Breast-Health Screening
Perceptions of Chinese Canadian
Immigrant Women
Immigrant & Racialized Women’s Health
Conference
February 21, 2014
Heidi Sin RN, PhD
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Outline
 Problem and purpose of the study
 Approach
 Research questions
 Study participants
 Data collection
 Results and Interpretation
 Recommendations
 Implications for Practices
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Problem
 Breast cancer is a prominent type of cancer in women.
 Breast cancer accounted for 458,000 deaths globally.
 In Canada, 22,700 individuals diagnosed with breast
cancer along with 5,100 cancer-related deaths in 2012.
 Regular breast-health screening could reduce
mortality from breast cancer.
 Screening rate was low within ethno-cultural groups.
 Result in high mortality and morbidity.
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Purpose
To explore the perceptions of breast-health screening
among Chinese Canadian immigrant women, aged 30 to
69 and barriers that prevented them from having breasthealth screening.
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Research Method and Design
 Qualitative case study
 Demographic survey
 Semistructured interview
 Focus group
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Research Question
What are the perceptions of breast-health screening
among Chinese Canadian immigrant women aged 30 to
69?
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Research Subquestions
 Types of preventive health measures
 Perceived benefits of breast-health screening
 Obstacles to breast-health screening
 Females’ perceptions of condition, situations, or
contexts that influence their lived experiences with
breast-health screening
 Perceived role of breast-health screening
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Characteristics of population
 Chinese women aged 30 to 69.
 Born and received education in mainland China.
 First language is Mandarin.
 Have immigrated to Canada for 5 years or less.
 Residents in the Greater Toronto Area.
 Acquired no history of breast cancer.
 Approached Welcome Centre Immigrant Services-
Markham South or The Cross-Cultural Community
Services Association.
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Data Collection
 Pilot study
 Fifteen semistructured interviews
 Two focus groups
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Results and Interpretations
Subquestion 1: What types of preventive health measures used by
Chinese Canadian immigrant women?
Theme: Influence of Chinese cultural beliefs and practices to
maintain health
 Healthy eating
 Physical activities
 Positive attitude
 Regular daily activities
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Results and Interpretations
Subquestion 2: What are the perceived benefits of breasthealth screening for Chinese Canadian immigrant
women?
Theme: Important role of a female caregiver in a family
 Early detection of breast cancer
 Prevention of illness
 Beneficial to individuals and family members
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Results and Interpretations
Subquestion 3: What are the obstacles to breast-health
screening for Chinese Canadian immigrant women?
Theme: Accessibility to and utilization of screening services
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Lack of knowledge
Inconvenience
Language proficiency
Embarrassment
Perceived illness
Radiation
Cost
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Results and Interpretations
Subquestion 4: What are the females’ perceptions of
condition, situations, or contexts that influence their lived
experiences with breast-health screening?
Two themes: Lack of preventive health concept and
experiences affect participation
Lack of preventive health concept
 Perceived illnesses
 Awareness of breast cancer impact
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Results and Interpretations
Subquestion 4: What are the females’ perceptions of
condition, situations, or contexts that influence their lived
experiences with breast-health screening?
Theme: Experiences affect participation
 Positive / negative perceptions of screening
 Someone with breast cancer
 Screening experiences
 Screening instructions
 Positive / negative emotional responses
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Results and Interpretations
Subquestion 5: What perceived role does breast-health
screening play in Chinese Canadian immigrant women’s
health?
Theme: Lack of information about breast-health screening
program
 Benefits of screening
 Importance of screening
 Individual responsibility
 Breast-health screening program
 Current health status
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Recommendations
 Develop culturally-sensitive linguistic programs and
educational materials in consideration of Chinese
health beliefs.
 Establish better communication between health care
providers and clients and recommendation by
physicians.
 Include breast-health screening as a standard item
within annual check-up.
 Promotion of breast-health screening through ethnic
media.
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Recommendations
 Expand the operating hours for screening clinic and
initiation of mobile women’s clinic.
 Provide translation services, comfortable and
supportive environment at the breast-health screening
clinics.
 Provide linguistic culturally educational program to
include preventive health concept.
 Provide community-based outreach educational
programs and a lay health educator program.
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Implications for Practices
To increase participation in breast-health screening:
 Increase knowledge.
 Reduce perceived barriers, facilitate perceived
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benefits, minimize negative experiences.
Promote self care message.
Involve physicians.
Send reminders through a systematic approach.
Remove embarrassment by given options.
Review health organizations role.
Conduct further longitudinal studies.
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Thank you!!
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References
 Anagnostououlos, F., Dimitrakaki, C., Fitzsimmons, D., Potamianos,
G., Niakas, D., & Tountas, Y. (2012). Health beliefs and illness
perception as related to mammography uptake in randomly selected
women in Greece. Journal of Clinical Psychology in Medical Settings, 19,
147-164. doi:10.1007/s10880-011-9272-1
 Ayala, G. X., Vaz, L., Earp, J. A., Elder, J. P., & Cherrington, A. (2010).
Outcome effectiveness of the lay health advisor model among Latino in
the United States: An examination by role. Health Education Research,
25(5), 815-840. doi:10.1093/her/cyq035
 Bloomberg, L., & Volpe, M. (2008). Completing your qualitative
dissertation: A roadmap form beginning to end. Thousand Oaks, CA.
Sage.
21
References
 Canadian Cancer Society , Public Health Agency of Canada, & Statistics





Canada. (2012). Canadian cancer statistics 2012. Toronto, Canada:
Canadian Cancer Society.
Cancer Care Ontario. (2010). Ontario breast cancer screening program
20th anniversary report 1990-2010. Toronto, ON: Author.
Chen, Y. L. D. (1996). Conformity with nature: A theory of Chinese
American elders’ health promotion and illness prevention process.
Advances in Nursing Science, 19(2), 17-26.
Christensen, L. B., Johnson, R. B., & Turner, L.A. (2011). Research
methods, design, and analysis (11th ed.). Boston, MA: Allyn & Bacon.
Finlay, L. (2009). Debating phenomenological research methods.
Phenomenological and Practices, 3(1), 6-25.
Gay, L. R., Mills, G. E., & Airasian, P. (2006). Educational research.
Competencies for analysis and applications. Upper Saddle River, NJ:
Pearson.
22
References
 Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior
and health education. Theory, research and practice (4th ed.).
Hoboken, NJ: Jossey-Bass.
 Inoue, M., Pickard, G. J., Welch-Saleeby, P., & Johnson, S. (2009).
African-American caregivers’ breast health behavior. Health Education
Research, 24(5), 735-747. doi:10.1093/her/cyp008
 Kwok, C., Fethney, J., & White, K. (2012). Mammographic screening
practices among Chinese-Australian women. Journal of Nursing
Scholarship, 44 (1), 11-18. doi:10.1111/j.1547-5069.2011.01429x
 Lee-Lin, F., Menon, U., Pett, M., Nail, L., Lee, S., & Mooney, K. (2007).
Breast cancer beliefs and mammography screening practices among
Chinese American immigrants. Journal of Obstetric, Gynecologic, &
Neonatal Nursing, 36, 212-221. doi:10.1111/J.1552-6909.2007.00141.x
23
References
 Lee-Lin, F., Menon, U., Nail, L., & Lutz, K. F. (2012). Findings from
focus groups indicating what Chinese American immigrant women
think about breast cancer and breast cancer screening. Journal of
Obstetric Gynecologic & Neonatal Nursing, 00(00), 1-11.
doi:10.1111/j.1552-6909.2012.01348x
 Leedy, P. D., & Ormrod, J. E. (2010). Practical research: Planning and
design (9th ed.). Upper Saddle River, NJ: Pearson.
 Liang, W., Wang, J. H., Chen, M. Y., Feng, S., Lee, M., Schwartz, M.
D.,…Mandelblatt, J. S. (2008). Developing and validating a measure of
Chinese cultural views of health and cancer. Health Education and
Behavior, 35, 361-375. doi:10.1177/1090198106294893
 Mapp, T. (2008). Understanding phenomenology: The lived
experience. British Journal of Midwifery, 16, 308-311.
24
References
 Morgan, D. L. (1997). Focus groups as qualitative research. Newbury
Park, California: Sage.
 Moustakas, C. (1994). Phenomenological research methods. Thousand
Oaks, CA: Sage.
 Shin, K., Kim, M., & Chung, S. (2009). Methods and strategies utilized
in published qualitative research. Qualitative Health Research, 19, 850858.
 Sun, A., Zhang, J., Tsoh, J., Wong-Kim, E., & Chow, E. (2007). The
effectiveness in utilizing Chinese media to promote breast health
among Chinese women. Journal of Health Communication, 12, 157-171.
doi:10.1080/10810730601150106
25
References
 Tabar, L., Vitak, B., Yen, A. M., Cohen, A., Tot, T., Chui, S.Y.,…Duffy, S.
W. (2011). Swedish two-country trial: Impact of mammography
screening on breast cancer mortality during 3 decades. Radiology, 260,
658-663. doi:10.1148/radiol.11110469
 Todd, L. Harvey, E., & Hoffman-Goetz, L. (2011). Predicting breast and
colon screening among English-as-a- second-language older Chinese
immigrant women to Canada. Journal of Cancer Education, 26, 161-169.
doi: 10.1007/s13187-010-0141-7
 World Health Organization. (2013). Breast cancer: Prevention and
control. Retrieved from
http://www.who.int/cancer/detection/breastcancer/en
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