Increasing Breast Cancer Screening in Chinese Immigrants

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In New York City (NYC), persons of Chinese descent experience the highest cancer mortality rate of any ethnic group. Breast cancer is the most commonly diagnosed cancer in Chinese immigrant women, who experience substantial increases in breast cancer risk after spending a decade or more in the US. Regular mammography screening and timely follow up are crucial for early detection of breast cancer and increased survival. However, Chinese immigrant women in NYC report low utilization of screening mammography and are less likely to complete follow up in a timely manner compared to non-Latina white women. Chinese immigrants in NYC are more likely to live below the poverty line, to lack insurance, and to be without a usual source of care. Over 50% have less than a high school education, cannot speak or understand English, and would not see a western doctor as a first course even if they had symptoms. Research within this community has revealed that only 23% of Chinese immigrant women in NYC had ever had a mammogram in their lifetime. This is a population with great need for basic medical care, increased breast cancer knowledge, and access to breast cancer screening. Health disparities plague the health care system and arise from a complex interplay of economic, social, and cultural factors. The Health Belief Model (HBM) provides a framework for addressing cultural health disparities related to preventive health care and cancer screening by positing that making a decision to engage in a health behavior is determined by weighing perceived threats versus benefits. Guided by the HBM, the Witness Project uses narrative communication (e.g., storytelling, personal testimonials) to educate, persuade, and engage target communities about cancer prevention and screening. Our work in minority and immigrant communities has demonstrated that narrative communication can increase participation in breast cancer screening. However, the efficacy of these interventions has not been empirically tested among Chinese immigrants. The long-term goal of the proposed line of research is to increase breast cancer screening rates for NYC Chinese immigrants. We plan to accomplish this objective by pursuing the following specific aims: AIM 1. Culturally and linguistically adapt the Witness Project, a narrative breast cancer education program, for Chinese immigrant women. Focus groups and qualitative interviews will be conducted with community gatekeepers and stakeholders to obtain feedback on intervention content. AIM 2. Pilot test feasibility and acceptability of WP for Chinese immigrant women. Feasibility and acceptability of the pilot intervention will be assessed to determine effect sizes for a future large scale trial. Screening mammogram receipt and intentions to undergo mammography, as well as other HBM constructs will be compared in a pre-post design stratified by language. Successful completion of the study aims will make a novel and transformative contribution to the field of cancer screening, especially for this underserved population.