Participation of African Americans in research trials is low.
Understanding the perspectives of African American patients toward participation
in clinical trials is essential to understanding the disparities in
participation rates compared with whites. A qualitative study was conducted to
discover attitudes of the African American community regarding willingness to
participate in breast cancer screening and randomized clinical trials. Six focus
groups consisting of 8 to 11 African American women (N = 58), aged 30 to
65, were recruited from local churches. Focus group sessions involved a 2-hour
audiotaped discussion facilitated by 2 moderators. A breast cancer randomized
clinical trial involving an experimental breast cancer treatment was discussed
to identify the issues related to willingness to participate in such research
studies. Six themes surrounding willingness to participate in randomized
clinical trials were identified: (1) Significance of the research topic to the
individual and/or community; (2) level of trust in the system; (3) understanding
of the elements of the trial; (4) preference for “natural
treatments” or “religious intervention” over medical
care; (5) cost-benefit analysis of incentives and barriers; and (6) openness to
risk versus a preference for proven treatments. The majority (80%)
expressed willingness or open-mindedness to the idea of participating in the
hypothetical trial. Lessons learned from this study support the selection of a
culturally diverse research staff and can guide the development of research
protocols, recruitment efforts, and clinical procedures that are culturally
sensitive and relevant.
African American; Breast cancer; Clinical trials; Focus group study
Southeast Asians have higher liver cancer rates than any other racial/ethnic group in the US. Approximately 80 percent of liver cancers are etiologically associated with hepatitis B virus (HBV) infection which is endemic in Southeast Asia. An in-person survey of Cambodian women (n = 320) was conducted in Seattle, Washington, during 1999. The questionnaire included items about HBV knowledge, beliefs, and practices. Prior to being provided with a description of the disease, only about one-half (56 percent) of our respondents had heard of HBV infection. Less than one-quarter (23 percent) of the study group thought that asymptomatic individuals can transmit the disease to others. Most thought that HBV infection can cause liver cancer (54 percent) and death (72 percent). However, a minority thought that infection can be lifelong (24 percent) and incurable (15 percent). Only 38 percent reported they had been serologically tested for HBV. Finally, of those who had been tested and thought they were susceptible, two-thirds (67 percent) had not been vaccinated. Lower levels of education were associated with lower levels of HBV knowledge and serologic testing. Our findings suggest that Cambodian immigrants have low levels of HBV knowledge, serologic testing, and vaccination; and demonstrate a need for targeted educational interventions aimed at reducing HBV-related liver cancer mortality among Southeast Asian communities.
hepatitis B; liver cancer; Cambodian Americans
Cambodian Americans have an elevated risk of liver cancer. This health disparity is attributable to high rates of hepatitis B virus (HBV) infection. Our study examined factors associated with HBV testing among Cambodian men and women.
A population-based survey was conducted in the Seattle area. The Health Behavior Framework guided our survey instrument development. We attempted to interview a man and a woman in each household.
The sample included 300 men and 367 women. About one-half of the male (45%) and female (54%) respondents had been tested for HBV. Two factors were independently associated with testing among men and women: a doctor had recommended testing and had asked a doctor for testing. Knowing that someone who looks and feels healthy can spread HBV was independently associated with testing among men.
Low levels of HBV testing remain a public health problem among Cambodians. Interventions should improve patient-provider communication by encouraging providers who serve Cambodians to recommend HBV testing, as well as by empowering Cambodians to ask for testing.
Cambodian Americans; Hepatitis B Testing; Immigrant Health; Liver Cancer
Increasing numbers of patients require medical interpretation, yet few studies have examined its accuracy or effect on health outcomes.
To understand how alterations in medical interpretation affect health care delivery to patients with limited English proficiency (LEP), we aimed to determine the frequency, type, and clinical significance of alterations. We focused on best-case encounters that involved trained, experienced interpreters interacting with established patients.
We audio-recorded routine outpatient clinic visits in which a medical interpreter participated. Audiotapes were transcribed and translated into English. We identified and characterized alterations in interpretation and calculated their prevalence.
In total, 38 patients, 16 interpreters, and 5 providers took part. Patients spoke Cantonese, Mandarin, Somali, Spanish, and Vietnamese, and received care for common chronic health conditions.
Unlike previous methods that report numbers of alterations per interpreted encounter, we focused on alterations per utterance, which we defined as the unit of spoken content given to the interpreter to interpret. All alteration rates were calculated by dividing the number of alterations made during the encounter by the number of utterances for that encounter. We defined clinically significant changes as those with potential consequences for evaluation and treatment.
We found that 31% of all utterances during a routine clinical encounter contained an alteration. Only 5% of alterations were clinically significant, with 1% having a positive effect and 4% having a negative effect on the clinical encounter.
Even in a best case scenario, the rate of alteration remains substantial. Training interpreters and clinicians to address common patterns of alteration will markedly improve the quality of communication between providers and LEP patients.
interpretation; translation; communication barriers; language; physician-patient relations; limited English proficiency; quality of health care
Liver cancer occurs more frequently among Americans of Southeast Asian descent than any other group. This health disparity can be attributed to high rates of hepatitis B virus (HBV) infection. We examined HBV awareness, knowledge about HBV transmission, HBV testing levels, and HBV vaccination levels among Cambodian Americans.
A population-based survey was conducted in metropolitan Seattle during 2010. The study sample included 667 individuals. We created a composite knowledge score (0–9) by summing the number of correct answers to survey items addressing HBV transmission. Data were analyzed using Generalized Estimating Equations.
Seventy-eight percent of the study group had heard of HBV (before it was described to them). The proportions who knew that HBV cannot be spread by eating food prepared by an infected person, can be spread during childbirth, and can be spread during sexual intercourse were only 33%, 69%, and 72%, respectively. The mean knowledge score was 5.5 (standard deviation 1.7). Fifty percent of the survey respondents had been tested and 52% had been vaccinated. HBV awareness, higher knowledge scores, and vaccination were all associated (p<0.05) with younger age, higher educational level, younger age at immigration, and greater English proficiency.
Our study findings confirm the need for Khmer language HBV programs for less acculturated and educated members of the Cambodian community. Such programs should aim to increase HBV testing rates, HBV vaccination rates among individuals who remain susceptible to infection, and levels of knowledge about routes of hepatitis B transmission.
Cambodian Americans; hepatitis B; immigrant health; liver cancer
We conducted a trial to evaluate the effectiveness of a cervical cancer control intervention for Vietnamese women.
The study group included 234 women who had not received a Pap test in the last three years. Experimental group participants received a lay health worker home visit. Our trial end-point was Pap smear receipt within six months of randomization. Pap testing completion was ascertained through women's self-reports and medical record reviews. We examined intervention effects among women who had ever received a Pap smear (prior to randomization) and women who had never received a Pap smear.
Three-quarters of the experimental group women completed a home visit. Ever screened experimental group women were significantly more likely to report Pap testing (p<0.02) and have records verified Pap testing (p<0.04) than ever screened control group women. There were no significant differences between the trial arms for women who had never been screened.
Our findings indicate that lay health worker interventions for Vietnamese women are feasible to implement and can positively impact levels of Pap testing use among ever screened women (but not never screened women).
Asian Americans; Cancer; Screening
To conduct a randomized controlled trial to evaluate the cost effectiveness of a lay health worker-administered cervical cancer screening intervention for Vietnamese-American women.
The study group included 234 Vietnamese women in the Seattle, Washington area who had not received a Pap test in the last three years. Experimental group participants received a lay health worker home visit. The travel distance and time spent at each visit were recorded. Our trial end-point was Pap smear receipt within six months of randomization. Pap testing completion was ascertained through medical record reviews.
For all Vietnamese women, regardless of their prior history of screening, the cost per intervention was $104.0 (95% CI: $89.6–$118.4). The change in quality-adjusted life days per intervention was 1.26 (95% CI: −5.43–7.96), resulting in an incremental cost-effectiveness ratio (ICER) of $30,015 per quality-adjusted life year. The probability that the ICER exceeds $100,000 is 9.1%.
The degree of cost effectiveness of such interventions is sensitive to the assumed duration of behavioral change and the participants’ prior history of screening.
Cervical cancer; screening; cost effectiveness; lay health worker
Recent US data indicate that women of Vietnamese descent have higher cervical cancer incidence rates than women of any other race/ethnicity, and lower levels of Pap testing than white, black, and Latina women. Our objective was to provide information about Pap testing barriers and facilitators that could be used to develop cervical cancer control intervention programs for Vietnamese American women.
We conducted a cross-sectional, community-based survey of Vietnamese immigrants. Our study was conducted in metropolitan Seattle, Washington. A total of 1,532 Vietnamese American women participated in the study. Demographic, health care, and knowledge/belief items associated with previous cervical cancer screening participation (ever screened and screened according to interval screening guidelines) were examined.
Eighty-one percent of the respondents had been screened for cervical cancer in the previous three years. Recent Pap testing was strongly associated (p<0.001) with having a regular doctor, having a physical in the last year, previous physician recommendation for testing, and having asked a physician for testing. Women whose regular doctor was a Vietnamese man were no more likely to have received a recent Pap smear than those with no regular doctor.
Our findings indicate that cervical cancer screening disparities between Vietnamese and other racial/ethnic groups are decreasing. Efforts to further increase Pap smear receipt in Vietnamese American communities should enable women without a source of health care to find a regular provider. Additionally, intervention programs should improve patient-provider communication by encouraging health care providers (especially male Vietnamese physicians serving women living in ethnic enclaves) to recommend Pap testing, as well as by empowering Vietnamese women to specifically ask their physicians for Pap testing.
Cervical cancer; Immigrants; Pap testing; Vietnamese
Family communication is important for delivering high quality end-of-life care in the ICU, yet little research has been conducted to describe and evaluate clinician-family communication with non-English speaking family members. We assessed clinician-family communication during ICU family conferences involving interpreters and compared it to conferences without interpreters.
Cross-sectional descriptive study.
Family conferences in the ICU’s of four hospitals during which discussions about withdrawing life support or delivery of bad news were likely to occur.
70 family members from 10 interpreted conferences and 214 family members from 51 non-interpreted conferences. Nine different physicians led interpreted conferences and 36 different physicians led non-interpreted conferences.
All 61 conferences were audiotaped. We measured the duration of time that families, interpreters, and clinicians spoke during the conference and we tallied the number of supportive statements issued by clinicians in each conference.
The mean conference time was 26.3 ± 13 minutes for interpreted and 32±15 minutes for non-interpreted conferences (p=0.25). The duration of clinician speech was 10.9 ± 5.8 minutes for interpreted conferences and 19.6 ± 10.2 minutes for non-interpreted conferences (p=0.001). The amount of clinician speech as a proportion of total speech time was 42.7% in interpreted conferences and 60.5% in non-interpreted conferences (p=0.004). Interpreter speech accounted for 7.9 ± 4.4 minutes and 32% of speech in interpreter conferences. Interpreted conferences contained fewer clinician statements providing support for families, including valuing families’ input (p=0.01), easing emotional burdens (p<0.01), and active listening (p<0.01).
This study suggests that families with non-English speaking members may be at increased risk of receiving less information about their loved one’s critical illness as well as less emotional support from their clinicians. Future studies should identify ways to improve communication with, and support for, non-English speaking families of critically ill patients.
communication; end-of-life care; dying; death; palliative care; cross-cultural; limited English proficiency; family; interpreter
Census data show that the US Vietnamese population now exceeds 1,250,000. Cervical cancer among Vietnamese American women has been identified as an important health disparity. Available data indicate the cervical cancer disparity may be due to low Pap testing rates rather than variations in HPV infection rates and/or types. The cervical cancer incidence rates among Vietnamese and non-Latina white women in California during 2000–2002 were 14.0 and 7.3 per 100,000, respectively. Only 70% of Vietnamese women who participated in the 2003 California Health Interview Survey reported a recent Pap smear, compared to 84% of non-Latina white women. Higher levels of cervical cancer screening participation among Vietnamese women are strongly associated with current/previous marriage, having a usual source of care/doctor, and previous physician recommendation. Vietnamese language media campaigns and lay health worker intervention programs have been effective in increasing Pap smear use in Vietnamese American communities. Cervical cancer control programs for Vietnamese women should address knowledge deficits; enable women who are without a usual source of care to find a primary care doctor; and improve patient-provider communication by encouraging health care providers to recommend Pap testing, as well as by empowering women to ask for testing.
Cervical cancer; Pap testing; Vietnamese Americans
Census data indicate that Cambodian Americans are economically disadvantaged and linguistically isolated. In addition, cancer registry data show that Southeast Asians experience several cancer-related health disparities (e.g., markedly elevated risks of cervical and liver cancer). The Seattle regional Asian American Network for Cancer, Awareness, Research, and Training (AANCART) site has implemented a community-based cancer awareness program for Cambodian immigrants in collaboration with a Cambodian community coalition. Our cancer awareness program has the following goals: to assist individuals and organizations in advocating for a healthy community, to provide information within a cultural context, and to deliver information in ways that are useful and meaningful to the community. The program was guided by a community assessment that included the use of published data as well as information from qualitative interviews, focus groups, and quantitative surveys. Examples of community awareness activities include group presentations at community-based organizations (e.g., during English as a second language classes), health fair participation (including at nontraditional venues such as a farmers’ market serving Cambodians), and educational displays in neighborhood locations (e.g., at Cambodian video stores). In addition, the Seattle AANCART site has both inventoried and developed culturally appropriate Khmer language cancer education materials and disseminated materials through the ETHNOMED website. Our approach recognizes that limited English language proficiency may preclude many Cambodians from understanding publicly disseminated information, and Cambodian immigrants are often isolated and tend to stay close to their own neighborhoods.
AANCART; cancer; Asian; Cambodian; qualitative research
Cervical cancer occurs more frequently among Vietnamese Americans than women of any other race/ethnicity. In addition, previous studies in California have documented low Papanicolaou (Pap) testing rates in Vietnamese communities. This study focused on health care system factors and physician characteristics associated with recent cervical cancer screening among Vietnamese women. A population-based survey was conducted in Seattle during 2002. In-person interviews were conducted by bilingual, bicultural female survey workers. The survey response rate was 82% and 518 women were included in the analysis. Seventy-four percent of the respondents reported having been screened for cervical cancer on at least one occasion, and 64% reported a Pap smear within the previous 2 years. Women with a regular doctor were more likely to have been recently screened than those without a regular doctor (OR = 2.33, 95% CI = 1.45–3.74). Among those with a regular doctor, having a male physician, receiving care at a private doctor’s office (rather than a community, hospital, or multi-specialty clinic), and concern about the cost of health care were independently associated with lower screening rates. Physician ethnicity was not associated with recent Pap smear receipt. The findings support targeted interventions for Vietnamese women without a regular physician and private doctors’ offices that serve Vietnamese Americans. The availability of low cost screening services should be publicized in Vietnamese communities.
cervical cancer; immigrants; Pap testing; Vietnamese
Vietnamese American men are over 10 times more likely to be diagnosed with liver cancer than their white counterparts. This health disparity is attributable to high rates of hepatitis B virus (HBV) infection. Our study objective was to examine factors associated with HBV testing among Vietnamese men. A population-based survey was conducted in Seattle. The questionnaire content was guided by an earlier qualitative study and the Health Behavior Framework. The survey was completed by 345 men (response rate: 80%). About one-third (34%) of the respondents reported they had not been tested for HBV. The following factors were associated (P < 0.01) with previous testing in bivariate comparisons: having a regular source of care and regular provider; knowing that HBV can be spread during childbirth; believing HBV can cause liver cancer; and doctor(s) had recommended testing as well as had asked doctor(s) for testing. Three variables were independently associated with HBV testing in a logistic regression model: regular source of care (OR = 4.5; 95% CI = 2.6–7.9), physician recommendation (OR = 2.3, 95% CI = 1.3–4.0), and knowing HBV can be spread during childbirth (OR = 2.1; 95% CI = 1.2–3.9). Low levels of HBV testing remain a public health problem in some Vietnamese American sub-groups. Health education about HBV transmission may stimulate patients to seek testing. Intervention programs should specifically target Vietnamese men without a regular source of health care and physicians who serve Vietnamese communities.
Health behavior framework; Hepatitis B testing; Immigrant health; Liver cancer; Vietnamese Americans
Breast carcinoma is the most common major malignancy among several Asian-American populations. This study surveyed mammography screening knowledge and practices among Chinese-American women.
In 1999, the authors conducted a cross-sectional, community-based survey in Seattle, Washington. Bilingual and bicultural interviewers administered surveys in Mandarin, Cantonese, or English at participants’ homes.
The survey cooperation rate (responses among reachable and eligible households) was 72% with 350 eligible women (age ≥ 40 years with no prior history of breast carcinoma or double mastectomy). Seventy-four percent of women reported prior mammography screening, and 61% of women reported screening in the last 2 years. In multivariate analysis, a strong association was found between mammography screening and recommendations by physicians and nurses (prior screening: odds ratio [OR], 16.0; 95% confidence interval [95% CI], 7.8–35.0; recent screening: OR, 7.0; 95% CI, 3.8–13.6). This finding applied to both recent immigrants (< 15 years in the U.S.) and earlier immigrants (≥ 15 years in the U.S.). Thirty-two percent of women reported that the best way to detect breast carcinoma was a modality other than mammogram.
The authors recommend a multifaceted approach to increase mammography screening by Chinese-American women: recommendations from the provider plus targeted education to address the effectiveness of screening mammography compared with breast self examination and clinical breast examination.
mammography; screening; Asian; Chinese
Chinese American immigrants are a growing part of the United States population. Cervical cancer is a significant cause of morbidity and mortality among Chinese Americans. Pap smear testing is less common in Chinese American immigrants than in the general population. During 1999, we conducted a community-based survey of Chinese American women living in Seattle. We assessed knowledge of cervical cancer risk factors and history of Pap smear testing along with socioeconomic and acculturation characteristics. The overall estimated response rate was 64%, and the cooperation rate was 72%. Our study sample included 472 women. Most cervical cancer risk factors were recognized by less than half of our participants. Factors independently associated with knowledge of cervical cancer risk factors included marital status, employment, and education. Respondents with the highest knowledge had greater odds of ever receiving a Pap smear, compared to those respondents with the lowest knowledge (OR 2.5; 95% CI: 1.1,5.8). Our findings suggest a need for increased recognition of cervical cancer risk factors among Chinese American immigrants. Culturally and linguistically appropriate educational interventions for cervical cancer risk factors should be developed, implemented and evaluated.
cervix neoplasms; Chinese Americans; risk factors
Chinese American women have high rates of invasive cervical cancer, compared to the general population. However, little is known about the Pap testing behavior of ethnic Chinese immigrants.
We conducted a community-based survey of Chinese immigrants living in Seattle, Washington, during 1999. Two indicators of cervical cancer screening participation were examined: at least one previous Pap smear and Pap testing in the last 2 years.
The overall estimated response rate was 64%, and the cooperation rate was 72%. Our study sample for this analysis included 647 women. Nearly one quarter (24%) of the respondents had never had a Pap test, and only 60% had been screened recently. Factors independently associated with cervical cancer screening use included marital status, housing type, and age at immigration.
Our findings confirm low levels of cervical cancer screening among Chinese immigrants to North America. Culturally and linguistically appropriate Pap testing intervention programs for less acculturated Chinese women should be developed, implemented, and evaluated.
Chinese immigrants; cervical cancer; Pap testing
We summarized previous and ongoing cancer control research among Cambodian immigrants in Washington.
A literature review of articles and published abstracts was conducted.
Cambodian Americans have a limited understanding of Western biomedical concepts, and low levels of cancer screening participation.
Culturally appropriate cancer control interventions for Cambodian Americans should be developed, implemented, and evaluated.
We examined levels of Pap testing and factors associated with screening participation among Cambodian refugees.
A community-based, in-person survey was conducted in Seattle during late 1997 and early 1998. Interviews were completed by 413 women; the estimated response rate was 73%. We classified respondents into four Pap testing stages of adoption: precontemplation/contemplation (never screened), relapse (ever screened but did not plan to be screened in the future), action (ever screened and planned to be screened in the future), and maintenance (recently screened and planned to be screened in the future). Bivariate and multivariate techniques were used to examine various factors.
About one-quarter (24%) of the respondents has never been screened, and a further 22% had been screened but did not plan to obtain Pap tests in the future. Fifteen percent were in the action stage and 39% were in the maintenance stage. The following factors were independently associated with cervical cancer screening stages: previous physician recommendation; younger age; beliefs about Pap testing for post-menopausal women, screening for sexually inactive women, and regular checkups; provider ethnicity; prenatal care in the US; and problems finding interpreters.
Our findings confirm low Pap testing rates among Cambodian immigrants, and suggest that targeted interventions should be multifaceted.
Little information is available on the breast cancer screening behavior of Cambodian American women.
We identified households from multiple sources using Cambodian surnames and conducted a cross-sectional survey, administered by bilingual and bicultural interviewers. Breast cancer screening stages of adoption were examined based on concepts from the transtheoretical model of behavioral change.
Our response rate was 73% (398 women in clinical breast exam (CBE) analysis, and 248 in mammography analysis) with approximately 25% each in the maintenance stage. We found significant associations between screening stage with physician characteristics. Asian American female physician increased the likelihood of being in the maintenance stage (CBE, OR = 10.1, 95% CI 2.8–37.1; mammogram, OR = 74.7, 95% CI 8.3–674.6), compared to Asian American male physician with precontemplation/contemplation stage as our referent outcome.
Results from this study support the need to promote regular breast cancer screening among Cambodian American women. © 2002 International Society for Preventive Oncology. Published by Elsevier Science Ltd. All rights reserved.
Breast cancer; Screening; Asian; Stages of adoption
Southeast Asian women have low levels of Papanicolaou (Pap) testing participation. We conducted a group-randomized controlled trial to evaluate a cervical cancer screening intervention program targeting Seattle’s Cambodian refugee community.
Women who completed a baseline, community-based survey were eligible for the trial. Neighborhoods were the unit of randomization. Three hundred and seventy survey participants living in 17 neighborhoods were randomized to intervention or control status. Intervention group women received home visits by outreach workers and were invited to group meetings in neighborhood settings. The primary outcome measure was self-reported Pap testing in the year prior to completing a follow-up survey.
The proportion of women in the intervention group reporting recent cervical cancer screening increased from 44% at baseline to 61% at follow-up (+17%). The corresponding proportions among the control group were 51 and 62% (+11%). These temporal increases were statistically significant in both the intervention (P < 0.001) and control (P = 0.027) groups.
This study was unable to document an increase in Pap testing use specifically in the neighborhood-based outreach intervention group; rather, we found an increase in both intervention and control groups. A general awareness of the project among women and their health care providers as well as other ongoing cervical cancer screening promotional efforts may all have contributed to increases in Pap testing rates.
Cambodian Americans; Pap testing; Outreach
Chinese women in North America have high rates of invasive cervical cancer and low levels of Papanicolaou (Pap) testing use. This study examined Pap testing barriers and facilitators among Chinese American women.
A community-based, in-person survey of Chinese women was conducted in Seattle, Washington during 1999. Four hundred and thirty-two women in the 20–79 years age-group were included in this analysis. The main outcome measures were a history of at least one previous Pap smear and Pap testing within the last 2 years.
Nineteen percent of the respondents had never received cervical cancer screening and 36% had not been screened in the previous 2 years. Eight characteristics were independently associated with a history of at least one Pap smear: being married, thinking Pap testing is necessary for sexually inactive women, lack of concerns about embarrassment or cancer being discovered, having received a physician or family recommendation, having obtained family planning services in North America, and having a regular provider. The following characteristics were independently associated with recent screening: thinking Pap testing is necessary for sexually inactive women, lack of concern about embarrassment, having received a physician recommendation, having obtained obstetric services in North America, and having a regular provider.
Pap testing levels among the study respondents were well below the National Cancer Institute’s Year 2000 goals. The findings suggest that cervical cancer control interventions for Chinese are more likely to be effective if they are multifaceted. © 2002 International Society for Preventive Oncology. Published by Elsevier Science Ltd. All rights reserved.
Chinese Americans; Cervical cancer; Papanicolaou testing
North American Chinese women have lower levels of Papanicolaou (Pap) testing than other population subgroups. We conducted a randomized controlled trial to evaluate the effectiveness of two alternative cervical cancer screening interventions for Chinese women living in North America.
Four hundred and eighty-two Pap testing underutilizers were identified from community-based surveys of Chinese women conducted in Seattle, Washington, and Vancouver, British Columbia. These women were randomly assigned to one of two experimental arms or control status. Several Chinese-language materials were used in both experimental arms: an education-entertainment video, a motivational pamphlet, an educational brochure, and a fact sheet. Women in the first experimental group (outreach worker intervention) received the materials, as well as tailored counseling and logistic assistance, during home visits by trilingual, bicultural outreach workers. Those in the second experimental group (direct mail intervention) received the materials by mail. The control group received usual care. Follow-up surveys were completed 6 months after randomization to ascertain participants’ Pap testing behavior. All statistical tests were two-sided.
A total of 402 women responded to the follow-up survey (83% response rate). Of these women, 50 (39%) of the 129 women in the outreach group, 35 (25%) of the 139 women in the direct mail group, and 20 (15%) of the 134 women in the control group reported Pap testing in the interval between randomization and follow-up data collection (P<.001 for outreach worker versus control, P = .03 for direct mail versus control, and P = .02 for outreach worker versus direct mail). Intervention effects were greater in Vancouver than in Seattle.
Culturally and linguistically appropriate interventions may improve Pap testing levels among Chinese women in North America.
The objective of the study was to develop a culturally relevant video and a pamphlet for use as a cervical cancer screening educational intervention among North-American Chinese women. The project conducted 87 qualitative interviews and nine focus groups to develop a culturally tailored intervention to improve Pap testing rates. The intervention consisted of an educational/motivational video, a pamphlet, and home visits. Less acculturated Chinese women draw on a rich tradition of herbal knowledge and folk practices historically based on Chinese medical theory, now mixed with new information from the media and popular culture. The video, the pamphlet, and the outreach workers knowledge base were designed using these results and combined with biomedical information to address potential obstacles to Pap testing. Culturally relevant information for reproductive health promotion was easily retrieved through qualitative interviews and used to create educational materials modeling the integration of Pap testing into Chinese women’s health practices.
Pap testing; cervical cancer; cross-cultural medicine; Chinese; health education
To assess the comprehensibility of hepatitis B translations for Cambodian refugees, to identify Cambodian illnesses that include the symptoms of hepatitis, and to combine these observations with critical theoretical perspectives of language to reflect on the challenges of medical translation generally.
Open-ended, semistructured interviews, and participant-observation of a refugee community in Seattle, Washington.
Homes of Cambodian residents of inner-city neighborhoods.
Thirty-four adult Cambodian refugees who had each been educated about hepatitis B through public health outreach.
Medical interpreters translated hepatitis B as rauk tlaam, literally “liver disease.” Unfortunately, while everyone knew of the liver (tlaam), rauk tlaam was a meaningless term to 28 (82%) of 34 respondents and conveyed none of the chronicity and communicability intended by refugee health workers for 34 (100%) of the respondents. In contrast, all respondents knew illnesses named after symptom complexes that include the symptoms of acute and chronic hepatitis, but do not refer to diseased organs. The Cambodian words chosen to translate hepatitis B reflect the medical thinking and medical authority that can unintentionally overwhelm attempts at meaningful communication with non–English-speaking patients.
To improve comprehension of hepatitis B translations for the Khmer, translators must choose between medical terminology focused on the liver and Khmer terminology which identifies recognizable experiences, but represents important Khmer health concepts. A critical linguistic view of this situation suggests that for these translations to be meaningful clinicians and health educators must first analyze and then monitor the contextual significance of medical language. In cross-cultural settings, this means a partnership with medical interpreters to pay close attention to the expe-rience of illness and social context of the translation.
Cambodian refugees; hepatitis B; medical language; physician-patient interaction; medical translation