Awareness, knowledge, social norms, and vaccination intentions among Khmer mother-daughter pairs

Cervical cancer is caused by human papillomavirus (HPV) infection, which can be prevented by vaccination. Mothers play an important role in promoting vaccination and health education. However, Cambodian American mothers reported to have challenges to play a role as primary health educators due to lack of health knowledge and language and cultural gaps. Therefore, this study aims to understand the Cambodian American daughters' and mothers' awareness, knowledge and social norms of HPV vaccination and their health communication and vaccination decision-making. We conducted a pilot randomized clinical trial to promote HPV vaccination. In this study, we have only reported findings from baseline data examining individual, interpersonal and social determinants of HPV vaccination behavior among 19 dyads of Cambodian American mothers and daughters. Both mothers and daughters demonstrated low levels of awareness and knowledge. A significant relationship was found between the daughters' HPV vaccine decisions and their perception of their mothers' intention on HPV vaccination for them. Culturally and linguistically appropriate communication strategies such as storytelling or visual presentation approaches may be more effective than the current practice of using information-based written materials to promote HPV vaccination and health education among Cambodian Americans.

Factors Associated with HPV Vaccination among Cambodian American Teenagers

OBJECTIVES

Parents have general influence over their children's health and health behavior. However, given the dearth of specific literature regarding knowledge level and social and cultural factors influencing HPV vaccination behaviors among Cambodian American (CA) parent, it is difficult to develop an effective, evidence-based public health HPV vaccination program. Therefore, the objectives of this study were to determine the HPV vaccine uptakes among CA teenagers and to examine factors influencing HPV vaccine uptakes.

DESIGN AND SAMPLE

A descriptive, cross-sectional survey design and a combination of network and targeted sampling methods were used.

RESULTS

CA mothers (n = 130) completed a health survey through face-to-face interviews in either English or Khmer language. Girls vaccination rates were 29% while that of boys was 16%. Awareness and knowledge of HPV among CA mothers was very low, and many believed that their daughters, who speak English and were educated in the U.S., had more knowledge about health than they did. Logistic regression analysis showed that CA girls had significantly higher odds of vaccination when their mothers possessed a higher level of English reading ability and had greater awareness and knowledge of HPV.

CONCLUSIONS

The strikingly low rates of HPV vaccination among CA girls and boys underscore the need to improve vaccination outreach, education, and uptake. The findings can be used to develop targeted public health HPV vaccination programs for CAs, which will reduce cervical cancer disparities.

Abstract B57: Knowledge and cultural health beliefs of cervical cancer and attitudes and behaviors towards cervical cancer screening among Cambodian American women

Purpose: To determine the prevalence of cervical screening behavior among Cambodian American women, and their knowledge and cultural health beliefs about cervical cancer and attitudes towards cervical cancer screening.

Background: The incidence and mortality of cervical cancer has been significantly reduced in the United States as a result of cervical cancer screening. However, the incidence of cervical cancer is still high among Southeast Asian American women, and in particular among Cambodian American women. Yet, little is known about cervical cancer-related knowledge, attitudes, and screening behavior among Cambodian American women.

Methods: A descriptive and cross-sectional face-to-face survey was conducted. A community-based participatory research approach was used to recruit Cambodian American mothers and ethnic-based media strategies were utilized through Khmer radio and television and bilingual flyers throughout Cambodian community. Our survey instrument was constructed based on qualitative research and a literature review. Our qualitative study indicated that there are no words in Khmer for cervix, Pap smear, and cervical cancer. Therefore, diagrams or photographs that represent the terms were included in the survey. Basic descriptive statistics were performed to analyze and summarize demographics, cervical cancer screening behavior, cervical cancer-related knowledge, and attitudes toward the Pap test.

Results: One hundred thirty Cambodian American mothers (mean age =44.6; SD=7.6) completed the survey. Of the respondents 92% were from Cambodia, 48% were married or lived with a significant other, 78% lived in refugee camps, 45% reported speaking English very well or well, 62% had a government insurance program, and 45% had private health insurance. The majority of the participants (97%) reported that they have had a Pap test. Of those, 91% had the last Pap test 1-3 years ago. There was a lack of understanding and knowledge of cervical cancer; 47% reported that women will get cervical cancer because it runs in the family; 76% thought that smoking cannot cause cervical cancer; and 34% believed that cervical cancer is matter of Karma. The majority of the women (74%) thought that having a Pap test performed by a male doctor is embarrassing; 54% reported that the test is painful or uncomfortable; 51% reported that women who have never had sex did not need a pap test; 45% reported that women who are in menopause do not need a pap test or they dd not know the answer; and 22% reported that women who are widowed do not need the test or they did not know the answer.

Conclusion: The study findings provide insight and understanding of Cambodian American women's knowledge, cultural health beliefs, and attitudes towards cervical cancer and the Pap test. Although the prevalence of the Pap test was surprisingly high, the findings clearly indicated that there was a great deal of misunderstanding about cervical cancer and the Pap test. Our participants were middle-aged Cambodian American women; therefore, the findings may not be applicable to those from different age groups. Future studies are needed to explore other age groups. Moreover, culturally and linguistically appropriate educational interventions are needed to improve knowledge and understanding about cervical cancer and the Pap test for this population.

Citation Format: Minjin Kim, Haeok Lee, Ling Shi, Phala Chea, Kevin Tan. Knowledge and cultural health beliefs of cervical cancer and attitudes and behaviors towards cervical cancer screening among Cambodian American women. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B57.

Using qualitative methods to develop a contextually tailored instrument: Lessons learned

OBJECTIVE

To develop a population-specific instrument to inform hepatitis B virus (HBV) and human papilloma virus (HPV) prevention education and intervention based on data and evidence obtained from the targeted population of Khmer mothers reflecting their socio-cultural and health behaviors.

METHODS

The principles of community-based participatory research (CBPR) guided the development of a standardized survey interview. Four stages of development and testing of the survey instrument took place in order to inform the quantitative health survey used to collect data in stage five of the project. This article reports only on Stages 1-4.

RESULTS

This process created a new quantitative measure of HBV and HPV prevention behavior based on the revised Network Episode Model and informed by the targeted population. The CBPR method facilitated the application and translation of abstract theoretical ideas of HBV and HPV prevention behavior into culturally-relevant words and expressions of Cambodian Americans (CAs).

CONCLUSIONS

The design of an instrument development process that accounts for distinctive socio-cultural backgrounds of CA refugee/immigrant women provides a model for use in developing future health surveys that are intended to aid minority-serving health care professionals and researchers as well as targeted minority populations.

Khmer American Mothers' Knowledge about HPV and HBV Infection and Their Perceptions of Parenting: My English Speaking Daughter Knows More

PURPOSE

The purpose of this study is to explore and describe Khmer mothers' understanding of HBV and HPV prevention as well as their perception of parenting on health and health education of their daughters in the US.

METHODS

The qualitative pilot study guided by the revised Network Episode Model and informed by ethnographic analysis and community-based purposive sampling method were used. Face-to-face audiotaped interviews with eight Khmer mothers were conducted by bilingual female middle-aged community health leaders who spoke Khmer.

RESULTS

The findings revealed that Khmer mothers clearly lacked knowledge about HBV and HPV infection prevention and had difficulty understanding and educating their daughters about health behavior, especially on sex-related topics. The findings showed that histo-sociocultural factors are integrated with the individual factor, and these factors influenced the HBV and HPV knowledge and perspective of Khmer mothers' parenting.

CONCLUSIONS

The study suggests that situation-specific conceptual and methodological approaches that take into account the uniqueness of the sociocultural context of CAs is a novel method for identifying factors that are significant in shaping the perception of Khmer mothers' health education related to HBV and HPV prevention among their daughters. The communication between mother and daughter about sex and the risk involved in contracting HBV and HPV has been limited, partly because it is seen as a "taboo subject" and partly because mothers think that schools educate their children regarding sexuality and health.

HBV-related health behaviors in a socio-cultural context: perspectives from Khmers and Koreans

PURPOSE

The aim of this study is to explore factors influencing health and health care within the sociocultural context of Cambodian Americans (CAs or Khmers) and Korean Americans (KA) and to examine intergroup similarities and differences between CAs and KAs, focusing on hepatitis B virus (HBV) and liver cancer prevention behaviors.

METHODS

The study used a qualitative design guided by the revised Network Episode Model (NEM) and informed by ethnographic analysis. Focus group interviews with key informants among CA community health leaders (CHLs, n=14) and individual interviews with key informants of KA CHLs (n=9) were audiotaped and transcribed.

RESULTS

Three categories that influenced HBV and liver cancer prevention emerged from both CAs and KAs: the socio-cultural, individual, and behavioral. Four additional subcategories (sub-themes) of sociocultural were identified as socio-history, socio-medicine, socio-linguistic, and socio-health resources. Both CAs and KAs, however, have low levels of knowledge and significant misunderstandings about HBV infection.

CONCLUSIONS

The study identifies and compares the social-cultural determinant for HBV and liver cancer and highlights the factors of education, intercultural communication, and interactions within socio-cultural contexts of CA and KA subgroups. In general, conceptual overlaps are apparent between Khmers (from now on, the terms, CA and Khmer, will be used interchangeably) and Koreans except for the sub-theme of socio-history. However, differences in concept-specific attributes point to the need to account for differing conceptualizations and implications of specific ethnic groups' sociocultural contexts, and to design contextually-relevant outreach and educational interventions for targeted AAPI subgroups.