Korean American Women

Factors That May Lead to Being Screened Rarely or Never

Knowledge, Attitude, and Belief Barriers

• Language: little to no English proficiency¹
• Lack of specific symptoms or pain; feeling healthy²
• Fear of having cancer or other disease²
• Fatalistic attitude²
• Dislike of Pap test²
• Embarrassment of Pap test, especially with male doctors²
• Lack of familiarity with preventive health services²
• Procrastination³

External and Other Barriers

• Access to health care
• No health insurance^{2 3}
• Not having sufficient time²
• Cost
• Being both married and unemployed^{2 4}
• Having had a hysterectomy²
• Not having had routine checkup²

Factors That May Lead to Increased Screening

Knowledge, Attitudes, and Beliefs

• Higher levels of education³
• Perception of being threatened by cancer or being susceptible to it, including²
• Appearance of symptoms
• Family member or friend receiving a cancer diagnosis or dying from cancer
• Advice of a family member, friend, or medical provider

External and Other Factors

• Access to health care
• Having a regular source of health care³
• Having free screening service available at a health care clinic or hospital²
• Having had a regular checkup^{1 4 5}

Current Research on Outreach/Intervention Strategies

Communication Avenues

• Korean newspapers and television are useful sources for communicating health information and should be used.³



• Korean churches and community centers are the most preferred sites for obtaining community information in one sample of women.³
  
  Note: This success may be due to the overwhelming majority of women being Christian.³



• Korean social networks and friends are a useful source for communicating health information.³



• Free classes on reducing cancer risks were of high interest to one sample of Korean women. Locations that women find convenient include churches, community centers, hospitals, and local schools.⁴



• Periodic information seminars should be offered at the centers where Korean-American women can assemble easily, along with informal group sessions in which the women can converse with experts on cervical cancer prevention.¹

Health Education Materials

• Health education materials written in both Korean and English should be accurate, easy to understand, and informative about the cervical cancer risk factors and early detection. Information should be disseminated through the mass media as well as in brochures and pamphlets provided in community settings such as churches and social centers.^{2 3}

Health Professionals

• Physician outreach is important, as provider recommendation is highly valued. Nurses and other health care providers, including doctors and health educators, should educate female clients about the risk factors for cervical cancer and the benefits of early detection with Pap tests. Further, female physicians or advanced practice nurses, rather than male physicians, should provide exams.^{2 3}



• The number of ethnic minority physicians and advance practice nurses who can provide culturally and linguistically congruent services to such minorities should be increased.²



• Nurses and other providers who perform Pap tests should accurately explain and inform the women about the differences among uterine cancer, cervical cancer, and fibroid tumor so the client will not be confused about the risk factors and health-seeking behaviors. Further, providers should send a reminder card regularly and follow up with telephone contact if there are no initial responses from the women.²

Logistics

• Free or low-cost screening or group insurance plans should be provided to the Korean-American women in the community.²



• Screening appointments could be conceptualized and organized as a social event, with women coming in groups to give them a shared experience, buffer stress and anxiety, and reduce fear when going for such tests alone.²



• The health care facility in which screening occurs should be comfortable for the women in every way. In particular, examinations should be given by female advanced practice nurses or physicians, and the staff should speak Korean as well as English.²



• Transportation should be provided for women who have difficulty getting to the facility or who cannot afford transportation.²



• Flexible and convenient clinic hours, including evenings and weekends, are desirable for women who work long hours and are unable to get time off from work. A mobile clinic using a van equipped with Pap test and pelvic examination facilities would be a great asset in this effort.²

Works Cited

1. Juon HS, Choi Y, Kim MT. Cancer screening behaviors among Korean-American women. Cancer Detection and Prevention 24(6):589-601, 2000.



2. Lee MC. Knowledge, barriers, and motivators related to cervical cancer screening among Korean-American women: A focus group approach. Cancer Nursing 23(3):168-175, 2000.



3. Kim K, Yu ES, Chen EH, Kim J, Kaufman M, Purkiss J. Cervical cancer screening knowledge and practices among Korean-American women. Cancer Nursing 22(4):297-302, 1999.



4. Wismer BA, Moskowitz JM, Chen AM, Kang SH, Novotny TE, Min K, Lew R, Tager IB. Rates and independent correlates of Pap smear testing among Korean-American women. American Journal of Public Health 88(4):656-660, 1998.



5. Maxwell AE, Bastani R, Warda US. Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States. American Journal of Preventive Medicine 18(1):62-8, 2000.