meng zhao, phd, rn college of nursing & health sciences texas a&m university-cc the role of...
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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
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Screening Mammography4
Is recommended to women aged 50 and above as a regular practice in U.S.
Is not a regular practice in China
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Significance of the Study5
Rapid growth of Chinese immigrants
1990 20000
200000
400000
600000
800000
1000000
1200000
529837
988857
number
number
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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)
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Gaps in literature7
Research has not focused on Chinese-born immigrant women
Research questions have not targeted culture and the influence of Chinese community
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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
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Theoretical framework9
Practice
Capital
HabitusField
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Research design10
Qualitative Ethnography
semi-structured interview with open-ended questions (initial interviews with follow-ups)
Participant observation April 2009- July 2010
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Participants11
N= 15Age=40-68 (average=49)Married (separated)=9Married=6Education=all above associateChristian=4, Buddhist= 1, Polytheist=1,
Atheist=9
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Data management & analysis
12
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
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Major findings13
There are conflict findings between participant observation and interviews.
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“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……
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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……
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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
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Habitus about health promotion and illness prevention
17
Socialization (n=11) Exercise (n=12)Healthy food (n=8)Good sleep (n=10)Happiness (n=7)“God helps” (n=4)
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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
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Factors related to screening mammography utilization
19
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)
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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)
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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
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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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23
Questions?