Abstract
Background: Chinese Canadian women have higher cervical cancer incidence, and lower Pap testing, rates than the general Canadian population. Predisposing, enabling and reinforcing factors associated with ever having a Pap test, and having a recent Pap test within the last 2 years, were assessed in Chinese women in British Columbia using the PRECEDE-PROCEED model.
Method: Chinese women (n=512) between the ages of 20 and 79 years and residing in Greater Vancouver were interviewed about Pap testing, health care, traditional health beliefs, acculturation and sociodemographic characteristics. Two analyses were done, comparing women who had ever and never had a Pap test, and comparing women who had and had not received a recent Pap test. Focus groups and qualitative interviews ensured cultural sensitivity in the survey questionnaire.
Results: Seventy-six percent reported ever having a Pap test and 57% reported having a Pap test within the last 2 years. Traditional health beliefs were not associated with ever or recent Pap testing. However, belief that Pap testing prevented cancer and general knowledge about the Pap test were associated with screening. Concern about pain/discomfort with the test, availability of time, culturally sensitive health care services and recommendation for Pap testing by a physician were also associated with screening. Factors differed for ever, and recently, having a Pap test.
Interpretation: Pap testing is less common among Chinese Canadian women. Continuing education about Pap testing is recommended for physicians serving underscreened Chinese women. Culturally and linguistically appropriate educational materials are needed for the Chinese community.
Résumé
Contexte: La proportion des Canadiennes d’origine chinoise qui se soumettent au test de Papanicolaou est plus faible, et les taux d’incidence du cancer du col de l’utérus sont plus élevés que dans la population canadienne en général. Nous avons utilisé le modèle PRECEDE/PROCEED pour évaluer la relation entre les facteurs de prédisposition, d’incitation et de renforcement et le fait d’avoir ou de ne pas avoir subi un test de Papanicolaou au cours des deux dernières années, chez les Canadiennes d’origine chinoise de la Colombie-Britannique.
Méthode: Nous avons mené des entrevues auprès de femmes d’origine chinoise (n=512) âgées de 20 à 79 ans qui habitent la région métropolitaine de Vancouver. Les questions ont porté sur le test de Papanicolaou, les soins de santé, les croyances traditionnelles en matière de santé, l’acculturation et les caractéristiques socio-démographiques. Nous avons ensuite établi une première comparaison entre les femmes qui ont déjà subi un test de Papanicolaou et celles qui ne l’ont jamais subi, et une deuxième entre celles qui ont ou qui n’ont pas subi le test récemment. Des groupes échantillons et des entretiens en profondeur ont permis de s’assurer que le questionnaire d’enquête prenait en compte les réalités culturelles.
Résultats: Parmi les femmes interrogées, 76 % ont déclaré n’avoir jamais subi un test de Papanicolaou et 57 % ont affirmé avoir subi le test au cours des deux dernières années. Nous n’avons pas établi de lien entre les croyances traditionnelles en matière de santé et le fait d’avoir ou de ne pas avoir subi un test de Papanicolaou. Cependant, nous avons pu établir une relation entre le dépistage et la connaissance générale du test de Papanicolaou et le fait de croire qu’il peut prévenir le cancer. Les préoccupations concernant la douleur causée par le test ou l’inconfort, le temps disponible, les services de santé culturellement adaptés et le fait d’être incitée à se soumettre au test de Papanicolaou par un médecin ont également été associés au dépistage. Les facteurs diffèrent dans le cas des femmes qui n’ont jamais subi un test de Papanicolaou ou de celles qui l’ont subi récemment.
Interprétation: Le test de Papanicolaou est une pratique moins courante chez les Canadiennes d’origine chinoise. Les médecins qui sont en contact avec des femmes d’origine chinoise qui ne se soumettent pas au test de dépistage devraient recevoir une formation continue sur le test de Papanicolaou. La communauté chinoise devrait avoir à sa disposition des documents éducatifs adaptés sur le plan culturel et linguistique.
Footnotes
Acknowledgements: This work was supported by the US National Cancer Institute (Grant #74326 and Cooperative Agreement #86322) and the British Columbia Health Research Foundation (Grant #180(96-2)).
References
- 1.Statistics Canada. Visible minority populations, 1996 Census, Canada, provinces and territories. Ottawa, ON: Statistics Canada; 1996. [Google Scholar]
- 2.Guo W, Hsing AW, Li J, Chen JS, Chow WH, Blot WJ. Correlation of cervical cancer mortality with reproductive and dietary markers, and serum markers in China. Int J Epidemiol. 1994;23:1127–32. doi: 10.1093/ije/23.6.1127. [DOI] [PubMed] [Google Scholar]
- 3.Archibald CP, Coldman AJ, Wong FL, Band PR, Gallagher RP. The incidence of cervical cancer among Chinese and Caucasians in British Columbia. Can J Public Health. 1993;84:238–45. [PubMed] [Google Scholar]
- 4.Centers for Disease Control. Behavioral risk factor survey of Chinese: California, 1989. MMWR. 1992;41:266–70. [PubMed] [Google Scholar]
- 5.Truman BI, Wing JS, Keenan NL. Asians and Pacific Islanders. In: Satcher D, Bales VS, Harris JR, Truman BI, editors. Chronic Disease in Minority Populations. Atlanta: Centers for Disease Control; 1994. [Google Scholar]
- 6.Hiatt RA, Pasick RJ, Pereq-Stable EJ, McPhee SJ, Engelstad L, Lee M, et al. Pathways to early cancer detection in the multiethnic population of the San Francisco Bay area. Health Educ Q. 1996;23:10–27. doi: 10.1177/109019819602301S03. [DOI] [Google Scholar]
- 7.Cervical Cancer Screening Program. 1999 Annual Report. Vancouver: BC Cancer Agency, 1999;4.
- 8.Cervical Cancer Screening Program. 2000 Annual Report. Vancouver: BC Cancer Agency, 2000;16.
- 9.Hislop TG, Teh C, Lai A, Labo T, Taylor VM. Sociodemographic factors associated with cervical cancer screening in BC Chinese women. BCMJ. 2000;42:456–60. [Google Scholar]
- 10.Taylor V, Jackson JC, Tu S-P, Yasui Y, Schwartz SM, Kuniyuki A, et al. Cervical cancer screening among Chinese Americans. Cancer Detection and Prevention. 2002;26:139–45. doi: 10.1016/S0361-090X(02)00037-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Green L, Krueler M. Health Promotion Planning: An Educational and Environmental Approach. Palo Alto: Mayfield; 1991. Applications of PRECEDE-PROCEED in community settings. [Google Scholar]
- 12.Lee M, Lee F, Stewart S. Pathways to early breast and cervical cancer detection for Chinese American women. Health Educ Q. 1996;23:76–88. doi: 10.1177/109019819602301S07. [DOI] [Google Scholar]
- 13.McPhee SJ, Bird JA, Ha NT, Jenkins CNH, Fordham D, Le B. Pathways to early cancer detection for Vietnamese women: Health is gold. Health Educ Q. 1996;23:60–75. doi: 10.1177/109019819602301S06. [DOI] [Google Scholar]
- 14.Taylor VM, Jackson JC, Tu SP. Cancer control research among Cambodian Americans in Washington. Asian Am Pac Isl J Health. 2000;8:32–38. [PMC free article] [PubMed] [Google Scholar]
- 15.Jackson JC, Do H, Chitnarong K, Tu SP, Marchand A, Hislop G, Taylor V. Development of cervical cancer control interventions for Chinese immigrants. J Immig Health. 2002;4:147–57. doi: 10.1023/A:1015650901458. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Eyton J, Neuwirth G. Cross-cultural validity: Ethnocentrism in health studies with special reference to the Vietnamese. Soc Sci Med. 1984;18:447–53. doi: 10.1016/0277-9536(84)90061-3. [DOI] [PubMed] [Google Scholar]
- 17.Statistics Canada. Unpublished data. 1996. [Google Scholar]
- 18.Hislop TG, Schwartz S, Taylor V, Jackson C, Tu SP. Identification of Chinese subjects for etiolog-ical and cancer control research: Description of sampling methods based upon surnames. North American Association of Central Cancer Registries Annual Meeting. New Orleans, April 15–20, 2000;87.
- 19.Rosner B. Fundamentals of Biostatistics. Fifth. Boston: Duxbury; 2000. [Google Scholar]
- 20.Breslow NE, Day NE. Statistical Methods in Cancer Research. Lyon: International Agency Cancer Research; 1980. [Google Scholar]
- 21.Michielutte R, Dignan MB, Wells HB, Young LD, Jackson DS, Sharp PC. Development of a community cancer education program: The Forsyth County, NC, cervical cancer prevention project. Public Health Rep. 1989;104:542–51. [PMC free article] [PubMed] [Google Scholar]
- 22.Deschamps M, Band PR, Hislop TG, Clarke HF, Smith JM, Ng VTY. Barriers to cervical cytology screening in Native women in British Columbia. Cancer Detection and Prevention. 1992;16:337–39. [PubMed] [Google Scholar]
- 23.Orton M, Fitzpatrick R, Fuller A, Mant D, Mlynek C, Thorogood M. Factors affecting women’s response to an invitation to attend for a second breast cancer screening examination. Br J Gen Pract. 1991;41:320–22. [PMC free article] [PubMed] [Google Scholar]
- 24.Chen A, Ng P, Sam P. Special health problems of Asians and Pacific Islanders. In: Matzen RN, Long RS, editors. Clinical Preventive Medicine. St. Louis: Mosby; 1993. [Google Scholar]
- 25.Uba L. Cultural barriers to health care for Southeast Asian refugees. Public Health Rep. 1992;107:544–48. [PMC free article] [PubMed] [Google Scholar]
- 26.Coyne CA, Hohman K, Levinson A. Reaching special populations with breast and cervical cancer public education. J Cancer Educ. 1992;7:293–303. doi: 10.1080/08858199209528186. [DOI] [PubMed] [Google Scholar]
- 27.Kelaher M, Gillespie AG, Allotey P, Manderson L, Potts H, Sheldrake M, et al. The Transtheoretical Model and cervical screening: Its application among culturally diverse communities in Queensland, Australia. Ethnicity and Health. 1999;4:259–76. doi: 10.1080/13557859998047. [DOI] [PubMed] [Google Scholar]
- 28.Wismer BA, Moskowitz JM, Chen AM, Kang SH, Novotny TE, Min K, et al. Rates and independent correlates of Pap smear testing among Korean-American women. Am J Public Health. 1998;88:656–60. doi: 10.2105/AJPH.88.4.656. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Taylor VM, Hislop TG, Jackson J T S-P, Yasui Y, Schwartz SM, et al. A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America. JNCI. 2002;94:670–77. doi: 10.1093/jnci/94.9.670. [DOI] [PMC free article] [PubMed] [Google Scholar]