Breast Cancer Beliefs and Mammography Screening Practices Among Chinese American Immigrants

Breast cancer and breast cancer screening use-beliefs and behaviours in a nationwide study in Malaysia

BACKGROUND

Many upper-middle-income countries (UMICs), including Malaysia, continue to face low breast cancer (BC) screening rates and patients with delayed presentation of BC. This study investigated the role of beliefs about BC and use of screening (e.g. beliefs about whether or not screening reduced the possibility of dying from BC).

METHODS

A nationwide cross-sectional study was conducted in which a total of 813 women (aged ≥ 40 years old) were randomly selected and surveyed using the validated Awareness and Beliefs about Cancer (ABC) measure. The association between BC screening use, sociodemographic characteristics, and negative beliefs about BC screening were analysed using stepwise Poisson regressions.

RESULTS

Seven out of ten Malaysian women believed that BC screening was necessary only when experiencing cancer symptoms. Women > 50 years and from households with more than one car or motorcycle were 1.6 times more likely to attend a mammogram or a clinical breast examination (mammogram: Prevalence Ratio (PR) = 1.60, 95% Confidence Interval (CI) = 1.19-2.14, Clinical Breast Examination (CBE): PR = 1.61, 95% CI = 1.29-1.99). About 23% of women expected to feel anxious about attending BC screening, leading them to avoid the procedure. Women who held negative beliefs about BC screening were 37% less likely to attend a mammogram (PR = 0.63, 95% CI = 0.42-0.94) and 24% less likely to seek a CBE (PR = 0.75, 95% CI = 0.60-0.95).

CONCLUSIONS

Public health strategies or behaviour interventions targeting negative beliefs about BC screening among Malaysian women may increase uptake and reduce late presentation and advanced-stage cancer. Insights from the study suggest that women under 50 years, in the lower income group without a car or motorcycle ownership, and of Malay or Indian ethnicity (compared to Chinese-Malay) are more likely to hold beliefs inhibiting BC screening.

Effect of social support and barrier perceptions of disabled women on early detection of breast cancer

In the study, we examine the effect of social support and disability perception of disabled women on early diagnosis behaviors of breast cancer. The research was conducted as descriptive. The sample of the study consisted of 105 participants. The breast self-examination barrier perception point average of the participants applying the breast self-examination was statistically significantly lower than those not applying and the barrier perception point average of participants having mammography was statistically significantly lower than those not having it (p < 0.05).

Beliefs, fear and awareness of women about breast cancer: Effects on mammography screening practices

AIM

This study sought to investigate the beliefs, fear and awareness about breast cancer and mammography screening practices of women in Iran.

METHODS

This descriptive-correlational study was conducted at Tabriz, East Azerbaijan Province, northwest of Iran from February-July 2017. One hundred and fifty-two women aged 40 years and older, who were referred to 12 health centres for health services were selected via clustering sampling. Associations between variables and mammography screening practices were examined using bivariate and multivariate logistic regression analyses. Participants who had a mammogram within the last 24 months were compared with those who had none. Sociodemographic questionnaire, Champion's Breast Cancer Fear Scale, Champion's Health Belief Model Scale for Mammography Screening, Breast Cancer Awareness Scale and Powe Fatalism Inventory were the tools used for data gathering.

RESULTS

Just 38.2% of women reported having a mammogram within the last 24 months. Self-efficacy (OR = 5.36, B = 1.68, p < .001), susceptibility (OR = 2.83, B = 1.04, p < .001), motivation (OR = 2.11, B = 0.75, p = .024) and lower perceived barriers (OR = 0.25, B = -1.37, p < .001) were associated with being screened. Neither fatalistic belief nor awareness towards breast cancer was significant.

Psychosocial predictors of mammography history among Chinese American women without a recent mammogram

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.

Predictors of never having a mammogram among Chinese, Vietnamese, and Korean immigrant women in the U.S

BACKGROUND

Breast cancer is the most common cancer among Asian women in the U.S. The first objective was to investigate predictors (including ethnicity) of never having a mammogram in middle-aged and older Chinese, Vietnamese, and Korean immigrant women (main effects). The second objective was to explore whether relationships between predictors and never having a mammogram varied across the three groups (moderation effects of ethnicity).

METHODS

Merged (2005-2007-2009-2011) California Health Interview Survey data were utilized. Unweighted sample was 3,710 Asian women ages 40 years and older (Chinese = 1,389; Vietnamese = 1,094; Korean = 1,227). Replicate weighted total sample size was 1,710,233 (Chinese = 940,000; Vietnamese = 410,000; Korean = 360,000). Replicate-weighted multivariate logistic regression was applied. Interaction effects (moderator role of ethnicity) were also examined, using multivariate logistic regression, for the second objective.

RESULTS

For the first objective, odds of never having a mammogram were higher for women who were Korean (Ref = Vietnamese), unmarried, or a non-U.S. citizen. Odds were lower in women ages 50-59 or 60-69 (Ref = 70-85). Regarding the second objective, only for Chinese women, odds of never having a mammogram were lower as the number of physician visits got higher.

CONCLUSION

Culturally-sensitive outreach and services should be developed to target higher-risk groups. Patient-centered healthcare strategies tailored for the three groups could be effective. For Chinese women, in particular, regular information sessions or education programs could be provided for enhancing their physician visits.

Perceived Barriers to Mammography Adoption among Women in Iran: A Qualitative Study

Background

Breast cancer is the most commonly diagnosed tumorous cancer and the second leading cause of cancer-related deaths among women worldwide. This study aimed to qualitatively explore the barriers to mammography adoption among Iranian women.

Methods

This study is a qualitative component of a large research project on exploratory sequential mixed method design, utilizing conventional content analysis. In total, 24 participants were selected from among women who had participated in the first phase of the study. Data were collected through in-depth, semi-structured interviews.

Results

Five main themes were extracted, consisting of unawareness of mammography, fear control, priority of mammography needs, inadequate competency of mammography centers, and a sense of losing family support.

Conclusion

Different perceived barriers within various levels (individual, intrapersonal, health systems, and community) play influential roles in women’s decisions to participate in breast cancer screening program, which indicates the cultural aspect of perceived barriers in different communities and countries. The study provides the basis for intervention planning in this regard.

Beliefs about Breast Cancer among Women in the Western Amazon: A Population-Based Study

Objective: Evaluate the beliefs about the risk factors for breast cancer in a population of women from the western Amazon and determine the factors associated with the higher belief scores presented by this population. Methods: A population-based cross-sectional study included 478 women aged >40 years residing in Rio Branco, Acre, Brazil. An American Cancer Society questionnaire was applied to assess the knowledge, attitudes, and beliefs about breast cancer. Results: The main beliefs about the risk factors for breast cancer were breast trauma (95%), use of underwire bra (58.5%), and a high number of sexual partners (55.5%). Women from younger age groups presented higher belief scores (Bcoefficient: –0.04, 95% CI: –0.07; –0.01) than those of women from older age groups. A strong association was noted between high knowledge scores of risk factors and signs/symptoms of the disease and high belief scores in the study group (Bcoefficient:0.33;95%CI:0.28;0.38). Conclusion: The results indicate the existence of important beliefs related to the risk factors for breast cancer. Women from younger age groups, women who have seen a gynecologist in the past 2 years, and women who had more knowledge about the risk factors and signs and symptoms of breast cancer had higher belief scores.

Self-perceived burden mediates the relationship between self-stigma and quality of life among Chinese American breast cancer survivors

PURPOSE

Cancer-related self-stigma (the internalized sense of shame about having cancer) has been found to associate with poorer quality of life (QoL) among cancer survivors. However, culturally salient illness beliefs (e.g., cancer is contagious; cancer is a result of karma; and cancer brings shame to the family) may make Chinese cancer survivors vulnerable to self-stigmatization. This study examined the association between self-stigma and QoL among Chinese American breast cancer survivors (BCS). To understand the potential mechanism, the mediating role of self-perceived burden to caregivers between self-stigma and QoL was also examined.

METHODS

Chinese American BCS (n = 136) were recruited through community-based cancer associations. Participants' self-stigma, self-perceived burden, and QoL were measured in a questionnaire package.

RESULTS

Structural equation modeling results supported the proposed mediation model in predicting physical QoL (χ²(100) = 123.041, CFI = 0.982, TLI = 0.975, RMSEA = 0.041) and emotional QoL (χ²(84) = 137.277, CFI = 0.958, TLI = 0.940, RMSEA = 0.069), with satisfactory model fit indices. Both the indirect effects from self-stigma to QoL via self-perceived burden (physical: β = - 0.13; 95% CI = - 0.22, - 0.07 and emotional: β = - 0.11; 95% CI = - 0.22, - 0.04) and the direct effects from self-stigma to poorer QoL were significant (physical: β = - 0.22; 95% CI = -0.34, -0.10 and emotional: β = - 0.39; 95% CI = - 0.54, - 0.23), suggesting a partial mediation effect of self-perceived burden between self-stigma and QoL.

CONCLUSIONS

Self-stigma could reduce physical and emotional QoL through increasing self-perceived burden. Interventions aiming to reduce Chinese American BCS' self-stigma and perceptions of burdensomeness may facilitate improvement in QoL, which in turn promotes better cancer survivorship.

Identifying the Social Determinants of Breast Health Behavior: a Qualitative Content Analysis

Background: Prevention, early diagnosis and reduction of mortality caused by breast cancer are the priorities of the world health systems. The aim of this study was to identify the social factors that affect the women’s breast health behavior based on the social determinants model of the World Health Organization (WHO). Materials and Method: This qualitative study was conducted and analyzed using content analysis approach. The data were collected from 32 participants by semi-structured interviews and focused group discussion. The participants comprised of breast surgeons, radiologists, health care providers and women over 35 years of age in Tehran who were selected through purposeful sampling. The interviews continued until data saturation was reached. Results: Based on the experiences of the participants, three themes were obtained from the data that shaped the women’s breast health behavior, including 1) the context of health policy, 2) socioeconomic status, and 3) cultural, psychological, and behavioral factors. Conclusion: A better understanding of social determinants related to breast health behavior can be effective in designing and applying of appropriate theories and models of education and intervention, so that, by early diagnosis of breast cancer and timely treatment of patients, the disease complications and mortality would be reduced.

Determinants of Breast Cancer Screening by Mammography in Women Referred to Health Centers of Urmia, Iran

Background:

In women, breast cancer accounts for 30 percent of all cancers and it is the second leading cause of mortality. Mammography is considered an effective procedure to detect early breast cancer recommended by World Health Organization. This study was aimed to evaluate breast cancer screening determinants in women referred to health centers of Urmia for mammography in 2017.

Materials and Methods:

In this descriptive-analytic cross-sectional study, 348 women referred to health centers of Urmia were selected using multistage sampling. Data were collected using a standard questionnaire for mammography screening determinants, with a checklist including demographic characteristics, family, social and economic factors and midwifery background. Analysis was with SPSS software version 20for descriptive and inferential statistic tests, P<0.05 being considered significant.

Results:

The proportion performing mammography was 12%. Significant relationships were noted with income, menopause status, a history of breast cancer in close relatives, beliefs, inaccessibility, knowledge, cues to action, emotions, self-care, and life priorities (P<0.05). There were no significant links with age at marriage, first age of delivery, number of children, duration of breastfeeding, status of residency, education, marital status, occupation, history of breastfeeding, and previous breast problems (P>0.05).

Conclusions:

The findings of this study showed that the status of breast cancer screening in participating women was not satisfactory. Therefore, promotion of screening methods by health policy makers in Iran is necessary and given that reliance solely on education is not sufficient, it is essential to pay attention to barriers and eliminate them.

Breast Cancer and Mammography Screening: Knowledge, Beliefs and Predictors for Asian Immigrant Women Attending a Specialized Clinic in British Columbia, Canada

Screening mammography (MMG) reduces breast cancer mortality; however, Asian immigrant women underutilize MMG. The Asian Women's Health Clinic (AWHC) was established to promote women's cancer screening amongst this population. This study evaluated the rate, and predictors, of MMG amongst women attending the AWHC. Women (N = 98) attending the AWHC completed a questionnaire. Descriptive statistics and multivariable logistic regression evaluated rate and predictors of MMG. Most participants (87 %, n = 85) reported having had a mammogram. Significant MMG predictors were: lower perceived MMG barriers [lifetime: OR (CI) 1.19 (1.01-1.49); past 2 years: OR (CI) 1.11 (1.01-1.25)], and knowing someone with breast cancer [past year: OR (CI) 3.42 (1.25-9.85); past 2 years: OR (CI) 4.91 (1.32-2.13)]. Even amongst women using preventive medicine, 13 % report never having had a mammogram. More research is needed into innovative interventions, e.g. the AWHC, and breast cancer-related outcomes amongst Asian immigrant women.

Effects of Interventions Based on Health Behavior Models on Breast Cancer Screening Behaviors of Migrant Women in Turkey

BACKGROUND

Antalya is a city receiving internal and external migration in Turkey, including migrant women in need of developing breast cancer screening behaviors.

OBJECTIVE

The aim of this study was to develop breast cancer screening behaviors of migrant women through nursing interventions based on the Health Belief Model and the Health Promotion Model.

METHODS

This quasi-experimental study was conducted with 200 women (100 women in the intervention group, 100 women in the control group) in Antalya. The intervention group received training, consultancy service, and reminders and was followed up at 3 and 6 months after interventions.

RESULTS

The rates of breast self-examination, clinical breast examination and mammography were higher at months 3 and 6 in women in the intervention group compared with the women in the control group. In the intervention group, perceptions of susceptibility and barriers decreased after the interventions, and benefit, health motivation, and self-efficacy perceptions increased. According to month 6 data, in the intervention group, the decrease of each unit in perception of barriers increased the rate of breast self-examination 0.8 times and the rate of mammography 0.7 times. An increase of each unit in health motivation increased the rate of clinical breast examination 1.3 times and the rate of mammography 1.5 times.

CONCLUSION

Interventions based on health behavior models positively affected breast cancer screening behaviors of migrant women. Health motivations and perceptions of barriers are determinants in performing the screening behaviors.

IMPLICATIONS FOR PRACTICE

Migrant women should be supported more by healthcare professionals regarding recognition of breast health and disease and in transportation to screening centers in their new location.

The Role of Community Education in Increasing Knowledge of Breast Health and Cancer: Findings from the Asian Breast Cancer Project in Boston, Massachusetts

In the past decade, cancer rates have significantly decreased in the USA, but breast cancer survival is lower in Asian American women, likely due to lower rates of screening behaviors in Asian Americans compared to other ethnicities, which could lead to later stage cancer diagnosis and increased mortality. This paper reports on the Asian Breast Cancer (ABC) Project, a three-phase peer-led community program designed to promote cancer prevention by improving breast cancer screening rates among Chinese and Vietnamese women in the Greater Boston area. The three phases of planning and coalition building, community health worker training, and the community workshop intervention are described. The workshop intervention was evaluated by comparing pre- and post-workshop questionnaires evaluating knowledge about breast cancer screening and prevention. Two hundred fifty-two women participated in the program across 14 workshops. Each participant completed questionnaires about demographics, access to health care, and a five-item self-administered questionnaire about breast cancer knowledge. Results showed that the majority of the women had received a clinical breast exam or mammogram in the past 12 months (69 and 59 %, respectively), and older women were more likely to get a mammogram (85 %) or clinical breast exams (74 %) compared to younger women. Eighty-one percent of women were interested in reminder systems. Baseline knowledge was high for three survey questions about mammograms and breast cancer risk (88-97 %). For questions with fewer correct answers at baseline, knowledge about the meaning of lumps in the breast significantly increased (69 to 80 % correct, p < 0.0001), as well as knowledge about frequency of clinical breast exam (48 to 67 % correct, p < 0.0001). This pilot project indicated a partial effectiveness of the community workshop in a population with high baseline knowledge. The education workshop increased knowledge about breast lumps and clinical exam frequency. We also identified that reminder systems and appointment assistance are desired by this population. Our findings inform future cancer screening strategies for Asian Americans.

Breast Cancer Awareness among Women in Western Amazon: a Population Based Cross-Sectional Study

Background:

A general lack of women`s awareness of breast cancer has been one of the barriers to screening and early presentation. Thus, the aim of this study was to evaluate levels of knowledge about risk factors, and early warning signs of breast cancer, and to determine factors associated with better levels of comprehension.

Methods:

A population-based cross-sectional study was carried out among 478 women over 40 years old, living in Rio Branco city, western Amazon. All were interviewed using the “Breast cancer knowledge, attitudes and practice scale”, developed by American Cancer Society.

Results:

Among the respondents, only 28.6% of women were aware that advanced age highly increases the risk. Around 30% of participants recognized nipple retraction as a sign of breast cancer. Breast cancer knowledge varied according to age in such a way that the mean scores were high from 40-69 years and decreased dramatically among those aged ≥70 (β=-0.06, p=0.031). Access to health services such as the Pap-test (β=2.45, p=0.027) and attending a gynecologist in the past two years (β=1.88, p=0.005) were statistically associated with the score of breast cancer knowledge.

Conclusion:

The findings indicate that women living in urban areas, having gynecological assessment, considering herself at high risk of developing breast cancer and thinking that breast cancer is a fatal disease are statistically associated with good knowledge of breast cancer risk factors, signs and symptoms, even adjusting for age and education.

Content Validity of a Screening Instrument for Breast Cancer Early Detection Among Asian American Women: The Cultural Health and Screening Mammography Belief Scale

BACKGROUND AND PURPOSE

Asian American women have the lowest mammography screening rate in the United States. There is no standardized instrument available to measure their cultural beliefs regarding screening mammography. The purpose of this study is to evaluate the content validity of the Cultural Health and Screening Mammography Belief Scale (CHSMBS) developed for this population. Procedures for Instrument Development: The content validity was examined using content validity index (CVI). Both item-level (I-CVI) and scale-level CVIs (S-CVI) were evaluated.

RESULTS

The instrument's I-CVIs ranged from 0.75 to 1.00, and the S-CVI was 1.00, reflecting excellent inter-rater agreement.

CONCLUSIONS

The study has established the scale's content validity to evaluate Asian American women's use of screening mammography. Further examination of the reliability and construct validity will add further support of the scale's utility in health research and practice.

Challenges in Cancer Self-management of Patients with Limited English Proficiency

Objective:

This paper summarizes the barriers and challenges in cancer care reported from a validation project of a self-management intervention handbook from Chinese-American cancer patients with limited English proficiency (LEP).

Methods:

Seven health-care providers (HCPs) and 16 Chinese-American cancer survivors with LEP were invited to validate a self-management intervention handbook through networking sampling method. Bilingual versions were developed and validated using the repeated translation process. Online and paper-based survey and interview were conducted to collect information on the perception of barriers and experiences on cancer care. Data were analyzed by the content analysis method.

Results:

The HCPs reported a bilingual self-management handbook which is useful and feasible for patient self-management. The challenges in giving cancer care to LEP patients included: patients do not engage in discussion, different cultural health beliefs, unable to speak to patients in their primary language, and patients are less likely to discuss emotional and social challenges during treatments. The common barriers and experiences during cancer care included: limited understanding about treatment/medication and side effects, language barriers such as unable to communicate to make the decision, unable to understand information related to resources and do not know what questions to ask, and do not know what to expect during their cancer treatment.

Conclusions:

The current findings highlight the need of cancer self-management support for culturally diverse LEP cancer patients. Further research can include applying the supportive intervention to all LEP cancer patients.

A Longitudinal Examination of Stages of Change Model Applied to Mammography Screening

Application of behavior change theories to ethnically diverse groups is limited. In a secondary analysis of intervention study data, we tested the validity of the transtheoretical model (TTM) of change among Chinese American immigrant women. Three hundred mammography non-adherent women were randomized to an intervention or control group. Compared with contemplators (60%), precontemplators reported higher perceived mammography barriers (p < .001) and lower breast cancer susceptibility (p < .01). Baseline contemplators were 1.5 times more likely to have a mammogram post intervention compared with precontemplators. Upward shift in stage of change was higher in the intervention than the control group at 3 months (odds ratio [OR] = 6.14), 6 months (OR = 4.82), and 12 months (OR = 2.85). Women with an upward shift at 3 months were more likely to complete mammography at 12 months (OR = 15.44). The results supported the TTM stages of change. Education targeted to Chinese women's stages of change has significant potential to decrease breast cancer screening disparities.

Breast Health Intervention Effects on Knowledge and Beliefs Over Time Among Chinese American Immigrants--a Randomized Controlled Study

Chinese American immigrant women, nonadherent with mammography in the past 12 months, (N = 300) were enrolled in a randomized controlled trial designed to change knowledge and beliefs and increase mammogram use. This report describes intervention effects on changes in knowledge and beliefs between the control and educational groups over four time points (baseline and 3, 6, and 12 months). Variables measured included knowledge, perceived susceptibility, perceived general barriers to mammography, perceived benefits to mammography, and four cultural barriers to mammography (crisis orientation, modesty, use of Eastern medicine, reliance on others). At all three post-intervention time points, women in the education group had significantly higher knowledge scores than those in the control group, regardless of whether they had completed a mammogram during the study. Women in the education group reported higher perceived susceptibility to breast cancer at 3-month post-intervention. At 3- and 6-month post-intervention, regardless of mammogram screening completion, women reported lower concerns about modesty related to mammography when compared to the control group. By the 12-month post-intervention, women in the education group reported significantly fewer perceived barriers than the control group. A targeted breast health program successfully changed breast health knowledge and beliefs that were sustained for up to 6-12 months. Education targeted to women's knowledge and beliefs has significant potential for decreasing disparity in mammogram use among Chinese American immigrant women.

Breast cancer screening practices among Hong Kong Chinese women

BACKGROUND

Although the incidence rates of breast cancer have been increasing remarkably in Hong Kong over the last 2 decades, little is known on breast cancer screening practices among this group of women.

OBJECTIVES

This study aimed to report breast cancer screening practices among Hong Kong Chinese women and to examine the relationship between (1) demographic factors and (2) the modified Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) score and women's breast screening behaviors.

METHODS

A descriptive and cross-sectional method was used. Both English and Chinese versions of the modified CBCSB were administered. Of 946 Hong Kong Chinese women older than 18 years and invited to participate in the study, 753 (79.6%) completed and returned the questionnaire.

RESULTS

The majority of participants (70%-90%) had heard of breast self-examination (BSE), clinical breast examination (CBE), and mammograms. Only 33.3% performed a BSE monthly; 37.8% and 32.7% of women within the targeted age group had a CBE annually and had a mammogram every 2 years, respectively. Being married and part-time employment were positively associated with women who performed BSE as recommended. In terms of modified CBCSB score, women who had BSE, CBE, and mammogram as recommended had significantly higher scores on the subscale attitudes to health check-up.

CONCLUSION

Attitudes toward health check-up was influential in compliance with breast cancer screening practices among Chinese-Australian women.

IMPLICATIONS FOR PRACTICE

Effort should be focused on specific subgroups of Hong Kong Chinese women, to fully understand the barriers involved in participating in breast cancer screening practices.

Factors associated with mammography adherence among married Chinese women in Yanbian, China

BACKGROUND

Despite the efficacy of regular mammograms, the incidence and mortality rate of breast cancer have been increasing in China. Insufficient studies on the factors affecting mammography adherence in Chinese married women have been conducted. The purpose of the present study was to explore the factors associated with adherence to guidelines for regular mammography among Chinese married women.

MATERIALS AND METHODS

The participants were recruited conveniently and included Chinese and Korean Chinese women who were married, living at Yanbian City in China. Demographic information, status regarding eight risk factors of breast cancer, health responsibility, and perceived benefits/barriers of mammography were obtained. Descriptive analyses, t-test, and multivariate analysis were performed. Hierarchical logistic regression was conducted to explore the factors associated with regular mammography adherence in Chinese and Korean Chinese subgroups.

RESULTS

About 24% of the sample population was adherent in going for regular mammography. The adherent group was significantly more educated, had more children, and had a lower proportion experiencing early menarche and a greater menopausal proportion than the non-adherent group. The final model using logistic regression analysis showed that being Chinese [OR=2.199 (1.224-3.951)], having no or one child [OR=4.879 (1.835-12.976)], early menarche [OR=3.515 (1.057-11.694)], being menopausal [OR=3.120 (0.965-10.088)], aged 40-49 [OR=2.374 (1.099-5.124)], having low education [OR=0.400 (0.211-0.765)], and perceiving greater benefits in doing mammography [OR=1.080 (1.014-1.151)] were significantly associated with mammography adherence, after controlling for covariates.

CONCLUSIONS

Sociocultural sensitive intervention for minorities should be emphasized when improving the adherence of regular mammography. Intervention tailored for women with lower education should be delivered and the benefits of mammography should be propagated to women in rural areas of China.

A Breast Health Educational Program for Chinese-American Women: 3- to 12-Month Postintervention Effect

Purpose.

To test the efficacy of a culturally targeted breast cancer screening educational program in increasing mammogram completion in Chinese-American immigrant women.

Design.

Randomized controlled study

Setting.

Chinese communities, Portland, Oregon.

Subjects.

From April 2010 to September 2011, 300 women were randomized to receive a theory-based, culturally targeted breast cancer screening educational intervention (n = 147) or a mammography screening brochure published by the National Cancer Institute (n = 153).

Intervention.

The two-part intervention consisted of group teaching with targeted, theory-based messages followed by individual counseling sessions.

Measures.

Mammography completion, perceived susceptibility, perceived benefits, perceived barriers, perceived cultural barriers, and demographic variables.

Analysis.

A 2 × 3 mixed logistic model was applied to determine odds ratio of mammogram completion.

Results.

Behavior changed in both groups, with a total of 170 participants (56.7%) reporting a mammogram at 12 months. The logistic model indicated increased odds of mammogram completion in the intervention compared to the control group at 3, 6, and 12 months. When controlling for marital status, age, and age moved to the United States, the intervention group was nine times more likely to complete mammograms than the control group.

Conclusion.

The culturally targeted educational program significantly increased mammogram use among Chinese immigrant women. Further testing of effectiveness in larger community settings is needed. The intervention may also serve as a foundation from which to develop education to increase cancer screening among other minority subgroups.

Developing and evaluating an individually tailored intervention to increase mammography adherence among Chinese American women

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.

Factors influencing the stages of breast cancer at the time of diagnosis in Thai women

BACKGROUND

Early diagnosis of breast cancer leads to early treatment therefore improving women's health. However, most Thai women are diagnosed at a late stage.

OBJECTIVE

This cross-sectional correlational study was designed to explore factors influencing the diagnosis of early stage breast cancer in Thai women.

METHOD

Thai women (n = 400) newly diagnosed breast cancer at all clinical stages from public hospitals in Bangkok Metropolitan completed a questionnaire about knowledge of breast cancer and screening. The questionnaire addressed pre-diagnosis data about: (1) health care provider's recommendations to undertake breast screening, (2) health coverage for mammography (MM) costs and (3) regularity of breast screening behaviors in terms of breast self-examination (BSE), clinical breast examination (CBE) and MM including stage breast cancer at diagnosis. Data analysis was determined by PASW Statistics version 18 as univariate and multivariate logistic regression.

RESULTS

Health coverage for MM costs and all three behaviors were significantly related to and could predict the early stages breast cancer at diagnosis (p < 0.05): health coverage for MM costs (OR = 0.32, 95% confidence interval [CI], 0.17-0.63), BSE (OR = 8.08, CI 95%, 3.93-16.63), CBE (OR = 12.54, CI 95%, 2.29-68.65) and MM (OR = 5.89, CL 95%, 1.13-30.73).

CONCLUSIONS

All three behaviors are essential and related to one another. CBE on a regular basis is the best predictor for early stages breast cancer at diagnosis in Thai context. Nurses should provide information and teach including re-check the woman's skills to perform BSE regularly.

Adaptation and testing of instruments to measure cervical cancer screening factors among Vietnamese immigrant women

PURPOSE

Vietnamese American women diagnosed with cervical cancer are more likely to have advanced cancer than non-Hispanic White women. We sought to (a) develop a culturally sensitive Vietnamese translation of the Revised Susceptibility, Benefits, and Barriers Scale; Cultural Barriers to Screening Inventory; Confidentiality Issues Scale; and Quality of Care from the Health Care System Scale and (b) examine the psychometric properties.

DESIGN

Cross-sectional study with 201 Vietnamese immigrant women from the Portland, Oregon, metropolitan area.

METHOD

We used a community-based participatory research approach and the U.S. Census Bureau's team approach to translation.

RESULTS

Cronbach's alpha ranged from .57 to .91. The incremental fit index ranged from .83 to .88.

DISCUSSION AND CONCLUSIONS

The instruments demonstrated moderate to strong subscale internal consistency. Further research to assess structural validity is needed.

IMPLICATIONS FOR PRACTICE

Our approaches to translation and psychometric examination support use of the instruments in Vietnamese immigrant women.

Health Behaviors, Disparities and Deterring Factors for Breast Cancer Screening of Immigrant Women - A Challenge to Health Care Professionals

Background

This literature review was made to provide comprehensive to provide comprehensive understanding of health disparities as well as factors and barriers to cancer screening of immigrant women in multicultural societies.

Methods:

Published articles from 1990–2013 were searched using databases such as CINAHL, MEDLINE, PubMed and Science Direct showing evidence of contributing factors and barriers to breast cancer screening practices of immigrant women in developed and developing countries. Based on the inclusion criteria, a total of 45 qualified articles were included in the review process.

Results:

Articles included were quantitative and qualitative, written in English for publication, and subjects were middle-aged, married immigrant women. The identified influential factors and barriers that prevent immigrant women from cancer screening were categorized as individual, socio-cultural and behavioral factors. Socioeconomic status, education level and knowledge, availability of health insurance and acculturation were among the individual factors. Presence of social support and recommendation from health care professionals were strongly associated with compliance with cancer screening. Cultural beliefs and practices as well as behavioral factors were among the barriers that deter women from participating in cancer screening.

Conclusion:

To alleviate the negative factors and barriers that affect the participation of high-risk immigrant women, a client-centered assessment and intervention approach with specific regard to cultural beliefs and practices should be considered by health care professionals. Joint effort of individuals, community, health care professionals and government institutions are recommended to further address the continuous rise of breast cancer mortality worldwide.

Feasibility of a targeted breast health education intervention for Chinese American immigrant women

PURPOSE/OBJECTIVES

To assess the feasibility and acceptability of a targeted educational intervention to increase mammography screening among Chinese American women.

DESIGN

One-group pre- and post-test quasiexperimental design.

SETTING

Metropolitan areas of Portland, OR.

SAMPLE

44 foreign-born Chinese American women aged 40 years and older.

METHODS

Participants who had not had a mammogram within the past 12 months were recruited and enrolled to a targeted breast health educational program. Before starting the group session, participants completed a baseline survey, which was administered again 12 weeks postintervention.

MAIN RESEARCH VARIABLES

Completion of mammography screening test, movement in stage of readiness, mammography and breast cancer knowledge, perceived susceptibility, perceived benefits, and perceived common and cultural barriers.

FINDINGS

The study response rate was high (71%). Of the 42 women who completed the study, 21 (50%) had a mammogram postintervention. The top three reasons for not completing a mammogram at the end of the study were no need or no symptom, busy, and reliance on family for assistance. Mean breast cancer susceptibility scores increased significantly at post-test as theorized (t[40] = -2.88, p < 0.01). Participants were more likely to obtain a mammogram when they had been in the United States for 3-15 years.

CONCLUSIONS

A targeted program that aims to increase breast health knowledge, improve access, and remove barriers may promote mammography screening among Chinese American immigrant women.

IMPLICATIONS FOR NURSING

This promising intervention now being tested under a randomized, controlled design can be adapted to other Asian subgroups.

KNOWLEDGE TRANSLATION

Targeted breast health intervention is feasible for improving mammography screening among Chinese immigrant women. Educating these women about early detection is important, as the first sign of breast cancer usually shows on a woman's mammogram before it can be felt or any other symptoms are present. Immigrant women may be too busy to dedicate proper time to self-care behaviors; therefore, making it easier and faster for them to obtain a mammogram may improve the screening rate.

Confirmatory factor analysis of the Chinese Breast Cancer Screening Beliefs Questionnaire

BACKGROUND

Chinese women have been consistently reported as having low breast cancer screening practices. The Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) was designed to assess Chinese Australian women's beliefs, knowledge, and attitudes toward breast cancer and screening practices.

OBJECTIVES

The objectives of the study were to confirm the factor structure of the CBCSB with a new, larger sample of immigrant Chinese Australian women and to report its clinical validity.

METHODS

A convenience sample of 785 Chinese Australian women was recruited from Chinese community organizations and shopping malls. Cronbach α was used to assess internal consistency reliability, and Amos v18 was used for confirmatory factor analysis. Clinical validity was assessed through linear regression using SPSS v18.

RESULTS

The 3-factor structure of the CBCSB was confirmed, although the model required respecification to arrive at a suitable model fit as measured by the goodness-of-fit index (0.98), adjusted goodness-of-fit index (0.97), normed fit index (0.95), and root mean square error of approximation (0.031). Internal consistency reliability coefficients were satisfactory (>.6). Women who engaged in all 3 types of screening had more proactive attitudes to health checkups and perceived less barriers to mammographic screening.

CONCLUSION

The CBCSB is a valid and reliable tool for assessing Chinese women's beliefs, knowledge, and attitudes about breast cancer and breast cancer screening practices.

IMPLICATION FOR PRACTICE

The CBCSB can be used for providing practicing nurses with insights into the provision of culturally sensitive breast health education.

What factors explain disparities in mammography rates among Asian-American immigrant women? A population-based study in California

BACKGROUND

The purpose of this study was to compare rates of screening mammography among immigrant women in five Asian-American ethnic groups in California, and ascertain the extent to which differences in mammography rates among these groups are attributable to differences in known correlates of cancer screening.

METHODS

Using 2009 data from the California Health Interview Survey, we compared the rates of mammography among Chinese, Filipino, Japanese, Korean, and Vietnamese immigrants 40 years and older. To assess the impact of Asian ethnicity on participation in screening, we performed multiple logistic regression analysis with models that progressively adjusted for acculturation, sociodemographic characteristics, access to health care, and breast cancer risk factors, and examined the predicted probabilities of screening after adjusting for these factors.

FINDINGS

Participation in screening mammography differed according to ethnicity, with Filipina and Vietnamese Americans having the highest rates and Korean Americans having the lowest rates of lifetime and recent (past 2 years) screening. These differences decreased substantially after adjusting for acculturation, sociodemographic factors, and risk factors of breast cancer, but differences remained, most notably for Korean Americans, who continued to have the lowest predicted probability of screening even after adjustment for these factors.

CONCLUSIONS

This analysis draws attention to low mammography screening rates among Asian-American immigrants, especially recent immigrants who lack health insurance. Given that their breast cancer incidence is rising with length of stay in the United States, it is important to increase regular mammography screening in these groups.

The role of a lack of social integration in never having undergone breast cancer screening: results from a population-based, representative survey in the Paris metropolitan area in 2010

OBJECTIVES

This study aims to investigate the association between social contact and social support and women's breast cancer screening (BCS) practices, taking their socioeconomic status (SES) into account.

METHODS

The SIRS survey was conducted in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For the 784 women aged 50years or older with no history of breast cancer, multivariate logistic regressions and bootstrap methods were used to analyze the factors associated with never having undergone BCS.

RESULTS

6.5% of these women had never undergone BCS. In multivariate analysis, being older, having a low education level, having poor-quality health insurance, and having one or less than one social contact per 3-day period were significantly associated with never having undergone BCS during their lifetime, but the level of social support was not. The strength of the association with a low frequency of social contact tended to increase with age.

CONCLUSION

This study analyzed the role of social contact in social inequalities in BCS practices in the Paris metropolitan area. Like SES, social integration and social isolation should be taken into consideration by public health professionals and practitioners when planning BCS programs and incentives.

Pathways of cervical cancer screening among Chinese women

Background

The purpose of this community-based study was to develop a structural equation model for factors contributing to cervical cancer screening among Chinese American women.

Methods

A cross-sectional design included a sample of 573 Chinese American women aged 18 years and older. The initial step involved use of confirmatory factor analysis, that included the following variables: access to and satisfaction with health care, and enabling and predisposing cultural and health beliefs. Structural equation model analyses were conducted on factors related to cervical cancer screening.

Results

Age, marital status, employment, household income, and having health insurance, but not educational level, were significantly related to cervical screening status. Predisposing and enabling factors were positively associated with cervical cancer screening. The cultural factor was significantly related to the enabling factor or the satisfaction with health care factor.

Conclusion

This model highlights the significance of sociocultural factors in relation to cervical cancer screening. These factors were significant, with cultural, predisposing, enabling, and health belief factors and access to and satisfaction with health care reinforcing the need to assist Chinese American women with poor English fluency in translation and awareness of the importance of cervical cancer screening. Community organizations may play a role in assisting Chinese American women, which could enhance cervical cancer screening rates.

Understanding breast cancer screening practices in Taiwan: a country with universal health care

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.

Barriers to screening mammography

Breast cancer (BRCA) is the second most commonly diagnosed cancer among women in the USA, and mammography is an effective means for the early detection of BRCA. Identifying the barriers to screening mammography can inform research, policy and practice aiming to increase mammography adherence. A literature review was conducted to determine common barriers to screening mammography adherence. PsycINFO and PubMed databases were searched to identify studies published between 2000 and 2012 that examined barriers associated with reduced mammography adherence. Three thematic groups of barriers, based on social ecology, were identified from the literature: healthcare system-level, social and individual-level barriers. Researchers must consider screening behaviour in context and, therefore, should simultaneously consider each level of barriers when attempting to understand screening behaviour and create interventions to increase mammography adherence.

Breast and cervical cancer screening disparity among Asian American women: does race/ethnicity matter [corrected]?

BACKGROUND

Ethnic minorities are frequently considered as one homogeneous group in research, and this trend is particularly true for Asian Americans. This article seeks to uncover the intragroup differences in cancer screening behavior among subgroups of Asian American women by disaggregating them into six subgroups. The subgroups were compared with non-Latina white women to examine differences in breast and cancer screening rates and relevant factors associated with receiving these screenings.

METHODS

Three-year merged data from the 2001, 2003, and 2005 California Health Interview Survey (CHIS) were used to investigate the subgroup differences. Samples for the current study were restricted to non-Latina white and Asian American women whose age was ≥ 18 years (n = 58,000) for cervical cancer screening and ≥ 40 years (n = 43,518) for breast cancer screening at the time of the interview.

RESULTS

Results showed marked differences in cancer screening rates among Asian American subgroups and between cancer types. Cervical cancer screening rates were noticeably higher than breast cancer screening rates in all groups. The Korean group consistently showed the lowest rates of both cancer screenings. Japanese ranked the highest (79.5%) in breast cancer screening but the second lowest (79.7%) in cervical cancer screening. Enabling factors, such as having private health insurance and a usual source of care, were found to be the strongest predictors of receiving both breast and cervical cancer screening. Screenings for both types of cancer increased if a woman was married or was born in the United States.

CONCLUSIONS

The findings of this study illustrate the heterogeneity that exists among Asian American subgroups in their cancer screening behaviors. Further development of culturally relevant and ethnic-specific cancer prevention strategies and policies that address the subgroup differences within the larger racial/ethnic population are needed. Public health outreach and cancer education should be prioritized to the Asian American women who are more recent arrivals in the United States and have minimal access to healthcare.

Pathways of Breast Cancer Screening Among Chinese American Women

OBJECTIVE

The purpose of this community-based study was to develop a structural equation model for factors contributing to breast cancer screening among Chinese American women.

METHODS

A cross-sectional design included a sample of 440 Chinese American women aged 40 years and older. The initial step involved use of confirmatory factor analysis, which included the following variables: access/satisfaction with health care, enabling, predisposing, and cultural and health belief factors. Structural equation model analyses were conducted to evaluate factors related to breast cancer screening in Chinese American women.

RESULTS

Initial univariate analyses indicated that women without health insurance were significantly more likely to report being never-screened compared to women with health insurance. Structural equation modeling techniques were used to evaluate the utility of the Sociocultural Health Behavior model in understanding breast cancer screening among Chinese American women. Results indicated that enabling and predisposing factors were significantly and positively related to breast cancer screening. Cultural factors were significantly associated with enabling factors and satisfaction with healthcare. Overall, the proposed model explained 34% of the variance in breast cancer screening among Chinese American women.

CONCLUSIONS

The model highlights the significance of enabling and predisposing factors in understanding breast cancer screening behaviors among Chinese American women. In addition, cultural factors were associated with enabling factors, reinforcing the importance of providing translation assistance to Chinese women with poor English fluency and increasing awareness of the critical role of breast cancer screening. Partnering with community organizations may help to facilitate and enhance the screening rates.

Development of the Thai breast cancer belief scale for Thai immigrants in the United States

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.

A community-based participatory research approach to understanding pap testing adherence among Vietnamese American immigrants

OBJECTIVE

To explore factors potentially influencing Pap testing practices among Vietnamese American immigrant women (VIW, foreign-born) and describe their awareness of cervical cancer screening resources in their community.

DESIGN

Descriptive study guided by the ecological model and community-based participatory research principles.

SETTING

Portland, Oregon, metropolitan area.

PARTICIPANTS

Vietnamese American immigrant women (211) who were age 21 and older.

METHODS

We used descriptive statistics and logistic regression analyses to analyze a self-administered questionnaire that was pretested and translated using a team approach.

RESULTS

Approximately 74% of VIW who completed the survey reported at least one Pap test, and 69% reported Pap testing history adherent to national guidelines. The factor most strongly associated with Pap testing receipt was suggestion from a friend, followed by longer residency in the United States, lower perceived common barriers, and lower perceived cultural barriers, for example, lack of family support and use of Eastern/Asian medicine. The factor most strongly associated with guideline adherence was having health insurance, followed by a recommendation from a physician or nurse practitioner. Only 11% of VIW knew where to obtain a free or low-cost Pap tests.

CONCLUSION

Nurses can influence rates of Pap testing among VIW by providing health education through outreach programs targeted at lay health workers and their social networks, identifying at-risk patients such as recently immigrated women, reducing perceived common and cultural barriers to Pap testing, and helping women seek alternative payment options if they lack health insurance. Primary health care providers should be reminded of their essential role in increasing Pap testing adherence.

Findings from focus groups indicating what Chinese American immigrant women think about breast cancer and breast cancer screening

OBJECTIVES

To explore beliefs of Chinese American, immigrant women related to breast cancer and mammography.

DESIGN

Qualitative description with semistructured focus groups.

SETTING

Metropolitan Portland, Oregon.

PARTICIPANTS

Thirty eight foreign-born Chinese women, age 40 and older, in five focus groups.

METHODS

Focus group discussions in Chinese were audiotaped, transcribed, and translated into English. Using a process of directed content analysis, group transcripts were coded for themes based on the discussion guide.

RESULTS

Three main themes emerged from the analysis: knowledge and beliefs; support, communication, and educational needs; and access to care. Subthemes included beliefs such as barriers and facilitators to screening and perceptions about personal breast cancer risk. Several women were profoundly affected by the negative breast cancer-related experiences of relatives and friends. Some common myths remain about causes and treatment of breast cancer.

CONCLUSIONS

Although Chinese American immigrant women share beliefs with other minority women in the United States, some culturally related barriers such as alienation due to cultural reasons for not sharing diagnosis with anyone and beliefs about the efficacy of Eastern versus Western medicine may affect adherence to screening and treatment. Facilitators included being told to get the test and getting screened for the sake of the family, whereas erroneous information about the cause of breast cancer such as diet and stress remained. Primary care providers such as advanced practice nurses should take into account culturally driven motivations and barriers to mammography adherence among Chinese American immigrant women. Provider/client interactions should involve more discussion about women's breast cancer risks and screening harms and benefits. Such awareness could open a dialogue around breast cancer that is culturally sensitive and nonthreatening to the patient. Information may need to be tailored to women individually or targeted to subethnic groups rather than using generic messages for all Asian immigrant women.

Major ethnic group differences in breast cancer screening uptake in Scotland are not extinguished by adjustment for indices of geographical residence, area deprivation, long-term illness and education

Background:

Breast cancer screening data generally show lower uptake in minority ethnic groups. We investigated whether such variations occur in Scotland.

Methods:

Using non-disclosive computerised linkage we combined Scottish breast screening and Census 2001 data. Non-attendance at first breast-screening invitation (2002–2008) was compared between 11 ethnic groups using age-adjusted risk ratios (RR) with 95% confidence intervals (CI), multiplied by 100, using Poisson regression.

Results:

Compared with the White Scottish (RR=100), non-attendance was similar for Other White British (99.5, 95% CI 96.1–103.2) and Chinese (112.8, 95% CI 96.3–132.2) and higher for Pakistani (181.7, 95% CI 164.9–200.2), African (162.2, 95% CI 130.8–201.1), Other South Asian (151.7, 95% CI 118.9–193.7) and Indian (141.7, 95% CI 121.1–165.7) groups. Adjustment for rural vs urban residence, long-term illness, area deprivation and education, associated with risk of non-attendance, increased the RR for non-attendance except for Pakistani women where it was modestly attenuated (RR=164.9, 149.4–182.1).

Conclusion:

Our data show important inequality in breast cancer screening uptake, not attenuated by potential confounding factors. Ethnic inequalities in breast screening attendance are of concern especially given evidence that the traditionally lower breast cancer rates in South Asian groups are converging towards the risks in the White UK population. Notwithstanding the forthcoming review of breast cancer screening, these data call for urgent action.

Sociodemographic determinants of nonattendance in a population-based mammography screening program in the city of Manisa, Turkey

Objectives. Community based breast cancer screening has decreased breast cancer mortality in women. This study examined the predictors of nonattendence for invitational breast cancer screening in relation to socioeconomic status in the city of Manisa, in western Turkey. Study Design. For the evaluation of the reasons for refusing to participate in the study, two districts were selected. 446 women aged between 50 and 69 years were selected from the program database by systematic random sampling. Methods. The questionnaire consisted of sociodemographic variables and the adapted version of Champion's Health Belief Model Scale. Univariete and multivariete logistic regression analysis were performed throughout the data analysis. Results. Being from an urban district and being from the western region were the risk factors for not participating in the screening program (P = 0.014, P = 0.023). A statistical significance was found between mammography-benefit, mammography-barrier and program participation (P = 0.044, P = 0.006). Although there were many more barriers for not participating in the screening program for the women of the slum district, the attendence rate of the slum district was higher than that of the urban district. Conclusions. Increased attendance may be achieved through enhancement of breast cancer awareness and by reducing some of the modifiable barriers.

Influence of demographic factors, knowledge, and beliefs on Jordanian women's intention to undergo mammography screening

PURPOSE

The purpose of this study was to determine the influence of demographic characteristics, breast cancer knowledge, fatalistic beliefs, health beliefs, and subjective norms on Jordanian women's intention to participate in mammography screening.

DESIGN

A cross-sectional survey was used to collect data at 14 comprehensive healthcare centers in Amman and Zarqa, Jordan. A convenience sample of 142 Jordanian women 40 years of age or older with no history of breast cancer and able to read and write in Arabic participated.

METHODS

Self-report surveys included a combination of researcher-designed and existing instruments to measure the study variables. Data were analyzed using descriptive statistics, Pearson's correlation, t tests, and multiple logistic regression.

FINDINGS

Jordanian women surveyed lacked knowledge about breast cancer. Social norms and self-efficacy highly influenced these women's intention to engage in mammography screening. Younger women were more willing to indicate intention to engage in mammographic screening.

CONCLUSIONS

Self-efficacy and the social connectedness of Jordanian society, but not religious beliefs or perceived barriers to screening, influence Jordanian women's intention to undergo mammography. Future research should examine cultural influences, rather than religious beliefs, and investigate Jordanian women's potentially unique perspectives on barriers to actual mammography screening behavior.

CLINICAL RELEVANCE

The prevalence of mammography screening may be enhanced by focusing interventions on Jordanian women's support systems and empowering women by providing knowledge and skills needed to engage in the procedure.

Workplace-based breast cancer screening intervention in china

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPACT

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

Factors related to the Performance of Mammography Screening among Women with a Family History of Breast Cancer in Korea

PURPOSE

Early diagnosis is the primary method aimed at controlling breast cancer. The purpose of this study was to analyze some factors affecting the performance of mammography screening among women with a family history of breast cancer in Korea.

METHODS

This study applied a descriptive design method through structured self-report questionnaires. The Care Seeking Behavior Theory provided a theoretical framework for the study. Factors measured in this study represent demographic, clinical, and psychosocial variables including anxiety, barriers, utility, habits, perception, and facilitators. A total of 212 participants, of at least 20 years old, were sampled from April 8, 2010 to March 31, 2011. The data was analyzed by logistic regression method using the Statistical Package for the Social Science 18.0 software.

RESULTS

Of the 212 participants, 122 women (57.5%) went through mammography screening. The results of the analysis showed that (a) age (Odds Ratio [OR]=1.10, p<.001), (b) facilitating influences (OR=1.83, p=.008), (c) perception of mammography importance (OR=1.92, p=.011), (d) barriers to mammography (OR=0.60, p=.031), and (e) utility of mammography (OR=2.01, p=.050) significantly affect mammography screening.

CONCLUSION

The results underscore the impact that psychosocial variables in obtaining mammography have on adherence to screening. Women with a family history of breast cancer should be given accurate information and recommendation about mammography by healthcare provider and a regular source of healthcare.

Sociodemographic characteristics of women who engage in early breast cancer diagnostic behaviors: the case of Turkish women working in a textile factory

The purpose of this study was to assess behaviors and health beliefs concerning early diagnosis of breast cancer among women working in a textile factory in Turkey. The data were collected with tools designed by the researchers. The study population consisted of 167 women working in a textile factory in Izmir, Turkey. According to their responses, 23.4% of the women performed breast self-examinations and 12.6% received clinical breast examinations. Results indicated that 91.6% of the women had no education about breast cancer. Early methods of detecting breast cancer should be included in workplace education programs.

The experiences among older Taiwanese women facing a new diagnosis of breast cancer

BACKGROUND

Breast cancer is one of the most common types of cancer among women. Older women have differences in physical conditions and culture backgrounds compared with young age, which may influence their experiences in facing the diagnosis and treatment for breast cancer.

OBJECTIVE

The objective of the study was to explore the experiences of older Taiwanese women when they first faced a new diagnosis of breast cancer.

METHODS

A qualitative design was used. Fourteen women, aged 65 to 91 years, with a new diagnosis of breast cancer were interviewed within a month after they completed the first course of treatment at a cancer hospital in northern Taiwan.

RESULTS

Content analysis of the interviews revealed 5 themes: the delay in seeking medical help, the impact caused by the initial diagnosis, facing the threat from cancer and its treatments, the battle against the illness, and living with breast cancer.

CONCLUSION

Participants simultaneously faced physical discomfort, shock, denial, fear, worry, and hopelessness. Fortunately, despite these difficulties, they were encouraged to battle and live with breast cancer through the caring and support of family and by seeking information, searching for alternative therapies, practicing religion, readjusting their attitude to face the illness, getting back to a normal life, and appreciating the lives they have.

IMPLICATIONS FOR PRACTICE

It is vital to assist older Taiwanese women to go to the physician earlier when they find something abnormal in their breast. Children, female relatives, and friends have important roles in helping them face the disease and treatment of breast cancer.