Korean Immigrants & Mammography-Culture-Specific Health Intervention (KIM-CHI)

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DESCRIPTION (provided by applicant): Breast cancer is the most commonly occurring cancer and most common cause of cancer mortality among Korean American (KA) women, but mammography utilization among KA women remains suboptimal. Most breast cancer screening studies with KA women have been descriptive and correlational, but in this 4-year project we will test the effects of Korean Immigrants & Mammography-Culture-Specific Health Intervention (KIM-CHI) on adherence to recommended breast cancer screening protocols. The specific aims are to: (1) compare the group receiving KIM-CHI with an attention control group on mammogram attainment outcomes including number of mammograms obtained (0, 1, or 2) and if obtained, length of time to obtain the first mammogram, at 15 months using survival analysis; (2) compare the two groups on the mediating variables of health beliefs, knowledge, self-efficacy, spousal support and breast self-examination (BSE) practice at 2 weeks and 15 months using repeated measures multivariate analysis of variance; and (3) identify the mediating effects of health beliefs, knowledge, self-efficacy, spousal support, and BSE practice at 2 weeks on mammogram attainment outcomes at 15 months, using structural equation modeling. We have tested the feasibility of the KIM-CHI program targeting KA women by incorporating culture-specific strategies for changing (1) beliefs about breast cancer and screening, (2) knowledge of breast cancer and cancer screening, and (3) self-efficacy for obtaining a mammogram and requesting a referral for a mammogram from a physician. Using Korean churches randomly assigned to intervention or control conditions, a total sample of 400 KA women 40 years of age or older who have not had a mammogram within the past 2 years, along with their husbands in a separate group, will participate in a group session incorporating an educational DVD, BSE skill practice, peer discussion, and an assignment for the couple to have a discussion afterwards at home. Data on mammography attainment and the mediating variables will be collected at baseline and at 2-weeks and 15-months post-baseline. A strength of this proposal is the testing of a cost- conservative protocol with group delivery of consistent health behavior information using Korean role models, native Korean language, and male physician authentication as well inclusion of spouses for improving KA women's mammography attainment.