in 'barrier' definitions, how data were collected and reported, and the appropriateness of closed-ended measures were also examined. This literature may benefit from detailed and strategically designed studies that allow more clear-cut conclusions and better comparison across studies as well as improving closed-ended measures by incorporating insights from investigations using open-ended inquiry.
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Sharp JW, Hippe DS, Nakigudde G, Anderson BO, Muyinda Z, Molina Y, Scheel JR. Modifiable patient-related barriers and their association with breast cancer detection practices among Ugandan women without a diagnosis of breast cancer. PLoS One 2019; 14:e0217938. [PMID: 31220096 PMCID: PMC6586444 DOI: 10.1371/journal.pone.0217938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/21/2019] [Indexed: 12/25/2022] Open
Abstract
Most women with breast cancer in sub-Saharan Africa (SSA) are diagnosed with late-staged disease. The current study assesses patient-related barriers among women from a general SSA population to better understand how patient-related barriers contribute to diagnostic delays. Using convenience-based sampling, 401 Ugandan women without breast cancer were surveyed to determine how prior participation in cancer detection practices correlate with patient-related barriers to prompt diagnosis. In a predominantly poor (76%) and rural population (75%), the median age of the participants was 38. Of the women surveyed, 155 (46%) had prior exposure to breast cancer education, 92 (27%) performed breast self-examination (BSE) and 68 (20%) had undergone a recent clinical breast examination (CBE), breast ultrasound or breast biopsy. The most commonly identified barriers to prompt diagnosis were knowledge deficits regarding early diagnosis (79%), economic barriers to accessing care (68%), fear (37%) and poor social support (24%). However, only women who reported knowledge deficits-a modifiable barrier-were less likely to participate in cancer detection practices (p<0.05). Women in urban and rural areas were similarly likely to report economic barriers, knowledge deficits and/or poor social support, but rural women were less likely than urban women to have received breast cancer education and/or perform BSE (p<0.001). Women who have had prior breast cancer education (p<0.001) and/or who perform BSE (p = 0.02) were more likely to know where she can go to receive a diagnostic breast evaluation. These findings suggest that SSA countries developing early breast cancer detection programs should specifically address modifiable knowledge deficits among women less likely to achieve a diagnostic work-up to reduce diagnostic delays and improve breast cancer outcomes.
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Affiliation(s)
- Jake W. Sharp
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
| | - Daniel S. Hippe
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
| | | | - Benjamin O. Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Yamile Molina
- Community Health Sciences Division, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - John R. Scheel
- Department of Radiology, University of Washington, Seattle, Washington, United States of America
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Wu TY, Raghunathan V. The Patient Protection and Affordable Care Act and Utilization of Preventive Health Care Services Among Asian Americans in Michigan during Pre- and Post-Affordable Care Act Implementation. J Community Health 2019; 44:712-720. [PMID: 30798423 DOI: 10.1007/s10900-019-00628-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Since the implementation of the Patient Protection and Affordable Care Act (ACA), significant increases in the percent of insured United States residents has steadily increased. Studies have shown that there is an increase in preventative services usage and a decrease in chronic disease burden with increased access to insurance. However, very little has been studied about how the implementation of ACA has impacted utilization of health services and health status among Asian Americans. In this study, we recruited 427 Asian Americans who attended health fairs and examined (1) changes in health care coverage and utilization of preventive health services before and after ACA, (2) health status on chronic disease risk factors, (3) comparing health services utilization by insurance status and types of insurance, and (4) identifying relationships between health care utilization and demographic factors. Study results indicate that even though the percentage of insured Asian Americans in Michigan increased significantly over study periods, health care utilization and chronic disease burden did not change significantly. The insured tended to utilize preventive health services more than the uninsured, but the types of insurance did not affect health care utilization. Gender and having a primary care physician were significant predictors in determining health care utilization. There is a need in this population for language-appropriate and culturally-sensitive education about the importance and availability of preventive services, which could improve adherence to preventive health services, thereby reducing health disparities.
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Affiliation(s)
- Tsu-Yin Wu
- School of Nursing, Eastern Michigan University, 311 Everett L. Marshall Building, Room 328, Ypsilanti, MI, 48197, USA.
| | - Vedhika Raghunathan
- College of Literature, Science and the Arts, University of Michigan, Ann Arbor, USA
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Beliefs of Immunosuppressive Medication Among Chinese Renal Transplant Recipients, as Assessed in a Cross-Sectional Study With the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Transplant Proc 2019; 51:742-748. [PMID: 30979459 DOI: 10.1016/j.transproceed.2018.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adherence to immunosuppressive medication (IM) after renal transplantation is crucial to survival of patient and graft outcomes; whether beliefs about IM adherence and other sociodemographic factors affect IM adherence is debatable. OBJECTIVE This study aimed to examine the beliefs on IM and IM adherence in Chinese renal transplant recipients. METHODS Across-sectional survey was conducted. Self-developed IM beliefs questionnaire guided by health belief model was used to measure IM beliefs. The Basel Assessment of Adherence to Immunosuppressive Medications Scale was used to assess drug adherence. RESULTS The nonadherence rate to IM in 208 renal transplant recipients during outpatient follow-up was 44.2%. There were statistically significant associations between adherence and the marital status (P < .001). Perceived seriousness of not taking IM (P < .001) and perceived barriers of taking IM (P < .001) were significantly associated with IM adherence. After controlling other factors, married marital status, high levels of perceived seriousness of not taking IM, and lower levels of perceived barriers of taking IM (P = .007) were significantly associated with IM adherence. CONCLUSION Marital status and IM beliefs are closely association with IM adherence in Chinese renal transplant recipients.
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Maltese Translation and Adaptation of Champion's Health Belief Model Scale and the Revised Illness Perception Questionnaire for Breast Screening Among Maltese Women. J Nurs Meas 2017; 25:486-503. [PMID: 29268831 DOI: 10.1891/1061-3749.25.3.486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Translating, adapting, and piloting Champion's Health Belief Model Scale for Mammography Screening (CHBMS-MS) and Revised Illness Perception Questionnaire (IPQ-R) among Maltese women. METHODS The Maltese questionnaire (Maltese Breast Screening Questionnaire [MBSQ]) was developed through 9 steps. Bilingual women (n = 15) completed MBSQ at 2 time points. RESULTS During forward-backward translations (Steps 1-4), 4 English controversial terms were raised. Twelve experts agreed on terminologies during adaptation process (Step 5). Following face validity (n = 6; Step 6), 3 items were deleted. Following reconciliation (Step 7) and proofreading (Step 8), MBSQ consisted of 121 items. Pilot testing (Step 9) showed positive correlation (CHBMS-MS = .87, IPQ-R = .85; p < .001); high Cronbach's alpha (CHBMS-MS = .93, IPQ-R = .92); overall acceptable internal consistency (CHBMS-MS = .69-.83, IPQ-R = .75-.93); and acceptable test-retest reliability correlations: CHBMS-MS (Maltese = .62-.76; English = .61-.84), IPQ-R (Maltese=.63-.82; English = .61-.91; p < .001). CONCLUSIONS Maltese and English scale items demonstrated high reliability and validity preliminary values.
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Scheel JR, Molina Y, Anderson BO, Patrick DL, Nakigudde G, Gralow JR, Lehman CD, Thompson B. Breast Cancer Beliefs as Potential Targets for Breast Cancer Awareness Efforts to Decrease Late-Stage Presentation in Uganda. J Glob Oncol 2017; 4:1-9. [PMID: 30241166 PMCID: PMC6180808 DOI: 10.1200/jgo.2016.008748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose To assess breast cancer beliefs in Uganda and determine whether these beliefs
are associated with factors potentially related to nonparticipation in early
detection. Methods A survey with open- and close-ended items was conducted in a community sample
of Ugandan women to assess their beliefs about breast cancer. Linear
regression was used to ascertain associations between breast cancer beliefs
and demographic factors potentially associated with early detection,
including socioeconomic factors, health care access, prior breast cancer
knowledge, and personal detection practices. Results Of the 401 Ugandan women surveyed, most had less than a primary school
education and received medical care at community health centers. Most women
either believed in or were unsure about cultural explanatory models for
developing breast cancer (> 82%), and the majority listed these
beliefs as the most important causes of breast cancer (69%). By comparison,
≤ 45% of women believed in scientific explanatory risks for
developing breast cancer. Although most believed that regular screening and
early detection would find breast cancer when it is easy to treat (88% and
80%, respectively), they simultaneously held fatalistic attitudes toward
their own detection efforts, including belief or uncertainty that a cure is
impossible once they could self-detect a lump (54%). Individual beliefs were
largely independent of demographic factors. Conclusion Misconceptions about breast cancer risks and benefits of early detection are
widespread in Uganda and must be addressed in future breast cancer awareness
efforts. Until screening programs exist, most breast cancer will be
self-detected. Unless addressed by future awareness efforts, the high
frequency of fatalistic attitudes held by women toward their own detection
efforts will continue to be deleterious to breast cancer early detection in
sub-Saharan countries like Uganda.
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Affiliation(s)
- John R Scheel
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Yamile Molina
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Benjamin O Anderson
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Donald L Patrick
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Gertrude Nakigudde
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Julie R Gralow
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Constance D Lehman
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Beti Thompson
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
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Wu TY, Park Y. Demographic Predictors and Cancer Screening Among Asian Americans in Michigan: Role of Refugee Status. J Racial Ethn Health Disparities 2017. [PMID: 28643271 DOI: 10.1007/s40615-017-0397-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although the Asian American population has steadily increased since 1980s, there remains a paucity of literature on cancer screening utilization on this population. The purpose of this study was to evaluate preventive health and screening practices by examining demographic predictors of health and screening behaviors among 217 Asian Americans living in state of Michigan. Several demographic and acculturation-related factors were found to be associated with "ever screened" status in the bivariate analyses. This included the examination of the relationships among refugee status and cancer screening practices among Asian Americans. After adjusting for other demographic correlates, Asian Americans in the refugee group had lower screening rates in colorectal and breast cancer. Our findings emphasize the need for effective interventions to increase cancer screening rates in this vulnerable population.
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Affiliation(s)
- Tsu-Yin Wu
- Eastern Michigan University School of Nursing, 311 Everett L. Marshall Building, Ypsilanti, MI, 48197, USA.
| | - Yeyun Park
- University of Michigan, Literature, Science and Arts, Ann Arbor, MI, USA
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Procrastination as a Key Factor in Postpartum Screening for Diabetes: A Qualitative Study of Iranian Women with Recent Gestational Diabetes. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017. [DOI: 10.5812/ircmj.44833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wu TY, Chen SL. Breast Cancer Screening Practices and Related Health Beliefs among Taiwanese Nurses. Asia Pac J Oncol Nurs 2017; 4:104-111. [PMID: 28503640 PMCID: PMC5412145 DOI: 10.4103/2347-5625.204495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: Breast cancer is one of most common cancer types among women in Taiwan. Nurses are in an ideal position to promote breast cancer screening and educate individuals about breast health-related issues. This exploratory study aims to provide preliminary information on Taiwanese nurses’ beliefs about breast cancer, breast cancer-related knowledge, and their cancer screening practices. Methods: In this cross-sectional study, a total of 96 nurses completed self-report questionnaires. Results: Participants were knowledgeable about the different breast cancer screening modalities and the risk factors for breast cancer, but various misconceptions about breast cancer were still observed. Nevertheless, more than 50% of participants reported that they never had clinical breast examinations, ultrasound, and/or mammography screening in the past. Conclusions: Our study sample demonstrated greater knowledge on modalities of breast cancer screening modalities and the risk factors for breast cancers but lower screening practices. Future studies that examine the impact of demographics and the reinforcing and inhibiting factors related to nurses’ screening uptake are warranted.
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Affiliation(s)
- Tsu-Yin Wu
- School of Nursing, Eastern Michigan University, Ypsilanti, MI, USA
| | - Shu-Ling Chen
- Department of Nursing, Hung Kuang University, Taichung, Taiwan, Republic of China
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Santelli JS. Development and Psychometric Testing of the Criterion-Referenced Measurement Tool for Genetics. J Nurs Meas 2016; 24:69-91. [PMID: 27103246 DOI: 10.1891/1061-3749.24.1.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to develop a criterion-referenced instrument to provide effective documentation of knowledge of advanced practice nursing in genetics. METHODS This is a methodological psychometric study. RESULTS The Criterion-Referenced Measurement Tool for Genetics (CRMTG) was found to be valid with a content validity index of .88 and reliable with a Cronbach's alpha of .99 based on the findings of this study. The CRMTG pass rates indicated a significant difference between nurses who practice in a genetic setting and nurses who do not practice in a genetic setting (p < .001). CONCLUSIONS The CRMTG was found to be a valid and reliable instrument to provide effective documentation of knowledge of advanced practice nursing in genetics.
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Sun Y, Sarma EA, Moyer A, Messina CR. Promoting mammography screening among Chinese American women using a message-framing intervention. PATIENT EDUCATION AND COUNSELING 2015; 98:878-83. [PMID: 25858632 DOI: 10.1016/j.pec.2015.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/12/2015] [Accepted: 03/21/2015] [Indexed: 05/14/2023]
Abstract
OBJECTIVES This study examined the role of women's perceptions about the relative pros versus cons (decisional balance) of mammography in moderating Chinese American women's responses to gain- and loss-framed messages that promote mammography. METHODS One hundred and forty-three Chinese American women who were currently nonadherent to guidelines for receiving annual screening mammograms were randomly assigned to read either a gain- or loss-framed culturally appropriate print brochure about mammography screening. Mammography screening was self-reported at a 2-month follow-up. RESULTS Although there was not a main effect for message frame, the hypothesized interaction between message frame and decisional balance was significant, indicating that women who received a framed message that matched their decisional balance were significantly more likely to have obtained a mammogram by the follow-up than women who received a mismatched message. CONCLUSIONS Results suggest that decisional balance, and more generally, perceptions about mammography, may be an important moderator of framing effects for mammography among Chinese American women. PRACTICE IMPLICATIONS The match between message frame and decisional balance should be considered when attempting to encourage Chinese American women to receive mammography screening, as a match between the two may be most persuasive.
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Affiliation(s)
- Yiyuan Sun
- School of Nursing, Stony Brook University, Stony Brook, USA
| | | | - Anne Moyer
- Department of Psychology, Stony Brook University, Stony Brook, USA
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Yue Z, Li C, Weilin Q, Bin W. Application of the health belief model to improve the understanding of antihypertensive medication adherence among Chinese patients. PATIENT EDUCATION AND COUNSELING 2015; 98:669-673. [PMID: 25746128 DOI: 10.1016/j.pec.2015.02.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 02/02/2015] [Accepted: 02/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES We aimed to gain insight into antihypertensive medication adherence on the basis of a well-developed behavior theory. METHODS A cross-sectional study of Chinese hypertensive patients was conducted using the health belief model as a theoretical framework. RESULTS The HBM explained 48.8% of the variance in antihypertensive medication adherence with an overall prediction accuracy was 82.8%. After adjusting for controlling factors, the HBM explained 50.5% of the variance in antihypertensive medication adherence with an overall prediction accuracy of 86.2%. Higher levels of perceived susceptibility (p = 0.017), cues to action (p=0.034), and self-efficacy (p = 0.002) and a lower level of perceived barriers (p < 0.001) were significantly associated with better antihypertensive medication adherence. The risk factors of older age (p = 0.037), longer duration of HTN (p = 0.003), longer duration of drug use (p = 0.001), and taking a combination of antiplatelet agents (p < 0.001) were significantly associated with better antihypertensive medication adherence and influenced different HBM constructs. CONCLUSION The HBM is reliable in predicting medication adherence among Chinese hypertensive patients. Intervention programs in clinical practice could be guided by the relationship between risk factors and HBM constructs and antihypertensive medication adherence. PRACTICE IMPLICATIONS This study provides a structured understanding of the relationships between risk factors and HBM constructs and antihypertensive medication adherence.
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Affiliation(s)
- Zhao Yue
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Li
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Weilin
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Wang Bin
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China.
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Chan DNS, So WKW. A systematic review of randomised controlled trials examining the effectiveness of breast and cervical cancer screening interventions for ethnic minority women. Eur J Oncol Nurs 2015; 19:536-53. [PMID: 25840817 DOI: 10.1016/j.ejon.2015.02.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/13/2015] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine the effect that breast and/or cervical cancer screening programmes for ethnic minority women have on their knowledge of and beliefs about breast or cervical cancer and screening, and on their screening intentions and uptake rates. Recommendations are also made for the format and content of such programmes, based on existing evidence. METHODS A comprehensive literature search was carried out both manually and by means of five electronic databases. The findings are summarised and synthesised in narrative fashion. RESULTS The ten RCTs included here were conducted among ethnic minority women in the United States or Canada, where breast or cervical cancer screening programmes have led to improvements in screening intentions, knowledge of cervical cancer and pap test uptake. The Breast Cancer Screening Belief Scale and self-reporting were the methods commonly used to measure outcomes. The shared characteristics of both countries' programmes were that they were theory- and language-based, the instruction took place in a community setting, the materials were culturally relevant, the content highlighted key messages about breast or cervical cancer and screening measures, and there were multiple intervention strategies. CONCLUSION Breast or cervical cancer screening programmes in Western countries have demonstrated improvements in knowledge of the disease, screening intentions and pap test uptake, although evidence on the effectiveness of the interventions has been limited. The common characteristics of programmes are identified, but a comprehensive model is still needed to link these characteristics with other factors and mediators influencing outcomes.
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Affiliation(s)
- Dorothy N S Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Wu TY, Lin C. Developing and evaluating an individually tailored intervention to increase mammography adherence among Chinese American women. Cancer Nurs 2015; 38:40-9. [PMID: 24621965 PMCID: PMC4161668 DOI: 10.1097/ncc.0000000000000126] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast cancer consistently is the most commonly diagnosed cancer and the second most common cause of cancer mortality among Asian Americans in the United States. The incidence of breast cancer in Asian American women has been increasing at a much higher rate than in white women. OBJECTIVES A randomized control single-blind study was conducted comparing the efficacy of an individually tailored telephone counseling and National Cancer Institute brochure. METHODS The sample consisted of 193 Chinese American women with no breast cancer history. The participants were randomly assigned to either an intervention or a control group. Self-reported data that included demographic variables, knowledge, beliefs, and screening behaviors were collected at baseline and 4 months. RESULTS The intervention group had increased screening to 40% compared with 33% for the control group at 4 months; the difference was not statistically significant. When the subanalyses were performed, the intervention is effective in certain demographic groups (ie, elderly women aged ≥65 years and recent immigrants). The study intervention was well accepted by participants and perceived as feasible and culturally appropriate based on process evaluation. CONCLUSIONS The study also demonstrates the feasibility of recruiting and retaining eligible women to participate, and the results show that both study intervention and printed materials increase awareness of the importance of breast cancer screening and screening behaviors for Chinese American women. IMPLICATIONS FOR PRACTICE Oncology nurses and advanced practice nurses can play critical roles on this medically underserved population that experiences disparities in breast cancer mortality by providing culturally appropriate counseling to promote screening adherence.
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Affiliation(s)
- Tsu-Yin Wu
- Author Affiliations: School of Nursing, Eastern Michigan University, Ypsilanti, Michigan
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Wu TY, Lin C, Chen SL, Jung Y. A community-based intervention to promote breast cancer awareness and screening among Asian American women. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2014; 34:171-85. [PMID: 24928609 DOI: 10.2190/iq.34.2.e] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cancer is the leading cause of death for Asian Americans, and breast cancer is the leading cancer diagnosed among Asian American women. Despite the alarming facts, Asian American women have low breast cancer screening rates. This study examined the effects of a culturally appropriate community-based breast intervention program on participants' knowledge about breast cancer and intention for screening among Southeast Asian and South Asian women in Michigan. Data were collected from 166 women. At baseline, participants had limited knowledge of breast cancer screening guidelines and misconceptions about the risk factors of breast cancer. After the educational intervention, participants reported significantly higher knowledge scores related to breast cancer and screening recommendations and intentions to obtain follow-up CBE and mammograms. This culturally appropriate intervention provides strategies to overcome personal instructional barriers to meet the needs of this group for early detection and cancer control.
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Survey of breast cancer mammography screening behaviors in Eastern Taiwan based on a health belief model. Kaohsiung J Med Sci 2014; 30:422-7. [DOI: 10.1016/j.kjms.2014.04.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/27/2014] [Accepted: 03/17/2014] [Indexed: 11/23/2022] Open
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Kharameh ZT, Foroozanfar S, Zamanian H. Psychometric Properties of the Persian Version of Champion's Health Belief Model Scale for Colorectal Cancer Screening. Asian Pac J Cancer Prev 2014; 15:4595-9. [DOI: 10.7314/apjcp.2014.15.11.4595] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wu TY, Chung S, Yeh MC, Chang SC, Hsieh HF, Ha SJ. Understanding breast cancer screening practices in Taiwan: a country with universal health care. Asian Pac J Cancer Prev 2013; 13:4289-94. [PMID: 23167330 DOI: 10.7314/apjcp.2012.13.9.4289] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
While the incidence of breast cancer (BC) has been relatively low in Asian countries, it has been rising rapidly in Taiwan. Within the last decade, it has replaced cervical cancer as the most diagnosed cancer site for women. Nevertheless, there is a paucity of studies reporting the attitudes and practices of breast cancer screening among Chinese women. The aim of this study is to assess Taiwanese women's knowledge of and attitudes toward BC screening and to identify potential factors that may influence screening behavior. The study population consisted of a sample of 434 Taiwanese women aged 40 and older. Despite access to universal health care for Taiwanese women and the fact that a majority of the women had heard of the breast cancer screening (mammogram, clinical breast exams, etc.), the actual utilization of these screening modalities was relatively low. In the current study, the majority of women had never had mammograms or ultrasound in the past 5 years. The number one most reported barriers were "no time, " "forgetfulness, " "too cumbersome, " and "laziness, " followed by the perception of no need to get screened. In addition, the results revealed several areas of misconceptions or incorrect information perceived by study participants. Based on the results from the regression analysis, significant predictors of obtaining repeated screening modalities included age, coverage for screening, barriers, self-efficacy, intention, family/friends diagnosed with breast cancer. The findings from the current study provide the potential to build evidence-based programs to effectively plan and implement policies in order to raise awareness in breast cancer and promote BC screening in order to optimize health outcomes for women affected by this disease.
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Affiliation(s)
- Tsu-Yin Wu
- Healthy Asians Americans Project, Eastern Michigan, United States.
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Charkazi A, Samimi A, Razzaghi K, Kouchaki GM, Moodi M, Meirkarimi K, Kouchaki AM, Shahnazi H. Adherence to recommended breast cancer screening in Iranian turkmen women: the role of knowledge and beliefs. ISRN PREVENTIVE MEDICINE 2013; 2013:581027. [PMID: 24977094 PMCID: PMC4062865 DOI: 10.5402/2013/581027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 01/26/2013] [Indexed: 11/23/2022]
Abstract
The aim of the current study was to investigate breast cancer screening performance among Iranian Turkmen women along with their knowledge and beliefs. A cross-sectional study was carried out in June to December 2011. Through clustered sampling method, 1080 Iranian Turkmen women completed the questionnaire including breast cancer screening adherence, knowledge, fatalism beliefs, and perceived threat using Champions Health Belief Model Scale (CHBMS).The mean age of the participants was 43.04 (SD = 11.80) years. Compliance rate in a regular basis based on national guidelines was 13.1%, 2.5%, and 0.9% for SBE, CBE, and mammography, respectively. A mere 4% have been provided adequately with information about breast cancer. Having knowledge was the best predictor of breast cancer screening adherence along with high educated husbands for SBE performing. Susceptibility and fatalism were low and were influenced by participants' educational level and age. In conclusion, Iranian Turkmen women had insufficient knowledge, low perceived susceptibility, high fatalistic belief, and very poor adherence to breast cancer screening. There is a need for providing breast cancer education programs among the Iranian Turkmen women to increase their adherence rate.
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Affiliation(s)
- Abdurrahman Charkazi
- Department of Public Health, School of Health, Golestan University of Medical Sciences, Km 2 Gorgan-Sari Road, Gorgan, Iran
| | - Afieh Samimi
- School of Health, Golestan university of Medical Sciences, Gorgan, Iran
| | - Khadijeh Razzaghi
- School of Health, Golestan university of Medical Sciences, Gorgan, Iran
| | | | - Mitra Moodi
- Department of Public Health, School of Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Kamal Meirkarimi
- School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Hossein Shahnazi
- Department of Health Promotion and Health Education, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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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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Baysal HY, Polat H. Determination of the breast cancer risk levels and health beliefs of women with and without previous mammography in the eastern part of Turkey. Asian Pac J Cancer Prev 2012; 13:5213-7. [PMID: 23244137 DOI: 10.7314/apjcp.2012.13.10.5213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This research was conducted to determine the breast cancer risk levels of women with and without previous mammography and their beliefs on breast cancer and mammography. METHODS The sample for this descriptive research consisted of women aged 50 years or older who were registered at the Family Health Center in the city center of Erzurum. The research was conducted with a total of 420 women with at least one mammography (210) and without mammography (210) who presented to the center on Wednesdays and Thursdays for any reason between 1 January 2010 and 1 January 2011. Research data were collected using the personal information "Breast Cancer Risk Assessment Form" accepted and recommended by the Turkish Ministry of Health, and the Champion's Health Belief Model Scale for Breast Cancer and Screening (CHBMS). Data were evaluated using percentages and means with the t-test. RESULTS According to the research data, 89.8% of the women were found to be in the low risk group, 87.6% with and 91.9% without mammography. When the health beliefs of women with and without mammography were compared, it was found that susceptibility, seriousness, motivation, mammography benefit scores were higher among those with mammography (p<0.01). The mammography barrier score average was higher in the group without mammography (p<0.01). CONCLUSION Knowing women's health beliefs, which have positive and negative effects on participating in mammography screening, may increase the rate of mammography uptake among women. Moreover, women with high breast cancer risk may be determined by increasing society's level of knowledge on breast cancer and risk factors.
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Improving Breast Cancer Outcomes among Women in China: Practices, Knowledge, and Attitudes Related to Breast Cancer Screening. Int J Breast Cancer 2012; 2012:921607. [PMID: 23304529 PMCID: PMC3523407 DOI: 10.1155/2012/921607] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 10/04/2012] [Indexed: 12/22/2022] Open
Abstract
Background. Breast cancer is a major public health issue and the most commonly diagnosed cancer for women worldwide. Despite lower incidence rates than those living in Western countries, breast cancer incidence among Chinese women has increased dramatically in the past 20 years. Nevertheless, there is a paucity of studies reporting the attitudes toward and practices of breast cancer screening among Chinese women. Methods. This cross-sectional study examined the practices, knowledge, and attitudes toward breast cancer screening (BCS) on a convenience sample of 400 Chinese women. Results. Among study participants, 75% of the women never had a mammogram and the top three barriers reported were low priority, feeling OK, and lack of awareness/knowledge toward breast cancer screening. The results from the logistic regression model showed increased self-efficacy; having performed monthly self-exams, and having had clinical breast exams in the past two years were significant correlates while demographic variables were not correlated with screening behaviors. Conclusion. The findings provide a foundation to better understand beliefs and practices of Chinese women toward BCS and highlight the critical need for general public, health professionals, and the health care system to work collaboratively toward improving the quality of breast cancer care in this population.
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Kumsuk S, Flick LH, Schneider CSJK. Development of the Thai breast cancer belief scale for Thai immigrants in the United States. J Nurs Meas 2012; 20:123-41. [PMID: 22988783 DOI: 10.1891/1061-3749.20.2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Asian American women have not benefited from the decline in breast cancer mortality and have lower rates of mammography use. Understanding mammography behaviors among these Asian American women requires culturally specific measures. Champion's belief scale was translated into Thai and cultural items were added. The Thai breast cancer belief scale (TBCBS), the Suinn-Lew self-identification acculturation, and the Asian values scale-revised were administered to 250 Thai immigrants. The TBCBS was tested for face validity, construct validity, and internal consistency. Factor analysis reflected the 4 constructs of the health belief model and accounted for 45.8% of the variance. Cronbach's alpha ranged from .77 to .90. Modest correlations were observed between TBCBS subscales and acculturation scales. Results indicate that the TBCBS measures breast cancer beliefs among Thai immigrant population.
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Wang JHY, Schwartz MD, Brown RL, Maxwell AE, Lee MM, Adams IF, Mandelblatt JS. Results of a randomized controlled trial testing the efficacy of a culturally targeted and a generic video on mammography screening among chinese-american immigrants. Cancer Epidemiol Biomarkers Prev 2012; 21:1923-32. [PMID: 22971901 DOI: 10.1158/1055-9965.epi-12-0821] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Research comparing the effects of culturally targeted and generic but linguistically appropriate intervention programs is limited. We conducted a randomized controlled trial comparing the efficacy of a culturally targeted video, a generic video, and a fact sheet (control) in promoting mammography screening among Chinese-American immigrants. METHODS We randomized 664 Chinese-American women from the Washington, DC, and New York City areas who were older than 40 years and nonadherent to annual mammography screening guidelines to three study arms (each with ∼221 women). The outcome was self-reported mammography screening 6 months post intervention. Measures of knowledge, Eastern cultural views, and health beliefs were administered before and after the intervention. RESULTS The culturally targeted video, the generic video, and the fact sheet increased mammography use by 40.3%, 38.5%, and 31.1% from baseline, respectively. A significant intervention effect was observed only in one subgroup: The culturally targeted video significantly increased mammography screening among low-acculturated women over the fact sheet [OR, 1.70; 95% confidence interval (CI), 1.04-2.78]. Overall, women who obtained a mammogram during the follow-up period reported significantly fewer barriers to screening after intervention than those who had not obtained screening. Both of the video groups reported fewer barriers after intervention than the control group. CONCLUSIONS Both theoretically guided videos increased the likelihood of mammography use to a similar extent. Cultural targeting was only effective for low-acculturated women. Both videos reduced perceived barriers to screening and consequently increased screening behavior. IMPACT The results of this study provide empirical evidence on the efficacy of cultural targeting for minority immigrants.
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Affiliation(s)
- Judy Huei-yu Wang
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, 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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Wang JHY, Schwartz MD, Luta G, Maxwell AE, Mandelblatt JS. Intervention tailoring for Chinese American women: comparing the effects of two videos on knowledge, attitudes and intentions to obtain a mammogram. HEALTH EDUCATION RESEARCH 2012; 27:523-36. [PMID: 22327806 PMCID: PMC3337423 DOI: 10.1093/her/cys007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study utilized data from an ongoing randomized controlled trial to compare a culturally tailored video promoting positive attitudes toward mammography among Chinese immigrant women to a linguistically appropriate generic video and print media. Intervention development was guided by the Health Belief Model. Five hundred and ninety-two immigrant Chinese Americans from the metropolitan Washington, DC, and New York City areas completed telephone interviews before and after intervention. Changes in knowledge, Eastern views of health care (fatalism and self-care), health beliefs (perceived susceptibility, severity, benefits and barriers) and screening intentions were measured. Results showed that both videos improved screening knowledge, modified Eastern views of health care, reduced perceived barriers and increased screening intentions relative to print media (all P < 0.05). The generic video increased screening intention twice as much as the cultural video, although subgroup analysis showed the increase was only significant in women aged 50-64 years. Only Eastern views of health care were negatively associated with screening intentions after adjusting for all baseline covariates. These data suggest that a theoretically guided linguistically appropriate video that targets women from various ethnic groups is as efficacious in modifying attitudes toward mammography screening as a video that is exclusively tailored for Chinese immigrant women.
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Affiliation(s)
- Judy Huei-yu Wang
- Department of Oncology and Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
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Tovar EG, Rayens MK, Clark M, Nguyen H. Development and psychometric testing of the Health Beliefs Related to Cardiovascular Disease Scale: preliminary findings. J Adv Nurs 2010; 66:2772-84. [DOI: 10.1111/j.1365-2648.2010.05443.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Elsie KM, Gonzaga MA, Francis B, Michael KG, Rebecca N, Rosemary BK, Zeridah M. Current knowledge, attitudes and practices of women on breast cancer and mammography at Mulago Hospital. Pan Afr Med J 2010; 5:9. [PMID: 21120008 PMCID: PMC2984320 DOI: 10.4314/pamj.v5i1.56186] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 04/30/2010] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Breast cancer is the third commonest cancer in Ugandan women. Women present late for breast cancer management which leads to high mortality rates. The objective of the study was to assess the knowledge, attitudes and practices of Ugandan women concerning breast cancer and mammography. METHODS This was a descriptive cross-sectional study where 100 women reporting to the Radiology department were interviewed. We used consecutive sampling. Interviewer-administered questionnaires were used to collect opinions of the participants. For data analysis, answers were described as knowledge, attitude, practice and they were correlated with control variables through the chi-square. Bivariate and logistic regression analyses were also used. RESULTS Most of the women (71%) had no idea about mammography. More than 50% did not know about risk factors for breast cancer. The attitude towards mammography was generally negative. Regarding seeking for mammography; level of literacy, occupation and marital status were significant on bivariate analysis, however only level of literacy and employment remained the significant independent variables on logistic regression analysis. The main barrier to mammography was mainly lack of information. CONCLUSION Women in this study had inadequate knowledge and inappropriate practice related to mammography as a procedure for breast cancer investigation.
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Affiliation(s)
- Kiguli-Malwadde Elsie
- Radiology department, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Wang JH, Mandelblatt JS, Liang W, Yi B, Ma IJ, Schwartz MD. Knowledge, cultural, and attitudinal barriers to mammography screening among nonadherent immigrant Chinese women: ever versus never screened status. Cancer 2009; 115:4828-38. [PMID: 19645031 DOI: 10.1002/cncr.24517] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Chinese-American women have much lower mammography screening rates than the general population. This study examined the collective impact of knowledge, cultural views, and health beliefs on intentions to obtain mammography among Chinese women who had not had a mammogram in the previous year. METHODS Five hundred sixty-six immigrant Chinese women from the Washington, District of Columbia and New York metropolitan areas completed baseline assessments for a longitudinal intervention study. Validated surveys were used to measure variables of interest. The outcomes were 1) past mammography use (ever vs never) and 2) future screening intention. RESULTS Only 35% of the participants reported intentions to obtain mammograms, with approximately 19% of the never users reporting intentions (vs 44% ever users). Ever users had higher knowledge (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.03-1.25), less Eastern cultural views (OR, 0.78; 95% CI, 0.70-0.87), and perceived fewer barriers (OR, 0.78; 95% CI, 0.70-0.87) than never users, controlling for covariates. Never users were more likely to be recent immigrants, have low income, have limited English ability, and lack regular sources of care than ever users (all P<.001). Multivariate models showed that ever users who were employed received physician recommendations, had less Eastern views, perceived higher susceptibility, and were more likely to have intentions. Among never users, being 40-49 years of age and perceiving fewer barriers led to increased intention. CONCLUSIONS Understanding cultural patterns and health beliefs in Chinese women is critical to changing their screening behaviors. Interventions that address their common beliefs and specific group barriers are optimal for promoting mammography adherence.
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Affiliation(s)
- Judy H Wang
- Department of Oncology and Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia 20007, USA.
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Wu TY, Ronis D. Correlates of recent and regular mammography screening among Asian-American women. J Adv Nurs 2009; 65:2434-46. [DOI: 10.1111/j.1365-2648.2009.05112.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wu TY, Hsieh HF, West BT. Stages of mammography adoption in Asian American women. HEALTH EDUCATION RESEARCH 2009; 24:748-759. [PMID: 19318524 DOI: 10.1093/her/cyp009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Asian American women have the lowest mammography screening rate and are often diagnosed at later stages of breast cancer compared with other ethnic groups. This study applied the Transtheoretical Model and examined the relationships between stages of mammography adoption and mammography-related beliefs while controlling for socio-demographic factors. The study consisted of a convenience sample of 315 participants from four populous Asian ethnic groups in Michigan (109 Asian Indians, 51 Chinese, 36 Koreans and 119 Filipinos). In this relatively small sample, Koreans appeared to be more likely to be at the pre-contemplation stage and less likely to be at the maintenance stage. Perceived barriers and decisional balance scores differed by stage, with pre-contemplators reporting highest barriers and lowest scores in decisional balance. In terms of specific barrier items, pre-contemplators also displayed significantly greater agreement for most of the barrier items. Participants in the action stage have less favorable decisional balance than those in two earlier stages (i.e. contemplation and relapse). Common barriers for this sample of Asian participants included the items related to access and modesty issues. Overall, the study supports the notion that assessing differences in mammography-related beliefs by stage of screening behavior may facilitate the development of stage-matched interventions for Asian ethnic groups.
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Affiliation(s)
- Tsu-Yin Wu
- School of Nursing, Eastern Michigan University, Ypsilanti, MI 48197, USA.
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Joseph G, Burke NJ, Tuason N, Barker JC, Pasick RJ. Perceived susceptibility to illness and perceived benefits of preventive care: an exploration of behavioral theory constructs in a transcultural context. HEALTH EDUCATION & BEHAVIOR 2009; 36:71S-90S. [PMID: 19805792 PMCID: PMC2941192 DOI: 10.1177/1090198109338915] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes how the social context of transculturation (cultural change processes) and transmigration (migration in which relationships are sustained across national boundaries) can directly influence use of mammography screening. The authors conducted semistructured interviews with Latino and Filipino academics and social service providers and with U.S.-born and immigrant Latinas and Filipinas to explore direct and indirect influences of social context on health behavior (Behavioral Constructs and Culture in Cancer Screening study). Iterative analyses identified themes of the transcultural domain: colonialism, immigration, discrimination, and therapeutic engagement. In this domain, the authors examine two key behavioral theory constructs, perceptions of susceptibility to illness and perceptions of benefits of preventive medical care. The findings raise concerns about interventions to promote mammography screening primarily based on provision of scientific information. The authors conclude that social context affects behavior directly rather than exclusively through beliefs as behavioral theory implies and that understanding contextual influences, such as transculturation, points to different forms of intervention.
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Affiliation(s)
- Galen Joseph
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, CA 94143, USA.
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Stewart SL, Rakowski W, Pasick RJ. Behavioral constructs and mammography in five ethnic groups. HEALTH EDUCATION & BEHAVIOR 2009; 36:36S-54S. [PMID: 19805790 PMCID: PMC2921882 DOI: 10.1177/1090198109338918] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intention, self-efficacy, perceived susceptibility, perceived benefits, and subjective norms are key constructs of health behavior theories; their predictive validity for cancer screening has not been ascertained in multiethnic populations. Participants were 1,463 African American, Chinese, Filipina, Latina, and White women aged 40 to 74 interviewed by telephone in their preferred languages. The relationship between baseline constructs and mammography 2 years later was assessed using multivariable logistic regression. Intention predicted mammography overall and among Whites (odds ratio [OR] = 5.0, 95% confidence interval [CI] = 2.4, 10), with racial/ethnic differences in association (p = .020). Self-efficacy predicted mammography overall and among Whites (OR = 3.5, 95% CI = 1.1, 11), with no racial/ethnic interaction. Perceived benefits and subjective norms were associated with screening overall and in some racial/ethnic groups. These results generally support cross-cultural applicability of four of the five constructs to screening with mixed predictive value of measures across racial/ethnic groups. Additional in-depth inquiry is required to refine assessment of constructs.
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Affiliation(s)
- Susan L Stewart
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94143-0981, USA.
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Comparison of two different educational methods on teachers’ knowledge, beliefs and behaviors regarding breast cancer screening. Eur J Oncol Nurs 2009; 13:94-101. [DOI: 10.1016/j.ejon.2009.01.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 12/24/2008] [Accepted: 01/11/2009] [Indexed: 11/17/2022]
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Champion VL, Monahan PO, Springston JK, Russell K, Zollinger TW, Saywell RM, Maraj M. Measuring mammography and breast cancer beliefs in African American women. J Health Psychol 2008; 13:827-37. [PMID: 18697896 DOI: 10.1177/1359105308093867] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although intervention trials have demonstrated significant improvement in mammography adherence for African American women, many of the current measurement tools used in these interventions have not been assessed for validity and reliability in ethnic minorities. This study assessed the validity and reliability of Health Belief Model (HBM) variables that are often the target of mammography interventions. Scale validity and reliability was assessed for HBM scales in a sample of 344 low-income African American women. Validity was supported through exploratory factor analysis and theoretical prediction of relationships. Internal consistency reliability was .73 or above for all scales.
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Wu TY, Hsieh HF, West BT. Demographics and Perceptions of Barriers Toward Breast Cancer Screening Among Asian-American Women. Women Health 2008; 48:261-81. [DOI: 10.1080/03630240802463384] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tsu-Yin Wu
- a School of Nursing, Eastern Michigan University , Ypsilanti , MI
| | - Hsing-Fang Hsieh
- b Center of Health Communication Research, University of Michigan , Ann Arbor , MI
| | - Brady T. West
- c Center for Statistical Consultation and Research, University of Michigan , Ann Arbor , MI
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Abstract
This article reviews the contribution and potential of widely used health behavior theories in research designed to understand and redress the disproportionate burden of breast cancer borne by diverse race/ethnic, immigrant, and low-income groups associated with unequal use of mammography. We review the strengths and limitations of widely used theories and the extent to which theory contributes to the understanding of screening disparities and informs effective intervention. The dominant focus of most theories on individual cognition is critically assessed as the abstraction of behavior from its social context. Proposed alternatives emphasize multilevel ecological approaches and the use of anthropologic theory and methods for more culturally grounded understandings of screening behavior. Common and alternative treatments of fatalism exemplify this approach, and descriptive and intervention research exemplars further highlight the integration of screening behavior and sociocultural context.
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Affiliation(s)
- Rena J Pasick
- Comprehensive Cancer Center, University of California, San Francisco, CA 94143-0981, USA.
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48
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Avci IA. Factors associated with breast self-examination practices and beliefs in female workers at a Muslim community. Eur J Oncol Nurs 2008; 12:127-33. [PMID: 18242140 DOI: 10.1016/j.ejon.2007.11.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 08/15/2007] [Accepted: 11/04/2007] [Indexed: 11/16/2022]
Abstract
The purpose of this descriptive correlational study was to identify knowledge levels and performance frequency of breast self-examination (BSE) and to examine variables related to breast cancer screening behaviors in a sample of Turkish women. Data were collected from a convenience sample of 103 Muslim female workers at a hazelnut factory in Ordu city, Turkey, using an adapted version of Champion's revised Health Belief Model Scale. Results showed that 26.2% of the women reported knowledge of BSE and 4.3% reported that they perform BSE. Higher health motivation, higher perceived self-efficacy of BSE, marital status, and familial breast cancer history were significantly associated with BSE performance. Higher levels of health motivation and higher perceived self-efficacy of BSE were also significantly associated with knowledge of BSE.
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Affiliation(s)
- Ilknur Aydin Avci
- Nursing Department, Samsun Health School, Ondokuz May University, Public Health Nursing, Turkey.
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Gomez SL, Tan S, Keegan THM, Clarke CA. Disparities in mammographic screening for Asian women in California: a cross-sectional analysis to identify meaningful groups for targeted intervention. BMC Cancer 2007; 7:201. [PMID: 17961259 PMCID: PMC2198916 DOI: 10.1186/1471-2407-7-201] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 10/26/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer among the rapidly growing population of Asian Americans; it is also the most common cause of cancer mortality among Filipinas. Asian women continue to have lower rates of mammographic screening than women of most other racial/ethnic groups. While prior studies have described the effects of sociodemographic and other characteristics of women on non-adherence to screening guidelines, they have not identified the distinct segments of the population who remain at highest risk of not being screened. METHODS To better describe characteristics of Asian women associated with not having a mammogram in the last two years, we applied recursive partitioning to population-based data (N = 1521) from the 2001 California Health Interview Survey (CHIS), for seven racial/ethnic groups of interest: Chinese, Japanese, Filipino, Korean, South Asian, Vietnamese, and all Asians combined. RESULTS We identified two major subgroups of Asian women who reported not having a mammogram in the past two years and therefore, did not follow mammography screening recommendations: 1) women who have never had a pap exam to screen for cervical cancer (68% had no mammogram), and 2) women who have had a pap exam, but have no women's health issues (osteoporosis, using menopausal hormone therapies, and/or hysterectomy) nor a usual source of care (62% had no mammogram). Only 19% of Asian women who have had pap screening and have women's health issues did not have a mammogram in the past two years. In virtually all ethnic subgroups, having had pap or colorectal screening were the strongest delineators of mammography usage. Other characteristics of women least likely to have had a mammogram included: Chinese non-U.S. citizens or citizens without usual source of health care, Filipinas with no health insurance, Koreans without women's health issues and public or no health insurance, South Asians less than age 50 who were unemployed or non-citizens, and Vietnamese women who were never married. CONCLUSION We identified distinct subgroups of Asian women at highest risk of not adhering to mammography screening guidelines; these data can inform outreach efforts aimed at reducing the disparity in mammography screening among Asian women.
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Affiliation(s)
- Scarlett Lin Gomez
- Northern California Cancer Center, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Susanna Tan
- Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, 94305, USA
| | - Theresa HM Keegan
- Northern California Cancer Center, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Christina A Clarke
- Northern California Cancer Center, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
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50
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Wu TY, West BT. Mammography Stage of Adoption and Decision Balance Among Asian Indian and Filipino American Women. Cancer Nurs 2007; 30:390-8. [PMID: 17876185 DOI: 10.1097/01.ncc.0000290812.14571.2c] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cancer is the leading cause of death among Asian American women, and the death rate has increased almost 200% since 1990. Previous research has applied the transtheoretical model constructs to examine cancer screening behavior; however, to our knowledge, this is the first such investigation to examine relationships between stages of mammography adoption and decision balance among Asian American women. This article presents study findings from a convenience sample of 228 women aged 40 to 81 years (mean = 55.0, SD = 9.6) residing in southeastern Michigan. The current study demonstrates excellent support for the psychometric properties of a pros and cons measure, with promising Cronbach alphas above .70. Results from confirmatory factor analysis also support the factor structure derived from exploratory factor analysis with good model fit indices. This study also provides some support on transtheoretical model-hypothesized relationships in this sample of Asian American women that, as the stages of adoption of mammography proceeded from earlier to later ones, the decisional balance would become more favorable. The specific beliefs (both positive and negative) associated with the various stages of mammography adoption have implications for health professionals in developing stage-matched interventions to motivate women in adopting regular mammography.
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Affiliation(s)
- Tsu-Yin Wu
- School of Nursing, Eastern Michigan University, Ypsilanti, Mich 48197, USA.
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