Development of a cervical cancer control intervention program for Cambodian American women.

Southeast Asian immigrants have lower levels of Pap testing than any other racial/ethnic group in the US, and are particularly unfamiliar with western culture and biomedical concepts of prevention. We completed an ethnographic study (N = 42) focusing on cervical cancer screening among Cambodian American women. We also conducted a community-based survey (N = 413) to examine the generalizability of our qualitative results. This report summarizes the results, and describes how we used our findings to influence the content of a multifaceted intervention program targeting Cambodian immigrants. The following constructs were found to be barriers to cervical cancer control: a traditional orientation to the prevention, causation, and treatment of disease; lack of familiarity with western early detection concepts; low levels of knowledge about cervical cancer; concerns about the Pap testing procedure; and health care access issues. In general, the quantitative results confirmed our ethnographic findings. The intervention program, which is delivered by bicultural outreach workers, includes home visits, presentations at small group meetings, barrier-specific counseling, use of a Khmer-language video, and tailored logistic assistance (e.g., transportation and medical interpretation). Both the video and presentation provide cultural context while simultaneously addressing multiple barriers to screening (e.g., women's fear of surgery and preference for female providers). Outreach workers are trained to counsel women about 10 potential barriers including avoidance of biomedicine, perceptions that gynecologic exams are embarrassing, and lack of English proficiency. Our results reinforce the importance of considering health problems within the context of a population's traditional belief systems and daily routines.

Use of qualitative methods to study diet, acculturation, and health in Chinese-American women.

Improving the health status of minority populations in the United States is a major public health challenge. This report describes an anthropological approach to obtaining information needed for designing and evaluating a culturally appropriate dietary intervention for Chinese-Americans. Ninety-minute qualitative interviews were conducted with 30 less-acculturated Chinese-American women in their native language (Cantonese or Mandarin), soliciting information from participants regarding usual food consumption; knowledge, attitude, and beliefs about diet and disease; and factors that influence food choices. Interviews were recorded, translated, transcribed, and coded for themes. Two focus groups with 6 participants each were conducted to cross-validate the interview findings. Among our participants, breakfast was usually the first meal to be "Westernized," largely for reasons of convenience. Food quality, cost, and availability were some of the most important predictors of dietary change after immigration to the United States. Respondents said that there was a strong connection between diet and disease. However, they were not familiar with US dietary guidelines, food labels, or other sources of dietary information, but reported that friends and Chinese newspapers were their primary source of nutrition information. We used these findings to develop quantitative dietary survey instruments adapted for Chinese-Americans. This type of qualitative groundwork is an important precursor to the design, implementation, and evaluation of dietary interventions for minorities.

Bridging cultures through the development of a cervical cancer screening video for Cambodian women in the United States.

BACKGROUND: Southeast Asian women have higher invasive cervical cancer rates than any other U.S. racial/ethnic population subgroup, and their levels of Pap testing do not even approach the year 2000 goals. Video is a particularly useful medium for cancer education in Cambodian refugee communities because of low literacy levels and high rates of VCR ownership. METHODS: The authors produced a motivational Pap-testing video for Cambodian American women. The 18-minute Khmer-language video is entitled "The Preservation of Traditions." Content, with respect to cervical cancer screening barriers and facilitators, was guided by intensive qualitative data collection. Barriers addressed were: beliefs that traditional postpartum practices protect against cervical disease, Cambodians do not get cervical cancer, and screening is unnecessary; fear of cancer as well as surgery; lack of understanding about preventive concepts and familiarity with the Pap test; concerns about embarrassment and pain; and problems with transportation and child care. Facilitators included the availability of female physicians and interpreters. A community coalition of Cambodian women and two community advisors participated in all aspects of the video development and production. Video techniques frequently used in American productions were adapted to the target audience. For example, cultural context was provided, use of biomedical terminology minimized, role modeling emphasized, and testimonial accounts avoided. CONCLUSION: The processes used to translate empirical evidence into meaningful educational messages, and to adapt American behavioral change techniques to Cambodian cultural norms, are generalizable to other less acculturated immigrant groups and cancer education topics.