Stage-Based Educational Interventions for Promoting Early Screening Mammography Use among Korean-American Women

Transcription

1 Stage-Based Educational Interventions for Promoting Early Screening Mammography Use among Korean-American Women Jin H. Kim, PhD. RN Associate Professor Chamberlain College of Nursing Funded by NIH/NINR (1 R21 NR A1)

2 SIGNIFICANCE OF PROBLEM Most frequently diagnosed cancer among Korean-American women Lowest screening mammography rates among other ethnic minority sub-population in the U.S.

3 STUDY METHODS Design Prospective Two-group Repeated-measures Quasi-experimental Purpose Implement culturally relevant, theory-based, targeted educational intervention specifically designed to promote the stage of readiness for mammography use among Korean-American women aged 40 years or older.

4 THEORETICAL FRAMEWORK Transtheoretical Model of Change (TTM) Individual health behavior change occurs as a process rather than as a dichotomous event Having a mammogram Action Maintenance: Annual mammogram as recommended Preparation: Making a plan/preparation as necessary for having a mammogram Contemplation: Thinking about having a mammogram Pre-contemplation: No intention to have a mammogram

5 Health Belief Model (HBM) Perceived Seriousness Perceived Benefits Perceived Susceptibility/Risk Perceived Barriers Woman Knowledge Perceived Self-efficacy Perceived Fear Woman will participate in breast cancer screening practice if she believes that she is susceptible to breast cancer (perceived risk), breast cancer is serious (perceived seriousness), is a benefit to have early screening (perceived benefits), obstacles to have early screening (perceived barriers) are outweighed by perceived benefits Woman has fear about breast cancer (perceived fear), has confidence in her own ability to follow through steps for having a mammogram (perceived self-efficacy), and possess cognitive information about breast cancer, early screening, and mammogram (knowledge)

6 INTEGRATED FRAMEWORK for KA WOMEN

7 KA Breast Cancer Screening Model Demographics GO EARLY Education Knowledge Acculturation Beliefs Perceived Susceptibility Perceived Benefits Perceived Barriers Perceived Fear Perceived Self-efficacy Modesty Fatalism Outcome Stage of Mammography Use Pre-contemplation Contemplation Relapse (Pre-contemplation/Con) Action

8 7 KA Churches 180 KA women aged 40 years or older N= 90: Intervention N= 90: Control 117-item questionnaire Setting, Sample, Eligibility Criteria

9 Educational Groups

10 PROTOCOL FLOWCHART Recruit participants in Control church Obtain Informed Consent Recruit participants in Intervention church Obtain Informed Consent Complete Time 1 Questionnaire Complete Time 1 Questionnaire Attend GO EARLY education session Complete Time 2 Questionnaire (16 weeks from Time 1) Complete Time 3 Questionnaire (24 weeks after Time 1)

11 Educational Intervention Culturally competent, stage-based educational program specifically designed to advance the stage of readiness for having screening mammography for early breast cancer detection 45-minute, semi-structured, interactive session on breast cancer knowledge and beliefs Presented by animated PowerPoint slides to women grouped according to stage of readiness for mammography use

12 Intervention Group by Stage of Mammography Use Pre-contemplators Never had a mammogram Not thinking about having one in the next 6 months Contemplators Never had a mammogram Thinking about having one in the next 6 months Relapsers Had at least one mammogram in the past Not on schedule now Pre-contemplation or contemplation Constructs Knowledge, perceived barriers, fears, acculturation, modesty, fatalism Emphasis on perceived benefits, susceptibility, self-efficacy Knowledge, perceived benefits, susceptibility, acculturation Emphasis on perceived barriers, fears, self-efficacy, modesty, fatalism Knowledge, perceived benefits, susceptibility, self-efficacy, fear, acculturation, modesty, fatalism Emphasis on specific barriers Content Breast cancer facts/figures, risk factors, treatment Early screening rates for KA women Recommended screening guidelines Emphasize the positive outcomes of regular mammography (cure with early detection) and confidence to complete all steps Survivor testimonial of having a mammogram Breast cancer facts/figures, risk factors, treatment Early screening rates for KA women Recommended screening guidelines Positive outcomes of regular mammography (cure with early detection) Emphasize decreasing specific barriers and increasing confidence to complete all steps of having a mammogram (self-efficacy) Survivor testimonial of having a mammogram Breast cancer facts/figures, risk factors, treatment Early screening rates for KA women Recommended screening guidelines Positive outcomes of regular mammography (cure with early detection) and confidence to complete all steps Emphasize specific barriers and strategies to avoid them based on issues identified by the group Survivor testimonial of having a mammogram

13 Demographics RESULTS/FINDINGS Total (N=180) Intervention (N=90) Control (N=90) Age, mean (SD) 52.4 (9.7) 55.6 (10.2) 49.3 (8.0) <.0001 Years in U.S. (%) 10 yrs > 10 yrs Household size (%) Annual Income (%) < $10,000 $10,000 - $39,999 $40,000 - $54,999 > $55, p <.001 <.05 <.0001 Perform BSE (%) <.05 Insurance Type (%) Private/HMO Medicare/Medicaid <.05

14 Scale Reliability

15 Changes in Knowledge & Beliefs (Pre- and Post-Test)

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17 Screening Mammogram by Stage of Readiness

18 Conclusion Educational intervention was culturally sensitive to KA women, had feasibility to implement in KA community setting, and can be replicated to other KA communities Education was effective in modifying the women s perceptions for having a mammogram. Longitudinal study with more repeated outcome measures to evaluate incremental changes and necessary timeframe for KA women to move Collaborate to compare the findings from KA women in other states and/or women in Korea vs. U.S. Clinically significant study findings

19 Future Research Needs: Follow-Up Interview 20 Women with Education had Mammogram 20 Women with No education & Yes Mammogram Language Barrier Difficulty of health care access 20 Women with Education had No Mammogram 20 Women with No education & No Mammogram