Development and psychometric validation of the Colorectal Cancer Literacy Scale-Uruguay Version.

Colorectal cancer is a leading cause of cancer death in Uruguay, yet less than half of the eligible population is up to date with screenings. Research is hampered because no measures exist to assess psychosocial factors that influence screening decisions in this population. To address this gap, we report on the development and psychometric validation of the Colorectal Cancer Literacy Scale-Uruguay Version, a scale based on the health literacy model. We developed an item pool based on the extant literature, obtained feedback from experts, and conducted focus groups with community participants and health care providers. After revision, we conducted a psychometric validation with a national community sample of 405 participants. Through an exploratory factor analysis, we identified four factors that were collapsed into two for theoretical and pragmatic reasons, representing (a) disposition toward cancer prevention and (b) attitudes, beliefs, and emotions about cancer. A third factor, knowledge about colorectal cancer, was examined separately given its distinct focus. Subsequently, we conducted a confirmatory factor analysis with the remaining sample participants using Rasch measurement theory for validation purposes and to further assess the scales' psychometric properties. The resulting 44-item scale presented a good model fit with adequate EAP reliabilities and good initial discriminant validity. Further criterion-related validity analyses should be performed when additional measures are available. The Colorectal Cancer Literacy Scale-Uruguay Version is a theoretically based measure that can bring to light barriers and facilitative factors in an underscreened population at risk. Implications for theory, research, and practice are discussed.

Creating community: Expanding access to psychosocial programs for Latina breast cancer survivors.

OBJECTIVE: Breast cancer survivors often derive benefits from psychosocial interventions, but less is known about Latina women's experiences. Given the disproportionately high disease burden faced by Latina survivors, it is critical to examine ways to enhance access for this population. Thus, the present study aimed to (a) examine women's perceptions of factors associated with effective delivery of a psychosocial program designed for Spanish speaking women with limited access to care, and (b) identify the mechanisms by which the program enhanced women's psychological well-being. METHODS: In a qualitative study, in-depth interviews were conducted with 15 immigrant Latina breast cancer survivors who previously received psychosocial services at a community-based organization. Grounded theory was used to analyze the data. RESULTS: Through open, axial, and selective coding, we arrived at the core category achieving a sense of community. The psychosocial program promoted access and enhanced women's psychological well-being by creating a sense of community among participants. This was facilitated by three primary aspects of service provision: access factors, a holistic approach to health, and therapeutic factors imparted through a biweekly support group. CONCLUSIONS: Psychosocial services promoted a sense of community among Latina breast cancer survivors while reflecting their cultural values and unique psychosocial needs. Findings may guide the development of interventions to increase access to care, enhance health outcomes, and create and maintain a sense of community among medically underserved populations.

Colorectal cancer screening in Uruguay: current assessment and roadmap for the future.

Cancer is a leading cause of death worldwide and is expected to remain a public health concern for years to come. Within Latin America, Uruguay has the highest colorectal cancer rates. Heeding past calls to action, in this article we provide a critical assessment of colorectal cancer needs and opportunities in Uruguay with a focus on developing a roadmap for future action. First, we provide an overview of risk factors, screening procedures and guidelines, and screening rates. Next, we provide an overview of psychosocial factors that influence colorectal cancer screening, with the goal of providing guidance for future behavioral health promotion initiatives in Uruguay. In this effort, we present four conceptual models that may be used for interventions: the ecological systems theory, informed decision-making, the health beliefs model, and the health literacy model. Subsequently, we propose using an integrated model based on the ecological systems theory and health literacy model to develop national, local, and community-based interventions to increase screening rates and lower the colorectal cancer burden in Uruguay. We close the paper with a summary and implications section, including recommendations for future research programs focused on the assessment of factors that influence screening.

"I never heard anything about it": Knowledge and psychosocial needs of Latina breast cancer survivors with lymphedema.

OBJECTIVE: Breast cancer is the most commonly diagnosed form of cancer and the leading cause of cancer-related death among Latina women in the United States. One aspect of recovery that has been underrepresented in the English-language literature is the recovery of Latina women who have developed lymphedema, a debilitating condition characterized by persistent swelling of the arm, hand, chest, and/or breast. To fill this research gap, a study was conducted to examine the lived experiences of Latina women with breast cancer-related lymphedema. METHODS: Given the limited scholarship on this topic, qualitative methods were used to obtain a foundational and nuanced understanding of Latina women's experiences. Semi-structured interviews were conducted with a sample of 10 Latina survivors with breast cancer-related lymphedema. Data were analyzed through thematic analysis and constant comparison methodology. RESULTS: The data analysis yielded three major themes: knowledge of lymphedema, impact of lymphedema diagnosis, and coping with lymphedema. Participants had limited knowledge of lymphedema and its risk factors upon diagnosis, in addition to barriers accessing quality care. They also noted psychological distress related to a significant financial burden as well as social anxiety related to interacting with others while wearing compression gloves or sleeves. A major coping strategy was receiving social support from friends, family, peers in structured support groups, and spiritual/religious groups or practices. CONCLUSIONS: Our findings bring to light contextual factors that may place Latina breast cancer survivors at increased risk for lymphedema and for experiencing a high burden managing their condition. Recommendations are provided for primary, secondary, and tertiary prevention.

Colorectal cancer screening in Uruguay: current assessment and roadmap for the future

Abstract Cancer is a leading cause of death worldwide and is expected to remain a public health concern for years to come. Within Latin America, Uruguay has the highest colorectal cancer rates. Heeding past calls to action, in this article we provide a critical assessment of colorectal cancer needs and opportunities in Uruguay with a focus on developing a roadmap for future action. First, we provide an overview of risk factors, screening procedures and guidelines, and screening rates. Next, we provide an overview of psychosocial factors that influence colorectal cancer screening, with the goal of providing guidance for future behavioral health promotion initiatives in Uruguay. In this effort, we present four conceptual models that may be used for interventions: the ecological systems theory, informed decision-making, the health beliefs model, and the health literacy model. Subsequently, we propose using an integrated model based on the ecological systems theory and health literacy model to develop national, local, and community-based interventions to increase screening rates and lower the colorectal cancer burden in Uruguay. We close the paper with a summary and implications section, including recommendations for future research programs focused on the assessment of factors that influence screening.

Development and Evaluation of a Cancer Literacy Intervention to Promote Mammography Screening Among Navajo Women: A Pilot Study.

PURPOSE: Develop and evaluate a mammography intervention that provides hope about cancer prevention and treatment. DESIGN: Pilot randomized controlled trial. SETTING: Two communities on the Navajo Nation. PARTICIPANTS: Navajo women and support persons. INTERVENTION: Both groups received standard care: one home visit discussing mammography pros/cons and barriers. The treatment group received an intervention based on Navajo language via an additional home visit with health education materials (written and oral) in English and Navajo, including a Navajo Cancer Glossary with a new descriptive phrase for cancer. ANALYSIS: Between control and intervention conditions, we compared baseline sociodemographics; changes from baseline to 3 months on mammography completion and breast cancer literacy scores. MEASURES: (1) intervention feasibility; (2) self- and clinic-reported mammography screening completion; (3) breast cancer literacy. RESULTS: A total of 25 participants were randomly assigned (13 treatment, 12 control), with 7 support persons in each arm. Mean age was 53 years, 90% had a high school degree or higher, 86% spoke Navajo and English. At 3 months, 44% had a clinically verified mammogram. Mammography completion was 57% among those with a support person and 27% among those without (P = .14). Intervention women reported more breast cancer beliefs consistent with mammography (P = .015). CONCLUSIONS: Increases in breast cancer beliefs consistent with mammography show promise. Findings highlight a need to tailor education materials to Navajo culture/language and focus on enhancing support.

Mexican American College Men's (Mis)Understandings About HPV and Cervical Cancer.

Latinas have disproportionally high rates of cervical cancer in part due to their reliance on Latino partners to make sexual health decisions, their limited knowledge about human papillomavirus (HPV), and inconsistent Pap smear screening behaviors. In this qualitative study, we examined the sexual health beliefs of Latino college men regarding HPV. Participants included 6 Mexican American college students from a large Midwestern university. We conducted 18 in-depth individual interviews about men's beliefs, attitudes, and knowledge about HPV. Through theme analysis, we identified 4 themes suggesting that participants' limited knowledge of HPV places their female partners at risk. Implications for health promotion programming are discussed.

Adapting a Cancer Literacy Measure for Use Among Navajo Women.

PURPOSE: The authors designed a community-based participatory research study to develop and test a family-based behavioral intervention to improve cancer literacy and promote mammography among Navajo women. METHOD: Using data from focus groups and discussions with a community advisory committee, they adapted an existing questionnaire to assess cancer knowledge, barriers to mammography, and cancer beliefs for use among Navajo women. Questions measuring health literacy, numeracy, self-efficacy, cancer communication, and family support were also adapted. RESULTS: The resulting questionnaire was found to have good content validity, and to be culturally and linguistically appropriate for use among Navajo women. CONCLUSIONS: It is important to consider culture and not just language when adapting existing measures for use with AI/AN (American Indian/Alaskan Native) populations. English-language versions of existing literacy measures may not be culturally appropriate for AI/AN populations, which could lead to a lack of semantic, technical, idiomatic, and conceptual equivalence, resulting in misinterpretation of study outcomes.

"Our organs have a purpose": body image acceptance in Latina breast cancer survivors.

OBJECTIVE: Studies examining body image concerns among breast cancer survivors have primarily captured the experiences of non-Latina white women. Thus, little is known about body image concerns among Latinas. To address this gap, we examined Latina breast cancer survivors' lived experiences related to body image. METHODS: Twenty-seven Latina breast cancer survivors provided data through focus groups and individual interviews as part of a larger study conducted by the first author. In the current paper, we conducted a secondary thematic analysis to uncover women's experiences unique to body image concerns. RESULTS: We identified 2 themes related to women's experiences with body image: (a) perceptions of loss and reconstruction and (b) process of achieving body image acceptance. The salience of these themes varied as a function of survivorship stage and type of surgery. CONCLUSIONS: Body image concerns are distressing for Latina breast cancer survivors. Accepting their altered appearance was an ongoing and complex process. Clinical implications include the need for psychoeducational programs and tailored interventions to enhance women's body image acceptance.

Essential Qualitative Inquiry in the Development of a Cancer Literacy Measure for Immigrant Women.

In this article, we describe the development of a comprehensive measure of breast and cervical cancer literacy for immigrant populations. To our knowledge, this is the first attempt to use a health literacy framework in this endeavor. Using qualitative strategies, we (a) developed an understanding of the experiences of Mexican and Filipina immigrant women with low health literacy through individual interviews, (b) conducted focus groups to obtain feedback from experts and participants to determine the adequacy of items included in the measure, and (c) refined the set of items to create an empirically based measure. The final measure included 129 items that assess beliefs, attitudes, knowledge, emotions, and contextual factors related to breast and cervical cancer. Processes for adapting the measure for use with other immigrant groups are discussed.

Suddenly, a carriage appears: social support needs of Latina breast cancer survivors.

Through focus groups and individual interviews, data were gathered on the emotional, informational, and instrumental support needs of 22 immigrant Latina women. A thematic analysis revealed that participants who perceived to receive social support reported less psychological distress and better adjustment to breast cancer than those who did not perceive this support. Types and sources of support varied across survivorship stages. Many needs were related to financial, linguistic, and cultural barriers participants encountered in the course of the disease. Based on the findings, we conclude with several clinical recommendations to improve the quality of life in this medically underserved population.

Design elements for the development of cancer education print materials for a Latina/o audience.

Health educators can help reduce cancer disparities in Latino populations through the creation of effective print materials. In this effort, the National Cancer Institute conducted a comprehensive needs assessment to identify key design elements of cancer education programs and create a cost-effective process that would ensure consistency in the development of materials. This article introduces the Checklist of Design Elements for the Development of Cancer Education Print Materials for Latina/o Audiences (CEMLA), which includes a total of 10 design elements related to the process of developing materials and content. Using social learning theory as a theoretical framework, design elements are included that reflect cultural sensitivity at the surface and deep structure levels. This is the most comprehensive effort to date to integrate and synthesize theory and application in the design of materials for this audience.

Latina breast cancer survivors' lived experiences: diagnosis, treatment, and beyond.

Latina breast cancer survivors are not benefiting from advances in psychosocial interventions. Despite their greater breast cancer burden, there is a dearth of information about this population. This qualitative study examined the experiences of 18 immigrant Latina breast cancer survivors along the survivorship continuum, from diagnosis to long-term survivorship. The authors conducted separate focus groups with women in the acute, reentry, and long-term survivorship stages. Through grounded theory analysis, the authors uncovered 5 themes of experience: perceptions of psychological well-being, impact of diagnosis, impact of treatment, need for social support, and development of new attitudes. Some themes were applicable across all survivorship stages, whereas others were more salient at a particular stage. Within themes, the authors identified experiences reported in the general literature (i.e., the debilitating effect of chemotherapy) and distinct cultural experiences (i.e., fear that a cancer diagnosis leads to certain death). Results suggest that treatments tailored for each survivorship stage are more likely to be effective than generic interventions. These findings have the potential to lessen health disparities in utilization of psychosocial treatments by Latina breast cancer survivors.

Differences in predictors of cervical and breast cancer screening by screening need in uninsured Latino women.

BACKGROUND: Latino women experience higher mortality for cervical cancer and lower 5-year survival for breast cancer than non-Latino White women. Adherence with screening recommendations can increase chances of survival, yet the factors that influence screening behaviors in uninsured women are not well documented. METHODS: Uninsured Latino women (N = 467) recruited in four US cities participated in the study. Logistic regression was used to model adherence to recommendations by screening type (cervical or breast cancer) and screening need (needs to obtain initial screening, overdue for rescreening, up-to-date with rescreening). RESULTS: Predictors differed by type of screening and screening need. Women who reported exposure to cancer education were more likely to have had a mammogram and to be up-to-date with Pap smear screening than women without such exposure. Women who were younger, had more than a sixth grade education, and/or had children were more likely to have had a Pap smear. Older women who had been in the US the longest were more likely to be overdue for a Pap smear. Women with incomes 5000 to 7000 were more likely to have obtained a mammogram. Regional differences were found with respect to mammography screening and maintenance behaviors. CONCLUSIONS: Exposure to cancer education is an important predictor of screenings among uninsured urban Latino women. The potential of creating educational interventions that can increase screening rates among women who evidence health disparities is encouraging. Recruitment strategies to reach women in need of screenings are provided.

Latina college students' sexual health beliefs about human papillomavirus infection.

To examine Latina college students' sexual health beliefs about human papillomavirus (HPV), 16 self-identified Latina college students from a large Midwestern university participated in three focus groups. The authors found that participants' knowledge of HPV and cervical cancer was extremely low. Women did not obtain Pap screenings consistently, nor did they use condoms in a consistent manner. They perceived that cultural norms that support silence about sexual topics hinder their knowledge acquisition about sexual issues. Participants also recognized that their insufficient knowledge could jeopardize their health and expressed a willingness to actively stop this intergenerational cycle of silence within their families. Findings highlight the importance of incorporating cultural considerations when designing research and educational programs with Latina college students.

Breast cancer detection among older Latinas: is it worth the risk?

Fifty-eight Latinas participated in focus group interviews to assess their perceptions about screening to detect breast cancer (BC). Grounded theory methods helped uncover a cultural explanatory model that explained how cultural and psychosocial dynamics influence BC screening decisions. According to this model, Latinas generally perceived BC screening as a risky behavior. Three themes emerged that influenced the amount and type of perceived risks: feeling healthy (i.e., perceptions about the etiology of the illness and its nature), feeling indecent (i.e., the behaviors involved in screening), and feeling threatened (i.e., the anticipated consequences of BC detection). Screening was perceived as risky because of many personal and interpersonal consequences associated with detecting BC. Latinas' subjective assessment that detecting BC is too risky might influence their participation in screening procedures. Health education programs should aim at helping Latinas perceive that the early detection of BC is a life-saving benefit that outweighs its perceived risks.

Chinese immigrant mothers of adolescents: self-perceptions of acculturation effects on parenting.

Immigrant families in the United States experience many adjustments, including the challenge of parenting in a new context. The relationship between self-perceptions of parenting behavior and mothers' perceived acculturation levels for themselves and their children was examined in 95 Chinese immigrant mothers. Data showed that mothers perceived their children as more acculturated than themselves, mothers reported a great need to learn more about how their children are growing up today, a larger perceived acculturation gap was associated with more parenting difficulties, and several factors contributed to perceptions of a more favorable parenting experience. Culturally responsive methodologies used in the translation and administration of measures, and specific modifications made to develop the Chinese version of the Parent Success Indicator, are discussed.

The abbreviated multidimensional acculturation scale: empirical validation with two Latino/Latina samples.

Two studies were conducted to develop and examine internal consistencies and validate the Abbreviated Multidimensional Acculturation Scale. Study 1 participants were 156 Latino/Latina college students. Findings indicated good internal reliabilities for all 3 subscales. Adequate concurrent validity was established with length of residence in the United States. The scale also showed adequate convergent and discriminant validity. Study 2 participants were 90 Latino/Latina community members. The subscales were also reliable and showed adequate concurrent validity with length of residence in the United States. Convergent and discriminant validity were also adequate. Construct validity was further demonstrated through factorial analyses of the combined samples (N = 246). Three separate factors emerged: cultural identity, language competence, and cultural competence.