When Social Work Client Self-Determination Principle Meets Confucius Culture: A Living Will Decision-Making Case Study in China.

Background. In western countries like the United States of America, living will is seen as a vehicle for achieving greater wisdom and skill in a fundamental aspect of health care and a civilized approach to mortality. However, the inception of living will in China emerged only a decade ago. Although, nowadays, Chinese medical social workers can provide living will service in health settings, their services are in a preliminary status. Objective. This exploratory case study aims to present an ethical dilemma and analyzes the reasons the social work client self-determination principle failed in living will decision-making in the oncology ward that has Confucius as a cultural context. Results. This case illustrates that the patient's family has the final say in living will decision-making. The social work principle of client self-determination exemplifies the difficulties of applying medical social work practices with living will to Chinese patients in hospital wards. Conclusions. Chinese patients and their families are still bound to Confucianism's long tradition. In China, individuals are still being defined by relationships, and the "self" exists only in a hierarchical interpersonal network known as the differential pattern. The Chinese people do not like to talk about death. Even in modern society, it will take time for the Chinese people to come to terms with the end-of-life planning with living will, mainly for cancer patients after diagnosis. Practice Implications. Future social work practices that implied living will similar to this case that has Confucius culture in the background should consider the cultural context where the social worker-client are situated and the types of social work values the profession hold.

Increasing hepatitis B screening for hmong adults: results from a randomized controlled community-based study.

BACKGROUND: Hepatitis B-linked liver cancer disproportionately affects Hmong Americans. With an incidence rate of 18.9 per 100,000, Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites. Serologic testing for the hepatitis B virus (HBV) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk. METHODS: Academic researchers and Hmong leaders collaborated in the design, conduct, and evaluation of a 5-year randomized controlled trial testing a lay health worker (LHW) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation. RESULTS: Intervention group participants were more likely to report receiving serologic testing for HBV (24% vs. 10%, P = 0.0056) and showed a greater mean increase in knowledge score (1.3 vs. 0.3 points, P = 0.0003) than control group participants. Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [OR 3.5; 95% confidence interval (CI) 1.3-9.2], improvement in knowledge score (OR 1.3 per point; 95% CI 1.02-1.7), female gender (OR 5.3; 95% CI 1.7-16.6), and having seen a doctor in the past year at baseline (OR 4.8; 95% CI 1.3-17.6). The most often cited reason for testing was a doctor's recommendation. CONCLUSIONS: LHWs were effective in bringing about HBV screening. Doctor visits and adherence to doctors' recommendations were pivotal. Participation of health care providers is essential to increase HBV testing. IMPACT: LHWs can significantly increase HBV screening rates for Hmong but their doctors' recommendation is highly influential and should be pursued.

Mental health status of the Hmong Americans in 2011: three decades revisited.

This article provides a comprehensive overview of the Hmong in America and encompasses their mental health status for the past 35 years. Since their mass arrival to the United States in 1975, limited research has been compiled to track the specific mental health issues that affect this collective community alone. Major chronological research findings were compiled for this article and specific findings concerning the Hmong and their mental health issues were compared to findings for other Southeast Asian groups. In conclusion, the findings of this article indicate that the Hmong still have higher rates of being diagnosed with depression, the lowest help-seeking behaviors in utilizing Western medicine, and the lowest arithmetic average of "happiness" scaled on an assessment tool. The purpose of this article is to better steer future research projects that entail tracking and differentiating the specific mental health domains of the Hmong.

Factors associated with pap testing among Hmong women.

This paper reports the baseline data on the proportion of Hmong women (n=402), ages 18-65, in Sacramento, California who reported that they had a Pap test for the early detection of cervical cancer. We assessed the association between sociodemographic characteristics and Pap test receipt using chi-squared and multiple logistic regression analyses. Only 74% had ever had a Pap test, with 61% tested in the previous three years, compared with 91% and 86%, respectively, of California women overall. Women were more likely to have had a recent Pap test if they were age 21-30 (OR=3.0 vs. age 51-65, 95% CI 1.4-6.7) or 31-40 (OR=3.0, 95% CI 1.4-6.4), and less likely if they were single (OR=0.4 vs. married/partnered, 95% CI 0.2-1.0) or born in the U.S. (OR=0.3 vs. <10 years in U.S., 95% CI 0.1-0.8).

Access to Adequate Healthcare for Hmong Women: A Patient Navigation Program to Increase Pap Test Screening.

This paper describes the development and implementation of a Hmong Cervical Cancer Intervention Program utilizing a patient navigation model to raise cervical cancer awareness for Hmong women through educational workshops and to assist Hmong women in obtaining a Pap test. Out of 402 women who participated in a baseline survey, the Patient Navigation Program was able to enroll 109 participants who had not had a Pap test in the past 3 years and had never had a Pap test. Through utilization of outreach, an awareness campaign and patient navigation support, at least 38 percent of 109 participants obtained a Pap test. Overall, 21 workshops and 43 outreach activities were conducted by the Hmong Women's Heritage Association, leading to 63 percent of those enrolled in the Patient Navigation Program who could be contacted to obtain a Pap test.