Validation of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool for postnatal depression in Samoan and Tongan women living in New Zealand.

AIM: To validate the EPDS as a screening tool for postnatal depression in Samoan and Tongan women living in New Zealand. METHODS: 85 Samoan and 85 Tongan women who delivered babies at Middlemore Hospital from February 2009 to June 2010 completed the EPDS questionnaire and from 4 weeks after delivery followed by an interview using a Composite International Diagnostic Interview (CIDI) within 4 weeks of the EPDS completion. RESULTS: The EPDS in English, Tongan and Samoan languages is a valid and consistent tool for screening for PND in Samoan and Tongan women. A cut-off score of ≥10 for Tongan and ≥11 for Samoan women gave the best sensitivity (80%) and specificity (80%) combination whereas a higher cut-off of ≥16 for Tongan and ≥17 Samoan women gave the best positive predictive value (82%) and negative predictive value (86%) for serious depression. The lower cut-off scores correctly diagnosed 82% and the higher cut-offs more than 87% of women with serious depression. CONCLUSION: The EPDS was an acceptable and valid tool for PND screening in English, Samoan and Tongan languages amongst Samoan and Tongan women. The cut-offs for PND screening were dissimilar in the two groups with a ≥10 for Tongan and ≥11 for Samoan women. A higher cut-off of ≥16 for Tongan and ≥17 for Samoan women improves the predictive value of the instrument.

Tongan perceptions of cancer.

BACKGROUND: There is little published information about cancer-related knowledge, attitudes, and preventive behaviors of Tongans in the United States. The purpose of this study was to evaluate answers to the following questions: What is cancer? What causes cancer? And what can you do to prevent cancer? METHODS: We completed face-to-face, semi-structured interviews with 48 self-reported Tongans (16 men and 32 women) over the age of 18 years, selected through non-probability purposive sampling with help from Tongan community-based organizations. The questions regarded demographic characteristics, and cancer-related knowledge, attitudes and preventive behaviors. The research settings were San Mateo, California and Salt Lake City, Utah. We analyzed the data using qualitative content analysis of individual interviews to identify themes. RESULTS: All but one of the 48 participants had migrated to the U.S. from Tonga. The average income was approximately $3100 per month and average household size was six. Fewer than half of participants had health insurance. The theme that cancer was equivalent to death was pervasive through all the responses. Weaknesses in the body and exposure to toxins in the environment were dominant themes in the causation of cancer. Leading a healthy life and prayer were among the preventive measures cited by the respondents. CONCLUSION: The association of cancer with death is a strong indication that cancer information is not reaching this community. Interventions must take this into account and include Tongan cancer survivors in order to enhance the effectiveness of early screening efforts.

Tongan-American women's breast cancer knowledge, attitudes, and screening behaviors.

OBJECTIVE: Breast cancer is the most common cancer for many Pacific Islander American populations, but virtually nothing is known about the cancer risks and screening behaviors of many specific ethnic subgroups. This paper examines the breast cancer risk, knowledge, attitudes, and screening behaviors of Tongan-American women. DESIGN: Research activities were conducted in 3 phases: determination of cancer proportional ratios using data from the California Cancer Registry, exploratory focus groups conducted with 22 women, and self-administered surveys from 303 women (for a response rate of 92%). SETTING AND PARTICIPANTS: Survey respondents were Tongan-American women aged 40 years and older, residing in Los Angeles and Orange Counties. RESULTS: The breast is the most common cancer site for Tongan women, followed by the cervix and uterus, lung and bronchus, and stomach. The proportion of all cancers accounted for by breast cancer is lower among Tongan women (0.8) compared to White women. We found low rates for all types of breast cancer screening: only 40% of respondents had ever performed a breast self-examination (BSE); 26% ever received a clinical breast exam (CBE); and 25% ever received a mammogram. Many misperceptions existed about breast cancer causes, signs, and symptoms as well as the role of screening in detecting pre-symptomatic cancers. CONCLUSIONS: Much emphasis needs to be placed on improving early breast cancer screenings among Tongan-American women, including comprehensive community education, culturally tailored and linguistically appropriate materials, and improved access to low-cost screening sites.