Decrease Cervical Cancer Incidence among Asian American Women

1. Significant disparities in cervical cancer incidence and mortality exist among Asian American women (Fang, Ma, & Tan, 2011).
2. The problem is decreased rates of routine cervical cancer screening due to limited patient knowledge and cultural beliefs.
3. Target Population: Asian American women ages 26-65

2. Literature Review
   1. Clarity/Significance of the problem
      1. Screening rates among Asian Americans are much lower than other ethnic groups in the U.S and fall below recommended guidelines (Hou, Sealy & Kabiru, 2011).
   2. Epidemiology
      1. Laotian, Samoan, and Vietnamese women have highest cervical cancer rates in the U.S. (Office on Women’s Health [OWH], 2010). 
   3. Barriers to Change/Contributing Factors:
      1. Common barriers include shyness, poor health knowledge, limited social support, access barriers, and fear of cancer (Hou, Sealy, & Kabiru, 2011). 
      2. Other Factors - Psychosocial (Lor, Khang, Xiong, Moua, & Lauver, 2013)
         1.  Embarrassment of discussing private health matters
         2.  Asian women are expected to be passive in nature
   4. Current Approaches
      1. One-on-one education
      2. Group education 
      3. Entertainment education (Love, Mouttapa, & Tanjasiri, 2009).
      4. Recall methods: postal letter, message by phone, or phone call 
3. Purpose of the Paper
   1. Discuss contributing factors related to decreased cervical cancer screening rates among Asian American women
   2. Propose an intervention intended to raise awareness in efforts to increase screening (and decrease incidence and mortality.) 
4. Theoretical Frameworks
   1. Health Promotion Model
      1. Defines health as a positive dynamic state, takes into account individual characteristics and experiences, such as personal socio-cultural factors.
   2. Cultural Care Theory
      1. Beliefs, values, and habits affect health
   3. Linking framework to problem/intervention
      1. Educational material that will incorporate beliefs and values may decrease cultural barriers
      2. Patients aware of personal socio-cultural factors will increase knowledge that may influence behavioral health outcomes
5. Intervention
   1. Program is intended to provide a culturally tailored and linguistically appropriate educational pamphlet about the importance & guidelines of routine screening

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1. Goal of the intervention: to increase knowledge and screening rates among the target population
2. Implementation
   1. Design educational pamphlet (Appendix A)
      1. Current data, facts and statistics about cervical cancer rates
      2. Information about cultural beliefs/ barriers
      3. Pertinent knowledge about pathophysiology of cervical cancer
      4. Importance of cervical cancer screening/Risks and Consequences
   2. Translation into multiple languages (Chinese, Vietnamese, Laotian, Korean)
   3. Distribution
      1. Access in communities – community based clinic
      2. Asian Health Services (Oakland, CA)
   4. Design cervical cancer questionnaire (Appendix B)
      1. 10 multiple choice items to test areas of:
         1. General information about cervical cancer/definition, prevalence/incidence rates, causes, risk factors, symptoms, examination process, treatment and prevention (Choi, 2013)
3. Evaluation 
   1. Method/Tool
      1. Questionnaire Format (10 Multiple Choice Items)
      2. 100 women participants (N=100)
   2. Control = Baseline questionnaire (Pre-Test)
   3. Measurement of Knowledge
      1. Pre-Test & Post-Test
      2. Participants will complete questionnaire before and after the intervention
      3. Results will be compared for learner knowledge
   4. Evaluate intervention based on:
      1. # of pamphlets given
      2. # of participants with increase in post-test scores (increase knowledge)
4. Risk/Benefit
   1. Ethical Considerations
      1. Protecting Participants' Rights:
         1. Voluntary participation, informed written consent, psychological harm (fear, sensitive subject matter)
      2. Protecting Participants' Privacy:
         1. Confidentiality, anonymity, data collection used only for research purposes
5. Healthy Policy Implications
   1. Cost
      1. Problem: Cervical cancer is the leading cause of death among low-resource settings. The “annual direct medical cost of cervical cancer. ... was estimated at $6 billion" (National Business Group on Health [NBGH], 2012).
      2. Impact of Intervention: Preventative services and screening will reduce medical care costs than compared to if intervening at later stages of the disease process.
      3. Consideration of costs for intervention:
         1.  Translation services, time, and printing materials
   2. Access
      1. Problem: Language barrier and poor access to educational materials in multiple languages
      2. Intervention will make information readily available, education pamphlet is feasible in terms of distribution and sustainable across multiple communities, and intervention will increase access to preventative and screening care by eliminating cultural and language barriers.
   3. Quality
      1. Problem: “On average, 26.3 years of life is lost by each women who dies of cervical cancer” (NBGH, 2012).
      2. Impact of Intervention: The intervention will result in improved health and better quality of life by reducing the incidence of cancer (early detection and treatment can prevent 75% of cancers of developing).
6. Conclusion
   1. Asian American women are at higher risk for cervical cancer due to limited knowledge and cultural barriers leading to decreased cervical cancer screening
   2. The proposed intervention is intended to provide a culturally tailored and linguistically appropriate educational pamphlet
   3. The goal of the intervention is intended to increase knowledge about the importance of cervical cancer screening
   4. The intervention will be evaluated with a pre-post test questionnaire method used to measure learner knowledge
   5. Health Policy Implications of cost, access, and quality were considered during the proposed intervention

References:

Choi, S. (2013). Development of an Educational Program to Prevent Cervical Cancer among Immigrants in Korea. Asian Pacific Journal of Cancer Prevention, 5345-5349.

Fang, C. Y., Ma, G. X., & Tan, Y. (2011). Overcoming barriers to cervical cancer screening among Asian American women. North American Journal of Medicine & Science, 4(2), 77-83.

Hou, S. I., Sealy, D. A., & Kabiru, C. W. (2011). Closing the disparity gap: Cancer screening interventions among Asians--a systematic literature review. Asian Pacific Journal of Cancer Prevention : APJCP, 12(11), 3133-3139. 

Lor, M., Khang, P., Xiong, P., Moua, K., & Lauver, D. (2013). Understanding among women's beliefs, Feelings, norms, and external conditions about breast and cervical cancer screening. Public Health Nursing, 420-428. doi: 10.1111/phn.12043. 

Love, G., Mouttapa, M., & Tanjasiri, S. (2009). Everybody's talking: Using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women. Health Education Research, 829-838. doi: 10.1093/her/cyp019.

National Business Group on Health (2012, October 01). Cervical cancer (screening): Evidence statement. Retrieved from https://www.businessgrouphealth.org/preventive/topics/cervical_cancer.cfm

Office on Women’s Health [OWH], (2010). Minority women’s health: Cervical cancer. Retrieved from http://womenshealth.gov/minority-health/asian-americans/cervical-cancer.html