Breast Cancer Education Program Wants to Know:
By Nina Goodman
On the Front Page...
Asian American women may pay little attention to educational messages that are not culturally appropriate, according to the findings of numerous focus groups and interviews conducted by the National Cancer Institute's Office of Communications, as part of its Breast Cancer Education Program. This is just one of the findings from NCI's qualitative research with Asian American immigrant women ages 40 to 74 who still mostly speak their native language.
OC conducted this preliminary research to learn how Asian American women think and feel about breast cancer and mammography screening. Specifically, the research was designed to review the literature on their use of mammography; understand the reasons why they get or do not get mammograms; learn whether and how cultural factors affect their decisions about getting mammograms; and, identify ways to communicate messages about breast cancer and mammography screening to them.
OC's research on Asian women's knowledge, attitudes and behavior about breast cancer and mammography was conducted in three phases. First, a Medline literature review determined what is already known about breast cancer and mammography screening behavior among Asian American women. Second, in-depth telephone interviews were conducted with key staff members of four organizations that are involved in Asian-specific breast cancer education efforts. These groups were the American Cancer Society Chinese Unit; the Korean Health Education, Information & Research Center; the National Asian Women's Health Organization; and the Vietnamese Community Health Promotion Project. Third, eight focus groups were held with Asian women in New York City and Los Angeles two groups each with women who spoke Cantonese, Mandarin, Korean or Vietnamese.
To be eligible for the groups, participants had to have one of these languages as their mother tongue, primarily speak the language of their native country, and be 40 to 74 years of age. All of the women who participated in the focus groups were first-generation immigrants, and most had lived in the U.S. for at least 10 years. All sessions were conducted in the language of women in the group.
Findings Highlight Barriers to Screening
The literature noted a lack of knowledge among immigrant Asian women regarding breast cancer and mammography screening. Similarly, the interviewed organizations and most focus group participants perceived that immigrant Asian women know little about breast cancer and the importance of mammography screening, and thus require the most basic information. Specifically, they noted that many Asian women may think that breast cancer is due to fate.
Focus group participants agreed that breast cancer is an important health issue, although some said that other health issues, such as heart disease, are more important to Asian women. Still, for many immigrant Asian women the word "cancer" is strongly associated with "fear" and "death" and as a result, group participants confirmed that many women in their communities were not getting mammograms.
When asked what would motivate a woman to get a mammogram, those in the focus groups stated peace of mind (particularly in knowing that one can stay healthy for one's family) and early detection. Specifically, one woman said, "If the mother is healthy, it is good for the family."
Primary barriers for not getting a mammogram were competing concerns (such as taking time to care for their families and adapting to the American culture), as well as cost, language barriers and lack of symptoms. As a result, some participants mentioned that Asian women will often delay visiting a physician until they are so sick that they are unable to attend to other, higher priority concerns. As one woman put it, "I don't like seeing the doctor unless I cannot move about then I may go in and see a doctor."
Both the organizations and focus group participants identified the types of information sources that would be most effective for reaching Asian women with breast cancer and mammography information: family members, friends and neighbors; Asian physicians; in-language broadcast and print media; and community organizations such as food markets, churches/temples and civic clubs. Interestingly, very few participants named cancer societies, health fairs, nurses, pharmacists, herbalists, the Internet or toll-free phone lines as resources for cancer information.
Research Results Put to Work
The findings from this research emphasize the importance of developing culturally appropriate messages and materials using input from members of the intended audience, as well as from knowledgeable community organizations.
"As a result of these findings," says Dr. Susan Sieber, director of the Office of Communications, "OC will look to involve national and local organizations who work with Asian communities for assistance with strategic program planning for the Breast Cancer Education Program. These partnerships are essential for developing a complete picture of the Asian audiences that NCI is trying to reach."
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