Instrument Adaptation, Modification, and Validation for Cultural Beliefs About Colorectal Cancer Screening Among Korean Americans

A Moderating Role of Gender in Online Health Information Seeking Behaviors for Colorectal Cancer Knowledge among Korean Americans Aged 50 to 75 Years

Korean Americans have consistently reported the underutilization of colorectal cancer (CRC) screening, despite their high rates of CRC incidence and mortality. Research has indicated suboptimal CRC knowledge in Korean Americans as one of the main barriers to their recommended CRC screening. Also, research has shown the potential of online health information seeking (OHIS) to improving cancer knowledge and the gender-based differences in the link between OHIS and cancer knowledge. Thus, this study aimed to examine the association between OHIS and CRC knowledge and the moderating effect of gender in this association among Korean Americans. A cross-sectional survey with purposive sampling was conducted of 421 Korean Americans aged 50 to 75 years in the Southeastern U.S. Three-step hierarchical multiple regression analyses were performed to investigate if three blocks of variables-Block 1: control variables (sociodemographics and health-related information), Block 2: independent variables (OHIS and gender), and Block 3: an (OHIS × gender) interaction term-significantly reduce unexplained variance in CRC knowledge. The analyses showed that the final model fits best accounting for 29.3% of the variance in CRC knowledge. Also, the analyses showed that OHIS was positively associated with CRC knowledge and gender moderated the association between OHIS and CRC knowledge. The findings close the knowledge gap existing in the body of literature on the connection of OHIS to CRC knowledge in Korean Americans. Findings also extend the understanding of gender-specific approaches leveraging OHIS for CRC prevention education among Korean Americans.

Correlates of Stigma Toward Mental Health Service Use Among Filipino Americans and Korean Americans

Asian Americans are less likely than Whites to seek mental care and when they do, there is a substantial delay in help-seeking. Stigma associated with mental health service use is one of the major barriers to help-seeking among Asian Americans. However, few studies have examined multi-layered contextual predictors of stigma to examine joint as well as unique contributions of each predictor. Using a cross-sectional study of 376 Filipino and 412 Korean American parents from the Midwestern U.S., we investigated how individual, familial, ethnic cultural, and macro level factors were associated with stigma among immigrant parents. The findings from hierarchical regressions suggest that familial and ethnic cultural factors are prominent predictors of stigma among Korean Americans, whereas macro level factors are particularly pertinent to Filipino Americans. This study highlights the significance of subgroup specific interventions to be effective in addressing unmet mental care needs in distinct subgroups of Asian Americans.

Effect of education based on the Common-Sense Model of Self-Regulation on blood pressure and self-management of hypertensive patients: A clinical trial study

Objective

This study aimed to determine the impact of training based on the Common-Sense Model of Self-Regulation (CSM) on blood pressure and self-management of patients with hypertension.

Methods

This randomized controlled trial study was conducted. Seventy-two hypertensive patients were referred to the Farshchian Hospital clinic in Hamadan from April 2021 to March 2022. Samples were selected and randomly assigned to the intervention group (n = 36) and control group (n = 36). The intervention group participated in a training program based on the CSM in five sessions of 30-45 min for one month. Phone follow-up was also done once every three days. The control group only received routine clinic education. The clinic's nurse measured the patients' blood pressure, and the participants completed the self-management questionnaire before and three months after the start of the study.

Results

A total of 68 participants completed the study. Results showed that before the intervention, there was no statistically significant difference in the mean scores of self-management and its dimensions, systolic, diastolic, and mean arterial pressure between intervention and control groups (P > 0.05). However, after the intervention, the mean of systolic blood pressure (116.21 ± 14.52 vs. 128.62 ± 16.88) mmHg, mean arterial pressure (88.03 ± 8.47 vs. 98.11 ± 11.69) mmHg and the scores of self-management and its dimensions among patients in the intervention group were decreased comparison with control group (P < 0.05).

Conclusions

Education based on the CSM improved self-management and blood pressure reduction in hypertensive patients, so nurses should use it as an effective educational model.

Cultural adaptation of the person-centered maternity care scale at governmental health facilities in Cambodia

BACKGROUND

In Cambodia, the importance of valuing women's childbirth experiences in improving quality of care has been understudied. This is largely because of absence of reliable Khmer tools for measuring women's intrapartum care experiences. Generally, cross-cultural development of those tools often involves translation from a source language into a target language. Yet, few earlier studies considered Cambodian cultural context. Thus, we developed the Cambodian version of the Person-Centered Maternity Care (PCMC) scale, by culturally adapting its original to Cambodian context for ensuring cultural equivalence and content validity.

METHODS

Three rounds of cognitive interviewing with 20 early postpartum women were conducted at two governmental health facilities in Cambodia. Cognitive interviewing was composed of structured questionnaire pretesting and qualitative probing. The issues identified in the process of transcribing and translating audio-recorded cognitive interviews were iteratively discussed among study team members, and further analyzed.

RESULTS

A total of 14 issues related to cultural adaptations were identified in the 31 translated questions for the Cambodian version of the PCMC scale. Our study identified three key findings: (i) discrepancies between the WHO recommendations on intrapartum care and Cambodian field realities; (ii) discrepancies in recognition on PCMC between national experts and local women; and (iii) challenges in correctly collecting and interpreting less-educated women's views on intrapartum care.

CONCLUSION

Not only women's verbal data but also their non-verbal data and cultural contexts should be comprehensively counted, when reflecting Cambodian women's intrapartum practice realities in the translated version. This is the first study that attempted to develop the tool for measuring Cambodian women's experiences during childbirth, by addressing cross-cultural issues.

Contraceptive Decision Making Among Latina Immigrants: Developing Theory-Based Survey Items

BACKGROUND

Contraception is important for reproductive autonomy, yet many Latinas do not use contraception consistently despite research reporting a desire to do so. Factors varying in priority and value come into play during contraceptive decision making. When measuring these, relevant survey items may vary by populations.

AIM

This study focused on developing an ethnically responsive, patient-centered, content-valid survey for measuring factors that influence contraceptive decision making among immigrant Latinas.

METHOD

Nonpregnant self-identified Latinas ages 15 to 24 years in Baltimore, MD, were recruited from a family planning facility. Using the theory of planned behavior as a theoretical framework and prior formative research, initial survey items were drafted (Step 1). Content validation and cognitive interviewing procedures (Step 2 and Step 3) were used to develop final items.

RESULTS

Final items (27) were content-validated by the target population; items reflect important factors and relevant contexts affecting contraceptive decision making among Latinas in Baltimore.

DISCUSSION

These theory-based items provide an important contribution to the literature because they measure and explore factors related to contraceptive decision making in an understudied population. Providers might consider these factors during counseling to build patient-centered communication. These items might serve to measure responses to theory of planned behavior-based interventions designed to improve the contraceptive counseling of Latinas.

Is Colorectal Cancer Screening Associated with Stages of Weight Control Among Korean Americans Aged 50-75 Years Old?: Implications for Weight Control Practice

OBJECTIVE

To examine the associations of colorectal cancer (CRC) screening with stages of weight control among Korean Americans (KAs) using the transtheoretical model and provide implications for their weight control practice.

METHODS

A quantitative, cross-sectional survey was employed to collect data on current weight control behaviors and intentions, CRC screening history, previous cancer diagnosis, body mass index, number of chronic conditions, perceived health status, health insurance, and sociodemographics. Purposive sampling was implemented to recruit KA participants in the Atlanta metropolitan area in the USA from May 2015 to February 2016. A total of 433 KAs aged 50 to 75 years completed a self-report survey questionnaire. Descriptive and bivariate analyses and multiple logistic regressions were performed using Stata Version 14/MP software.

RESULTS

Applying the stages of the transtheoretical model 53% were positioned in the first two stages (precontemplation and contemplation) of weight control with 47% being in the last two stages (action and maintenance). Participants who had been screened for CRC were more likely to be in the last two stages of weight control compared with those who had not been screened (OR = 2.49; p = 0.003).

CONCLUSIONS

The findings suggest that preventive healthcare such as CRC screening may provide the opportunity for health education interventions to help encourage weight control efforts and behaviors in the KA community. Future research is warranted to investigate the underlying mechanism behind the link between CRC screening and weight control to guide the development of interventions for eliminating health disparities.

Enriching the quality of cross-cultural instrument development through cognitive interviewing: Implications for nursing research

AIM

During cross-cultural instrument development, a gap commonly exists between the intended meaning of questionnaire items and the extent to which the participant understands that meaning. Because cognitive interviewing can provide such a powerful means for ensuring an accurate interpretation of items, the purpose of this report is to provide a practical guide to encourage its use in nursing research.

METHODS

This report provides in-depth information describing: (a) advantages of cognitive interviewing, particularly for cross-cultural instrument development; (b) specific problems it can identify and solve; (c) strategies for performing cognitive interviews, including the four-step model of the question-and-answer process; (d) practical guidance for conducting successful cognitive interviews.

RESULTS

To achieve linguistic validity as well as cultural relevance, a variety of factors need to be considered in addition to language, such as cultural interpretations, attitudes, and values. Examples of health-related studies are presented, demonstrating the advantages of cognitive interviewing for instrument development and cross-cultural research. These examples show how cognitive interviewing can be productively used to verify question clarity, patient comprehension, and patients' ease of response and judgment while also helping to establish content validity based on patients' perspectives.

CONCLUSIONS

Cognitive interviewing can help nurse researchers discover potential instrument flaws and correct them in advance, subsequently avoiding collection of inaccurate data. Thus, cognitive interviewing should be considered an effective pretesting method for development of accurate instruments, particularly in cross-cultural nursing research.

Adaptation and validation of the health belief model scale for colorectal cancer screening

Korea has the second highest incidence of colorectal cancer in the world. Instruments that are culturally and contextually sensitive, as well as valid and reliable, for determining health beliefs regarding colorectal cancer screening are essential for obtaining accurate information. The purpose of this study was to adapt and validate the health belief model scale for Koreans regarding colorectal cancer and fecal occult blood test utilization. Individual and cognitive interviews (also known as cognitive debriefing) with 33 Koreans, expert reviews with seven nursing practitioners and professors, and a pilot test with 18 Koreans were conducted to make the existing health belief model scale culturally and contextually sensitive. Subsequently, a cross-sectional survey with 728 Koreans aged >50 years was conducted. Exploratory and confirmatory factor analyses of the construct validity and internal consistency reliability supported the adapted health belief model scale. The adapted and validated health belief model scale in this study could contribute to the assessment of health beliefs regarding the fecal occult blood test among Koreans with a greater degree of accuracy with respect to Korean culture and context.

Factor structure and internal reliability of cultural belief scales about colorectal cancer screening among Koreans in the Republic of Korea

BACKGROUND

Culturally sensitive, reliable and valid cultural belief scales for colorectal cancer (CRC) screening in Koreans in the Republic of Korea are not available in the literature. The purpose of this study was to adapt and validate existing cultural belief scales for CRC screening in Koreans.

METHODS

Individual interviews, expert reviews, and a pilot test were conducted for instrument adaptation, and a cross-sectional survey with 884 Koreans was conducted for instrument validation. Construct validity using exploratory and confirmatory factor analyses and reliability of the Korean version of the instruments were examined.

RESULTS

Exploratory factor analysis using c four factors that accounted for 48.12% of the variance. The validity and reliability of the cultural belief scales were supported by confirmatory factor analysis and Cronbach's alpha.

CONCLUSIONS

The results of the present study showed that the four-factor cultural belief scales were culturally sensitive, reliable and valid in Koreans. The final cultural belief scales could be used to identify cultural beliefs more accurately and specifically, as well as to develop effective interventions to increase CRC screening in Koreans in the Republic of Korea.

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

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