Abstract
Objectives: Cancer screening participation is typically low among newcomers to Canada. Consequently, mortality and morbidity rates are higher in ethno/cultural populations. There are inherent challenges in reaching these population groups to increase awareness and participation in cancer screening. Many reports have cited the need for culturally appropriate materials and multi-pronged strategies for effective outreach in the Chinese community. This paper outlines the consultation/development process and evaluation strategy for promoting cancer screening among Chinese women with limited English language skills.
Participants: As Chinese is the third most commonly spoken language in Canada, this community education project focused on health promoters providing services to Chinese women 50 years and older.
Setting: Ontario communities.
Intervention: Partners and stakeholders were consulted and engaged to define the best approach to develop and distribute culturally sensitive public education resources to assist communities in realizing greater awareness of and participation in cancer screening.
Outcomes: Customized resource kits were developed and distributed to the target population over the course of two phases of this project. An evaluation strategy was designed and implemented to assess the impact of the project.
Conclusion: The process to develop culturally sensitive and evidence-based materials for Chinese is detailed in this article. This multi-year project designed and distributed customized resource kits, through consultation with partners and stakeholders. Project outcomes will be further assessed one year after distribution of the kits.
Keywords: Underscreened, Chinese, cancer screening, vulnerable populations, ethno-cultural intervention, project process
Résumé
Objectifs: La participation au dépistage du cancer est habituellement faible chez les nouveaux arrivants au Canada. Par conséquent, les taux de mortalité et de morbidité sont plus élevés chez les populations ethnoculturelles. Il existe des défis inhérents à surmonter pour atteindre ces groupes de la population afin de les sensibiliser davantage et d’accroître leur participation au dépistage du cancer. De nombreux rapports ont cité le besoin de documents pertinents sur le plan culturel et de stratégies à volets multiples afin d’atteindre efficacement la collectivité chinoise. Cet article souligne le processus d’élaboration et de consultation ainsi que la stratégie d’évaluation pour la promotion du dépistage du cancer chez les Chinoises ayant une connaissance limitée de l’anglais.
Participants: Étant donné que le chinois représente la troisième langue la plus parlée au Canada, ce projet d’éducation de la collectivité est centré sur les promoteurs de la santé offrant des services aux Chinoises de 50 ans ou plus.
Lieu: Collectivités ontariennes
Intervention: Nous avons consulté les partenaires et les intervenants et leur avons demandé de définir la meilleure méthode pour élaborer et distribuer des ressources d’éducation du public respectueuses de la culture afin d’aider les collectivités à être plus familières avec le dépistage du cancer et à y participer davantage.
Résultats: Nous avons élaboré des trousses de ressources personnalisées et les avons distribuées à la population cible au cours de deux étapes de ce projet. Nous avons conçu une stratégie d’évaluation que nous avons mise en œuvre afin d’évaluer les répercussions du projet.
Conclusion: Dans cet article, nous présentons en détail le processus d’élaboration de documents fondés sur des données probantes et respectant la culture à l’intention des Chinois. Ce projet pluriannuel a permis de concevoir et de distribuer des trousses de ressources personnalisées grâce à des consultations avec des partenaires et des intervenants. Nous évaluerons davantage les résultats du projet un an après la distribution des trousses. Ce modèle de projet peut être utile pour l’adaptation et être utilisé avec d’autres groupes ethnoculturels à l’intérieur et à l’extérieur de l’Ontario.
Mots clés: dépistage insuffisant, Chinois, dépistage du cancer, populations à risque, intervention ethnoculturelle, processus de projet
Footnotes
This project template may be useful for adaptation and use in other ethnocultural groups within and outside Ontario.
Acknowledgement: This project was supported by Cancer Care Ontario.
References
- 1.Hiatt RA, Pasick RJ. Unsolved problems in early breast cancer detection: Focus on the underserved. Breast Cancer Res Treat. 1996;40(1):37–51. doi: 10.1007/BF01806001. [DOI] [PubMed] [Google Scholar]
- 2.Bird JA, McPhee SJ, Ha NT, Le B, Davis T, Jenkins CN. Opening pathways to cancer screening for Vietnamese-American women: Lay health workers hold a key. Prev Med. 1998;27(6):821–29. doi: 10.1006/pmed.1998.0365. [DOI] [PubMed] [Google Scholar]
- 3.Carey Jackson J, Taylor VM, Chitnarong K, Mahloch J, Fischer M, Sam R, et al. Development of a cervical cancer control intervention program for Cambodian American women. J Community Health. 2000;25(5):359–75. doi: 10.1023/A:1005123700284. [DOI] [PubMed] [Google Scholar]
- 4.Do HH, Taylor VM, Yasui Y, Jackson JC, Tu SP. Cervical cancer screening among Chinese immigrants in Seattle, Washington. J Immigr Health. 2001;3(1):15–21. doi: 10.1023/A:1026606401164. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Hiatt RA, Pasick RJ, Stewart S, Bloom J, Davis P, Gardiner P, et al. Community-based cancer screening for underserved women: Design and baseline findings from the Breast and Cervical Cancer Intervention Study. Prev Med. 2001;33(3):190–203. doi: 10.1006/pmed.2001.0871. [DOI] [PubMed] [Google Scholar]
- 6.Taylor VM, Hislop TG, Jackson JC, Tu SP, Yasui Y, Schwartz SM, et al. A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America. J Natl Cancer Inst. 2002;94(9):670–77. doi: 10.1093/jnci/94.9.670. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Kim H, Lee KJ, Lee SO, Kim S. Cervical cancer screening in Korean American women: Findings from focus group interviews. Taehan Kanho Hakhoe Chi. 2004;34(4):617–24. doi: 10.4040/jkan.2004.34.4.617. [DOI] [PubMed] [Google Scholar]
- 8.Yip MP, Tu SP, Chun A, Yasui Y, Taylor VM. Participation in colorectal cancer screening among Chinese Americans. Asian Pac J Cancer Prev. 2006;7(4):645–50. [PubMed] [Google Scholar]
- 9.Kwok C, Sullivan G. Chinese-Australian women’s beliefs about cancer: Implications for health promotion. Cancer Nurs. 2006;29(5):E14–E21. doi: 10.1097/00002820-200609000-00014. [DOI] [PubMed] [Google Scholar]
- 10.Kwok C, Sullivan G. The concepts of health and preventive health practices of Chinese Australian women in relation to cancer screening. J Transcult Nurs. 2007;18(2):118–26. doi: 10.1177/1043659606298503. [DOI] [PubMed] [Google Scholar]
- 11.Robb KA, Solarin I, Power E, Atkin W, Wardle J. Attitudes to colorectal cancer screening among ethnic minority groups in the UK. BMC Public Health. 2008;8(1):34. doi: 10.1186/1471-2458-8-34. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Black M, Yamada J, Mann V, Micucci S. Effectiveness of Strategies to Increase Cervical Cancer Screening in Clinic-Based Settings: A Systematic Review of the Literature 1989–1999. 2000. [Google Scholar]
- 13.Lofters A, Glazier RH, Agha MM, Creatore MI, Moineddin R. Inadequacy of cervical cancer screening among urban recent immigrants: A population-based study of physician and laboratory claims in Toronto, Canada. Prev Med. 2007;44(6):536–42. doi: 10.1016/j.ypmed.2007.02.019. [DOI] [PubMed] [Google Scholar]
- 14.McDonald JT, Kennedy S. Cervical cancer screening by immigrant and minority women in Canada. J Immigr Minor Health. 2007;9(4):323–34. doi: 10.1007/s10903-007-9046-x. [DOI] [PubMed] [Google Scholar]
- 15.Bagley C. Barriers to breast and cervical cancer screening in underserved women of the District of Columbia. Burnett. 1995;22(10):1551–57. [PubMed] [Google Scholar]
- 16.Taylor VM, Jackson JC, Tu SP, Yasui Y, Schwartz SM, Kuniyuki A, et al. Cervical cancer screening among Chinese Americans. Cancer Detect Prev. 2002;26(2):139–45. doi: 10.1016/S0361-090X(02)00037-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Ralston JD, Taylor VM, Yasui Y, Kuniyuki A, Jackson JC, Tu SP. Knowledge of cervical cancer risk factors among Chinese immigrants in Seattle. J Community Health. 2003;28(1):41–57. doi: 10.1023/A:1021381105325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Kwok C, Cant R, Sullivan G. Factors associated with mammographic decisions of Chinese-Australian women. Health Educ Res. 2005;20(6):739–47. doi: 10.1093/her/cyh034. [DOI] [PubMed] [Google Scholar]
- 19.Dhooper SS. Health care needs of foreign-born Asian Americans: An overview. Health Soc Work. 2003;28(1):63–73. doi: 10.1093/hsw/28.1.63. [DOI] [PubMed] [Google Scholar]
- 20.Ngo-Metzger Q, Massagli MP, Clarridge BR, Manocchia M, Davis RB, Iezzoni LI, et al. Linguistic and cultural barriers to care. J Gen Intern Med. 2003;18(1):44–52. doi: 10.1046/j.1525-1497.2003.20205.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients’ assessments of care in Medicaid managed care. Health Serv Res. 2003;38(3):789–808. doi: 10.1111/1475-6773.00147. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.BC Cancer Agency, Screening Programs. Community Development Pilot Projects: Screening Programs and Health Authority Partnership. 2002. [Google Scholar]
- 23.Kwok C, Sullivan G. Influence of traditional Chinese beliefs on cancer screening behaviour among Chinese-Australian women. J Adv Nurs. 2006;54(6):691–99. doi: 10.1111/j.1365-2648.2006.03872.x. [DOI] [PubMed] [Google Scholar]
- 24.Twinn S, Cheng F. A case study of the effectiveness of nurse-led screening programmes for cervical cancer among Hong Kong Chinese women. J Adv Nurs. 1999;29(5):1089–96. doi: 10.1046/j.1365-2648.1999.00991.x. [DOI] [PubMed] [Google Scholar]
- 25.Yu ES, Kim KK, Chen EH, Brintnall RA. Breast and cervical cancer screening among Chinese American women. Cancer Pract. 2001;9(2):81–91. doi: 10.1046/j.1523-5394.2001.009002081.x. [DOI] [PubMed] [Google Scholar]
- 26.Hislop TG, Deschamps M, Teh C, Jackson C, Tu SP, Yasui Y, et al. Facilitators and barriers to cervical cancer screening among Chinese Canadian women. Can J Public Health. 2003;94(1):68–73. doi: 10.1007/BF03405056. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Sent L, Ballem P, Paluck E, Yelland L, Vogel AM. The Asian Women’s Health Clinic: Addressing cultural barriers to preventive health care. CMAJ. 1998;159(4):350–54. [PMC free article] [PubMed] [Google Scholar]
- 28.Ahmad F, Shik A, Vanza R, Cheung A, George U, Stewart DE. Popular health promotion strategies among Chinese and East Indian immigrant women. Women Health. 2004;40(1):21–40. doi: 10.1300/J013v40n01_02. [DOI] [PubMed] [Google Scholar]
- 29.Statistics Canada. 2001 Census Nation Tables Population by Home Language. 2001. [Google Scholar]
- 30.St. Stephen’s Community House. Breast Cancer Education and Early Detection for Chinese and Portuguese Communities. 2001. [Google Scholar]
- 31.York Region BreastCervical Health Coalition. Breaking the Barriers: A Lay Health Educator Program to Promote Breast Screening among Chinese Women in York Region. 2002. [Google Scholar]
- 32.Lin JS, Finlay A, Tu A, Gany FM. Understanding immigrant Chinese Americans’ participation in cancer screening and clinical trials. J Community Health. 2005;30(6):451–66. doi: 10.1007/s10900-005-7280-5. [DOI] [PubMed] [Google Scholar]
- 33.Parsa P, Kandiah M, Abdul Rahman H, Zulkefli NM. Barriers for breast cancer screening among Asian women: A mini literature review. Asian Pac J Cancer Prev. 2006;7(4):509–14. [PubMed] [Google Scholar]
- 34.Kung E-L, Chan A-C, Chong Y-S, Pham T, Hsu-Hage B-H. Internet J Health Promot 1997. 2008. Promoting breast screen in Melbourne Chinese women using ethno-specific health promotion strategies. [Google Scholar]
- 35.Cancer Care Ontario. Communication with Under-served Populations. 1999. [Google Scholar]
- 36.Centers for Disease ControlPrevention. Reaching Women for Mammography and Screening: Successful Strategies of National Breast and Cervical Cancer Early Detection Program. 1997. [Google Scholar]
- 37.Provincial Cancer Prevention and Screening Council. Report on Cancer 2020: A Call for Renewed Action on Cancer Prevention and Detection in Ontario. 2006; Issue 1.