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Korean women: breast cancer knowledge, attitudes and behaviors
– Reported, May 25, 2013
Breast cancer is the most common form of cancer in Asian American women, and their cancer screening rates are lower than any other ethnic group. Incidence of breast cancer among Asian American women increases with the duration of their US residency, making breast cancer education even more important as U.S. duration increases . With the assistance of key informants, the social patterns of Asian American women were evaluated for places where health-related data might be collected and educational interventions offered. Asian grocery stores appeared to offer a valuable site for a community based health education program.
Results confirm the low breast cancer screening rates previously reported among Korean women. The lack of sufficient breast cancer knowledge reported by the study participants may have contributed to this low screening adherence. Women’s willingness to learn, discuss, and share breast cancer information with their family and friends suggests that these low screening rates might be improved by focused educational intervention programs.
The follow up results demonstrated a slight improvement in screening adherence that might have been the result of the breast cancer information the women received. Since this was a demonstration project rather than a randomized trial, it is not possible to determine if the intervention did in fact have a causal role in helping to facilitate the reported increased screening or if the increased screening rates were the results of chance alone. Further research is needed.
The lack of reported embarrassment may help to explain the high degree of acceptability women demonstrated toward learning about this very personal health concern in a very public venue, from a culturally aligned, but veritable, stranger. Alternatively, the acceptability of the grocery store-based education program may also have been a consequence of the participants’ view that the grocery store venue is within the exclusive purview of women’s social milieu. Few men were present, and those who were present, were there to provide transportation and physical assistance to the women they accompanied. While they waited for the women, male health educators engaged them in discussions of the important role men can play in promoting adherence to breast cancer screening guidelines.
Consistent with previous studies, virtually all women preferred to be interviewed in Korean . With 34% of the women reporting language as a barrier to breast cancer education, lack of language proficiency appears to be an important barrier to Korean women’s access to health care.
Time was the most frequently reported barrier to participation in cancer education programs, suggesting that part of this program’s success at reaching the women was due to its ability to combine education with women’s routine patterns of daily living and hence, ease of accessibility. Women were able to incorporate education into their daily routine and received educational booklets for later reading. They also received the phone number to schedule a free breast cancer screening through the State’s Breast Cancer Early Detection Program. Eligible women were given appointments when they called. Women who were not economically challenged and at least 40 years of age, and hence not program-eligible, were directed to other appropriate, local screening services.
Since the program was offered at the participating grocery stores, women could return with additional questions or bring loved ones for training. Even on days when the education program was not being offered, women might still be reminded to schedule appointments by subliminal cuing associated with passing the usual location for the educational program.
The relatively low rate of Koreans who reported having had a clinical breast exam and/or mammogram could also be attributed to limited attention that has been given to the role of filial piety within the Korean family. In the Korean household, the eldest son and his wife care for the elders and make all important decisions for the family . Breast cancer educational programs that provide information to these younger, guardians of family well being could work synergistically with educational programs focused on the women themselves.
Previous studies have documented the common misconceptions among Korean women related to breast cancer. The cause of breast cancer has been attributed to air pollution, moral wrong doing, hitting or bumping the breasts, and temperature change . The educational program did not challenge these disbeliefs, but instead, offered information the women could use to alter their risk of late stage detection and its consequences. Following the Health Belief Model, the intervention strategy was to give women information that would foster a greater internal locus of control and encourage proactive screening behaviors.
Traditional medicine such as acupuncture and herbs were also identified as alternatives to breast cancer screening in previous studies. Mistrust, or lack of a personal relationship with a physician could also discourage an older woman from going to the doctor and levitate towards the comforts of traditional medicine. The education program and the breast cancer screening activities it promoted, incorporated strategies for facilitating Korean women’s prompt access to health care providers and the breast cancer screening they could provide, without undermining their respect for traditional medicine.
Given the Korean American women’s low screening rates and their willingness to learn and share breast cancer information, the provision of culturally sensitive learning opportunities appears to be worthwhile. Programs that are easy for women to access and also recognize the role of the eldest son in family matters would appear to be both acceptable and effective methods of encouraging Korean women to adhere to recommended breast cancer screening guidelines. Given the demonstrated acceptability of the Asian Grocery-Store-Based Cancer Education Program, this program’s format may also be applicable for promoting awareness of other health and social welfare issues.
CREDITS.
http://www.biomedcentral.com/
Georgia R Sadler*, Lisa T Ryujin, Celine M Ko and Emily Nguyen
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