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Yang W, Liu Y, Zhang G, Yao Y, Wang Y, Leng D, Li C, Liu K, Liu J, Pu Y, Li M, Yang B, Zhang S, Mu D, Zhang X. Health literacy and associated factors in China: findings from the Wa ethnic group. Front Public Health 2024; 12:1407593. [PMID: 38979042 PMCID: PMC11228141 DOI: 10.3389/fpubh.2024.1407593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/06/2024] [Indexed: 07/10/2024] Open
Abstract
Background The health literacy of ethnic groups in remote areas of China is far from satisfactory. However, the health literacy of ethnic groups in China remains unclear. This study aimed to explore the health literacy of the "advancing directly" ethnic group and its influencing factors. Methods A cross-sectional study was conducted using a staged sampling method among the Wa ethnic group, who have rapidly transitioned directly from the traditional lifestyle of slash-and-burn cultivation to modern societies. We used the Health Literacy Questionnaire (HLQ) to assess health literacy. We defined low health literacy as less than 60% of the total score and adequate health literacy as more than 80% of the total score. Results A total of 668 individuals met the inclusion criteria and the mean age was 42.19 (SD 10.56) years. The mean HLQ total score was 29.9 (SD 10.56). The prevalence of adequate health literacy was 0.89%. There were significant differences between the low and the non-low health literacy groups in terms of gender, age, education, marital status, occupation, residing place, current smoking status, and waist circumference (all p < 0.05). Multiple linear regression analysis showed that women (t = 9·418, p < 0.001), older age (B = -0.0091, t = -2.644, p = 0.008), low educational level (B = 0.766, t = 6.018, p < 0.001), current smoking (B = -2.66, t = -3.038, p = 0.008), and residence far from township (B = -5.761, t = -4.1, p < 0.001) were associated with low HLQ total score. Conclusion Our findings suggest that the health literacy of the Wa ethnic group is far from favorable. It indicates the need for increased efforts in improving the health literacy of "advancing directly" ethnic groups.
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Affiliation(s)
- Wanqiu Yang
- School of Ethnology and Sociology, Yunnan University, Kunming, China
- School of Medicine, Yunnan University, Kunming, China
| | - Yi Liu
- Yunnan Provincial Center for Population and Health Publicity and Education, Kunming, China
| | - Guangjie Zhang
- School of Vocational and Continuing Education, Yunnan University, Kunming, China
| | - Yu Yao
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Yanqing Wang
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Dan Leng
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Chaoxiao Li
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Kunjie Liu
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Jiazhou Liu
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Yongjie Pu
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Mufei Li
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Borui Yang
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Shuting Zhang
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Di Mu
- School of Ethnology and Sociology, Yunnan University, Kunming, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Chan TKC, Tan LWL, van Dam RM, Seow WJ. Cancer Screening Knowledge and Behavior in a Multi-Ethnic Asian Population: The Singapore Community Health Study. Front Oncol 2021; 11:684917. [PMID: 34476210 PMCID: PMC8406849 DOI: 10.3389/fonc.2021.684917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022] Open
Abstract
Background Cancer has become the leading cause of mortality in Singapore and among other Asian populations worldwide. Despite the presence of National Cancer Screening programmes in Singapore, less than half of the population has had timely screening according to guidelines. The underlying factors of poor cancer screening rates and health outcomes among Asian ethnic groups remain poorly understood. We therefore examined cancer screening participation rates and screening behavior in a multi-ethnic Singapore population. Methods We collected data from 7,125 respondents of the 2015–2016 Singapore Community Health Study. Factors associated with cervical, breast, and colorectal cancer screening were evaluated using modified Poisson regression. Adjusted prevalence ratios were computed with 95% confidence intervals after adjusting for confounders. Results The mean age of the respondents was 57.7 ± 10.9 years; 58.9% were female and were predominately Chinese (73.0%), followed by Malay (14.2%), and Indian (10.9%). Less than half of the respondents in the recommended age groups had undergone cancer screening (cervical, 43%; breast, 35.1%; colorectal, 27.3%). Malay respondents were significantly less likely to screen as recommended for cervical (aPR = 0.75, CI = 0.65–0.86, p < 0.001), breast (aPR = 0.83, CI = 0.68–0.99, p = 0.045), and colorectal cancer (aPR = 0.55, CI = 0.44–0.68, p < 0.001), as compared to Chinese respondents. Respondents who had obtained lower secondary level education were 42% more likely to screen for cervical cancer (aPR = 1.42, CI = 1.23–1.64, p < 0.001), and 22% more likely to screen for breast cancer (aPR = 1.22, CI = 1.02–1.46, p = 0.032), compared to those with primary level education and below. Respondents with a household income ≥S$10,000/month were 71% more likely to screen for breast cancer (aPR = 1.71, CI = 1.37–2.13, p < 0.001), as compared with <$2,000/month. Conclusions Ethnicity and socio-economic status were significantly associated with lower uptake of cancer screening tests in Singapore. To improve the screening uptake among disadvantaged groups, a multi-faceted approach is needed that addresses the barriers to screening such as the adequacy of subsidy schemes and ethnic differences.
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Affiliation(s)
| | - Linda Wei Lin Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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3
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Cheng C, Beauchamp A, Elsworth GR, Osborne RH. Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups. J Med Internet Res 2020; 22:e18476. [PMID: 32788144 PMCID: PMC7453328 DOI: 10.2196/18476] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. OBJECTIVE This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. METHODS A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. RESULTS A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. CONCLUSIONS The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia.,Deakin University, School of Health and Social Development, Faculty of Health, Burwood, Australia
| | - Alison Beauchamp
- Department of Rural Health, Monash University, Melbourne, Australia.,Department of Medicine - Western Health, The University of Melbourne, Melbourne, Australia.,Australian Institute for Musculoskeletal Science, Sunshine Hospital, St Albans, Australia
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
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Explaining Health Outcomes of Asian Immigrants: Does Ethnicity Matter? J Racial Ethn Health Disparities 2019; 7:446-457. [PMID: 31768963 DOI: 10.1007/s40615-019-00673-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/10/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
The present study intended to evaluate whether 4 discrete ethnic groups of Asian immigrants could, for empirical reasons, be assigned a set of unique operating factors explaining health outcomes of members. The set comprised several acculturation, social structure, lifestyle, and health-related factors. Our study asked if these factors uniformly explained health outcomes across the 4 groups. We pooled National Health Interview Survey (NHIS) data dating 1999-2015 and developed 2 outcomes: self-rated health and self-reported chronic illness (specifically, diagnosis of cardiovascular disease, prediabetes/diabetes, hypertension, cancer, or stroke). Since data for smaller Asian ethnic groups are not readily available, we confined our analyses to respondents of Chinese, Filipino, Asian Indian, and "other Asian" ethnicity. Descriptive statistics suggested that Asian Indian respondents were least likely to report having 1 of the 5 specified serious illnesses and self-rated their health higher than the other 3 respondent groups. Additionally, while some factors (e.g., body mass index, depression) proved related to the health outcomes across the 4 ethnic groups, we did observe for each group a unique pattern of factors associated with the outcomes. Our results confirmed, furthermore, a moderating role for ethnicity in associations between the outcomes and those operating factors in the set we evaluated. The study results should be of use in tailoring preventive and intervention programs to various ethnic groups of Asian immigrants; clearly, in promoting health, one approach will not fit all.
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Predicting Behavioral Intentions Related to Cervical Cancer Screening Using a Three-Level Model for the TPB and SCT in Nanjing, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193575. [PMID: 31554338 PMCID: PMC6801508 DOI: 10.3390/ijerph16193575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 11/16/2022]
Abstract
: Objective: Exploring how the theory of planned behavior (TPB), social capital theory (SCT), cervical cancer knowledge (CCK), and demographic variables predict behavioral intentions (BI) related to cervical cancer screening among Chinese women. METHODS Self-administered questionnaires were distributed to 496 women, followed by a path analysis. RESULTS The three-level model was acceptable, χ2(26, 470) = 26.93, p > 0.05. Subjectively overcoming difficulties, support from significant others, screening necessity, and the objective promotion factor promoted BI, with effect sizes of 0.424, 0.354, 0.199, and 0.124. SCT and CCK promoted BI through TPB, with effect sizes of 0.262 and 0.208. Monthly income, education, age, and childbearing condition affected BI through TPB, SCT, and CCK, with effect sizes of 0.269, 0.105, 0.065, and -0.029. CONCLUSION The three-level model systematically predicted behavioral intentions relating to cervical cancer screening.
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Rogers EA, Chanthanouvong S, Saengsudham C, Tran V, Anderson L, Zhang L, Lee HY. Factors Associated with Reported Colorectal Cancer Screening Among Lao-American Immigrants in Minnesota. J Immigr Minor Health 2019; 22:375-382. [PMID: 31098763 DOI: 10.1007/s10903-019-00899-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Colorectal Cancer (CRC) is common in Lao Americans, but screening is suboptimal. To investigate CRC screening rates of Lao Americans in Minnesota, and how predisposing characteristics, enabling resources, and perceived need are associated with screening. We conducted a convenience-sample cross-sectional survey of 50-75-year-old Lao Americans, using step-wise multivariate logistic regression to identify factors associated with ever being screened. Of the 118 survey participants, 45% ever received CRC screening. In univariate regression, some enabling resources (having a primary care provider, higher self-efficacy in pursuing screening) and perceived needs (knowledge of who should be screened, higher number of chronic illnesses) were associated with screening. In multivariate logistic regression, the odds of ever being screened was 12.4 times higher for those with a primary care provider than for those without (p = 0.045). The findings reinforce a need for developing culturally tailored interventions focused on Lao-American immigrants to promote CRC screening.
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Affiliation(s)
- Elizabeth A Rogers
- Department of Medicine, UMN Applied Clinical Research Program, University of Minnesota, 717 Delaware St. SE, Ste 166, Minneapolis, MN, 55414, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | | | | | - Vilamone Tran
- Lao Assistance Center of Minnesota, Minneapolis, MN, USA
| | - Layne Anderson
- College of Biological Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Lei Zhang
- Clinical and Translational Science Institute Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN, USA
| | - Hee Yun Lee
- School of Social Work, University of Minnesota, Minneapolis, MN, USA
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Chen Y, Xie C, Zhang Y, Li Y, Ehrhardt S, Thio CL, Nelson KE, Chen Y, Lin CS. Knowledge regarding hepatitis B mother-to-child transmission among healthcare workers in South China. J Viral Hepat 2018; 25:561-570. [PMID: 29194878 DOI: 10.1111/jvh.12839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/19/2017] [Indexed: 01/17/2023]
Abstract
To determine the knowledge regarding hepatitis B virus (HBV) mother-to-child transmission (MTCT) and its prevention and treatment among healthcare workers (HCWs) in Guangdong Province, China, an HBV endemic area. An HBV knowledge questionnaire was administered to 900 HCWs from the 3rd Affiliated Hospital of Sun Yat-Sen University and 2 rural hospitals in Guangdong Province. The 27 items in the questionnaire fell into 3 sections: HBV MTCT general knowledge, respondents' practices of preventing HBV MTCT and awareness of the resources of preventing HBV MTCT. The data collected were coded and analysed using SPSS software version 20. In total, 503 of 900 HCWs responded to the survey (response rate: 55.9%). Eighty-four individuals responded correctly to all of the knowledge questions: 58 were doctors, and 26 were nurses (P < .05). Doctors more often performed practices than nurses (t = 3.591, P < .01). Participants from the infectious disease department demonstrated a significantly higher proportion of correct answers and resource utilization than other specialties (χ2 = 14.052, 7.998, P < .01). In terms of the average knowledge score, t test or ANOVA showed that there were significant differences between the specialty groups (t = 3.110, P < .01), hospital level groups (t = 2.337, P < .05) and age groups (F = 3.020, P < .05). Respondents' initiative increased with hospital level and age (t = 2.993, 7.493, P < .01). A considerable percentage of HCWs has misconceptions about HBV MTCT. Healthcare workers, in particular nurses, those working in noninfectious disease departments or township hospitals and younger medical staff, lack systematic and comprehensive knowledge about HBV MTCT and are in urgent need of HBV-related training.
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Affiliation(s)
- Y Chen
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - C Xie
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Y Zhang
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Y Li
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - S Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C L Thio
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - K E Nelson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Y Chen
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - C-S Lin
- Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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8
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Gu C, Chan CWH, Chow KM, Yang S, Luo Y, Cheng H, Wang H. Understanding the cervical screening behaviour of Chinese women: The role of health care system and health professions. Appl Nurs Res 2018; 39:58-64. [PMID: 29422178 DOI: 10.1016/j.apnr.2017.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 06/24/2017] [Accepted: 09/23/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In China, cervical cancer cases are increasing, making an impact on the worldwide burden of cervical cancer. Despite the initiatives undertaken by the Chinese government, the current coverage of cervical screening in China remains suboptimal. There is an urgent need to identify the facilitators and barriers associated with the uptake of cervical cancer screening among the Chinese population. PURPOSE The study aimed to explore the experiences and perceptions of cervical cancer screening of mainland Chinese women in relation to their screening behaviour, particularly in the aspects of health care system and health profession roles. METHODS A qualitative research was conducted using semi-structured interviews. A total of 27 Chinese women aged 25 to 50 (both screened and non-screened women) completed the interviews. The analysis of the interview data was undertaken inductively using latent content analysis. DISCUSSION AND CONCLUSION Results showed that organised health examination programmes provide a good basis for integrating cervical screening into broader checks on the health of women, and utilising different networks of social support facilitate the utilisation of the screening service. However, education on cervical cancer and screening must be made more generally available. More importantly, there is a need for a more participatory and empowering exchange in the encounter between health professions and these women. Appropriate training program is strongly recommended for health professions about communicate skills with patients. Future work should focus on identifying strategies to overcome the barriers to cervical screening related to health care system and medical professions among this population.
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Affiliation(s)
- Can Gu
- Xiangya School of Nursing, Central South University, Changsha, PR China.
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong.
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong.
| | - Shengbo Yang
- Third Xiangya Hospital, Central South University, Changsha, PR China.
| | - Yang Luo
- Xiangya School of Nursing, Central South University, Changsha, PR China.
| | - Huilin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, PR China.
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Lee H, Ghebre R, Le C, Jang YJ, Sharratt M, Yee D. Mobile Phone Multilevel and Multimedia Messaging Intervention for Breast Cancer Screening: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2017; 5:e154. [PMID: 29113961 PMCID: PMC5698632 DOI: 10.2196/mhealth.7091] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 07/08/2017] [Accepted: 07/29/2017] [Indexed: 12/20/2022] Open
Abstract
Background Despite the increasing breast cancer incidence and mortality rates, Korean American immigrant women have one of the lowest rates of breast cancer screening across racial groups in the United States. Mobile health (mHealth), defined as the delivery of health care information or services through mobile communication devices, has been utilized to successfully improve a variety of health outcomes. Objective This study adapted the principles of mHealth to advance breast cancer prevention efforts among Korean American immigrant women, an underserved community. Methods Using a randomized controlled trial design, 120 Korean American women aged 40 to 77 years were recruited and randomly assigned to either the mMammogram intervention group (n=60) to receive culturally and personally tailored multilevel and multimedia messages through a mobile phone app along with health navigator services or the usual care control group (n=60) to receive a printed brochure. Outcome measures included knowledge, attitudes, and beliefs about breast cancer screening, readiness for mammography, and mammogram receipt. The feasibility and acceptability of the mMammogram intervention was also assessed. Results The intervention group showed significantly greater change on scores of knowledge of breast cancer and screening guidelines (P=.01). The intervention group also showed significantly greater readiness for mammography use after the intervention compared with the control group. A significantly higher proportion of women who received the mMammogram intervention (75%, 45/60) completed mammograms by the 6-month follow-up compared with the control group (30%, 18/60; P<.001). In addition, the intervention group rated satisfaction with the intervention (P=.003), effectiveness of the intervention (P<.001), and increase of knowledge on breast cancer and screenings (P=.001) significantly higher than the control group. Conclusions A mobile phone app–based intervention combined with health navigator service was a feasible, acceptable, and effective intervention mechanism to promote breast cancer screening in Korean American immigrant women. A flexible, easily tailored approach that relies on recent technological advancements can reach underserved and hard-to-recruit populations that bear disproportionate cancer burdens. Trial Registration Clinicaltrials.gov NCT01972048; https://clinicaltrials.gov/show/NCT01972048 (Archived by WebCite at https://clinicaltrials.gov/archive/NCT01972048/2013_10_29)
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Affiliation(s)
- Hee Lee
- School of Social Work, College of Education and Human Development, University of Minnesota, Twin Cities, St Paul, MN, United States
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology and Women's Health, School of Medicine, University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | - Chap Le
- Division of Biostatistics, School of Public Health, University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | - Yoo Jeong Jang
- Department of Educational Psychology, College of Education and Human Development, University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | - Monica Sharratt
- School of Social Work, College of Education and Human Development, University of Minnesota, Twin Cities, St Paul, MN, United States
| | - Douglas Yee
- Division of Hematology, Oncology and Transplantation, School of Medicine and Pharmacology, University of Minnesota, Twin Cities, Minneapolis, MN, United States
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Uysal Toraman A, Yildirim N. Knowledge About Cervical Cancer Risk Factors and Practices of Pap Testing Among Turkish Immigrant Women in the United States. J Immigr Minor Health 2017; 20:1222-1229. [PMID: 28929252 DOI: 10.1007/s10903-017-0653-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to examine knowledge about cervical cancer risk factors and practices of Pap testing among female Turkish immigrants in the state of Florida in the United States of America (USA). This descriptive study was conducted between April and September 2012. The study sampling was consist of 156 Turkish women living in the state of Florida. A questionnaire-based survey was conducted among the population of Turkish immigrant women. On the survey form comprised of a total of 37 questions and three sections there are questions pertaining to the socio-demographic characteristics of the individuals, their knowledge on the cervical cancer risk factors and their approach to getting Pap smear tests. Statistical Package for Social Sciences (version 16.0) was used to compute frequency and descriptive statistics related to demographic data. The average age of the women is 35.67 ± 10.0. More than half of women (66%) women reported cervical cancer screening at least one. Over two-thirds knew that having abnormal vaginal bleeding (85.8%) and vaginal infections (78.2%), having sexual activity with a man who has had multiple sexual partners (61.5%), and having multiple sexual partners (61.5%) increase the risk of cervical cancer. The result of the multivariate regression analysis have determined that the age of immigrant women (OR 11.3, 95 % CI 5.1-25.2, p:0.000) and the number of children ( OR 3.4, 95 % CI 1.7-6.9, p:0.000) are factors that impact pap smear testing behavior. Our study findings confirm low levels of Pap testing and show important knowledge deficits about cervical cancer risk factors and the importance of Pap testing among Turkish immigrant women. It is recommended that the immigrant women be educated about cervical cancer by means of organizing conferences in their own language and preparing informative materials.
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Affiliation(s)
- Aynur Uysal Toraman
- Department of Public Health Nursing, Faculty of Nursing, Ege University, 35100, Bornova, Izmir, Turkey.
| | - Nilufer Yildirim
- Department of Public Health Nursing, Faculty of Nursing, Ege University, 35100, Bornova, Izmir, Turkey
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Xu K, Watanabe-Galloway S, Rochling FA, Zhang J, Farazi PA, Peng H, Wang H, Luo J. Practice, Knowledge, and Barriers for Screening of Hepatocellular Carcinoma Among High-Risk Chinese Patients. Ann Glob Health 2017; 83:281-292. [PMID: 28619403 DOI: 10.1016/j.aogh.2017.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is among the leading causes of cancer deaths in China. Considering its poor prognosis when diagnosed late, Chinese guidelines recommend biannual screening for HCC with abdominal ultrasound and serum α-fetoprotein (AFP) test for high-risk populations. OBJECTIVES To investigate the practice, knowledge, and self-perceived barriers for HCC screening among high-risk hospital patients in China. METHODS An interview-based questionnaire was conducted among Chinese patients with chronic hepatitis B and/or chronic hepatitis C infection from outpatient clinics at 2 tertiary medical institutions in Shanghai and Wuhan, China. FINDINGS Among 352 participating patients, 50.0% had routine screening, 23.3% had irregular screening, and 26.7% had incomplete or no screening. Significant determinants for screening included higher level of education, underlying liver cirrhosis, a family history of HCC, and better knowledge concerning viral hepatitis, HCC, and HCC screening guidelines. Moreover, factors associated with better knowledge were younger age, female gender, urban residency, education level of college or above, annual household income of greater than 150,000 RMB, and longer duration of hepatitis infection. The 3 most common barriers reported for not receiving screening were not aware that screening for HCC exists (41.5%), no symptoms or discomfort (38.3%), and lack of recommendation from physicians (31.9%). CONLUSIONS Health care professionals and community leaders should actively inform patients regarding the benefits of HCC screening through design of educational programs. Such interventions are expected to increase knowledge about HCC and HCC screening, as well as improve screening adherence and earlier diagnosis.
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Affiliation(s)
- Kerui Xu
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE.
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Fedja A Rochling
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Jianjun Zhang
- Department of Hepatology, Hubei Third People's Hospital, Wuhan, Hubei, China
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Hongyan Peng
- Department of Hepatology, Hubei Third People's Hospital, Wuhan, Hubei, China
| | - Hongmei Wang
- Department of Health Services Research & Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Jiangtao Luo
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE
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Li S, Sim SC, Lee L, Pollack HJ, Wyatt LC, Trinh-Shevrin C, Pong P, Kwon SC. Hepatitis B Screening & Vaccination Behaviors in a Community-based Sample of Chinese & Korean Americans in New York City. Am J Health Behav 2017; 41:204-214. [PMID: 28452698 PMCID: PMC5472990 DOI: 10.5993/ajhb.41.2.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES As Asian Americans are dis- proportionately affected by the hepatitis B virus (HBV), we explored predictors of HBV screening and vaccination among Chinese and Korean Americans. METHODS We used cross-sectional data from a com- munity-based sample of Chinese Americans (N = 502) and Korean Americans (N = 487) residing in the metropolitan New York City area during 2008-2009. Logistic regression models were stratified by Asian-American subgroup and sex to predict HBV screening (for the entire sam- ple) and HBV vaccination (among those not HBV positive). RESULTS Overall, screening rates were high (71.3% among Chinese and 70.1% among Koreans). The majority of respondents were aware of HBV; however, knowledge about HBV transmission was low. In logistic regression, a physician recommendation was consistently associated with HBV screening and vaccination outcomes across all groups; having heard of HBV was significantly associated with screening and vaccination among Chinese males and screening among Korean males and females. Screening and vaccination barriers were reported among all groups, and included lack of knowledge and feeling well/having no health issues. CONCLUSIONS Targeted efforts in these at-risk communities are necessary to improve HBV knowledge, address misinformation about HBV, and eliminate provider-, patient-, and resource-related barriers to HBV screening and vaccination.
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Affiliation(s)
- Shijian Li
- SUNY Old Westbury, Department of Public Health, Old Westbury, NY, USA
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Lee HY, Rhee TG, Kim NK. Cancer literacy as a mediator for cancer screening behaviour in Korean adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:e34-e42. [PMID: 25975449 DOI: 10.1111/hsc.12243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 06/04/2023]
Abstract
This study investigates the cancer literacy level in Korean adults and examines whether cancer literacy plays a mediating role in the relationship between population characteristics and cancer screening behaviours. We collected data from 585 community-dwelling adults in Korea using self-administered surveys and face-to-face interviews from October to December in 2009. Guided by Andersen's behavioural model, we used a structural equation model to estimate the effect of cancer literacy as a mediator and found that cancer literacy mediated cancer screening behaviour. In the individual path analysis models, cancer literacy played a significant mediating role for the use of eastern medicine, fatalism, health status and the number of chronic diseases. When controlling for other relevant covariates, we found that in the optimal path model, cancer literacy played a mediating role in the relationship between the use of eastern medicine and self-rated health status as well as cancer screening behaviour. Thus, developing community-based cancer education programmes and training clinical practitioners in eastern medicine clinics about the importance of informing their patients about regular cancer screening may be an option to boost cancer literacy and screening behaviour in Korea.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, College of Education and Human Development, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
| | - Taeho Greg Rhee
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
| | - Nam Keol Kim
- Department of Educational Psychology, College of Education and Human Development, University of Minnesota, Twin Cities, Minneapolis, Minnesota, USA
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Tung WC, Granner M, Lu M, Qiu X. Predictors of cervical cancer screening for Chinese American women. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/27/2022]
Affiliation(s)
- W.-C. Tung
- Orvis School of Nursing; University of Nevada; Reno NV USA
| | - M. Granner
- School of Community Health Sciences; University of Nevada; Reno NV USA
| | - M. Lu
- School of Community Health Sciences; University of Nevada; Reno NV USA
| | - X. Qiu
- University of California; Davis CA USA
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15
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Hweissa N, Lim J, Su T. Health-care providers' perceptions, attitudes towards and recommendation practice of cervical cancer screening. Eur J Cancer Care (Engl) 2016; 25:864-70. [DOI: 10.1111/ecc.12537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2016] [Indexed: 11/28/2022]
Affiliation(s)
- N.Ab. Hweissa
- Department of Social and Preventive Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - J.N.W. Lim
- Department of Allied and Public Health; Faculty of Medical Science; Anglia Ruskin University; Cambridge UK
| | - T.T. Su
- Centre for Population Health (CePH); Department of Social and Preventive Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
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16
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Colorectal Cancer Screening among Chinese, Cambodian, and Vietnamese Immigrants in Chicago. J Racial Ethn Health Disparities 2015; 2:473-80. [PMID: 26863553 DOI: 10.1007/s40615-015-0095-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/13/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
Asian Americans are now the most rapidly growing minority group in the USA. Over 60 % of Asian Americans in the USA are immigrants. Cancer has been the leading cause of death among Asian Americans since 1980. Understanding the barriers to screening is essential to reduce the unnecessary burden of cancer. Little is known about colorectal cancer screening behavior among foreign-born Asian Americans and how socio-demographic factors may influence the behavior. Even less is known about disaggregated Asian subgroups. Using data from the Chicago Asian Community Survey, a local health assessment survey of three Asian subgroups in Chicago, Chinese, Cambodian, and Vietnamese, this study found that the colorectal cancer screening rate were much lower among foreign-born Asian Americans in Chicago (30 %) than the national rate for the general population (59 %). Furthermore, we studied disaggregated data to determine colorectal cancer screening differences between communities. Findings from this study provide a critical evidence base to inform future research and intervention designs.
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Sentell TL, Tsoh JY, Davis T, Davis J, Braun KL. Low health literacy and cancer screening among Chinese Americans in California: a cross-sectional analysis. BMJ Open 2015; 5:e006104. [PMID: 25564140 PMCID: PMC4289731 DOI: 10.1136/bmjopen-2014-006104] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Cancer is the leading cause of death among Asian Americans. Chinese Americans comprise the largest Asian American ethnic group. Low health literacy (LHL) is associated with lower cancer screening rates, but this association has not been studied in Chinese Americans. We examined the relationship between LHL and meeting US Preventive Service Task Force (USPSTF) guidelines for cervical, colorectal and breast cancer screening among Chinese Americans. DESIGN Observational study of Chinese respondents in the 2007 California Health Interview Survey, a population-based survey. Interview languages included English, Cantonese and Mandarin. SETTING California, USA PARTICIPANTS: Chinese respondents in age/gender groupings appropriate for USPSTF cancer screening guidelines (cervical: women ages 21-65, n=632; colorectal: men or women ages 50-75, n=488; and breast: women ages 50-74, n=326). OUTCOMES Relationships were tested using multivariable logistic regression models controlling for healthcare access and demographic factors, including limited English proficiency (LEP). The combined effects of having both LHL and LEP were specifically examined. LHL was measured by 2-items on perceived ease-of-use of written medical materials. All study variables were self-reported. RESULTS Cancer screening percentages among Chinese Americans were 77.8% for cervical, 50.9% for colorectal (47.9% for women and 54.2% for men), and 85.5% for breast. LHL was associated with lower odds of meeting breast cancer screening guidelines (OR 0.41; 95% CI 0.20 to 0.82). Respondents with both LHL and LEP were significantly less likely to have up-to-date colorectal (OR 0.49; 95% CI 0.25 to 0.97) and breast cancer screening (OR 0.21; 95% CI 0.08 to 0.54) than those with neither health communication barrier. In all multivariable models, having seen a physician in the past year was a significant predictor of an up-to-date screening. CONCLUSIONS In Chinese Americans, LHL and LEP were negatively associated with up-to-date breast and colorectal cancer screening, independent of a recent physician visit. Efforts to promote cancer screening among Chinese Americans should consider and address LHL, LEP and physician access barriers.
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Affiliation(s)
- Tetine L Sentell
- Office of Public Health Studies, University of Hawaii, Honolulu, Hawaii, USA
| | - Janice Y Tsoh
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Terry Davis
- Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - James Davis
- Biostatistics Core, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Kathryn L Braun
- Office of Public Health Studies, University of Hawaii and ‘Imi Hale Native Hawaiian Cancer Network,Honolulu,Hawaii, USA
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18
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Lee HY, Koopmeiners JS, Rhee TG, Raveis VH, Ahluwalia JS. Mobile phone text messaging intervention for cervical cancer screening: changes in knowledge and behavior pre-post intervention. J Med Internet Res 2014; 16:e196. [PMID: 25164545 PMCID: PMC4180333 DOI: 10.2196/jmir.3576] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/28/2014] [Indexed: 11/14/2022] Open
Abstract
Background Cervical cancer poses a significant threat to Korean American women, who are reported to have one of the highest cervical cancer mortality rates in the United States. Studies consistently report that Korean American women have the lowest Pap test screening rates across US ethnic groups. Objective In response to the need to enhance cervical cancer screening in this vulnerable population, we developed and tested a 7-day mobile phone text message-based cervical cancer Screening (mScreening) intervention designed to promote the receipt of Pap tests by young Korean American women. Methods We developed and assessed the acceptability and feasibility of a 1-week mScreening intervention to increase knowledge of cervical cancer screening, intent to receive screening, and the receipt of a Pap test. Fogg’s Behavior Model was the conceptual framework that guided the development of the mScreening intervention. A series of focus groups were conducted to inform the development of the intervention. The messages were individually tailored for each participant and delivered to them for a 7-day period at each participant’s preferred time. A quasi-experimental research design of 30 Korean American women aged 21 to 29 years was utilized with baseline, post (1 week after the completion of mScreening), and follow-up (3 months after the completion of mScreening) testing. Results Findings revealed a significant increase in participants’ knowledge of cervical cancer (P<.001) and guidelines for cervical cancer screening (P=.006). A total of 23% (7/30) (95% CI 9.9-42.3) of the mScreening participants received a Pap test; 83% (25/30) of the participants expressed satisfaction with the intervention and 97% (29/30) reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention. Conclusions This study provides evidence of the effectiveness and feasibility of the mScreening intervention. Mobile technology is a promising tool to increase both knowledge and receipt of cervical cancer screening. Given the widespread usage of mobile phones among young adults, a mobile phone-based health intervention could be a low-cost and effective method of reaching populations with low cervical cancer screening rates, using individually tailored messages that cover broad content areas and overcome restrictions to place and time of delivery.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work and University of Minnesota Masonic Cancer Center, College of Education and Human Development, University of Minnesota, Twin Cities, St Paul, MN, United States.
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Goss PE, Strasser-Weippl K, Lee-Bychkovsky BL, Fan L, Li J, Chavarri-Guerra Y, Liedke PER, Pramesh CS, Badovinac-Crnjevic T, Sheikine Y, Chen Z, Qiao YL, Shao Z, Wu YL, Fan D, Chow LWC, Wang J, Zhang Q, Yu S, Shen G, He J, Purushotham A, Sullivan R, Badwe R, Banavali SD, Nair R, Kumar L, Parikh P, Subramanian S, Chaturvedi P, Iyer S, Shastri SS, Digumarti R, Soto-Perez-de-Celis E, Adilbay D, Semiglazov V, Orlov S, Kaidarova D, Tsimafeyeu I, Tatishchev S, Danishevskiy KD, Hurlbert M, Vail C, St Louis J, Chan A. Challenges to effective cancer control in China, India, and Russia. Lancet Oncol 2014; 15:489-538. [PMID: 24731404 DOI: 10.1016/s1470-2045(14)70029-4] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunately, improvements in socioeconomic conditions are usually associated with increased cancer incidence. In this Commission, we focus on China, India, and Russia, which share rapidly rising cancer incidence and have cancer mortality rates that are nearly twice as high as in the UK or the USA, vast geographies, growing economies, ageing populations, increasingly westernised lifestyles, relatively disenfranchised subpopulations, serious contamination of the environment, and uncontrolled cancer-causing communicable infections. We describe the overall state of health and cancer control in each country and additional specific issues for consideration: for China, access to care, contamination of the environment, and cancer fatalism and traditional medicine; for India, affordability of care, provision of adequate health personnel, and sociocultural barriers to cancer control; and for Russia, monitoring of the burden of cancer, societal attitudes towards cancer prevention, effects of inequitable treatment and access to medicine, and a need for improved international engagement.
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Affiliation(s)
- Paul E Goss
- Harvard Medical School, Boston, MA, USA; Avon Breast Cancer Center of Excellence, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Brittany L Lee-Bychkovsky
- Harvard Medical School, Boston, MA, USA; Department of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA; International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Lei Fan
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Breast Surgery Department, Shanghai, China
| | - Junjie Li
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Breast Surgery Department, Shanghai, China
| | - Yanin Chavarri-Guerra
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Pedro E R Liedke
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Oncologia Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
| | - C S Pramesh
- Department of Surgical Oncology/Clinical Research, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Tanja Badovinac-Crnjevic
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; University Hospital Zagreb, Department of Oncology, Zagreb, Croatia
| | - Yuri Sheikine
- Harvard Medical School, Boston, MA, USA; Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Zhu Chen
- State Key Lab of Medical Genomics, Shanghai Institute of Hematology, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - You-lin Qiao
- Department of Cancer Epidemiology, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiming Shao
- Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Breast Surgery Department, Shanghai, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Daiming Fan
- Fourth Military Medical University, State Key Laboratory of Cancer Biology & Xijing Hospital of Digestive Diseases, Xi'an, Shaanxi Province, China
| | - Louis W C Chow
- Organisation for Oncology and Translational Research, Hong Kong, China; UNIMED Medical Institute, Comprehensive Centre for Breast Diseases, Hong Kong, China
| | - Jun Wang
- Institute of Public Health Economics and Management, Central University of Finance and Economics, Beijing, China
| | - Qiong Zhang
- Department of Economics, School of Economics, Central University of Finance and Economics, Beijing, China
| | - Shiying Yu
- Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gordon Shen
- University of California, Berkeley, CA, USA; Cancer Institute & Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Arnie Purushotham
- King's Health Partners Cancer Centre, King's College London, Guy's Hospital, London, UK
| | - Richard Sullivan
- King's Health Partners Cancer Centre, King's College London, Guy's Hospital, London, UK; Institute of Cancer Policy, King's College London, Guy's Hospital, London, UK
| | - Rajendra Badwe
- Administration, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Shripad D Banavali
- Department of Medical and Pediatric Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Reena Nair
- Department of Clinical Hematology, Tata Medical Center, Kolkata, West Bengal, India
| | - Lalit Kumar
- Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Purvish Parikh
- Clinical Research and Education, BSES GH Municipal Hospital, Mumbai, India
| | | | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Subramania Iyer
- Amrita Institute of Medical Sciences & Research Centre, Head & Neck/Plastic & Reconstructive Surgery, Kochi, Kerala, India
| | | | | | - Enrique Soto-Perez-de-Celis
- Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Dauren Adilbay
- Astana Oncology Center, Head and Neck Oncology, Astana, Kazakhstan
| | - Vladimir Semiglazov
- Reproductive System Tumors Department, NN Petrov Research Institute of Oncology, St Petersburg, Russia
| | - Sergey Orlov
- Department of Thoracic Oncology, Saint Petersburg Medical University, Saint Petersburg, Russia
| | | | - Ilya Tsimafeyeu
- Russian Society of Clinical Oncology, Kidney Cancer Research Bureau, Moscow, Russia
| | - Sergei Tatishchev
- Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | | | - Marc Hurlbert
- Avon Foundation Breast Cancer Crusade, New York, NY, USA
| | - Caroline Vail
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica St Louis
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Arlene Chan
- Breast Cancer Research Centre-Western Australia and Curtin University, Perth, WA, Australia
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Carney PA, Lin FL, Mongoue-Tchokote S, Mori M, Leung H, Lau C, Le TD, Lieberman DA. Improving colorectal cancer screening in Asian Americans: Results of a randomized intervention study. Cancer 2014; 120:1702-12. [PMID: 24595714 PMCID: PMC4041689 DOI: 10.1002/cncr.28640] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/20/2013] [Accepted: 12/10/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND 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. METHODS Baseline data were collected on participants' demographic characteristics, knowledge, attitudes, beliefs about cancer, its risk factors, and intention to keep up to date on cancer screening in the future. Fifteen intervention sessions were held between April and June of 2011. Follow-up surveys were administered in the postintervention period to both intervention and control participants. Those randomized to the control group received educational pamphlets in their native language. RESULTS The intervention had the greatest influence on the Chinese subgroup, which had improved scores relative to the control group for perceived behavior control and intentions (preintervention vs postintervention change: control group, -0.16; intervention group, 0.11; P = .004), behavioral beliefs on cancer screening (preintervention vs postintervention change: control group, -0.06; intervention group, 0.24; P = .0001), and attitudes toward behavior (preintervention vs postintervention change: control group, -0.24; intervention group, 0.35; P ≤ .0001). The intervention had no effect on behavioral beliefs about cancer, control beliefs, or perceived behavioral control (reliance on family). Although the intention to stay up to date for cancer screening increased in 2 study groups (Chinese and Vietnamese), these increases were not significant. CONCLUSIONS An educational program delivered by culturally specific community health educators using culturally appropriate language influences some knowledge, attitude, and behavioral beliefs but not others.
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Affiliation(s)
- Patricia A. Carney
- Professor of Family Medicine and of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR
| | - Frances Lee Lin
- Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR
| | - Solange Mongoue-Tchokote
- Knight Cancer Institute Biostatistics Shared Resource, Oregon Health & Science University, Portland, OR
| | - Motomi Mori
- Knight Cancer Institute Biostatistics Shared Resource, Oregon Health & Science University, Portland, OR
- Professor of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR
| | - Holden Leung
- Asian Health and Service Center, Oregon Health & Science University, Portland, OR
| | - Christine Lau
- Asian Health and Service Center, Oregon Health & Science University, Portland, OR
| | - TD Le
- Fellow, Division of Gastroenterology, Oregon Health & Science University, Portland, OR
| | - David A. Lieberman
- Professor of Medicine, Division of Gastroenterology, Oregon Health & Science University, Portland, OR
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Teng FF, Mitchell SM, Sekikubo M, Biryabarema C, Byamugisha JK, Steinberg M, Money DM, Ogilvie GS. Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda. BMJ Open 2014; 4:e004783. [PMID: 24727360 PMCID: PMC3987737 DOI: 10.1136/bmjopen-2014-004783] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 03/12/2014] [Accepted: 03/18/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To define embarrassment and develop an understanding of the role of embarrassment in relation to cervical cancer screening and self-collected human papillomavirus (HPV) DNA testing in Uganda. DESIGN Cross-sectional, qualitative study using semistructured one-to-one interviews and focus groups. PARTICIPANTS 6 key-informant health workers and 16 local women, purposively sampled. Key informant inclusion criteria: Ugandan members of the project team. Focus group inclusion criteria: woman age 30-69 years, Luganda or Swahili speaking, living or working in the target Ugandan community. EXCLUSION CRITERIA unwillingness to sign informed consent. SETTING Primary and tertiary low-resource setting in Kampala, Uganda. RESULTS In Luganda, embarrassment relating to cervical cancer is described in two forms. 'Community embarrassment' describes discomfort based on how a person may be perceived by others. 'Personal embarrassment' relates to shyness or discomfort with her own genitalia. Community embarrassment was described in themes relating to place of study recruitment, amount of privacy in dwellings, personal relationship with health workers, handling of the vaginal swab and misunderstanding of HPV self-collection as HIV testing. Themes of personal embarrassment related to lack of knowledge, age and novelty of the self-collection swab. Overall, embarrassment was a barrier to screening at the outset and diminished over time through education and knowledge. Fatalism regarding cervical cancer diagnosis, worry about results and stigma associated with a cervical cancer diagnosis were other psychosocial barriers described. Overcoming psychosocial barriers to screening can include peer-to-peer education, drama and media campaigns. CONCLUSIONS Embarrassment and other psychosocial barriers may play a large role at the onset of a screening programme, but over time as education and knowledge increase, and the social norms around screening evolve, its role diminishes. The role of peer-to-peer education and community authorities on healthcare cannot be overlooked and can have a major impact in overcoming psychosocial and social barriers to screening.
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Affiliation(s)
- Flora F Teng
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheona M Mitchell
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Musa Sekikubo
- Department of Obstetrics and Gynecology, Makerere University/Mulago, National Referral Hospital, Kampala, Uganda
| | - Christine Biryabarema
- Department of Obstetrics and Gynecology, Makerere University/Mulago, National Referral Hospital, Kampala, Uganda
| | - Josaphat K Byamugisha
- Department of Obstetrics and Gynecology, Makerere University/Mulago, National Referral Hospital, Kampala, Uganda
| | - Malcolm Steinberg
- British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Deborah M Money
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia's Women's Hospital, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Gina S Ogilvie
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Center for Disease Control, Vancouver, British Columbia, Canada
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Chan CWH, Yang SB, Gu C, Wang X, Tao L. Perception of cervical cancer risk and screening behavior: a literature review. Int J Nurs Knowl 2014; 26:2-18. [PMID: 24673974 DOI: 10.1111/2047-3095.12028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE This review examines women's risk perception of cervical cancer, the factors influencing this perception, and the relationship between risk perception of cervical cancer and screening behavior. METHODS Integrative literature review method was used. FINDINGS The search procedure resulted in the identification of 42 studies, including 1 literature review and 41 primary studies. Trends and discrepancies in the literature are presented with interpretations and recommendations. CONCLUSION Existing theories of health behavior appear inadequate for understanding screening behavior, and further studies are recommended to enrich the knowledge base of nursing diagnoses in knowledge deficit and health-seeking behavior. IMPLICATIONS FOR NURSING PRACTICE Efforts would be made to improve nurses' understanding of risk perception of cervical cancer within specific cultural context.
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Affiliation(s)
- Carmen W H Chan
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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Lee-Lin F, Menon U, Leo MC, Pedhiwala N. Feasibility of a targeted breast health education intervention for Chinese American immigrant women. Oncol Nurs Forum 2014; 40:361-72. [PMID: 23803269 DOI: 10.1188/13.onf.361-372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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 woman's 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.
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Affiliation(s)
- Frances Lee-Lin
- School of Nursing, Oregon Health and Science University, Portland, USA.
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Jacobs EA, Rathouz PJ, Karavolos K, Everson-Rose SA, Janssen I, Kravitz HM, Lewis TT, Powell LH. Perceived discrimination is associated with reduced breast and cervical cancer screening: the Study of Women's Health Across the Nation (SWAN). J Womens Health (Larchmt) 2013; 23:138-45. [PMID: 24261647 DOI: 10.1089/jwh.2013.4328] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Racial disparities in breast and cervical cancer screening have been documented in African American, Hispanic, and Asian populations. Perceived discrimination may contribute to this disparity. The aim of this study was to understand the relationship between perceived everyday racial/ethnic and other discrimination and receipt of breast and cervical cancer screening in a multiethnic population of women. METHODS We analyzed data from 3,258 women participating in the Study of Women's Health Across the Nation (SWAN), a multiethnic/racial, longitudinal cohort study of the natural history of the menopausal transition conducted at seven U.S. sites. Participants completed a validated measure of perceived discrimination and reasons for believing that they were treated differently, along with Pap smears, clinical breast exams (CBE), and mammography at each follow-up period. We used multiple logistic regression for the binary outcomes of having a Pap smear, CBE, or mammogram in each of the two follow-up years, using self-reported "race discrimination" and "other discrimination" at baseline as the main predictors. RESULTS African American women reported the highest percentage of racial discrimination (35%), followed by Chinese (20%), Hispanic (12%), Japanese (11%), and non-Hispanic white women (3%). Non-Hispanic white women reported the highest percentage of "other" discrimination (40%), followed by Chinese (33%), African American (24%), Japanese (23%), and Hispanic women (16%). Perceived racial discrimination was not associated with reduced receipt of preventive screening, except in one fully adjusted model. Reported discrimination owing to "other" reasons, such as age or gender, was associated with reduced receipt of Pap smear (odds ratio [OR] 0.85; 95% confidence interval [CI] 0.74-0.99), CBE (OR 0.78; 95% CI 0.67-0.91), and mammography (OR 0.80; 95% CI 0.69-0.92) regardless of patient race. CONCLUSIONS Perceived discrimination is an important issue across racial/ethnic groups and is negatively associated with receipt of breast and cervical cancer screening. This is an important issue that needs to be further explored and addressed in efforts to improve the delivery of healthcare to all groups.
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Affiliation(s)
- Elizabeth A Jacobs
- 1 Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
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Lee HY, Vang S. Cultural beliefs and clinical breast examination in Hmong American women: the crucial role of modesty. J Immigr Minor Health 2013; 17:746-55. [PMID: 23943016 DOI: 10.1007/s10903-013-9890-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite grave cancer disparities in Hmong American women, investigation of the group's breast cancer screening behavior is sparse. This study examined how cultural factors are associated with breast cancer screening utilization, specifically clinical breast exam (CBE), in this population. One hundred and sixty-four Hmong American women between ages 18 and 67 were recruited from a large Midwestern metropolitan area with a median age of 28.0 years. Logistic regression was used to assess the association of cultural variables with receipt of CBE. Roughly 73% of Hmong American women reported ever having had a CBE. Logistic regression revealed that endorsing more modest views was the greatest barrier to ever having had a CBE. Age and language preference were also found to be significant predictors of past CBE use. Cultural factors should be considered in developing interventions aimed at promoting breast cancer screening in this population. In particular, Hmong American women who have less English proficiency and are relatively younger should be targeted in breast cancer screening efforts.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, Minneapolis-Saint Paul, MN, 55108, USA,
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Gu C, Chan CW, He GP, Choi K, Yang SB. Chinese women's motivation to receive future screening: The role of social-demographic factors, knowledge and risk perception of cervical cancer. Eur J Oncol Nurs 2013; 17:154-61. [DOI: 10.1016/j.ejon.2012.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 11/27/2022]
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Hsu L, Bowlus CL, Stewart SL, Nguyen TT, Dang J, Chan B, Chen MS. Electronic messages increase hepatitis B screening in at-risk Asian American patients: a randomized, controlled trial. Dig Dis Sci 2013; 58:807-14. [PMID: 23073671 PMCID: PMC3578075 DOI: 10.1007/s10620-012-2396-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 08/28/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatitis B (HBV) induced hepatocellular carcinoma is the greatest cancer health disparity affecting Asian Americans, but the prevalence of screening to detect HBV is suboptimal. AIMS Our aims were to determine the effectiveness of electronic health record (EHR) prompts to increase ordering of HBV tests among primary care providers (PCPs) within an academic health system. METHODS We conducted a randomized, controlled trial between April and June 2011 among 76 PCPs caring for 175 outpatient adults with Chinese or Vietnamese surnames, with appointments with providers and no history of HBV testing. Providers were randomized to either receive an EHR prompt for HBV testing prior to patients' appointments or usual care. Primary outcomes were the proportion of patients (1) whose physician ordered a HBsAg test and (2) who completed testing. Secondary outcomes were (A) test results and (B) whether the physicians followed-up on the results. RESULTS HBsAg tests were ordered for 36/88 (40.9 %) of the intervention patients and 1/87 (1.1 %) of the control patients [χ (2) (df = 1) = 41.48, p < 0.001]. Thirty intervention patients (34.1 %) and no control patients completed the HBsAg test [χ (2) (df = 1) = 35.80, p < 0.001]. Four (13.3 %) of the completed tests were HBsAg-positive, 14 (46.7 %) were immune, and 12 (40 %) were unprotected from HBV. Two HBsAg-positive patients were referred to specialists, and 3 unprotected patients were vaccinated for HBV. CONCLUSIONS EHR-based provider prompts significantly increased HBV testing in Chinese and Vietnamese patients when compared to "usual care." EHR prompts are a promising intervention that could significantly increase screening for HBV.
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Affiliation(s)
- Leeyen Hsu
- School of Medicine, University of California, Davis, Sacramento, CA 95817, USA.
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Electronic messages increase hepatitis B screening in at-risk Asian American patients: a randomized, controlled trial. Dig Dis Sci 2013. [PMID: 23073671 DOI: 10.1007/s10620-012-2396-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis B (HBV) induced hepatocellular carcinoma is the greatest cancer health disparity affecting Asian Americans, but the prevalence of screening to detect HBV is suboptimal. AIMS Our aims were to determine the effectiveness of electronic health record (EHR) prompts to increase ordering of HBV tests among primary care providers (PCPs) within an academic health system. METHODS We conducted a randomized, controlled trial between April and June 2011 among 76 PCPs caring for 175 outpatient adults with Chinese or Vietnamese surnames, with appointments with providers and no history of HBV testing. Providers were randomized to either receive an EHR prompt for HBV testing prior to patients' appointments or usual care. Primary outcomes were the proportion of patients (1) whose physician ordered a HBsAg test and (2) who completed testing. Secondary outcomes were (A) test results and (B) whether the physicians followed-up on the results. RESULTS HBsAg tests were ordered for 36/88 (40.9 %) of the intervention patients and 1/87 (1.1 %) of the control patients [χ (2) (df = 1) = 41.48, p < 0.001]. Thirty intervention patients (34.1 %) and no control patients completed the HBsAg test [χ (2) (df = 1) = 35.80, p < 0.001]. Four (13.3 %) of the completed tests were HBsAg-positive, 14 (46.7 %) were immune, and 12 (40 %) were unprotected from HBV. Two HBsAg-positive patients were referred to specialists, and 3 unprotected patients were vaccinated for HBV. CONCLUSIONS EHR-based provider prompts significantly increased HBV testing in Chinese and Vietnamese patients when compared to "usual care." EHR prompts are a promising intervention that could significantly increase screening for HBV.
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Gu C, Chan CWH, Twinn S, Choi KC. The influence of knowledge and perception of the risk of cervical cancer on screening behavior in mainland Chinese women. Psychooncology 2011. [DOI: 10.1002/pon.2037] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Can Gu
- The Nethersole School of Nursing; The Chinese University of Hong Kong; Hong Kong
| | - Carmen W. H. Chan
- The Nethersole School of Nursing; The Chinese University of Hong Kong; Hong Kong
| | - Sheila Twinn
- The Nethersole School of Nursing; The Chinese University of Hong Kong; Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing; The Chinese University of Hong Kong; Hong Kong
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Chinese-Australian Women’s Knowledge, Facilitators and Barriers Related to Cervical Cancer Screening: A Qualitative Study. J Immigr Minor Health 2011; 13:1076-83. [DOI: 10.1007/s10903-011-9491-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gor BJ, Chilton JA, Camingue PT, Hajek RA. Young Asian Americans' knowledge and perceptions of cervical cancer and the human papillomavirus. J Immigr Minor Health 2011; 13:81-6. [PMID: 20414727 DOI: 10.1007/s10903-010-9343-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cervical cancer is a major health disparity among Asian Americans, with cervical cancer rates of Vietnamese women being significantly higher than for the general US female population and low screening rates reported for Asian American females. Focus groups and interviews were conducted with young Vietnamese, Filipino, and Korean adults (ages 18-29) to collect information on knowledge, perceptions and sources of information regarding cervical cancer, Pap tests and the human papillomavirus. 16 Korean, 18 Vietnamese, and 18 Filipino (50% female) adults participated in the study. Many participants had never heard of HPV, cervical cancer and Pap testing. Cervical cancer screening rates were low for Korean and Vietnamese females and were influenced by moral beliefs and lack of awareness. Culturally relevant education materials that consider specific Asian ethnicity and language are needed to increase awareness of cervical cancer, Pap testing, and HPV among Asian American young adults.
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Affiliation(s)
- Beverly J Gor
- Department of Health Disparities Research, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Cultural views, English proficiency and regular cervical cancer screening among older Chinese American women. Womens Health Issues 2011; 20:272-8. [PMID: 20620915 DOI: 10.1016/j.whi.2010.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 02/19/2010] [Accepted: 03/23/2010] [Indexed: 11/21/2022]
Abstract
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.
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Fang CY, Ma GX, Tan Y. Overcoming Barriers to Cervical Cancer Screening Among Asian American Women. ACTA ACUST UNITED AC 2011; 4:77-83. [PMID: 21687826 DOI: 10.7156/v4i2p077] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Significant disparities in cervical cancer incidence and mortality exist among ethnic minority women, and in particular, among Asian American women. These disparities have been attributed primarily to differences in screening rates across ethnic/racial groups. Asian American women have one of the lowest rates of screening compared to other ethnic/racial groups. Yet Asian Americans, who comprise one of the fastest growing populations in the United States, have received the least attention in cancer control research. Studies suggest that various factors, including lack of knowledge, psychosocial and cultural beliefs, and access barriers, are associated with cervical cancer screening behaviors among Asian American women. Indeed, the few interventions that have been developed for Asian American women demonstrate that targeting these factors can yield significant increases in screening rates. It is important to note, however, that the effectiveness of educational interventions is often attenuated if access barriers are not adequately addressed. Hence, interventions that include key essential components, such as the use of community individuals as lay health workers, culturally-tailored and linguistically-appropriate educational materials, and navigation assistance to overcome access barriers, are more likely to be successful in enhancing screening rates. As the benefits of community-based cervical cancer prevention programs become more apparent, it will be essential to identify effective approaches for disseminating such programs more broadly. In conclusion, community-based cervical cancer screening programs have demonstrated promise in addressing existing cervical cancer disparities by increasing awareness and knowledge and promoting recommended screening behaviors. These findings will be instrumental in guiding future community-based programs to reduce cervical cancer health disparities among Asian American women.
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Affiliation(s)
- Carolyn Y Fang
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Robert C. Young Pavilion, 4 Floor, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111, Tel: 215-728-4062, ,
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Howlett RI, Larsh S, Dobi L, Mai V. Promoting cancer screening among Ontario Chinese women. Canadian Journal of Public Health 2010. [PMID: 19722348 DOI: 10.1007/bf03403954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Cancer screening participation is typically low among newcomers to Canada. Consequently, mortality and morbidity rates are higher in ethno/cultural populations. There are inherent challenges in reaching these population groups to increase awareness and participation in cancer screening. Many reports have cited the need for culturally appropriate materials and multi-pronged strategies for effective outreach in the Chinese community. This paper outlines the consultation/development process and evaluation strategy for promoting cancer screening among Chinese women with limited English language skills. PARTICIPANTS As Chinese is the third most commonly spoken language in Canada, this community education project focused on health promoters providing services to Chinese women 50 years and older. SETTING Ontario communities. INTERVENTION Partners and stakeholders were consulted and engaged to define the best approach to develop and distribute culturally sensitive public education resources to assist communities in realizing greater awareness of and participation in cancer screening. OUTCOMES Customized resource kits were developed and distributed to the target population over the course of two phases of this project. An evaluation strategy was designed and implemented to assess the impact of the project. CONCLUSION The process to develop culturally sensitive and evidence-based materials for Chinese is detailed in this article. This multi-year project designed and distributed customized resource kits, through consultation with partners and stakeholders. Project outcomes will be further assessed one year after distribution of the kits. This project template may be useful for adaptation and use in other ethnocultural groups within and outside Ontario.
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Fang DM, Lee S, Stewart S, Ly MY, Chen MS. Factors associated with pap testing among Hmong women. J Health Care Poor Underserved 2010; 21:839-50. [PMID: 20693730 DOI: 10.1353/hpu.0.0338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This paper reports the baseline data on the proportion of Hmong women (n=402), ages 18-65, in Sacramento, California who reported that they had a Pap test for the early detection of cervical cancer. We assessed the association between sociodemographic characteristics and Pap test receipt using chi-squared and multiple logistic regression analyses. Only 74% had ever had a Pap test, with 61% tested in the previous three years, compared with 91% and 86%, respectively, of California women overall. Women were more likely to have had a recent Pap test if they were age 21-30 (OR=3.0 vs. age 51-65, 95% CI 1.4-6.7) or 31-40 (OR=3.0, 95% CI 1.4-6.4), and less likely if they were single (OR=0.4 vs. married/partnered, 95% CI 0.2-1.0) or born in the U.S. (OR=0.3 vs. <10 years in U.S., 95% CI 0.1-0.8).
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Affiliation(s)
- Dao Moua Fang
- Hmong Women's Heritage Association, Sacramento, Calif 95822, USA
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An Exploration of Papanicolaou Smear History and Behavior of Patients With Newly Diagnosed Cervical Cancer in Taiwan. Cancer Nurs 2010; 33:362-8. [DOI: 10.1097/ncc.0b013e3181d6f792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt) 2010; 19:463-9. [PMID: 20156089 PMCID: PMC2867551 DOI: 10.1089/jwh.2009.1422] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The primary objective of the present study was to evaluate the effects of a community-based pilot intervention that combined cervical cancer education with patient navigation on cervical cancer screening behaviors among Chinese American women residing in New York City. METHODS Chinese women (n = 134) who had not had a Pap test within the previous 12 months were recruited from four Asian community-based organizations (CBOs). Women from two of the CBOs received the intervention (n = 80) consisting of education, interaction with a Chinese physician, and navigation assistance, including help in identifying and accessing free or low-cost screening services. The control group (n = 54) received education delivered by Chinese community health educators and written materials on general health and cancer screening, including cervical cancer, the Pap test, and information about sites that provided free screening. Study assessments were obtained in-person at baseline and postintervention. Screening behavior was self-reported at 12-month postintervention and verified by medical staff. RESULTS In the 12-month interval following the program, screening rates were significantly higher in the intervention group (70%) compared to the control group (11.1%). Hierarchical logistic regression analyses indicated that screening behavior was associated with older age (OR = 1.08, 95% CI = 1.01-1.15, p < .05). In addition, women with poorer English language fluency (OR = 0.30, 95% CI = 0.10-0.89, p < .05) and who did not have health insurance were less likely to obtain screening (OR = 0.15, 95% CI = 0.02-0.96, p < .05). Among health beliefs, greater perceived severity of disease was positively associated with screening behavior (OR = 4.26, 95% CI = 1.01-18.04, p < .05). CONCLUSIONS Community-based programs that provide combined education and patient navigation may be effective in overcoming the extensive linguistic and access barriers to screening faced by Chinese American women.
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Affiliation(s)
- Xingjie Wang
- Center for Asian Health, Department of Public Health, College of Health Professions, Temple University, Philadelphia, Pennsylvania
- Chinese Community Clinic, Flushing, New York
| | - Carolyn Fang
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Yin Tan
- Center for Asian Health, Department of Public Health, College of Health Professions, Temple University, Philadelphia, Pennsylvania
| | - Andy Liu
- Chinese American Community Business Network, New York, New York
| | - Grace X. Ma
- Center for Asian Health, Department of Public Health, College of Health Professions, Temple University, Philadelphia, Pennsylvania
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Relationships between decisional balance and stage of adopting mammography and Pap testing among Chinese American women. Cancer Epidemiol 2009; 33:374-80. [PMID: 19900848 DOI: 10.1016/j.canep.2009.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 04/21/2009] [Accepted: 10/06/2009] [Indexed: 11/21/2022]
Abstract
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.
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Tu R SP, Li L, Tsai JHC, Yip MP, Terasaki G, Teh C, Yasui Y, Hislop TG, Taylor V. A cross-border comparison of hepatitis B testing among chinese residing in Canada and the United States. Asian Pac J Cancer Prev 2009; 10:483-490. [PMID: 19640196 PMCID: PMC3856895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The Western Pacific region has the highest level of endemic hepatitis B virus (HBV) infection in the world, with the Chinese representing nearly one-third of infected persons globally. HBV carriers are potentially infectious to others and have an increased risk of chronic active hepatitis, cirrhosis, and hepatocellular carcinoma. Studies from the U.S. and Canada demonstrate that immigrants, particularly from Asia, are disproportionately affected by liver cancer. PURPOSE Given the different health care systems in Seattle and Vancouver, two geographically proximate cities, we examined HBV testing levels and factors associated with testing among Chinese residents of these cities. METHODS We surveyed Chinese living in areas of Seattle and Vancouver with relatively high proportions of Chinese residents. In-person interviews were conducted in Cantonese, Mandarin, or English. Our bivariate analyses consisted of the chi-square test, with Fisher's Exact test as necessary. We then performed unconditional logistic regression, first examining only the city effect as the sole explanatory variable of the model, then assessing the adjusted city effect in a final main-effects model that was constructed through backward selection to select statistically significant variables at alpha=0.05. RESULTS Survey cooperation rates for Seattle and Vancouver were 58% and 59%, respectively. In Seattle, 48% reported HBV testing, whereas in Vancouver, 55% reported testing. HBV testing in Seattle was lower than in Vancouver, with a crude odds ratio of 0.73 (95% CI = 0.56, 0.94). However after adjusting for demographic, health care access, knowledge, and social support variables, we found no significant differences in HBV testing between the two cities. In our logistic regression model, the odds of HBV testing were greatest when the doctor recommended the test, followed by when the employer asked for the test. DISCUSSION Findings from this study support the need for additional research to examine the effectiveness of clinic-based and workplace interventions to promote HBV testing among immigrants to North America.
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Affiliation(s)
- Shin-Ping Tu R
- Dept of Medicine, University of Washington, Seattle, WA, USA.
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Aragones A, Trinh-Shevrin C, Gany F. Cancer screening practices among physicians serving Chinese immigrants. J Health Care Poor Underserved 2009; 20:64-73. [PMID: 19202247 DOI: 10.1353/hpu.0.0117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chinese immigrants in the United States are broadly affected by cancer health disparities. We examined the cancer screening attitudes and practices of physicians serving Chinese immigrants in the New York City (NYC) area by mailing a cancer screening survey, based on current guidelines, to a random sample of physicians serving this population. Fifty three physicians (44%) completed the survey. Seventy-two percent reported following the guidelines for breast cancer, 35% for cervical cancer screening, and 45% for all colorectal cancer screening tests. Sixty-eight percent of physicians were satisfied with their current rates of cancer screening with their Chinese immigrant patient population. Physicians serving the Chinese community in NYC follow cancer screening guidelines inadequately. Cancer screening rates in this population could likely be increased by interventions that target physicians and improve awareness of guidelines and recommended best practices.
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Affiliation(s)
- Abraham Aragones
- Department of Preventive Medicine and Community Health, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
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Woodall ED, Taylor VM, Teh C, Li L, Acorda E, Tu SP, Yasui Y, Hislop TG. Sources of health information among Chinese immigrants to the Pacific Northwest. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2009; 24:334-340. [PMID: 19838895 PMCID: PMC2836713 DOI: 10.1080/08858190902854533] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Chinese immigrants to North America experience cancer-related health disparities and underutilize preventive care. Little is known about Chinese immigrants' sources of health information. METHODS A population-based survey of Chinese immigrants was conducted in Vancouver, British Columbia, Canada and Seattle, Washington. RESULTS The study group included 899 individuals. Less than three fourths of the respondents reported receiving health information from health care providers, and only a minority used the Internet as a source of health information. We found significant differences between the sources of health information in Seattle and Vancouver. CONCLUSIONS Health educators should consider available media outlets as well as the characteristics of a target community when planning intervention programs for Chinese immigrants.
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Affiliation(s)
- Erica D Woodall
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Peterson NB, Murff HJ, Cui Y, Hargreaves M, Fowke JH. Papanicolaou testing among women in the southern United States. J Womens Health (Larchmt) 2008; 17:939-46. [PMID: 18582173 DOI: 10.1089/jwh.2007.0576] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cervical cancer is largely preventable with screening using Papanicolaou (Pap) testing. We examined Pap testing among southern women, mostly of low income and educational status, to determine if rates were similar to those reported nationally and to examine which factors were related to receipt of Pap tests. METHODS Baseline interview data from 19,046 women aged 40-79 enrolled at community health centers into the Southern Community Cohort were analyzed. The percentages of women reporting a recent Pap test (within the past 3 years) were compared according to sociodemographic, healthcare access, and health-related behavior variables. Logistic regression analyses were employed to compute odds ratios (ORs) and corresponding 95% confidence intervals (95% CI). RESULTS Overall, 88% of the women reported having received a recent Pap test. Screening rates were high among all racial/ethnic groups, but highest for African American women. Not having a Pap test was significantly associated with lower education (OR declining to 0.73, 95% CI 0.64-0.85, among those with less than a high school education), lower income (OR declining to 0.61, 95% CI 0.43-0.87, among those with annual household incomes <$15,000), and not having health insurance (OR 0.83, 95% CI 0.71-0.97). The most common reason reported by women as to why they had not a Pap test was cost (25%), followed by reporting a doctor had not recommended the test (22%). CONCLUSIONS Pap testing was most frequent among African American women. Subsets, such as women with less education, low income, and no health insurance, however, may not be adequately screened for cervical cancer.
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Affiliation(s)
- Neeraja B Peterson
- Institute for Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8300, USA.
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Cervical cancer screening among immigrants and ethnic minorities: a systematic review using the Health Belief Model. J Low Genit Tract Dis 2008; 12:232-41. [PMID: 18596467 DOI: 10.1097/lgt.0b013e31815d8d88] [Citation(s) in RCA: 181] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematically review all studies examining sociocultural factors influencing cervical cancer screening among immigrant and ethnic minorities in the United States along the theoretical framework of the Health Belief Model. MATERIALS AND METHODS MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane database searches were conducted searching for English language, US-based studies to examine minority and immigrant populations within the theoretical framework of the Health Belief Model. Fifty-five of more than 3,381 potentially relevant articles were included in the final analysis. RESULTS Commonly held beliefs across several cultural groups emerged including the following: fatalistic attitudes, a lack of knowledge about cervical cancer, fear of Pap smears threatening one's virginity, as well as beliefs that a Pap smear is unnecessary unless one is ill. Beliefs unique to specific cultural groups included: body-focused notions among Hispanics, as childbirth, menses, sex, and stress were considered to play a role in one's susceptibility to cancer. African Americans identified administrative processes in establishing health care as barriers to screening, whereas Asian immigrants held a variety of misconceptions concerning one's susceptibility to cancer as well as stigmatization imposed by their own community and providers. CONCLUSION Health care providers and policy makers must be cognizant of the various sociocultural factors influencing health-related beliefs and health care utilization among immigrant and ethnic minorities in the United States. Culturally relevant screening strategies and programs that address these sociocultural factors must be developed to address the growing disparity in cervical cancer burden among underserved, resource-poor populations in the United States.
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Gao W, DeSouza R, Paterson J, Lu T. Factors affecting uptake of cervical cancer screening among Chinese women in New Zealand. Int J Gynaecol Obstet 2008; 103:76-82. [DOI: 10.1016/j.ijgo.2008.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 04/29/2008] [Accepted: 04/29/2008] [Indexed: 11/26/2022]
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Downs LS, Smith JS, Scarinci I, Flowers L, Parham G. The disparity of cervical cancer in diverse populations. Gynecol Oncol 2008; 109:S22-30. [PMID: 18482555 DOI: 10.1016/j.ygyno.2008.01.003] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 01/02/2008] [Indexed: 11/18/2022]
Abstract
Significant disparities in cervical cancer incidence and mortality rates among minority groups have been documented in the United States, despite an overall decline in these rates for the population as a whole. Differences in cervical cancer screening practices have been suggested as an explanation for these disparities, as have differences in treatment among various racial and ethnic groups. A number of factors are attributed to these observed differences. As minority populations continue to grow in size over the next 50 years, persistent disparities will place an ever increasing burden on these populations and on the national healthcare system. Strategies to reduce cervical cancer disparities need to be employed in order to reverse these trends.
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Affiliation(s)
- Levi S Downs
- University of Minnesota, Dept of OB/GYN and Women's Health, 420 Delaware Street, 8395 SE, MMC 395 Mayo, Minneapolis, MN 55455, USA.
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Lee-Lin F, Menon U, Pett M, Nail L, Lee S, Mooney K. Measuring breast cancer and mammography screening beliefs among Chinese American immigrants. West J Nurs Res 2008; 30:852-68. [PMID: 18515751 DOI: 10.1177/0193945908319247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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 (Cronbach's 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.
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Abstract
Chinese Americans are 10 times more likely to be diagnosed with hepatocellular carcinoma (HCC) than their white counterparts. About 80% of HCC's among Asian immigrants are associated with hepatitis B virus (HBV) infection. We used data from in-person interviews of Chinese residents in Seattle to examine factors associated with HBV testing. The survey was completed by 206 men and 236 women (cooperation rate: 58%). Less than one-half (48%) of respondents had been tested for HBV. Factors associated (p < 0.01) with ever having tested in bivariate comparisons included knowing that Chinese are more likely to be infected with HBV than Whites; individuals can be infected with HBV for life; HBV infection can cause liver cancer; not believing that HBV can be prevented by having a positive attitude; having a family member, friend, or medical doctor recommend testing; asking for testing from a medical doctor; and not needing interpreter services. In multiple regression analyses, the following factors were independently associated with testing: believing that Chinese were more likely than Whites to get HBV (p = 0.004), having a doctor recommend testing (p = 0.001), asking a doctor for the test (p < 0.001) and not needing an interpreter for doctors visits (p = 0.002). Intervention programs to improve HBV testing rates in Chinese Americans should include strategies to improve knowledge about the risk of HBV and encourage effective communication with health care providers about HBV testing.
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Lee-Lin F, Pett M, Menon U, Lee S, Nail L, Mooney K, Itano J. Cervical Cancer Beliefs and Pap Test Screening Practices Among Chinese American Immigrants. Oncol Nurs Forum 2007; 34:1203-9. [DOI: 10.1188/07.onf.1203-1209] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zhang Y, Borders TF, Rohrer JE. Correlates of Intent to Seek Unnecessary Pap Tests Among Elderly Women. Womens Health Issues 2007; 17:351-9. [DOI: 10.1016/j.whi.2007.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 04/17/2007] [Accepted: 06/01/2007] [Indexed: 10/22/2022]
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Consedine NS, Krivoshekova YS, Harris CR. Bodily embarrassment and judgment concern as separable factors in the measurement of medical embarrassment: psychometric development and links to treatment-seeking outcomes. Br J Health Psychol 2007; 12:439-62. [PMID: 17640455 DOI: 10.1348/135910706x118747] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Understanding why people do not always engage in medical examinations that might benefit them is a public health issue which is receiving increased attention. One area of promise involves the study of medical embarrassment, although current studies are weakened in that they measure medical embarrassment in a theoretically naïve and unidimensional manner and have assumed that embarrassment is exclusively a barrier to the timely seeking of treatment. DESIGN Convenience sampling was used to recruit 116 male and 134 female students (mean age = 19.94 years, 47.2% Caucasian, 20.4% African-American, 32.4% Asian) from two large universities in different parts of the United States. METHODS Participants completed a comprehensive measure of medical embarrassment, reported on previous treatment avoidance because of embarrassment, and recorded the frequency of psychological, general and sex-related visits across the previous 5 years. RESULTS As expected, medical embarrassment was not unidimensional and appeared to have two distinct factors--bodily embarrassment and judgment concern. Bodily embarrassment generally predicted less frequent medical contact although not equally so across domains and it interacted with judgment concern in several cases, providing preliminary evidence that there are situations in which aspects of medical embarrassment may actually facilitate greater medical contact. CONCLUSIONS The data highlight the importance of considering the role of emotions other than fear in health behaviour and the means by which they may facilitate or deter the timely seeking of diagnosis and treatment.
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