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Breast-Health Screening Perceptions of Chinese Canadian Immigrant Women

Breast-Health Screening Perceptions of Chinese Canadian Immigrant Women . Immigrant & Racialized Women’s Health Conference February 21, 2014 Heidi Sin RN, PhD. Outline. Problem and purpose of the study Approach Research questions S tudy participants Data collection

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Breast-Health Screening Perceptions of Chinese Canadian Immigrant Women

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  1. Breast-Health Screening Perceptions of Chinese Canadian Immigrant Women Immigrant & Racialized Women’s Health Conference February 21, 2014 Heidi Sin RN, PhD

  2. Outline • Problem and purpose of the study • Approach • Research questions • Study participants • Data collection • Results and Interpretation • Recommendations • Implications for Practices

  3. Problem • Breast cancer is a prominent type of cancer in women. • Breast cancer accounted for 458,000 deaths globally. • In Canada, 22,700 individuals diagnosed with breast cancer along with 5,100 cancer-related deaths in 2012. • Regular breast-health screening could reduce mortality from breast cancer. • Screening rate was low within ethno-cultural groups. • Result in high mortality and morbidity.

  4. Purpose To explore the perceptions of breast-health screening among Chinese Canadian immigrant women, aged 30 to 69 and barriers that prevented them from having breast-health screening.

  5. Research Method and Design • Qualitative case study • Demographic survey • Semistructured interview • Focus group

  6. Research Question What are the perceptions of breast-health screening among Chinese Canadian immigrant women aged 30 to 69?

  7. Research Subquestions • Types of preventive health measures • Perceived benefits of breast-health screening • Obstacles to breast-health screening • Females’ perceptions of condition, situations, or contexts that influence their lived experiences with breast-health screening • Perceived role of breast-health screening

  8. Characteristics of population • Chinese women aged 30 to 69. • Born and received education in mainland China. • First language is Mandarin. • Have immigrated to Canada for 5 years or less. • Residents in the Greater Toronto Area. • Acquired no history of breast cancer. • Approached Welcome Centre Immigrant Services-Markham South or The Cross-Cultural Community Services Association.

  9. Data Collection • Pilot study • Fifteen semistructured interviews • Two focus groups

  10. Results and Interpretations Subquestion 1: What types of preventive health measures used by Chinese Canadian immigrant women? Theme: Influence of Chinese cultural beliefs and practices to maintain health • Healthy eating • Physical activities • Positive attitude • Regular daily activities

  11. Results and Interpretations Subquestion 2: What are the perceived benefits of breast-health screening for Chinese Canadian immigrant women? Theme: Important role of a female caregiver in a family • Early detection of breast cancer • Prevention of illness • Beneficial to individuals and family members

  12. Results and Interpretations Subquestion 3: What are the obstacles to breast-health screening for Chinese Canadian immigrant women? Theme: Accessibility to and utilization of screening services • Lack of knowledge • Inconvenience • Language proficiency • Embarrassment • Perceived illness • Radiation • Cost

  13. Results and Interpretations Subquestion 4: What are the females’ perceptions of condition, situations, or contexts that influence their lived experiences with breast-health screening? Two themes: Lack of preventive health concept and experiences affect participation Lack of preventive health concept • Perceived illnesses • Awareness of breast cancer impact

  14. Results and Interpretations Subquestion 4: What are the females’ perceptions of condition, situations, or contexts that influence their lived experiences with breast-health screening? Theme: Experiences affect participation • Positive / negative perceptions of screening • Someone with breast cancer • Screening experiences • Screening instructions • Positive / negative emotional responses

  15. Results and Interpretations Subquestion 5: What perceived role does breast-health screening play in Chinese Canadian immigrant women’s health? Theme: Lack of information about breast-health screening program • Benefits of screening • Importance of screening • Individual responsibility • Breast-health screening program • Current health status

  16. Recommendations • Develop culturally-sensitive linguistic programs and educational materials in consideration of Chinese health beliefs. • Establish better communication between health care providers and clients and recommendation by physicians. • Include breast-health screening as a standard item within annual check-up. • Promotion of breast-health screening through ethnic media.

  17. Recommendations • Expand the operating hours for screening clinic and initiation of mobile women’s clinic. • Provide translation services, comfortable and supportive environment at the breast-health screening clinics. • Provide linguistic culturally educational program to include preventive health concept. • Provide community-based outreach educational programs and a lay health educator program.

  18. Implications for Practices To increase participation in breast-health screening: • Increase knowledge. • Reduce perceived barriers, facilitate perceived benefits, minimize negative experiences. • Promote self care message. • Involve physicians. • Send reminders through a systematic approach. • Remove embarrassment by given options. • Review health organizations role. • Conduct further longitudinal studies.

  19. Thank you!!

  20. References • Anagnostououlos, F., Dimitrakaki, C., Fitzsimmons, D., Potamianos, G., Niakas, D., & Tountas, Y. (2012). Health beliefs and illness perception as related to mammography uptake in randomly selected women in Greece. Journal of Clinical Psychology in Medical Settings, 19, 147-164. doi:10.1007/s10880-011-9272-1 • Ayala, G. X., Vaz, L., Earp, J. A., Elder, J. P., & Cherrington, A. (2010). Outcome effectiveness of the lay health advisor model among Latino in the United States: An examination by role. Health Education Research, 25(5), 815-840. doi:10.1093/her/cyq035 • Bloomberg, L., & Volpe, M. (2008). Completing your qualitative dissertation: A roadmap form beginning to end. Thousand Oaks, CA. Sage.

  21. References • Canadian Cancer Society , Public Health Agency of Canada, & Statistics Canada. (2012). Canadian cancer statistics 2012. Toronto, Canada: Canadian Cancer Society. • Cancer Care Ontario. (2010). Ontario breast cancer screening program 20th anniversary report 1990-2010. Toronto, ON: Author. • Chen, Y. L. D. (1996). Conformity with nature: A theory of Chinese American elders’ health promotion and illness prevention process. Advances in Nursing Science, 19(2), 17-26. • Christensen, L. B., Johnson, R. B., & Turner, L.A. (2011). Research methods, design, and analysis (11th ed.). Boston, MA: Allyn & Bacon. • Finlay, L. (2009). Debating phenomenological research methods. Phenomenological and Practices, 3(1), 6-25. • Gay, L. R., Mills, G. E., & Airasian, P. (2006). Educational research. Competencies for analysis and applications. Upper Saddle River, NJ: Pearson.

  22. References • Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education. Theory, research and practice (4th ed.). Hoboken, NJ: Jossey-Bass. • Inoue, M., Pickard, G. J., Welch-Saleeby, P., & Johnson, S. (2009). African-American caregivers’ breast health behavior. Health Education Research, 24(5), 735-747. doi:10.1093/her/cyp008 • Kwok, C., Fethney, J., & White, K. (2012). Mammographic screening practices among Chinese-Australian women. Journal of Nursing Scholarship, 44 (1), 11-18. doi:10.1111/j.1547-5069.2011.01429x • Lee-Lin, F., Menon, U., Pett, M., Nail, L., Lee, S., & Mooney, K. (2007). Breast cancer beliefs and mammography screening practices among Chinese American immigrants. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 36, 212-221. doi:10.1111/J.1552-6909.2007.00141.x

  23. References • Lee-Lin, F., Menon, U., Nail, L., & Lutz, K. F. (2012). Findings from focus groups indicating what Chinese American immigrant women think about breast cancer and breast cancer screening. Journal of Obstetric Gynecologic & Neonatal Nursing, 00(00), 1-11. doi:10.1111/j.1552-6909.2012.01348x • Leedy, P. D., & Ormrod, J. E. (2010). Practical research: Planning and design (9th ed.). Upper Saddle River, NJ: Pearson. • Liang, W., Wang, J. H., Chen, M. Y., Feng, S., Lee, M., Schwartz, M. D.,…Mandelblatt, J. S. (2008). Developing and validating a measure of Chinese cultural views of health and cancer. Health Education and Behavior, 35, 361-375. doi:10.1177/1090198106294893 • Mapp, T. (2008). Understanding phenomenology: The lived experience. British Journal of Midwifery, 16, 308-311.

  24. References • Morgan, D. L. (1997). Focus groups as qualitative research. Newbury Park, California: Sage. • Moustakas, C. (1994). Phenomenological research methods. Thousand Oaks, CA: Sage. • Shin, K., Kim, M., & Chung, S. (2009). Methods and strategies utilized in publishedqualitative research. Qualitative Health Research, 19, 850-858. • Sun, A., Zhang, J., Tsoh, J., Wong-Kim, E., & Chow, E. (2007). The effectiveness in utilizing Chinese media to promote breast health among Chinese women. Journal of Health Communication, 12, 157-171. doi:10.1080/10810730601150106

  25. References • Tabar, L., Vitak, B., Yen, A. M., Cohen, A., Tot, T., Chui, S.Y.,…Duffy, S. W. (2011). Swedish two-country trial: Impact of mammography screening on breast cancer mortality during 3 decades. Radiology, 260, 658-663. doi:10.1148/radiol.11110469 • Todd, L. Harvey, E., & Hoffman-Goetz, L. (2011). Predicting breast and colon screening among English-as-a- second-language older Chinese immigrant women to Canada. Journal of Cancer Education, 26, 161-169. doi: 10.1007/s13187-010-0141-7 • World Health Organization. (2013). Breast cancer: Prevention and control. Retrieved from http://www.who.int/cancer/detection/breastcancer/en

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