Frances Lee-Lin

CERVICAL CANCER BELIEFS AND PAP TEST SCREENING PRACTICES AMONG CHINESE AMERICAN IMMIGRANTS

PURPOSE/OBJECTIVES To examine beliefs and Pap test utilization among Chinese American women, the largest Asian female population in the United States. RESEARCH APPROACH Cross-sectional descriptive, correlational study. SETTING Metropolitan areas of Portland, OR. PARTICIPANTS 100 foreign-born Chinese women aged 40 years and older. METHODOLOGIC APPROACH Three questionnaires were modified, translated, combined, and pretested. Participants completed the self-administered questionnaire in a group setting. MAIN RESEARCH VARIABLES Utilization of Pap test screening, health beliefs, and cultural and sociodemographic variables. FINDINGS Sixty-eight percent reported having a Pap test within the prior three years (adherence), and 84% reported ever having a Pap test. The odds of Pap test use and adherence decreased with increasing age. Women with insurance or a regular healthcare provider had better odds of Pap test use and adherence. Older age, older age when a participant moved to the United States, and increased modesty were negatively associated with ever having had a Pap test. CONCLUSIONS Age and cultural beliefs influence Pap test use and adherence. The strength of provider recommendation and healthcare access as predictors suggest areas for interventions designed to increase screening for cervical cancer. INTERPRETATION Nurses play a vital role in preventive health care, especially with the growing number of advanced practice nurses delivering primary care. Primary healthcare providers should be reminded of their influential role in increasing adherence to cancer screening. Further health policy action is necessary to extend screening coverage to those who do not have adequate health insurance.

Breast and Cervical Cancer Screening Practices and Interventions Among Chinese, Japanese, and Vietnamese Americans

PURPOSE/OBJECTIVES To review research on breast and cervical cancer screening practices among Chinese, Japanese, and Vietnamese Americans. DATA SOURCES MEDLINE and the Cumulative Index to Nursing and Allied Health Literature databases. DATA SYNTHESIS Of the 28 studies reviewed, 19 (68%) were descriptive and 9 (32%) were interventions. Instruments were developed or translated into the native language. Inconsistent operational definitions for positive facilitators and negative barriers made comparisons across studies difficult. CONCLUSIONS Research about breast and cervical cancer screening is limited in these groups. All of the studies reviewed indicated low adherence to cancer screening guidelines. Some interventions showed promising results. Poor awareness about cancer was reported; positive facilitators and negative barriers were identified. IMPLICATIONS FOR NURSING The rapidly increasing number of Asian Americans in the United States underscores the need for further research in this area. Future studies should focus on each population as a disaggregated subgroup. Cancer control interventions should be culturally competent.

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 womens 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.

Measuring Breast Cancer and Mammography Screening Beliefs Among Chinese American Immigrants

Disparities in breast cancer outcomes persist among Asian American women. Breast cancer is the most commonly diagnosed cancer among Chinese American women. This article describes the psychometric evaluation of an instrument measuring knowledge and beliefs related to breast cancer and screening among Chinese American women aged 40 or older. A sample of 100 foreign-born Chinese American women were recruited from an Asian community. Guided by the health belief model, a questionnaire was adapted from three existing questionnaires. Principal axis factoring analyses yielded a three-factor solution that accounted for 53% of the variance in the breast cancer items and a four-factor solution that accounted for 69% of the variance in the cultural items (Cronbachs alphas = .71—.89). Whereas these findings contribute to the understanding of the psychometric properties of an instrument targeted for Chinese American women, additional research is needed to evaluate its utility and efficacy for other Asian Americans.

A Community‐Based Participatory Research Approach to Understanding Pap Testing Adherence Among Vietnamese American Immigrants

OBJECTIVE To explore factors potentially influencing Pap testing practices among Vietnamese American immigrant women (VIW, foreign-born) and describe their awareness of cervical cancer screening resources in their community. DESIGN Descriptive study guided by the ecological model and community-based participatory research principles. SETTING Portland, Oregon, metropolitan area. PARTICIPANTS Vietnamese American immigrant women (211) who were age 21 and older. METHODS We used descriptive statistics and logistic regression analyses to analyze a self-administered questionnaire that was pretested and translated using a team approach. RESULTS Approximately 74% of VIW who completed the survey reported at least one Pap test, and 69% reported Pap testing history adherent to national guidelines. The factor most strongly associated with Pap testing receipt was suggestion from a friend, followed by longer residency in the United States, lower perceived common barriers, and lower perceived cultural barriers, for example, lack of family support and use of Eastern/Asian medicine. The factor most strongly associated with guideline adherence was having health insurance, followed by a recommendation from a physician or nurse practitioner. Only 11% of VIW knew where to obtain a free or low-cost Pap tests. CONCLUSION Nurses can influence rates of Pap testing among VIW by providing health education through outreach programs targeted at lay health workers and their social networks, identifying at-risk patients such as recently immigrated women, reducing perceived common and cultural barriers to Pap testing, and helping women seek alternative payment options if they lack health insurance. Primary health care providers should be reminded of their essential role in increasing Pap testing adherence.

Improving colorectal cancer screening in Asian Americans: Results of a randomized intervention study.

The objective of this study was to use a randomized controlled trial design to test the impact of an educational intervention delivered by specially trained community health workers among Chinese, Korean, and Vietnamese participants ages 50 to 75 years on knowledge, attitudes, beliefs, and intentions regarding colorectal cancer screening.

A Breast Health Educational Program for Chinese-American Women: 3- to 12-Month Postintervention Effect

Purpose. To test the efficacy of a culturally targeted breast cancer screening educational program in increasing mammogram completion in Chinese-American immigrant women. Design. Randomized controlled study Setting. Chinese communities, Portland, Oregon. Subjects. From April 2010 to September 2011, 300 women were randomized to receive a theory-based, culturally targeted breast cancer screening educational intervention (n = 147) or a mammography screening brochure published by the National Cancer Institute (n = 153). Intervention. The two-part intervention consisted of group teaching with targeted, theory-based messages followed by individual counseling sessions. Measures. Mammography completion, perceived susceptibility, perceived benefits, perceived barriers, perceived cultural barriers, and demographic variables. Analysis. A 2 × 3 mixed logistic model was applied to determine odds ratio of mammogram completion. Results. Behavior changed in both groups, with a total of 170 participants (56.7%) reporting a mammogram at 12 months. The logistic model indicated increased odds of mammogram completion in the intervention compared to the control group at 3, 6, and 12 months. When controlling for marital status, age, and age moved to the United States, the intervention group was nine times more likely to complete mammograms than the control group. Conclusion. The culturally targeted educational program significantly increased mammogram use among Chinese immigrant women. Further testing of effectiveness in larger community settings is needed. The intervention may also serve as a foundation from which to develop education to increase cancer screening among other minority subgroups.

Feasibility of a targeted breast health education intervention for Chinese American immigrant women.

PURPOSE/OBJECTIVES To assess the feasibility and acceptability of a targeted educational intervention to increase mammography screening among Chinese American women. DESIGN One-group pre- and post-test quasiexperimental design. SETTING Metropolitan areas of Portland, OR. SAMPLE 44 foreign-born Chinese American women aged 40 years and older. METHODS Participants who had not had a mammogram within the past 12 months were recruited and enrolled to a targeted breast health educational program. Before starting the group session, participants completed a baseline survey, which was administered again 12 weeks postintervention. MAIN RESEARCH VARIABLES Completion of mammography screening test, movement in stage of readiness, mammography and breast cancer knowledge, perceived susceptibility, perceived benefits, and perceived common and cultural barriers. FINDINGS The study response rate was high (71%). Of the 42 women who completed the study, 21 (50%) had a mammogram postintervention. The top three reasons for not completing a mammogram at the end of the study were no need or no symptom, busy, and reliance on family for assistance. Mean breast cancer susceptibility scores increased significantly at post-test as theorized (t[40] = -2.88, p < 0.01). Participants were more likely to obtain a mammogram when they had been in the United States for 3-15 years. CONCLUSIONS A targeted program that aims to increase breast health knowledge, improve access, and remove barriers may promote mammography screening among Chinese American immigrant women. IMPLICATIONS FOR NURSING This promising intervention now being tested under a randomized, controlled design can be adapted to other Asian subgroups. KNOWLEDGE TRANSLATION Targeted breast health intervention is feasible for improving mammography screening among Chinese immigrant women. Educating these women about early detection is important, as the first sign of breast cancer usually shows on a womans mammogram before it can be felt or any other symptoms are present. Immigrant women may be too busy to dedicate proper time to self-care behaviors; therefore, making it easier and faster for them to obtain a mammogram may improve the screening rate.

Contributing factors to colorectal cancer and hepatitis B screening among Vietnamese Americans.

PURPOSE/OBJECTIVES To identify factors associated with screening for colorectal cancer (CRC) and hepatitis B, because hepatitis B can increase the risk of liver cancer. DATA SOURCES MEDLINE®, CINAHL®, and PsycINFO databases from January 1998 to April 2012. DATA SYNTHESIS The 23 reviewed studies included 15 descriptive, 2 intervention, 3 qualitative, 2 chart or medical record review, and 1 mixed method. Most studies used an investigator-developed instrument with no reported reliability. Inconsistent operational definitions for contributing factors to screening made it challenging to make comparisons. CONCLUSIONS CRC and hepatitis B screening are consistently low among Vietnamese Americans. Contributing factors included sociodemographics, knowledge, cultural beliefs, and external factors. External factors such as having a regular place of care and a healthcare provider were crucial because they influenced adherence to screening recommendations. Use of a public media education plus healthcare provider model and a culturally tailored intervention using Vietnamese lay advisors appeared to be promising for improving CRC screening. Additional intervention studies are needed to increase screening. IMPLICATIONS FOR NURSING Vietnamese is a fast-growing subgroup within the Asian American Pacific Islander (AAPI) group that may require targeted approaches to screening for disease. Future studies should focus on immigrants or those who were born in the United States (men and women) as disaggregated subgroups. Such research can inform culturally sensitive and appropriate interventions that may improve cancer screening rates. KNOWLEDGE TRANSLATION Although Vietnamese is the fourth largest racial-ethnic subgroup within the AAPI group, the literature about contributing factors to CRC and hepatitis B screening is limited among this subgroup. CRC and hepatitis B screening are consistently low among Vietnamese Americans. Use of public media education plus a healthcare provider model and a culturally tailored intervention using Vietnamese lay advisors appears promising for improving CRC screening.

A Longitudinal Examination of Stages of Change Model Applied to Mammography Screening

Application of behavior change theories to ethnically diverse groups is limited. In a secondary analysis of intervention study data, we tested the validity of the transtheoretical model (TTM) of change among Chinese American immigrant women. Three hundred mammography non-adherent women were randomized to an intervention or control group. Compared with contemplators (60%), precontemplators reported higher perceived mammography barriers (p < .001) and lower breast cancer susceptibility (p < .01). Baseline contemplators were 1.5 times more likely to have a mammogram post intervention compared with precontemplators. Upward shift in stage of change was higher in the intervention than the control group at 3 months (odds ratio [OR] = 6.14), 6 months (OR = 4.82), and 12 months (OR = 2.85). Women with an upward shift at 3 months were more likely to complete mammography at 12 months (OR = 15.44). The results supported the TTM stages of change. Education targeted to Chinese women’s stages of change has significant potential to decrease breast cancer screening disparities.