Dorothy N.S. Chan

Colorectal cancer screening behaviour and associated factors among Chinese aged 50 and above in Hong Kong – A population-based survey

PURPOSE This study reports the uptake rate of colorectal cancer screening among Chinese people aged 50 or above and the identified factors associated with the likelihood of undergoing such screening. METHODS A cross-sectional population-based telephone survey was conducted in Hong Kong during the period 2 to 28 May 2007. The survey covered demographics, perceived health status and susceptibility to cancer, utilisation of complementary medicine, family history of cancer and cancer screening behaviour. RESULTS The survey was completed by 2004 Hong Kong Chinese residents aged 50 or older (response rate = 66.6%). The uptake rate of a fecal occult blood test and a colonoscopy was 12% and 19% respectively. Factors associated with colorectal cancer screening behaviour included: male participants, ex-smokers, with cancer or other serious disease, a family history of cancer, perceived health status fair or poor, regular visits to a doctor to look after health, and utilisation of complementary medicine. CONCLUSIONS The uptake rate of this study population was low though an increasing trend did appear. Heath education and promotion programmes may focus on these identified factors to facilitate colorectal cancer screening in a Chinese population.

Longer term follow up of aerobic capacity in children affected by severe acute respiratory syndrome (SARS)

Background: A study was undertaken to investigate the aerobic capacity and pulmonary function of children 6 and 15 months after the diagnosis of severe acute respiratory syndrome (SARS). Methods: Thirty four patients of mean age 14.7 years completed both pulmonary function and maximal aerobic capacity tests at 6 months. All had normal clinical examination and were asymptomatic. Their exercise responses were compared with a group of healthy controls. Complete data were collected on 27 of the original 34 cases at 15 months. Results: Compared with normal controls, the patient group had significantly lower absolute and mass related peak oxygen consumption (peak V˙o2 (p<0.01)), higher ventilatory equivalent for oxygen (p<0.01), lower oxygen pulse (p<0.01), and a lower oxygen uptake efficiency slope (p<0.01) at 6 months. This impairment was unexpected and out of proportion with the degree of lung function abnormality. Residual high resolution computed tomography of thorax (HRCT) abnormalities were present in 14 patients. Those with abnormal HRCT findings had significantly lower mass related peak V˙o2 than subjects with normal radiology (p<0.01). Absolute and mass related peak V˙o2 in the patient group remained impaired at 15 months despite normalisation of lung function in all patients. Conclusions: The mechanism for the reduced aerobic capacity in children following SARS is not fully understood, but it is probably a consequence of impaired perfusion to the lungs at peak exercise and deconditioning.

Perspectives on the use of and service needs of cancer preventive services for ethnic minorities in Hong Kong: a study protocol

AIM To report a study protocol to explore the experience of cancer screening from the perspective of ethnic minorities in Hong Kong BACKGROUND Cancer is a major health problem, but screening can be effective in decreasing the incidence and mortality rates. Providing information on how to participate in recommended preventive measures and on accessibility to these services is a crucial step in promoting healthy behaviour. Ethnic minorities in Western countries are found to be less likely to use preventive services and encounter more barriers in doing so than the general population. DESIGN A mixed-method design with two phases has been chosen to meet the aims and objectives of the study, with Phase 1 using a self-reported survey and Phase 2 involving focus-group interviews. METHOD A convenience sample of 1540 South Asians (770 in each gender) will be recruited from community centres for the Phase 1 survey in 2013-2014, of whom 72-96 will be invited to participate in the Phase 2 interviews. The Survey and Behavioural Research Ethics Committee of the local university approved the study in March 2012. DISCUSSION The findings will provide detailed information on the use of cancer screening and the barriers that this minority population faces in Hong Kong. The findings will inform the government and policy-makers on the implementation of culture-specific interventions, so as to increase the screening uptake rate of this ethnic minority.

Gender differences in the use of colorectal cancer tests among older Chinese adults

PURPOSE The study aimed to explore the gender difference in using colorectal cancer (CRC) tests among Chinese aged 50 years or over. METHODS A cross-sectional study was conducted in 2004 Chinese older adults through anonymous telephone survey which covered socio-demographic variables, health status, use of complementary therapy, health-related perceptions and use of CRC tests. RESULTS The uptake rate of flexible sigmoidoscopy (FS)/colonoscopy was 14% for males and 10% for females, with males significantly more likely to have had the test after adjusting for their differences in socio-demographics, health status, use of complementary therapies, health-related perceptions and recommendation received from health professionals (adjusted OR = 1.5, 95% CI: 1.1-2.0, p = 0.005). The uptake of fecal occult blood test was nearly the same (19%) for both genders. Further interaction analyses indicates that the effect of a family history of cancer on the uptake of a FS/colonoscopy is significantly weaker in males than in females (the interaction odds ratio = 0.4, 95% CI: 0.2-0.8, p = 0.011), whereas a male perceived that visiting a doctor is good for health will be more likely to have an uptake of a FS/colonoscopy than a female with such perception (the interaction odds ratio = 2.1, 95% CI: 1.1-3.8, p = 0.018). CONCLUSIONS The uptake of CRC tests was low in this average-risk population. More effort is needed to educate the public about the importance and benefits of CRC tests. In view of the gender differences in some determinants of FS/colonoscopy uptake, particular attention should be given to develop gender-specific strategies to improve the rate.

A Systematic Review of the Factors Influencing Ethnic Minority Women’s Cervical Cancer Screening Behavior: From Intrapersonal to Policy Level

Background: Cervical cancer can be prevented by effective screening using Papanicolaou tests, but the utilization rate is lower among ethnic minorities than in the general population. Understanding the factors influencing minorities’ use of such screening can aid the design of an appropriate intervention to increase their uptake rate. Objective: The aims of this study were to examine the factors that influence ethnic minority women in using cervical cancer screening and the similarities and differences in associated factors across different groups and to explore the interrelationships between the factors identified. Methods: A literature search was conducted using Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, PsycINFO, and PubMed. Furthermore, 1390 articles were retrieved, of which 24 met the inclusion criteria. Critical appraisal was performed by means of a quality assessment tool. The findings were summarized in tabular and narrative forms. Results: The findings showed that certain factors commonly affected ethnic minority women’s screening behavior, including knowledge, attitude and perceptions, physician’s recommendation, quality of care and service, language, and acculturation. Culture-related factors, religion, and acculturation exhibited close interrelationships with the attitude and perceptions factor, resulting in behavioral change. Conclusions: The review sheds light on how common or unique are the factors across ethnic minorities and how these factors interact to influence behavior. Further studies are warranted to develop and test empirically a comprehensive model leading to a better understanding of the interrelationships between multiple factors. Implications for Practice: The model should be useful in informing policy makers about appropriate resource allocation and in guiding the development of culturally relevant programs to increase screening uptake.

Innovative Health Promotion Program on Breast Cancer Screening for Ethnic Minority Women in Hong Kong

Paper Presentation Purpose for the Program Hong Kong is a multiethnic society. About 72.6% of the ethnic minority population is South Asian. Lack of health insurance coverage, cultural values and beliefs, language barriers, and logistic and financial constraints are major barriers that deter the ethnic minority population from participating in cancer screening. Ethnic minority women are less educated, and most of them are housewives and submissive to their husbands. Traditional customs and cultural beliefs are major barriers for breast cancer screening. For example, touching oneself during breast self‐examination is seen as taboo by some, and some feel embarrassed about the discussion or examination of intimate body parts with male physicians. Proposed Change To raise awareness and knowledge about preventive measures for breast cancer that are currently available for this ethnic minority group of women (e.g., Indian, Nepalese, and Pakistani), we conducted a service project tailored for them. Implementation, Outcomes, and Evaluation We engaged nursing students and South Asian women ambassadors (who represented the ethnic minority population) as volunteer workers. The 2‐hour event consisted of three parts: health talk, practical demonstration, and multilanguage leaflets. The project also provided an experiential learning opportunity for nursing students. Several preparatory training workshops were organized to equip voluntary nursing students, the South Asian women ambassadors, and the interpreters with the teaching material and skills in delivering health education. Fifty‐three service recipients and 21 nursing students were recruited. Pretest and posttest evaluations using a short questionnaire were conducted to assess their knowledge, attitudes, and perceptions about cancer. Findings showed improvement in knowledge and risk perception on breast cancer. Recipients demonstrated satisfactory performance and self‐efficacy on breast self‐examination. Findings also supported an improved attitude and perception on healthy lifestyle. Implications for Nursing Practice Innovative and culturally‐sensitive information could successfully dispel the misconceptions of breast cancer and increase the awareness of breast cancer and available preventive services among ethnic minority women. South Asian women ambassadors helped to build up the mutual help network among the South Asian community and empowered women to make their own health decisions.

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 peoples attitudes, perceptions, and health practices. Often, such instruments are lacking in the study populations 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.