The Role of Medical Interpretation on Breast and Cervical Cancer Screening Among Asian American and Pacific Islander Women (original) (raw)
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Californian Journal of Health Promotion
Introduction: Early detection and screening are the most effective means to reduce cancer mortality in all populations. Asian American (AA) women have among the lowest rates in aggregate for use of early detection, and screening practices of all ethnic populations. The only nationally disaggregated populationbased data on these ethnic groups at the time of the study was the 1993-1994 National Health Interview Survey (NHIS) of English speaking AA, but 70% of the AA population is non-English speaking. Our study presents heretofore unavailable data for cancer screening for monolingual AA women for a comparable time period in California between 1992 and 1994, prior to initiation of the state and Federal programs targeting this group of women. Methods: Retrospective chart reviews of randomly selected medical records were conducted for the breast and cervical cancer screening practices of low-income, non-English speaking Chinese, Korean, and Thai women attending ethnic specific community-...
Limited English Proficiency and Breast and Cervical Cancer Screening in a Multiethnic Population
American Journal of Public Health, 2005
Objectives. We examined the relationship between ability to speak English and receipt of Papanicolaou tests, clinical breast examinations, and mammography in a multiethnic group of women in the United States. Methods. We used longitudinal data from the Study of Women Across the Nation to examine receipt of breast and cervical cancer screening among Chinese, Japanese, Hispanic, and White women who reported reading and speaking (1) only a language other than English, (2) another language more fluently than English, or (3) only English or another language and English with equal fluency. Logistic regression was used to analyze the data. Results. Reading and speaking only a language other than English and reading and speaking another language more fluently than English, were significantly and negatively associated with receipt of breast and cervical cancer screening in unadjusted models. Although these findings were attenuated in adjusted models, not speaking English well or at all remai...
Journal of Genetic Counseling, 2017
In cancer genetic counseling (CGC), communication across language and culture challenges the model of practice based on shared decision-making. To date, little research has examined the decision-making process of low-income, limited English proficiency (LEP) patients in CGC. This study identified communication patterns in CGC sessions with this population and assessed how these patterns facilitate or inhibit the decision-making process during the sessions. We analyzed 24 audio recordings of CGC sessions conducted in Spanish via telephone interpreters at two public hospitals. Patients were referred for risk of hereditary breast and ovarian cancer; all were offered genetic testing. Audio files were coded by two bilingual English-Spanish researchers and analyzed using conventional content analysis through an iterative process. The 24 sessions included 13 patients, 6 counselors, and 18 interpreters. Qualitative data analyses identified three key domains-Challenges Posed by Hypothetical Explanations, Misinterpretation by the Medical Interpreter, and Communication Facilitatorsthat reflect communication patterns and their impact on the counselor's ability to facilitate shared decision-making. Overall, we found an absence of patient participation in the decision-making process. Our data suggest that when counseling LEP Latina patients via medical interpreter, prioritizing information with direct utility for the patient and organizing information into short-and long-term goals may reduce information overload and improve comprehension for patient and interpreter. Further research is needed to test the proposed counseling strategies with this population and to assess how applicable our findings are to other populations.
Health Education Research, 2008
Despite rapidly increasing incidence rates of breast cancer, recent immigrants such as Korean-American (KA) women report disproportionately lower utilization of screening tests compared with other ethnic groups. Early screening of breast cancer for this population may be greatly facilitated by indigenous lay health workers (LHWs). We conducted an intervention trial with a 6-month follow-up. Trained LHWs recruited 100 KA women 40 years of age or older who had not had a mammogram during the past 2 years. Ninety-three completed followup questionnaires. A 120-min, in-class education combined with LHW follow-up counseling and navigation assistance through the health care system was provided. Rates of breast cancer screening behaviors significantly increased at 6 months (P < 0.001); changes between preand post-intervention were 31.9% for mammography, 23% for clinical breast examination and 36.2% for breast self-examination. Modesty toward screening significantly decreased over time, but we did not find any significant differences in breast cancer knowledge and beliefs before and after the intervention. Results support the efficacy of this neighborhood-based, culturally sensitive intervention. Further research should seek to replicate these findings and to incorporate more self-care skills such as health literacy when designing an intervention program for linguistically and culturally isolated immigrant women.
Impact of breast cancer screening intervention on Korean-American women in Maryland
Cancer Detection and Prevention, 2006
Background: Adherence to mammography guidelines among Korean-American women (KAW) is lower than that of Caucasian-Americans, and disparities in breast cancer screening related to lack of English proficiency is under-researched. This study examined the impact of a breast cancer intervention on intentions to use mammography among KAW. Methods: Face-to-face pre-intervention surveys were conducted in control (n = 95) and intervention groups (n = 105), and were followed by implementation of a breast cancer education program. At 6 months, both groups were re-interviewed by phone (92 control and 94 intervention participants). Generalized estimating equation (GEE) analysis was used to assess the intervention effect before and after the breast cancer educational program. Results: The intervention effect was statistically significant. Women in the intervention reported 2.96 times greater posttest intentions to have mammogram than those in the control group (95% CI, 1.13-7.66). Prior intentions, age, and positive attitudes toward mammography were associated with follow-up intentions to have a mammogram. Conclusion: This culturally and linguistically tailored educational intervention was effective in increasing breast cancer awareness in a non-English speaking population. #
Journal of Health Communication, 2013
The authors examined the relationship between low health literacy (LHL), limited English proficiency (LEP), and meeting current U.S. Preventive Service Task Force colorectal cancer (CRC) screening guidelines for Asians and Whites in California. For 1,478 Asian and 14,410 White respondents 50-75 years of age in the 2007 California Health Interview Survey, the authors examined meeting CRC screening guidelines using multivariable logistic models by LEP and LHL separately and in combination. Analyses were run with the full sample, then separately for Whites and Asians controlling for demographics and insurance. For those with LEP, patientprovider language concordance and CRC screening was examined. Overall, respondents with LEP and LHL were the least likely to meet CRC screening guidelines (36%) followed by LEP-only (45%), LHL-only (51%), and those with neither LHL nor LEP (59%), a hierarchy that remained significant in multivariable models. For Whites, LHL-only was associated with screening, whereas LEP-only and LEP and LHL were significant for Asians. Having a language concordant provider was not significantly
Medical care, 2010
Asian Americans (AA) have the lowest rates of cancer screening of all ethnic groups. Reasons for these low rates of screening frequently include low acculturation levels. However, screening rates remain low for most AA populations despite differences in acculturation levels, suggesting presence of other important modifiers such as access barriers. To compare the relative impact of access versus acculturation on breast and cervical cancer screening for AA subgroups. Multiple regressions models, controlling for sociodemographics, were developed for each AA subgroup. Women ages 18 and older from the 2003 California Health Interview Survey were included in this study. We included women with Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese origins. The dependent variables included clinical breast examination in the past year, mammogram in the past 2 years, and Pap test in the past 3 years. Independent variables included AA subgroup, access indicators, acculturation indica...
American Journal of Public Health, 2017
Objectives. To test a community health worker (CHW)-led health literacy intervention on mammogram and Papanicolaou test screening among Korean American women. Methods. We conducted a cluster-randomized trial at 23 ethnic churches in the Baltimore, Maryland–Washington, DC, metropolitan area between 2010 and 2014. Trained CHWs enrolled 560 women. The intervention group received an individually tailored cancer-screening brochure followed by CHW-led health literacy training and monthly telephone counseling with navigation assistance. Study outcomes included receipt of an age-appropriate cancer screening test, health literacy, cancer knowledge, and perceptions about cancer screening at 6 months. Results. The odds of having received a mammogram were 18.5 (95% confidence interval [CI] = 9.2, 37.4) times higher in the intervention than in the control group, adjusting for covariates. The odds of receiving a Papanicolaou test were 13.3 (95% CI = 7.9, 22.3) times higher; the odds of receiving ...
Can Language-Concordant Prevention Care Managers Improve Cancer Screening Rates?
Cancer Epidemiology, Biomarkers & Prevention, 2007
Objective: There is evidence that non-English speakers in the United States receive lower quality health care and preventive services than English speakers. We tested the hypothesis that Spanish-speaking women would respond differently to an intervention to increase up-to-date status for cancer screening. Study Design and Setting: A multisite randomized controlled trial showed that scripted telephone support, provided by a Prevention Care Manager (PCM), increased up-to-date rates for breast, cervical, and colorectal cancer screening. This subgroup analysis investigated the relative efficacy of the PCM among women who chose to communicate with the PCM in Spanish versus English. Results: Of 1,346 women in this analysis, 63% were Spanish speakers. Whereas the PCM intervention increased cancer screening rates generally, Spanish-speaking women seemed to benefit disproportionately more than English-speaking women for cervical cancer screening (unadjusted odds ratio, 1.77; 95% confidence i...
Health Education & Behavior, 2006
Cancer is the number one cause of death for Asian American women, yet they have the lowest rates of cancer screening. Contributing factors, particularly for Hmong women, include the lack of culturally and linguistically appropriate educational interventions. This study aimed to develop a culturally and linguistically appropriate intervention to improve the breast cancer screening rates among Hmong women in Fresno and San Diego, California. Intervention elements included the development of a flipchart, brochure, and video that presented basic breast health and screening information, along with the targeting of not only women but men to support their wives'breast cancer screenings. Analyses of pre-and postworkshop surveys showed increases in knowledge and more positive attitudes among all participants, behavioral intentions for clinical breast examinations and mammograms among women, and support for such exams and possible cancer treatment among men. Implications for further research and practice are discussed.