How Do Older Chinese Women View Health and Cancer Screening? Results from Focus Groups and Implications for Interventions
To qualitatively assess Chinese American women's views of health and illness and the potential influences of culture and language on cancer screening behavior.
Data were generated by five focus groups, each consisting of 9-12 Chinese American women aged 50 and older. Participants responded to open-ended questions assessing their perceptions of health and illness, knowledge about cancer, beliefs about and barriers to cancer screening, and screening and healthcare experiences in the USA. All conversations were tape-recorded and analyzed in the context of PRECEDE framework concepts of predisposing, enabling, and reinforcing factors.
The 54 participants had a mean age of 65 years, with an average age of immigration to the USA at 51 and average length of residence in the USA of 15 years. Participants considered outdoor exercise in the morning for fresh air and a hot-cold balanced diet as important means to health. None mentioned the importance of regular medical checkups or cancer screening. When talking about cancer prevention, a sense of fatalism was evident, such as 'no control of life and death' and 'what will happen will happen'. Lack of English capability was a major enabling barrier to healthcare. In addition, these women reported the need for help with transportation, especially for those living in suburban areas where public transportation is not readily available. Physician recommendation was identified as the most important reinforcing factor for cancer screening.
Our results suggest traditional Chinese beliefs, such as those pertaining to fatalism, self-care, and the hot and cold balance, influence the perceptions of older Chinese women regarding health, illness, and use of preventive healthcare. Interventions to improve cancer screening in this population should be tailored to the specific predisposing, enabling, and reinforcing factors of this population, including cultural views, language barriers, doctor-patient communication, and access to healthcare.
Available from: Nessie Shia
- "It may be appropriate to develop health promotion strategies that focus on the detection of benign tumors than to advertise cancer screening which evokes dread and fear in Chinese communities and to coach preventative strategies particularly as Chinese people believe in destiny and getting cancer are linked. Liang et al. (2004) Qualitative study to examine older Chinese women's views of health and influences of culture, language on BC screening behaviour redisposing factors, access to possible reinforcing factors that could possibly influence BCS in this under- screened population of women. "
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ABSTRACT: In Eastern Asia, as the incidence of breast cancer continues to increase yet compliance with breast cancer
screening in older Chinese women who are at risk of early stage breast cancer is poor. This meta-ethnography explored breast cancer awareness, attitudes and breast screening behaviour in older Chinese women. Nine qualitative studies were appraised using CASP tools. Many Chinese women believed that illness is preordained, therefore mammography was a futile exercise. Older Chinese women held erroneous views of breast cancer, and believed that if they developed this form of cancer they would hide the disease from their family due to perceptions of bad luck and derision for both the cancer patient and their family. There is a great need for targeted breast health educational programmes for Chinese migrant women that educate women to participate in mammography and promote acculturation and health education. Future public health programmes need to target older Chinese women.
Available from: Yingchun Ji
- "Regarding food, the majority of the informants also claimed that the balanced diet contributed to good health. The idea of balanced diet was similarly reported in previous studies for Chinese-born immigrant women  and was a unique health belief among Chinese-born immigrant women compared with other Asian groups . One woman who had stayed in the United States for more than six years said "
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ABSTRACT: Participant observation elicits unique observation data from both an insider's and an outsider's perspectives. Despite the growing tendency to adopt participant observation strategies in health care research regarding health-related beliefs and types of behavior, the use of participant observation in current research is mostly limited to structured clinical settings rather than community settings. In this paper, we describe how we use participant observation in a community health research study with Chinese-born immigrant women. We document discrepancies between these women's beliefs and types of behavior regarding health and health promotion. We further discuss the ethnical, time, and setting challenges in community health research using participant observation. Possible solutions are also discussed.
Available from: Diane L Lorenzetti
- "Identifying Asian populations to participate in breast and cervical cancer screening studies is challenging. Cultural taboos regarding discussing sexual related topics, and limited enthusiasm for research makes it challenging to recruit Asian women to participate in studies focused on breast and cervical cancer screening uptake [75-83]. Therefore, the validity of findings from small and/or convenient samples is questionable due to uncertainty of selection bias, incomparability between intervention and comparison groups, and lack of statistical power to determine significance. "
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The Asian population is one of the fastest growing ethnic minority groups in western countries. However, cancer screening uptake is consistently lower in this group than in the native-born populations. As a first step towards developing an effective cancer screening intervention program targeting Asian women, we conducted a comprehensive systematic review, without geographic, language or date limitations, to update current knowledge on the effectiveness of existing intervention strategies to enhance breast and cervical screening uptake in Asian women.
This study systematically reviewed studies published as of January 2010 to synthesize knowledge about effectiveness of cancer screening interventions targeting Asian women. Fifteen multidisciplinary peer-reviewed and grey literature databases were searched to identify relevant studies.
The results of our systematic review were reported in accordance with the PRISMA Statement. Of 37 selected intervention studies, only 18 studies included valid outcome measures (i.e. self-reported or recorded receipt of mammograms or Pap smear). 11 of the 18 intervention studies with valid outcome measures used multiple intervention strategies to target individuals in a specific Asian ethnic group. This observed pattern of intervention design supports the hypothesis that employing a combination of multiple strategies is more likely to be successful than single interventions. The effectiveness of community-based or workplace-based group education programs increases when additional supports, such as assistance in scheduling/attending screening and mobile screening services are provided. Combining cultural awareness training for health care professionals with outreach workers who can help healthcare professionals overcome language and cultural barriers is likely to improve cancer screening uptake. Media campaigns and mailed culturally sensitive print materials alone may be ineffective in increasing screening uptake. Intervention effectiveness appears to vary with ethnic population, methods of program delivery, and study setting.
Despite some limitations, our review has demonstrated that the effectiveness of existing interventions to promote breast and cervical cancer screening uptake in Asian women may hinge on a variety of factors, such as type of intervention and study population characteristics. While some studies demonstrated the effectiveness of certain intervention programs, the cost effectiveness and long-term sustainability of these programs remain questionable. When adopting an intervention program, it is important to consider the impacts of social-and cultural factors specific to the Asian population on cancer screening uptake. Future research is needed to develop new interventions and tools, and adopt vigorous study design and evaluation methodologies to increase cancer screening among Asian women to promote population health and health equity.
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