Transcript cultural beliefs - Avon Breast Health Outreach Program

Cultural Barriers to Early Breast
Cancer Detection Among African
Immigrants in California
Yewoubdar Beyene, PhD,
UCSF
Background: African Immigrants in the US
• Immigrants from the continent of Africa are the most recent
immigrant population in the US and steadily growing.
• Data from the 2000 Census shows a surge in African
migration to the United States over the past twenty years
(229%).
• The largest groups are from Nigeria (18.4%), followed by
Ethiopia (14.3%), and Egypt (12.5%).
• Currently, over three million African immigrants are
estimated to live in the U.S, more than 60% of whom are
between 30-55 years old.
• Like many other immigrants, African immigrants tend to
settle in urban areas and the majority live in California and
on the East Coast.
Breast Cancer in Africa
• Breast cancer is the second most common malignancy of
women in the region.
• Women diagnosed with breast cancer in African countries
seem to be a decade younger than their counterparts in the
West.
• The disease is most often advanced to stage III an IV at the time
of diagnosis.
Lack of Health Data on African immigrants in the US
• Lack of discrete population data for African immigrant
populations.
- Data on blacks include both foreign-born and US- born.
- On the few occasions when foreign-born data exists
on black populations, there is usually no distinction
among cultures.
• The health of African immigrants differs in many ways from the
health of U.S. born blacks with a long generational, social and
cultural history of living in the US.
•
Area of dissimilarity concerns:
- cultural beliefs
- practices toward health.
• Understanding health risks, managing illness, and utilization of
health services are more strongly influenced by cultural beliefs
and practices than by race.
• Immigrants bring their specific cultural heritage to the host
country with dramatically different beliefs, values, and customs
about health and illness, often contrasting with those of their
adoptive country.
• Consequently, many immigrants are impervious to public
health education about diseases that appear in American
media.
Beliefs and Risk of Breast Cancer among African
Immigrants
University of California, BCRP 5PB-0027
Objectives:
•To identify culturally specific factors that influence African
immigrant women’s:
-understanding of breast cancer symptom
presentations
- perceived risks
- barriers to early detection
- access to knowledge of early detection
- acceptance of breast cancer screening
guidelines
Study Design
• Focus group interviews with 20 key informants.
• In-depth interviews with 100 African immigrant women, age
ranged from 35-50.
• The participants for this study were recruited from a
convenience sample of African immigrants from Nigeria,
Ghana, Sierra Leone, Congo, Ivory Coast, Cameroon, Burundi,
Ethiopia, Eritrea, Kenya and Uganda.
Findings
Barriers to early detection screening:
• Cultural Beliefs
• Lack of knowledge and Invisibility
• Lack of Access to Health Care
BARRIERS TO EARY DETECTION SCREENING
CULTURAL BELIEFS
●Fear of dying -cancer is a death sentence
●Fear of finding cancer
Modesty - Cultural taboo of self breast examination
Stigma - Disclosure would jeopardize social standing
and marriage for the family members.
Mastectomy - disfigurement and physical disability
Reincarnation – a need to keep the body intact
LACK OF KNOWLEDGE
Lack of knowledge about treatment options
Invisibility-Lack of perceived risk
Misinterpretation of media health information
LACK OF ACCESS TO HEALTH CARE
●Lack of health insurance
●Lack of culturally tailored health forum
RANKED BARRIERS TO EARLY DETECTION
4
8%
1
50%
3
17%
2
25%
1
2
3
4
fear of dying
lack of knowledge
fear of mastectomy
self breast exam
Cultural Beliefs
• Not wanting to know if one has cancer
• Delay in seeking medical advice unless sick (No pain,
no symptom and no need to see a doctor)
• Faith- Everyone dies of something why find out early;
If you talk about an illness and you worry about it you
are bound to get it
• Stigma- belief that cancer is hereditary:
– Disclosure of cancer diagnosis would jeopardize
social standing and marriage possibilities.
– Fear of mastectomy because of strong cultural
stigma of disfigurement and physical disability.
– Modesty about touching ones breast, undressing
in front of others.
Lack of Knowledge and Invisibility
• Lack of representation
• It is not about me
• Lack of perceived risk (belief that breast cancer is an American
disease)
• Misinterpretation of media breast cancer information:
- information on family history and risk of breast cancer is
misaligned to validate the cultural beliefs that breast cancer is
inherited and therefore, reinforces stigma.
Lack of Access to Health Care
Lack of health insurance
• 73% of the women interviewed never had
mammography.
• 80% did not have health insurance and use emergency
rooms and health clinics.
• They don’t want mammography because they don’t
have insurance.
• Even if the mammography is free the uninsured
African immigrant women feel that they don’t have the
money to follow through.
Lack of culturally tailored health forum
•
Unlike other ethnic groups, African immigrant communities in
the US do not have any existing social structures targeted
specifically to their needs in the area of health promotion and
disease prevention.
•
Services provided to other ethnic minorities are not accessible
to immigrants from sub-Saharan Africa because of :
*social
*cultural
*linguistic differences
Remarks
• African immigrant women in this study were found to hold
health beliefs regarding susceptibility to cancer that were
congruent with their country of origin rather than with their
country of residence.
• Lack of access to medical care compounded by cultural
beliefs and patterns of health care seeking behaviors, such
as delay in seeking medical advice unless sick, not sharing or
discussing health problems with others and communication
problems with health care personnel, are barriers to breast
cancer early detection efforts among immigrant population.
• Moreover, the lack of a reliable census of African immigrant
populations in the US is a particular problem in addressing
health risks in these communities. The statistical aggregation
of African immigrants with native-born African Americans
causes serious setbacks in disease prevention efforts in
these immigrant communities.