Strategies for recruiting South Asian women to cancer screening research and the lessons learnt

Exploring the Barriers and Facilitators Influencing Human Papillomavirus Vaccination Decisions Among South Asian and Chinese Mothers: a Qualitative Study

Human papillomavirus (HPV) vaccines are safe and effective in preventing HPV infection and HPV-related cancers. However, the HPV vaccine uptake rate is lower among the ethnic minority population than in the majority population. This qualitative study explored the barriers and facilitators influencing South Asian minority and Chinese mothers' decisions to vaccinate their daughters against HPV in Hong Kong. South Asian and Chinese mothers with at least one daughter aged 9 to 17 years were recruited to this study. Twenty-two semi-structured focus group interviews were conducted, and the transcripts were analysed via content analysis. Two barriers and three facilitating factors were common among South Asian and Chinese mothers: inadequate knowledge of cervical cancer, HPV or the HPV vaccine and high perceived barriers to HPV vaccination due to vaccine cost, the receipt of reliable information from schools or the government, high perceived benefits of HPV vaccination to health, and the presence of vaccination programme arranged by school or government. Despite these commonalities, South Asian mothers experienced more barriers to making the decision to vaccinate than Chinese mothers. Particularly, obtaining family support was an important factor for South Asian mothers. The vaccination decision was considered a joint decision between the mother and father, and the father's agreement was of particular importance to Pakistani mothers. This study identified the factors that hindered and facilitated South Asian and Chinese mothers' decisions to vaccinate their daughters against HPV. The comparison between groups improves our understanding of the distinct needs of South Asian in Hong Kong.

Factors Influencing the Mammographic Screening Practices of South Asian Women in Hong Kong: A Qualitative Study

BACKGROUND

Breast cancer is a common type of cancer in South Asian women. Early detection by mammographic screening plays a significant role in improving survival rates. South Asian minorities in many countries have reported low mammographic screening rates.

OBJECTIVE

This study aimed to understand the factors that influence mammographic screening uptake among South Asian women in Hong Kong.

METHODS

This was a qualitative exploratory descriptive study. South Asian women 40 years or older with no history of breast cancer were recruited. In-depth face-to-face interviews were conducted following a semistructured interview guide. Thematic analysis was conducted to analyze the data.

RESULTS

A total of 31 South Asian women consented to participate. Among them, only 7 had ever undergone mammographic screening. The following themes of facilitating factors were identified: (1) influence of doctors, family, and friends; (2) strong sense of commitment to the family; and (3) accessibility and availability of mammographic screening information and services. The following themes for barriers to screening were identified: (1) beliefs about health management and social norms, (2) lack of knowledge and understanding of breast cancer and mammographic screening, (3) logistical barriers, and (4) physical barriers.

CONCLUSION

This study identified important facilitators and barriers that influence the uptake of mammographic screening among South Asian women in Hong Kong.

IMPLICATIONS FOR PRACTICE

The study findings can be used to guide the development and implementation of culturally relevant interventions to address barriers to screening, including the expected gender roles and responsibilities among women in their respective families.

Use of a Linguistically Appropriate Decision Aid for Cervical Cancer Screening of South Asian Ethnic Minority Women in Hong Kong: A Pilot Randomised Controlled Trial

BACKGROUND

Decision aids have been shown to be effective in assisting the decision-making process in healthcare settings. This study aimed to examine the feasibility and acceptability of a linguistically appropriate printed decision aid for cervical cancer screening in South Asian women and to preliminarily estimate its effects on decisional conflicts, clarity of values, risk perception, the screening decision and screening uptake.

METHODS

This was a pilot randomised controlled trial. Forty-eight South Asian women aged 25 to 64 years were recruited and allocated to either the intervention group or control group. The participants in the intervention group read a linguistically appropriate printed decision aid.

RESULTS

All of the participants in the intervention group agreed that the decision aid was useful in aiding their decision-making. These participants showed significantly greater improvement in decisional conflicts, clarity of values and risk perceptions than those in the control group (all p < 0.05). The screening uptake rate was significantly higher in the intervention group than in the control group (p < 0.001).

CONCLUSIONS

The decision aid was feasible and acceptable among South Asian women, and it resulted in reduced decisional conflict and increased screening uptake compared with usual care. To improve the convenience of using decision aids, they could be developed in various forms, such as printed and mobile application forms, to meet individual requirements.

TRIAL REGISTRATION

The trial was registered at the Chinese Clinical Trial Registry on 23 October 2021 (ChiCTR2100052225).

Development and evaluation of a multimedia intervention to promote cervical cancer prevention among South Asian women in Hong Kong

Objective: The uptake of cervical cancer screening among South Asian ethnic minorities is low, rendering them at higher risk of developing cervical cancer. Interventions should, therefore, be developed to enhance their knowledge of this disease and its prevention. We developed and implemented a Health-Belief-Model-based and culturally sensitive multimedia intervention for South Asian women in Hong Kong, and evaluated its feasibility, acceptability and effectiveness using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework.Design: At post-intervention, a short survey was conducted to assess the participants' perceptions of the acceptability and effectiveness of the intervention. Focus group and/or telephone interviews with persons-in-charge of community organizations were conducted to collect feedback on the intervention's effectiveness and long-term sustainability.Results: The intervention was implemented successfully in partnership with 54 community organizations, of which 51 expressed a willingness to continue doing so at their centers. 1061 South Asian women received the intervention through attendance at the 51 health talks held. Over 90% of them agreed that the intervention was acceptable and effective.Conclusions: The intervention appeared to be feasible, and is potentially effective in enhancing participants' knowledge of cervical cancer and self-efficacy in undergoing screening.

Methodological and Ethical Considerations in Research With Immigrant and Refugee Survivors of Intimate Partner Violence

To promote safe and positive health outcomes by utilizing culturally relevant evidence-based interventions for immigrant and refugee women survivors of intimate partner violence, their active participation in research is critical. With 43.6 million immigrants and refugees living in the United States, there is a need for research studies to eliminate health disparities in these populations. However, barriers to recruiting and retaining these populations in research prevent the provision of quality and culturally informed services to meet their needs. The aim of this article is to discuss the recruitment and retention strategies employed and analyze the methodological and ethical challenges in the context of the weWomen Study. The use of a multifaceted approach informed by best practices maximized recruitment efforts and active participation that generated high numbers of immigrant and refugee women participants. The study also substantiated the need for more community-based participatory approaches to engage community members in the development of culturally appropriate approaches that instill a sense of ownership over the research process. Active research participation of immigrant and refugee survivors will help investigators understand their unique needs and facilitate the implementation of targeted evidence-based interventions.

A Theory-Based and Culturally Aligned Training Program on Breast and Cervical Cancer Prevention for South Asian Community Health Workers: A Feasibility Study

BACKGROUND

Cancer screening uptake among South Asian ethnic minorities is reported to be relatively low. An outreach program, led by community health workers (CHWs), may increase the minority group's awareness of the importance of cancer screening.

OBJECTIVE

The aim of this study was to assess the feasibility and effectiveness of a theory-based, culturally sensitive program to train South Asian women in Hong Kong as CHWs.

METHODS

A CHW training program, guided by the Empowerment Model and the Health Belief Model, was developed and implemented. Its feasibility was evaluated through the recruitment of South Asian women to the program and their satisfaction with it. Its effectiveness was assessed by a test of knowledge, the participants' self-efficacy and competence, and their readiness to work as CHWs.

RESULTS

Five South Asian women were recruited to the training program. Outcomes included increased participants' knowledge of cancer and improved self-efficacy and competence in working as CHWs. All participants were highly satisfied with the program, although the addition of practical sessions in the South Asian community was suggested as a further improvement.

CONCLUSION

It seems to be feasible to train South Asian CHWs to deliver interventions to promote their peers' awareness of breast and cervical cancer prevention, although challenges exist in recruitment of trainees. More hands-on practical opportunities as CHWs would likely increase their effectiveness.

IMPLICATIONS FOR PRACTICE

The theoretical framework of our CHW training program and the incorporated cultural components could be useful for the development of future programs for training South Asian CHWs in delivering interventions on cancer prevention.

Effects of a Community Health Worker-Led Multimedia Intervention on the Uptake of Cervical Cancer Screening among South Asian Women: A Pilot Randomized Controlled Trial

The utilization rate of cervical cancer screening services among South Asian women is low. Multimedia interventions conducted by community health workers (CHWs) could potentially enhance the cervical cancer screening uptake among these individuals. This study aimed to investigate the feasibility and preliminary effects of a CHW-led multimedia intervention on cervical cancer screening uptake among this underprivileged group. This pilot study utilized a randomized wait-list controlled trial design. Forty-two South Asian women were recruited at six ethnic minority associations. Randomization of each organization into either the intervention arm or wait-list control arm was then performed. The intervention was conducted by the CHWs from the associations where the participants were recruited. Outcome measures, were assessed and compared at baseline and immediately post-intervention. We demonstrated that the intervention was feasible as evidenced by the high consent rate and low withdrawal and attrition rates. The intervention arm showed a statistically significant improvement in perceived benefits (p = 0.001) and perceived barriers (p = 0.02). However, no significant difference was noted in screening uptake and screening intention between arms. Our findings support the feasibility of CHW-led multimedia intervention and provide preliminary evidence of its effectiveness on enhancing the cervical cancer screening beliefs among South Asian women.

A community health worker-led multimedia intervention to increase cervical cancer screening uptake among South Asian women: study protocol for a cluster randomized wait-list controlled trial

Background

Marked ethnic disparities on cervical cancer screening have been observed among South Asian women. Multiple barriers, such as language difficulties, poor access to screening services, values, and beliefs, were identified. Multimedia interventions led by community health workers (CHWs) would likely reduce screening disparities and increase cervical screening uptake among South Asian women. This study aims to assess the effects of a CHW-led multimedia intervention on the uptake of cervical cancer screening among South Asian women.

Methods

This study is a cluster randomized wait-list controlled trial. A total of 408 South Asian women from Pakistan, India or Nepal will be recruited from six ethnic minority associations. Each association will be randomized to one of the two arms: an intervention arm (n = 3) that will undergo immediate treatment (CHW-led multimedia intervention) or a wait-list control arm (n = 3) that will receive delayed treatment. Each recruited CHW will be allocated to either arm according to the association she is affiliated with. The intervention arm will receive a CHW-led intervention comprising two components: multimedia education, and monthly telephone follow-up and navigation assistance. Participants in the control arm (n = 3) will be offered the CHW-led intervention after those in the intervention arm have completed the intervention. The primary outcome measure is the uptake of cervical cancer screening. Secondary outcomes include readiness to undergo screening and beliefs regarding cervical cancer screening. Outcomes assessments will be performed at baseline, immediately after, and 3 months after completion of the intervention.

Discussion

The results of this study will potentially provide significant practical implications for addressing the needs and increasing the uptake of cervical cancer screening among South Asian women.

Trial registration

Chinese Clinical Trial Registry, ChiCTR1800017227. Registered on 18 July 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3378-4) contains supplementary material, which is available to authorized users.

A Feasibility Study of Muslim Cancer Survivors' Experience in the United States: Recruitment and Data Collection

BACKGROUND

Studies with U.S. Muslims have had difficulty recruiting participants.

METHOD

This article, which was part of a larger qualitative study, aimed to describe the effectiveness of targeted recruitment and data collection strategies in Muslim cancer survivors. The purpose of the larger qualitative study was to gain an understanding of the experiences of Muslim cancer survivors in the United States. Four recruitment approaches were implemented to determine timeliness, diversity in respondents, and success in completing the interview.

RESULTS

Eighteen Muslim cancer survivors participated (12 males, 6 females). Ten Muslim participants were identified by community leaders, two by posted flyers, four using social media, and two by a physician. No burden was voiced by participants related to length, time, or location of interviews.

DISCUSSION

We demonstrated the feasibility of recruiting and interviewing Muslim cancer survivors. Using culturally sensitive approaches is important to encourage recruitment and participation in studies of Muslim cancer survivors.

Research recruitment: A marketing framework to improve sample representativeness in health research

AIMS

This discussion paper proposes a five-part theoretical framework to inform recruitment strategies. The framework is based on a marketing model of consumer decision-making.

BACKGROUND

Respondents in surveys are typically healthier than non-respondents, which has an impact on the availability of information about those most in need. Previous research has identified response patterns, provided theories about why people participate in research and evaluated different recruitment strategies. Social marketing has been applied successfully to recruitment and promotes focus on the needs of the participant, but little attention has been paid to the periods before and after participant-researcher contact (during advertising and following completion of studies). We propose a new model which conceptualises participation as a decision involving motivation, perception of information, attitude formation, integration of intention and action and finally evaluation and sharing of experience.

DESIGN

Discussion paper.

DATA SOURCES

This discussion paper presents a critical review. No literature was excluded on date and the included citations span the years 1981-2017.

IMPLICATIONS FOR NURSING

The proposed framework suggests that researchers could engage a broader demographic if they shape research design and advertising to perform functions that participants are seeking to achieve. The framework provides a novel and useful conceptualisation of recruitment which could help to inform public engagement in research design, researcher training and research policy.

CONCLUSION

This framework challenges researchers to investigate the goals of the potential participants when designing a study's advertising and procedures.

Translation and validation of translation in cross-cultural research: Strategies used in a study of cervical cancer screening among ethnic minorities

AIMS

A discussion of the challenges encountered during instrument translation and validation while researching cervical cancer screening among ethnic minorities and the strategies used to overcome them.

BACKGROUND

Given the increasing ethnic and cultural diversity of populations in different countries, culturally sensitive instruments are needed to evaluate people's attitudes, perceptions, and health practices. Often, such instruments are lacking in the study population's language.

DESIGN

Discussion paper.

DATA SOURCES

The discussion is based on our previous experience including the challenges encountered in the translation process and in the semantic and content validation and the strategies used to overcome them.

IMPLICATION FOR NURSING

Seeking help from community centres or translation agencies to use translators with a health care background and of the same cultural origins as the target participants is effective. Actively contacting potential experts through email addresses obtained from published research articles is another effective way to find suitable experts. Field testing of the study questionnaire is important in validation, as it uncovers difficulties that go beyond translation.

CONCLUSION

Good planning and preparation before the translation and validation work begins is always required. Working closely with translators and experts through discussion is the key to success.

Recruitment and Retention of South Asian Ethnic Minority Populations in Behavioral Interventions to Improve Type 2 Diabetes Outcomes

PURPOSE OF REVIEW

South Asian (SA) immigrants have a higher burden of type 2 diabetes, report poor self-management, and remain a hard-to-engage group in behavioral interventions. The purpose of this review was to characterize recruitment and retention of SAs in behavioral interventions.

RECENT FINDINGS

We identified 14 studies with limited information regarding recruitment and retention. Overall recruitment rates were low: 12 studies had a mean recruitment rate of 44% among those screened, and 9 studies with complete information on eligibility had a mean recruitment rate of 65.8% among those eligible. Mean retention rate was 79.4% across all 14 studies. Although unstandardized and inconsistent reporting limited our ability to draw any conclusions regarding the best strategies to maximize recruitment and retention, we were able to highlight some novel and effective strategies. There is a need for consistent and standardized reporting of recruitment and retention-related information to encourage meaningful research and guide researchers in efficient allocation of resources and a successful conclusion of future interventions.

Development and Evaluation of Multimedia Interventions to Promote Breast and Cervical Health among South Asian Women in Hong Kong: A Project Protocol

Recent studies conducted in the local community indicate that the uptake rates of breast and cervical cancer screening among South Asian ethnic minorities are lower than those of the general population. The development of interventions to promote these minorities' awareness of breast and cervical health and the importance of cancer screening is therefore required. This study protocol aims to develop culturally sensitive multimedia interventions to promote awareness of breast and cervical cancer prevention among South Asian women in Hong Kong, and to evaluate the outcomes of such interventions using a Reach-Effectiveness-Adoption-Implementation-Maintenance framework. By using a multimedia approach and developing socio-culturally relevant and linguistically appropriate educational materials, information related to cancer and accessible preventive measures for breast and cervical cancer is expected to be disseminated more effectively among South Asian women and ultimately increase their awareness of engaging in healthy lifestyles and taking part in cancer screening tests. Successful engagement of community partners will enhance the future sustainability of the project.