Cannas Kwok

Health seeking behaviours among Chinese-Australian women: implications for health promotion programmes

Preventive medicine is an important element of the Australian health care system. An essential aspect of the biomedical model of health care is screening for the early detection of disease in otherwise asymptomatic people. There is ample evidence that acceptance levels of western medicine vary and that a variety of health epistemologies and health practices coexist. To examine the extent to which Chinese-Australian women integrate western medicine practices in their health seeking behaviour, a qualitative study was conducted, which involved in-depth interviews in Cantonese with 20 women. Although adherence to western health beliefs and practices varied, in general these Chinese-Australian women sought medical help only after they felt unwell. Commonly, they first tried traditional remedies for minor diseases. Many saw no reason to participate in screening when they were asymptomatic. Direct communication with health care providers who speak the same language appears to be important to many Chinese-Australian women when seeking health care services. It is recommended that ethnic health workers should participate in screening programmes and other health promotion activities.

The Concepts of Health and Preventive Health Practices of Chinese Australian Women in Relation to Cancer Screening

Despite an emphasis on mammographic screening in Australia, Chinese Australian women have low participation rates. This qualitative study investigated how concepts of health and health promotion influence Chinese Australian womens decisions to participate in cancer screening, which is an important issue for nurses who work with multicultural populations. In-depth interviews were conducted with 20 Chinese Australian women. Using thematic data analysis, the findings showed that health and illness are taken-for-granted experiences of everyday life. When they were asymptomatic, most informants saw no reason to suspect that they may have diseases. Consistent with these health beliefs, the women focused on preserving and promoting health and overall well-being in everyday life rather than attempting to detect hidden disease by screening. These ideas and practices influenced behavior in relation to cancer diagnosis and in particular toward mammography.

Chinese-australian Women's Beliefs About Cancer: Implications for Health Promotion

Ethnicity and culture play significant roles in determining how an individual is likely to understand and explain cancer, which, in turn, is posited to have an impact on cancer screening behavior. Chinese women in Western countries are consistently reported to have low participation rates in mammographic screening. This may be related to the fact that women of Chinese ancestry have different images and beliefs about cancer, which can have implications for participation in health promotion programs regarding cancer prevention and early detection. To investigate this issue, a qualitative study involving in-depth interviews with 20 Chinese-Australian women was conducted. Embedded in the womens images of cancer were notions associated with fear, mystery, contagion, and stigma. Based on information provided by the women who participated in this study, 6 domains of folk explanations about the causes of cancer were identified: lifestyle, stress, environment, genes, unknown causes, and destiny. These beliefs should be considered in the design of breast health promotion programs because they are likely to have a bearing on Chinese-Australian womens attitudes regarding the value they perceive of cancer screening.

Chinese-Australian Women’s Knowledge, Facilitators and Barriers Related to Cervical Cancer Screening: A Qualitative Study

Understanding the different facilitators and barriers to screening within cultural and ethnic groups is important for developing appropriate education and outreach programs to underserved groups. Qualitative methods were employed to gain a rich understanding of participant views. In-depth interviews were conducted with 18 Chinese Australian women in their native languages and analysed using content analysis. Knowledge of cervical cancer was low, and few participants understood the benefits and purpose of screening. Having a doctor’s recommendation was a strong motivator, and returning for screening was encouraged by having a female Chinese doctor perform the exam, receiving a reminder letter and the absence of cost for screening participation. However, participation was inhibited by logistical barriers, cultural beliefs and previous painful screening experiences. A range of multifaceted facilitators and barriers must be considered when developing interventions to increase the rates of cervical screening in this population.

Cultural and linguistic isolation: The breast cancer experience of Chinese-Australian women – A qualitative study

Abstract Objectives: Although Chinese-Australian women are at higher risk of developing breast cancer after migration to Australia, information on their experience is limited. This paper explores Chinese-Australian women’s perceptions of the meaning and experience of a breast cancer diagnosis, treatment and coping mechanism. Methods: Three focus groups were conducted with 23 Chinese-Australian women diagnosed with breast cancer in their native language (Cantonese or Mandarin). Following transcription and translation, interview data was analysed by content analysis. Results: Culturally specific values, beliefs and language barriers played a significant role in shaping the women’s breast cancer experiences and their response to the diagnosis. Of note these women found the experience isolating and distressing, factors that were compounded by the lack of culturally sensitive resources and information. Conclusions: In providing information for Chinese-Australian women with breast cancer, culture, language and migration experience need to be taken into account.

Chinese Breast Cancer Screening Beliefs Questionnaire: development and psychometric testing with Chinese-Australian women.

AIM This paper is a report of the development and psychometric testing of the Chinese Breast Cancer Screening Beliefs Questionnaire, a culturally sensitive questionnaire for measuring Chinese-Australian womens beliefs, knowledge and attitudes towards breast cancer and breast screening practices. BACKGROUND Breast cancer is the leading cause of cancer morbidity among Chinese-Australian women. They are, however, 50% less likely to participate in all types of breast examination. A valid and reliable instrument to explore the breast cancer beliefs is essential for the development of interventions to promote breast cancer screening practices. METHOD Items for the questionnaire were drawn from a literature review and in-depth interviews. A panel of professional experts and lay women evaluated face and content validity. The instrument was translated from English to Chinese using back-translation. In 2008, a total of 292 Chinese-Australian women aged 22-78 years who were resident of Australia were included in testing the instrument. Multi-trait analysis and Cronbachs alpha were used to assess internal consistency reliability and exploratory factor analysis assessed construct validity. RESULTS The final 13-item questionnaire had satisfactory validity and internal consistency. Cronbachs alpha for the total scale was 0.76, and for the three subscales ranged from 0.70 to 0.79. Exploratory factor analysis showed that the scale reduced to three factors. CONCLUSION Preliminary data suggest that the Chinese Breast Cancer Screening Beliefs Questionnaire is a valid, reliable and culturally sensitive instrument for the measurement of Chinese-Australian womens beliefs, knowledge and attitudes about breast cancer and breast cancer screening.

Breast cancer screening practices among Chinese-Australian women

PURPOSE OF THE RESEARCH The aims of the study were to report breast cancer screening practices among Chinese-Australian women, and to examine the relationship between 1) acculturation, and 2) the Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) score and womens breast screening behaviours. METHOD AND SAMPLE A descriptive and cross-sectional method was used. Two hundreds and ninety-two Chinese-Australian women were recruited from a number of Chinese organizations. Both English and Chinese versions of the CBCSB Questionnaire were administered. Main research variables are breast cancer screening practices, acculturation factors and total scores on each of the CBCSB subscales. RESULT The majority of participants (76%-90%) had heard of breast self exam (BSE), clinical breast exam (CBE) and mammograms. Only 22.1% performed a BSE monthly and only 35.4% of women within the targeted age group had a CBE annually. Three quarters of women within the targeted age group reported they had a mammogram every two years or less. No statistically significant differences in acculturation and screening behaviours were found. In terms of CBCSB score, women who had CBEs and mammograms as recommended had significantly higher scores on the Attitudes to health checkup subscale. In addition, women who engaged in BSE and mammogram as recommended perceived less barriers to mammographic screening. CONCLUSIONS Attitudes towards health check-ups and perceived barriers to mammographic screening were influential in compliance with breast cancer screening among Chinese-Australian women.

Perceived information needs and social support of Chinese-Australian breast cancer survivors

BackgroundBoth informational and social support are vital components in achieving a high quality of life as a cancer survivor. The study aims to explore the perceptions of information needs and social support among Chinese-Australian breast cancer survivors and how these resources impacted their cancer experience.MethodsThree focus groups were conducted with 23 Chinese-Australian women diagnosed with breast cancer in their native language (Mandarin and Cantonese). Each interview was translated and transcribed. Content analysis was used to uncover the major themes.ResultThemes for information needs were identified as (1) using linguistically appropriate information, (2) the need for culturally sensitive information for the management of expected side effect and promotion of recovery and (3) the need for information on signs and symptoms of recurrence. Families were described as a primary source of multifaceted social support, although it was challenging to obtain. Support groups were also an important support source, but health care professionals were not identified as a source of support.ConclusionOur study has provided practical insight into the information needs and social support of Chinese women with breast cancer. These findings can be used to inform the development of linguistically and culturally tailored support and survivorship interventions for this vulnerable population.

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.

Development and evaluation of a culturally sensitive support group programme for Chinese-Australian women with breast cancer: A pilot study

KWOK C. & HO M. (2011) European Journal of Cancer Care20, 795–802 Development and evaluation of a culturally sensitive support group programme for Chinese-Australian women with breast cancer: a pilot study Cancer support groups are an important vehicle for providing informational and psychosocial support to cancer survivors. Studies suggest that people from minority cultures are underrepresented in cancer support groups. The aims of this study were to report the development and evaluation of a culturally sensitive support group programme for Chinese-Australian women with breast cancer and to evaluate the informational and psychosocial impact of the programme. In collaboration with a Chinese cancer support organisation, 29 women were enrolled in the programme which was evaluated by a combination of quantitative and qualitative approaches. The results indicated that the programme was well received by the participants who suggested that the content was useful and relevant. In addition, the findings indicated that the programme, designed to be culturally sensitive and linguistically appropriate, was effective in providing informational support and psychosocial support for the participants. A methodology for giving breast cancer survivors a sense of interconnectedness and thus minimising their feelings of isolation and helplessness, were also among the chief outcomes of this study. The study provided some insight into the development of supportive cancer survivorship care for women being treated for breast cancer in the Australian-Chinese community.Cancer support groups are an important vehicle for providing informational and psychosocial support to cancer survivors. Studies suggest that people from minority cultures are underrepresented in cancer support groups. The aims of this study were to report the development and evaluation of a culturally sensitive support group programme for Chinese-Australian women with breast cancer and to evaluate the informational and psychosocial impact of the programme. In collaboration with a Chinese cancer support organisation, 29 women were enrolled in the programme which was evaluated by a combination of quantitative and qualitative approaches. The results indicated that the programme was well received by the participants who suggested that the content was useful and relevant. In addition, the findings indicated that the programme, designed to be culturally sensitive and linguistically appropriate, was effective in providing informational support and psychosocial support for the participants. A methodology for giving breast cancer survivors a sense of interconnectedness and thus minimising their feelings of isolation and helplessness, were also among the chief outcomes of this study. The study provided some insight into the development of supportive cancer survivorship care for women being treated for breast cancer in the Australian-Chinese community.