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Community-Based Participatory Health Research: Understanding the Cultural Assets of Southeast Asian Women for the Promotion of Breast Health
Community-Based Participatory Health Research: Understanding the Cultural Assets of Southeast Asian Women for the Promotion of Breast Health is a two-year study designed to: 1) develop an in-depth understanding of the social and cultural determinants of preventive breast healthcare among Southeast Asian women and 2) apply this information to the development of a pilot breast health promotion intervention and healthcare provider training curriculum. Cancer is the leading cause of death among Asian American women, and there is growing evidence that breast cancer represents a significant health risk. Traditionally, Asians were believed to be at low risk of cancer, due to diet and other lifestyle factors; but, recent studies suggest that the portrait of Asian American breast health and preventive care is complex. While many of the major Asian ethnic groups in the U.S. emigrated from countries with the lowest breast cancer rates, breast cancer has been shown to grow in prevalence with successive generations in the U.S. Other studies suggest that Asian-born Asian Americans lag behind other groups in early detection. Research indicates that nearly a third of all Asian American women over the recommended age of 40 have not participated in breast cancer screening. In addition, research has raised concerns that health professionals may not address breast health with Asians due to misconceptions about breast cancer risks. For Southeast Asian women, these issues are compounded because they disproportionately experience barriers to healthcare including poverty, language and cultural barriers, and limited access to medical insurance and services. Two research questions will direct the proposed study: 1) What are the social and cultural factors that influence preventive breast healthcare and general health-seeking behavior among Southeast Asian American women? 2) How can this information be applied to promote prevention and early detection of breast cancer? The study population is Southeast Asian (i.e., Vietnamese, Cambodian, Laotian and Hmong) women in the U.S., over the age of 40. This population tends to be Asian-born, refugees of war and limited in English proficiency. The specific aims of the study are to discover relevant cultural patterns in the beliefs and behaviors of Southeast Asians and apply this knowledge to develop an intervention that will a) foster greater awareness of the breast cancer risk to Southeast Asian women and the efficacy of preventive measures, b) facilitate access to breast cancer screening, and c) enhance the capacity of healthcare professionals to take culturally competent preventive measures. The study design involves two major components: 1) a qualitative and exploratory study of the cultural and social determinants of Southeast Asian breast healthcare and 2) the development and formative evaluation of a pilot intervention. Key informant interviews with community members and health professionals will serve as the primary method of data collection for the first study component. Bilingual peer researchers representing each of the above-mentioned Southeast Asian communities will be recruited to participate in all aspects of the research process. Teamed with a professional researcher, peer researchers will be trained in interview methods, and be provided supervision. The qualitative study and second component, the pilot, will be guided by a Southeast Asian Women's Advisory Group. The methodological approach of participatory research will enhance the cultural appropriateness of the study, while facilitating access to populations and perspectives that might not otherwise be available. A community-based agency will serve as the pilot site for outreach and screening of Southeast Asian women, as well as health practitioner training. Working with an organization well-established within Asian American communities will facilitate formative evaluation of the pilot. Peer resarchers will conduct participant interviews, and supplemental data will be collected through limited participant observation, staff interviews and monitoring of program service data. There are several benefits and anticipated outcomes of the study including the development of culturally responsive services for the promotion of breast health; the establishment of a Southeast Asian Women’s Advisory Group, which will build the leadership capacity of these women to promote breast health in their communities; and, the enhancement of available research concerning Southeast Asian women and breast health promotion.
Community-Based Participatory Health Research: Understanding the Cultural Assets of Southeast Asian Women for the Promotion of Breast Health is a two-year project designed to meet the following objectives: 1) Learn more about the social and cultural factors that influence breast health among Southeast Asian women and 2) Create a pilot program that will both teach Southeast Asian women about breast health in culturally sensitive ways and train healthcare providers in Southeast Asian culture and related breast healthcare issues. Cancer is the leading cause of death among Asian American women, and there is growing evidence that breast cancer is a significant health risk for these women. Yet, there is a common misperception that Asian American women are at low risk of cancer. This misperception affects the preventive steps that Asian American women take, as well as how health professionals talk to them about breast health. Studies show that breast cancer rates increase with each generation that Asians live in the U.S. They also show that breast cancer is detected later in Asian-born Asian Americans than other groups. In addition, nearly a third of all Asian American women over the recommended age of 40 have not had breast cancer screening. For Southeast Asian women, issues of breast cancer and preventive care are especially serious, because these women are more likely to experience barriers to adequate care including poverty, language and cultural barriers, and limited access to medical insurance and services. There are two research questions that the project will examine: 1) What social and cultural factors influence how Southeast Asian women seek healthcare, and, more specifically, preventive breast healthcare? 2)How can we use this information to promote prevention and early detection of breast cancer? The project will target Southeast Asian(i.e., Vietnamese, Cambodian, Laotian and Hmong) women in the U.S. over 40. These women tend to be Asian-born, refugees of war and not fluent in English. The specific aims of the study are to a)make Southeast Asian women more aware of the risks of breast cancer and the helpfulness of early detection, b)help them take part in routine breast cancer screening, and c)support healthcare professionals in addressing breast health effectively with these women. There are two parts of the study design: 1) a "qualitative" study, consisting of interviews with Southeast Asian women and health professionals about the cultural influences that affect access to breast healthcare and 2) a pilot program, developed based on interviews. Bilingual “peer-to-peer” researchers representing each of the targeted Southeast Asian communities will conduct the interviews and help create the pilot program. In addition, a Southeast Asian Women's Advisory Group will be formed to guide the project and serve as community experts and liaisons. The project will be grounded in principles of “participatory research,” which involves participants in project design and implementation. This will ensure that the project is culturally appropriate and that interview data are useful and meaningful. For the pilot program, these teams will develop 1) a community "intervention" to promote breast cancer awareness and provide screening in Southeast Asian communities and 2) a training program for healthcare providers. The community-based agency that serves Asian Americans and Pacific Islanders will pilot the two components. Working with a known and trusted community-based organization will make the project more effective. The pilot will be evaluated through participant interviews, limited participant observation, staff interviews and program monitoring. The benefits and anticipated outcomes of the project include developing culturally responsive services for promoting breast health in Southeast Asian women; establishing a Southeast Asian Women’s Advisory Group, which will build the leadership capacity of these women to promote breast health in their communities; and, enhancing available information about Southeast Asian women and breast health promotion.