1

Breast-Health Screening Perceptions of Chinese Canadian

Immigrant Women

Immigrant & Racialized Women’s Health Conference

February 21, 2014

Heidi Sin RN, PhD

2

OutlineProblem and purpose of the studyApproachResearch questions Study participantsData collection Results and InterpretationRecommendationsImplications for Practices

3

ProblemBreast 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 DesignQualitative 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 SubquestionsTypes of preventive health measuresPerceived 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 populationChinese 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 InterpretationsSubquestion 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 InterpretationsSubquestion 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 InterpretationsSubquestion 3: What are the obstacles to breast-health screening for Chinese Canadian immigrant women?

Theme: Accessibility to and utilization of screening services

Lack of knowledgeInconvenienceLanguage proficiency EmbarrassmentPerceived illnessRadiationCost

13

Results and InterpretationsSubquestion 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 participationLack of preventive health conceptPerceived illnessesAwareness of breast cancer impact

14

Results and InterpretationsSubquestion 4: What are the females’ perceptions of condition, situations, or contexts that influence their lived experiences with breast-health screening?

Theme: Experiences affect participationPositive / negative perceptions of screeningSomeone with breast cancerScreening experiencesScreening instructionsPositive / negative emotional responses

15

Results and InterpretationsSubquestion 5: What perceived role does breast-health screening play in Chinese Canadian immigrant women’s health?

Theme: Lack of information about breast-health screening programBenefits of screeningImportance of screeningIndividual responsibility Breast-health screening programCurrent health status

16

RecommendationsDevelop 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

RecommendationsExpand 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 PracticesTo 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

20

Thank you!!

21

ReferencesAnagnostououlos, 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.

22

ReferencesCanadian 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.

23

ReferencesGlanz, 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

24

ReferencesLee-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.

25

ReferencesMorgan, 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 published qualitative 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

26

ReferencesTabar, 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