Cultural views, language ability, and mammography use in Chinese American women

How Can Framed Mammography Screening Messages Be Optimally Persuasive for Foreign-Born Chinese American Women?

BACKGROUND

Foreign-born Chinese American women (FBCAW) have the lowest mammography rates compared with other racial groups despite the overwhelming evidence of the benefits of screening. Message framing based on the prospect theory has shown significant but inconsistent effects on mammogram screening among ethnic minority groups.

OBJECTIVE

Using data from a randomized controlled trial, this secondary analysis aims to identify factors that interact with message framing to improve mammography screening in FBCAW.

METHODS

In the parent study, participants were randomized to receive either a gain- or loss-framed brochure that encouraged mammography screening. Data were collected at baseline and 2 months using validated questionnaires. For this secondary analysis, ordinal logistic regression was performed to identify moderation effects using both per-protocol and intention-to-treat principles.

RESULTS

Participants predominantly had low income, a low level of English proficiency, and no insurance. Lack of access to mammography services, knowledge of making a mammogram appointment, knowledge of insurance coverage for breast cancer treatment, education levels, and mammogram history were significant moderators of the framing effects. Overall, the moderation effects were larger when using per-protocol analysis. Some moderation results under intention-to-treat analysis were different from those using per-protocol analysis.

CONCLUSIONS

The persuasive effects of the loss- or gain-framed messages depend on the characteristics of FBCAW. Future studies can identify algorithms to select tailored messages that match individual FBCAW's characteristics to optimize the effects of framed messages.

IMPLICATIONS FOR PRACTICE

Findings of this study can guide healthcare providers, especially nurses, to choose different wording when communicating with their clients.

Breast cancer screening practices and associated factors among Chinese-Australian women living in Sydney: A cross-sectional survey study

This study aimed to investigate breast cancer screening practices and associated factors among Chinese‐Australian women. A cross‐sectional quantitative survey method including convenience and snowball sampling was used to recruit 115 Chinese‐Australian women living in Sydney, using a self‐administered survey. In all, 69.8% of participants reported recent clinical breast examinations and 73.3% had mammograms. Age, religion, employment status, and length of residence were associated with having a clinical breast examination. Income was related to having a mammogram. Associations between knowledge of breast cancer, cancer‐related beliefs, and screening participation were found. Length of residence in Australia was the strongest predictor of having a clinical breast examination and mammogram. The most common barrier to mammography was if women felt that doctors did not recommend it to them. Chinese‐Australian women need to be educated about awareness of their usual breast health to be aware of any changes, especially if women are not eligible for mammography or have difficulty in accessing health services. Tailored programs, improving screening experiences, and minimizing perceived barriers are needed to promote early detection of breast cancer among Chinese–Australian women.

Long-term Mammography Adherence among Uninsured Women Enrolled in the Breast Screening and Patient Navigation (BSPAN) Program

BACKGROUND

The Breast Screening and Patient Navigation (BSPAN) Program provides access to no-cost breast cancer screening services to uninsured women in North Texas. Using data from the longitudinal BSPAN program (2012-2019), we assessed prevalence and correlates of (i) baseline adherence and (ii) longitudinal adherence to screening mammograms.

METHODS

Outcomes were baseline adherence (adherent if women received second mammogram 9-30 months after the index mammogram) and longitudinal adherence (assessed among baseline adherent women and defined as being adherent 39 months from the index mammogram). We used multivariable logistic regression and multivariable Cox proportional hazards model to assess associations of sociodemographic and clinical characteristics with baseline and longitudinal adherence, respectively.

RESULTS

Of 19,292 women, only 5,382 (27.9%) were baseline adherent. Baseline adherence was more likely among women who were partnered, preferred speaking Spanish, had poor reading ability, had prior Papanicolaou (PAP) testing, and prior screening mammograms, compared with women who were non-partnered, preferred speaking English, had good reading ability, had no prior PAP testing, and no prior screening mammograms, respectively. Of those who were baseline adherent, 4,364 (81.1%) women demonstrated longitudinal adherence. Correlates of longitudinal adherence were similar to those from baseline adherence.

CONCLUSIONS

A large proportion of baseline adherent women (>80%) achieved longitudinal adherence, which highlights the importance of concentrating resources during the second mammogram in the progression toward continued adherence.

IMPACT

Results from our unique dataset provide realistic mammography adherence rates and may be generalizable to other areas introducing no-cost screening to low-income women, independent of any regular patient-centered medical home.

Culturally Tailored Intervention to Promote Mammography Screening Practice Among Chinese American Women: a Systematic Review

Our review aimed to assess the effectiveness of culturally tailored intervention in mammography practice for Chinese American women. We searched the entire paper published by the Cochrane Library, PubMed, and Web of Science from inception to 17 October 2019. Moreover, we manually checked reference lists of included studies to find other potentially eligible studies. It included clinical trials published in English that evaluated the effects of culturally tailored intervention on mammography practice for Chinese American women. Finally, we involved eight studies in our review. After the intervention, the mammography intention and breast cancer-related knowledge were significantly improved. However, there was no significant impact on mammography completion rate, perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, and Eastern cultural views of Chinese American women. The culturally tailored interventions could serve as promising approaches to improve mammography screening practice for Chinese American women, but further improvements are needed.

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.

Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States

To summarize the literature on barriers and facilitators to breast and cervical cancer screening among immigrants to the US. A literature review was conducted for studies on breast and cervical cancer screening among immigrant populations. A thematic analysis of 180 studies identified a variety of barriers and facilitators to screening at the personal and system levels. Personal barriers included lack of knowledge and insurance coverage, high cost of care, and immigration status. System barriers included poor access to services, lack of interpreter services, and insensitivity to patient needs. Facilitators to screening included knowledge of disease, access to information sources, physician recommendation, and social networks. Cultural norms and resource availability at the individual and system levels influence screening among immigrants. Health insurance coverage was found to be an important predictor of preventative screening use. Future research should seek to identify the best way to address this and other barriers to cancer screening among immigrants groups.

A Systematic Review of Promising Strategies of Faith-Based Cancer Education and Lifestyle Interventions Among Racial/Ethnic Minority Groups

Church-based interventions have been used to reach racial/ethnic minorities. In order to develop effective programs, we conducted a comprehensive systematic review of faith-based cancer prevention studies (2005~2016) to examine characteristics and promising strategies. Combination terms "church or faith-based or religion," "intervention or program," and "cancer education or lifestyle" were used in searching the five major databases: CINAHL; ERIC; Health Technology Assessments; MEDLINE; and PsycInfo. A total of 20 studies met study criteria. CDC's Community Guide was used to analyze and review group interventions. Analyses were organized by two racial groups: African American (AA) and Latino/Hispanic American groups. Results showed most studies reviewed focused on breast cancer alone or in combination with other cancers. Studies of Latino/Hispanic groups targeted more on uninsured, Medicare, or Medicaid individuals, whereas AA studies generally did not include specific insurance criteria. The sample sizes of the AA studies were generally larger. The majority of these studies reviewed used pre-post, posttest only with control group, or quasi-experience designs. The Health Belief Model was the most commonly used theory in both groups. Community-based participatory research and empowerment/ecological frameworks were also used frequently in the Latino/Hispanic studies. Small media and group education were the top two most popular intervention strategies in both groups. Although one-on-one strategy was used in some Latino studies, neither group used reducing client out-of-pocket costs strategy. Client reminders could also be used more in both groups as well. Current review showed church-based cancer education programs were effective in changing knowledge, but not always screening utilization. Results show faith-based cancer educational interventions are promising. To maximize intervention impact, future studies might consider using stronger study designs, incorporating a variety of proven effective strategies, including those frequently used evidence-based strategies, as well as exploring promising strategies among specific target groups.

Association Between Social Engagement and Cancer Screening Utilization in a Community-Dwelling Chinese American Older Population

Objectives: This study aims to examine the association between social engagement and cancer screening utilization among a Chinese American older population. Method: Data were drawn from the Population Study of Chinese Elderly (PINE). In total, 3,157 Chinese older adults enrolled in this study. Cancer screening utilization was assessed by asking whether participants had utilized cancer screenings. Social engagement was measured with 16 questions. Results: After controlling for potential confounders, a higher level of social engagement was associated with increased utilization in blood stool test (OR 1.03, [1.02, 1.05]), colonoscopy (OR 1.02, [1.01, 1.03]), mammography (OR 1.06, [1.05, 1.08]), Pap test (OR 1.04, [1.03, 1.06]), and prostate specific antigen (PSA) test (OR 1.03, [1.01, 1.05]). Compared with those with low levels of social engagement, older adults with high levels of social engagement were more likely to have utilized a blood stool test (OR 1.85, [1.46, 2.35]), a colonoscopy (OR 1.37, [1.09, 1.72]), a mammography (OR 3.05, [2.25, 4.14]), and a Pap test (OR 1.99, [1.49, 2.66]), but not more likely to have utilized a PSA test (OR 1.40, [0.97, 2.03]). Conclusion: This study underscores the association between active social engagement and increased utilization of cancer screening among a Chinese American older population. Improving social engagement could be helpful in promoting cancer screening utilization.

Breast Cancer Screening Beliefs Among Older Chinese Women in Chicago's Chinatown

Background

Chicago's Chinatown is home to a sizeable community of first-generation Chinese American immigrants. This qualitative study seeks to describe the attitudes toward, and barriers and facilitators of, breast cancer screening among Chinese women in Chicago's Chinatown to inform strategies for future interventions.

Methods

We conducted six focus groups among Chinese-speaking adult women aged 45 and older. Focus groups were transcribed, coded, and analyzed for emergent themes.

Results

Forty-seven women participated in focus groups; 10 (21%) had received a breast cancer diagnosis in their lifetime, all participants were foreign-born, and 80% have resided in the United States for over 10 years. Participants expressed a range of breast cancer beliefs, attitudes toward screening, barriers encountered, and facilitators. Some differences were noted between women with cancer and those without. Barriers described include language, time, not wanting to burden their adult children, and transportation. Navigation services and physician recommendation were suggested facilitators to screening.

Conclusions

Our findings have important implications for development of interventions and policies to bolster breast cancer screening among Chinese women. We highlight the need to connect Chinese older adults with resources to navigate the health care system and present opportunities for community stakeholders, researchers, health professionals, and policy makers to improve the health of Chinese Americans.

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.

[Awareness of breast cancer screening among general practitioners in Mohammedia (Morocco)]

Introduction

Le cancer du sein représente un problème de santé publique majeur au Maroc. C'est le premier cancer chez la femme. L'objectif de ce travail était d'évaluer les connaissances des médecins généralistes (MG) en matière de dépistage du cancer du sein dans la préfecture de Mohammedia Maroc.

Méthodes

Nous avons mené une étude transversale, descriptive, exhaustive incluant les 97 MG exerçant dans les établissements de soins de santé de base du secteur public et privé de la province de Mohammedia.

Résultats

Le taux de participation était de 87%. L'âge moyen des MG était de 49,6 ± 8,1. Quatre-vingt pour cent (n=55) des MG ont donné une incidence incorrecte, 77,6% (n=85) ont reconnu l'existence d'un plan national de prévention et de contrôle du cancer (PNPCC) au Maroc, et 67,1 des MG ont rapporté l'existence d'un registre du cancer au Maroc. Le secteur d'activité était associé significativement avec les connaissances des MG sur le PNPCC et sur l'existence d'un guide de détection précoce du cancer du sein avec respectivement (p=0,003 et p=0,001). Une association significative entre l'ancienneté et l'existence d'un guide de détection précoce du cancer du sein et d'un registre du cancer du sein a été retrouvée avec (respectivement p=0,005 et p=0.002).

Conclusion

À la lumière de ces résultats il faudra renforcer les connaissances et les pratiques des MG par la promotion de la formation initiale et continue sur le dépistage.

Breast cancer screening behaviors among Korean American immigrant women: findings from the Health Belief Model

This study examined the utilization of clinical breast examinations (CBEs) and mammograms among Korean American immigrant women and investigated how the six constructs of Health Belief Model (HBM) are associated with the receipt of breast cancer screening. Using a quota sampling strategy, 202 Korean American immigrant women were recruited in metropolitan areas in the northeastern United States. Approximately 64% of the participants reported having had at least one CBE in their lifetime, and about 81% of the sample had undergone at least one mammogram in their lifetime. Women who perceived themselves to be susceptible to breast cancer were more likely to have undergone a CBE, and women who had lower barriers to screening or demonstrated a higher level of confidence were more likely than their counterparts to undergo a mammogram. Findings suggest that HBM constructs such as susceptibility, barriers, and confidence should be considered when designing interventions aimed at promoting breast cancer screening.

Factors associated with willingness to participate in biospecimen research among Chinese Americans

A paucity of information exists on the recruitment of Asian Americans for biospecimen research. Although studies show that Chinese Americans are at high risk for hepatitis B virus (HBV) infection, little is known about their willingness to participate in HBV-related biospecimen research and how knowledge, attitudes, and cultural factors impact their willingness to participate. The study was guided by Community-Based Participatory Research principles. Data were derived from an assessment study on HBV-related biospecimen research participation among Chinese Americans in the Philadelphia region. The assessment was conducted with 415 Chinese Americans recruited from eight Chinese community-based organizations. Cultural beliefs, knowledge, and attitudes toward biospecimen research were examined for associations with their willingness to participate in biospecimen banking research. Overall, 192 (46.3%) of 415 participants who completed the assessment indicated they were willing to participate if they were invited to donate blood to be frozen and stored for future HBV biospecimen studies. Cultural variables significant in bivariate analysis included collectivism, knowledge about biospecimen research, and Yin-Yang beliefs. Fatalism and individualism were not associated with participation willingness. In multivariate analysis, age, health care attitudes, and trust were significantly associated with willingness to participate in biospecimen banking research. Asian American communities have little knowledge of biospecimen banking and will benefit from educational campaigns that emphasize collective benefits and attitudes towards and trust in the health care system. Understanding cultural factors is important for improving Chinese Americans' knowledge, awareness, and intentions of participation in biospecimen research. Similar efforts need to be undertaken to develop culturally appropriate educational intervention programs to increase participation in biospecimen research among other Asian American groups.

Views of mammography screening among U.S. Black and Hispanic immigrant women and their providers

Views of ethnic immigrant women's experiences about mammography screening are important to determine barriers to cancer screening. We explored perceptions and barriers about mammography screening and breast health services among Haitian, Hispanic, Portuguese, and Somali women (n = 51) using semistructured interviews. Providers (n = 19) offered insight into health system barriers. Content analysis was conducted using qualitative data from the 2011 Komen Massachusetts needs assessment. Grounded theory was employed to explore themes and patterns in narratives. Six themes represented knowledge, health care, culture, spirituality, survivorship, and health systems improvement. Results may inform breast health policies that impact ethnic immigrant women in Massachusetts.

Physician visits and preventive care among Asian American and Pacific Islander long-term survivors of colorectal cancer, USA, 1996-2006

PURPOSE

Published literature on receipt of preventive healthcare services among Asian American and Pacific Islander (API) cancer survivors is scarce. We describe patterns in receipt of preventive services among API long-term colorectal cancer (CRC) survivors.

METHODS

Surveillance, Epidemiology, and End Results registry-Medicare data were used to identify 9,737 API and white patients who were diagnosed with CRC during 1996-2000 and who survived 5 or more years beyond their diagnoses. We examined receipt of vaccines, mammography (females), bone densitometry (females), and cholesterol screening among the survivors and how the physician specialties they visited for follow-up care correlated to services received.

RESULTS

APIs were less likely than whites to receive mammography (52.0 vs. 69.3 %, respectively; P < 0.0001) but more likely to receive influenza vaccine, cholesterol screening, and bone densitometry. These findings remained significant in our multivariable model, except for receipt of bone densitometry. APIs visited PCPs only and both PCPs and oncologists more frequently than whites (P < 0.0001). Women who visited both PCPs and oncologists compared with PCPs only were more likely to receive mammography (odds ratio = 1.40; 95 % confidence interval, 1.05-1.86).

CONCLUSIONS

Visits to both PCPs and oncologists were associated with increased use of mammography. Although API survivors visited these specialties more frequently than white survivors, API women may need culturally appropriate outreach to increase their use of this test.

IMPLICATIONS FOR CANCER SURVIVORS

Long-term cancer survivors need to be aware of recommended preventive healthcare services, as well as who will manage their primary care and cancer surveillance follow-up.

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.

Identifying specific non-attending groups in breast cancer screening--population-based registry study of participation and socio-demography

Background

A population-based breast cancer screening programme was implemented in the Central Denmark Region in 2008–09. The objective of this registry-based study was to examine the association between socio-demographic characteristics and screening participation and to examine whether the group of non-participants can be regarded as a homogeneous group of women.

Method

Participation status was obtained from a regional database for all women invited to the first screening round in the Central Denmark Region in 2008–2009 (n=149,234). Participation data was linked to registries containing socio-demographic information. Distance to screening site was calculated using ArcGIS. Participation was divided into ‘participants’ and ‘non-participants’, and non-participants were further stratified into ‘active non-participants’ and ‘passive non-participants’ based on whether the woman called and cancelled her participation or was a ‘no-show’.

Results

The screening participation rate was 78.9%. In multivariate analyses, non-participation was associated with older age, immigrant status, low OECD-adjusted household income, high and low level education compared with middle level education, unemployment, being unmarried, distance to screening site >20 km, being a tenant and no access to a vehicle. Active and passive non-participants comprised two distinct groups with different socio-demographic characteristics, with passive non-participants being more socially deprived compared with active non-participants.

Conclusion

Non-participation was associated with low social status e.g. low income, unemployment, no access to vehicle and status as tenant. Non-participants were also more likely than participants to be older, single, and of non-Danish origin. Compared to active non-participants, passive non-participants were characterized by e.g. lower income and lower educational level. Different interventions might be warranted to increase participation in the two non-participant groups.

The association between general practitioners' attitudes towards breast cancer screening and women's screening participation

BACKGROUND

Breast cancer screening in Denmark is organised by the health services in the five regions. Although general practitioners (GPs) are not directly involved in the screening process, they are often the first point of contact to the health care system and thus play an important advisory role. No previous studies, in a health care setting like the Danish system, have investigated the association between GPs' attitudes towards breast cancer screening and women's participation in the screening programme.

METHODS

Data on women's screening participation was obtained from the regional screening authorities. Data on GPs' attitudes towards breast cancer screening was taken from a previous survey among GPs in the Central Denmark Region. This study included women aged 50-69 years who were registered with a singlehanded GP who had participated in the survey.

RESULTS

The survey involved 67 singlehanded GPs with a total of 13,288 women on their lists. Five GPs (7%) had a negative attitude towards breast cancer screening. Among registered women, 81% participated in the first screening round. Multivariate analyses revealed that women registered with a GP with a negative attitude towards breast cancer screening were 17% (95% CI: 2-34%) more likely to be non-participants compared with women registered with a GP with a positive attitude towards breast cancer screening.

CONCLUSION

The GPs' attitudes may influence the participation rate even in a system where GPs are not directly involved in the screening process. However, further studies are needed to investigate this association.

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.

Predicting breast and colon cancer screening among English-as-a-second-language older Chinese immigrant women to Canada

Little is known about the cancer screening behaviors of older ESL Chinese immigrant women. To explore predictors of colon and breast cancer screening in this population, 103 Mandarin- and Cantonese-speaking immigrant women ages 50 years and older were recruited. Participants completed questionnaires to evaluate screening behaviors, health literacy, and demographic characteristics. Eighty-five percent self-reported that they were current breast cancer screeners, and 75% were current colon cancer screeners. Recommendation from a physician, having a female physician, and high or moderate proficiency in English predicted current mammography screening. Physician recommendation, first language, and self-efficacy predicted use of colon cancer screening. Bivariate analyses also revealed an association between use of colon cancer screening and greater health literacy and longer residency in Canada. Important predictors of screening emerged that potentially informs interventions to increase cancer prevention among older Chinese immigrants. The essential role of physician recommendation was identified for both breast and colon cancer screening.

Cultural views, English proficiency and regular cervical cancer screening among older Chinese American women

OBJECTIVE

The purpose of this study was to investigate the association between cultural views, English proficiency, and regular cervical cancer screening among older Chinese women.

METHODS

The study sample consisted of 473 asymptomatic Chinese participants aged 50 and older recruited from community organizations. The study outcome was regular receipt of Pap tests, defined as having a recent test in the past 3 years and another within 3 years before the present test. Eastern cultural views were measured by a 30-item scale that assessed beliefs about illness and cancer. Sociodemographics, cancer worry, physician recommendation, health insurance, and access barriers were included as covariates in multiple logistic regression models.

RESULTS

A total of 239 (50.5%) Chinese American women had regular Pap tests. Findings indicate that 1) women who held more traditional Chinese cultural views were less likely to be a regular screener (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94-0.99); 2) women with higher English proficiency were 1.39 times more likely to have received regular Pap tests than women with lower proficiency (OR, 1.39; 95% CI, 1.13-1.72).

CONCLUSION

Cultural views and English proficiency were significant predictors of older Chinese American women regular receipt of Pap tests. Future research is needed to identify and design culturally and linguistically competent programs to promote cervical cancer screening.

Relationships between decisional balance and stage of adopting mammography and Pap testing among Chinese American women

BACKGROUND

The Transtheoretical Model has not been applied to explain cancer screening behavior among a large sample of Chinese Americans. This study examines the stage of adopting mammography and Pap testing in relation to women's decisional balance of cancer screening.

METHODS

We surveyed a sample of 507 Chinese American women aged 50 and older in the DC area in 2003 and 2004. We categorized women into six screening stages (pre-contemplation, contemplation, action, relapse, risk of relapse, and maintenance) based on the frequency and regularity of past screening behaviors and future intentions. We measured women's attitudes toward mammography and Pap testing by 22 pro and con statements. Decisional balance was calculated by the mean difference between pro and con scores. Multinomial regression analyses were used to examine the associations between decisional balance and stage of adoption, controlling for sociodemographics, English fluency, and physician and family recommendations.

RESULTS

Maintenance was the largest group among six stages (45% for mammography; 44% for Pap testing). Women in the maintenance group had the highest decisional balance scores, indicating more positive attitudes toward screening. Decisional balance was significantly related to stages of adopting mammograms and Pap testing after adjusting for other covariates.

CONCLUSIONS

This study demonstrated that Chinese American women's cancer screening behavior was associated with decisional balance, as described in the Transtheoretical Model. Cancer screening messages should be tailored to the needs of women in different stages of adopting mammography and Pap testing.