meng zhao, phd, rn college of nursing & health sciences texas a&m university-cc the role of...

MENG ZHAO, PHD, RNCOLLEGE OF NURSING & HEALTH SCIENCES

TEXAS A&M UNIVERSITY-CC

The role of culture on screening mammography utilization among Chinese-

born immigrant women in the United States: an ethnographic approach

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Introduction3

Chinese-born immigrant women, after immigrating to the United States, encounter cross-cultural challenges regarding their health care practices due to different cultural beliefs, views, and attitudes about

health and health care the systematic and structural differences between the

health care system in China and in the United States

Screening Mammography4

Is recommended to women aged 50 and above as a regular practice in U.S.

Is not a regular practice in China

Significance of the Study5

Rapid growth of Chinese immigrants

1990 20000

200000

400000

600000

800000

1000000

1200000

529837

988857

number

number

Significance of the Study 6

Breast cancer is the leading diagnosed cancer and the 3rd leading cause of cancer death among Chinese American women (Miller et al., 2008)

Chinese-born women, after immigrating in the United States, might have a higher risk to get breast cancer.

Asian American women have the lowest screening mammography utilization rate. (CDC,1990-2010)

Gaps in literature7

Research has not focused on Chinese-born immigrant women

Research questions have not targeted culture and the influence of Chinese community

Purpose of the study Get in-depth understanding of how

Chinese-born immigrant women view or perceive Health or illness Health promotion with a focus on breast cancer

prevention Health care practice

Explore factors related to their screening mammography utilization with a focus on culturally specific factors

Theoretical framework9

Practice

Capital

HabitusField

Research design10

Qualitative Ethnography

semi-structured interview with open-ended questions (initial interviews with follow-ups)

Participant observation April 2009- July 2010

Participants11

N= 15Age=40-68 (average=49)Married (separated)=9Married=6Education=all above associateChristian=4, Buddhist= 1, Polytheist=1,

Atheist=9

Data management & analysis

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Nvivo 8Contact summary sheet Participant observation data sheetCoding:

descriptive codes pattern codes

Organizing codes: tree codes within-case or cross-case data display

memos and journals

Major findings13

There are conflict findings between participant observation and interviews.

“natural” food14

……even if the product is labeled as “natural”, I do not consider it as natural. Natural food by definition is the food that I can cook. It’s real food, not something that has been labeled as natural product, but is actually processed. That’s why I never eat processed food or take those health supplements. The natural food I am referring to is those grow by themselves, not artificially synthesized……I don’t buy semi-finished or finished food, since I don’t know what they are made of……

……natural food is better. I mean the food that I can see and touch and grow in the nature……I worry about those semi-finished or finished food, since I don’t know what additives they (the makers) might put in the food……(that’s why) I rarely go out for eating……

Balanced diet15

……balanced diet is important……At our home, we usually eat some vegetables, fruits, rice, and flour. We also eat some meat and eggs each day……

……for good health, we need to balance what we eat for the three meals per day. We should eat a lot of vegetables and fruits, but we also need to eat some meat or eggs. It is not healthy to eat only particular food. Every kind of food is beneficial in some way to our health……

Habitus about health16

Health= physical health+ mental healthMental health is more valued than physical

healthSpiritual health is considered as part of

mental healthBroader concept of health

Diet Life style Little stress

Habitus about health promotion and illness prevention

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Socialization (n=11) Exercise (n=12)Healthy food (n=8)Good sleep (n=10)Happiness (n=7)“God helps” (n=4)

Habitus about health care practice18

Advantages Disadvantages

U.S. more advanced equipment;better environment;kindness of health care providers,greater flexibility in choosing providers

appointment systemreferral systemlanguage barrier

China Timeliness of service;Experienced physicians

less advanced equipmentlong waiting timenoisy, crowded environment

Factors related to screening mammography utilization

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Economic factors Health insurance (n=8) Pay out-of-pocket (n=3)

Regular check-up (n=8)Health care provider (n=6)Language barrier (n=6)Early detection and breast cancer incidence

(n=3)

Capital, observation & health information seeking20

Friends or family member (n=10)Internet (n=7)Health professionals (n=5)Newspaper (n=3)Job & colleagues (n=3)

Discussion21

Strength of the study The application of both in depth interview and

participant observationLimitation of the study

Sample & setting confined to local Chinese community

Implications for practice22

The understanding of the Chinese-born immigrant women’s use of screening mammography cannot be separated from their socio-cultural background.

Educate these women for knowledge of breast cancer and screening mammography

Assess these women’s social network, encourage them to make friends and participate in the community activities.

Intervention programs to improve the use of screening mammography should be culturally-specific.

Chinese language community education might be the an effective approach to improve Chinese-born immigrant women’s screening mammography utilization.

Internet-based intervention program might be appropriate.

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Questions?