Transcript Meng Zhao, PhD, RN College of Nursing

The role of culture on screening
mammography utilization among
Chinese-born immigrant women in the
United States: an ethnographic approach
MENG ZHAO, PHD, RN
COLLEGE OF NURSING & HEALTH SCIENCES
TEXAS A&M UNIVERSITY-CC
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Introduction
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 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 Mammography
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 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 Study
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 Rapid growth of Chinese immigrants
number
1200000
988857
1000000
800000
600000
529837
number
400000
200000
0
1990
2000
Significance of the Study
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 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 literature
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 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 framework
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Capital
Practice
Field
Habitus
Research design
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 Qualitative
 Ethnography
 semi-structured interview with open-ended questions (initial
interviews with follow-ups)
 Participant observation
 April 2009- July 2010
Participants
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 N= 15
 Age=40-68 (average=49)
 Married (separated)=9
 Married=6
 Education=all above associate
 Christian=4, Buddhist= 1, Polytheist=1, Atheist=9
Data management & analysis
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 Nvivo 8
 Contact summary sheet
 Participant observation data sheet
 Coding:
descriptive codes
 pattern codes
 Organizing codes:
 tree codes
 within-case or cross-case data display
 memos and journals

Major findings
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 There are conflict findings between participant
observation and interviews.
“natural” food
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 ……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 diet
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 ……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 health
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 Health= physical health+ mental health
 Mental health is more valued than physical health
 Spiritual health is considered as part of mental
health
 Broader concept of health
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Diet
Life style
Little stress
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 practice
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Advantages
Disadvantages
U.S.
more advanced
equipment;
better environment;
kindness of health care
providers,
greater flexibility in
choosing providers
appointment system
referral system
language barrier
China
Timeliness of service;
Experienced physicians
less advanced equipment
long waiting time
noisy, 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
seeking
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 Friends or family member (n=10)
 Internet (n=7)
 Health professionals (n=5)
 Newspaper (n=3)
 Job & colleagues (n=3)
Discussion
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 Strength of the study
 The application of both in depth interview and participant
observation
 Limitation of the study
 Sample & setting confined to local Chinese community
Implications for practice
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 The understanding of the Chinese-born immigrant women’s use
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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?