A Network-Based Intervention for Chamorros in Southern CA

Institution: University of California, Irvine
Investigator(s): Sora Tanjasiri, DrPH, MPH - Lola Sablan Santos,  -
Award Cycle: 2001 (Cycle VII) Grant #: 7BB-1901S Award: $165,419
Award Type: CRC Full Research Award
Research Priorities
Detection, Prognosis and Treatment>Imaging, Biomarkers, and Molecular Pathology: improving detection and diagnosis

This is a collaboration with: 7BB-1900S -

Initial Award Abstract (2001)
This three-year, community-based research project applies social network theory to test the effectiveness of a tailored, Chamorro lay health leader intervention to increase breast cancer screening rates among Chamorro women age 50 years and older in the counties of Los Angeles and Orange. The study employs a quasi-experimental (intervention and control group), prospective cohort, pretest/posttest design, with Chamorro women from Northern California (specifically Alameda, Solano and Santa Clara Counties) agreeing to serve as the comparison group.

This project hypothesizes that the intervention will significantly increase the rates of appropriate breast cancer screening (baseline and regular breast self-examination, clinical breast examination, and mammography), and that the increased screening rates will be related to increased diffusion of information and skills through naturally-occurring social networks of Chamorro women. During the three-year period, we will undertake the following major activities: 1) identification of Chamorro women 50+ years old who are linked to each other through close social (family and friendship) ties; 2) training of 20 Chamorro lay leaders in breast cancer information and screening (modeled after ACS’ Special Touch and the Wai’anae Cancer Research Project’s lay leader training programs); 3) implementation of lay leader-led small-group events to educate women about BSE, CBE and mammography; 4) linkage with other projects (OCAPICA’s Promoting Access To Health Project) to facilitate screening services for interested women; 5) follow-up measurement of women after 1 ½ years of intervention to measure changes in women’s behavior and diffusion of those behaviors through social networks; and 6) dissemination of materials and training to Chamorro women in the bay area (who served as the "controls") as well as to other Chamorro and Pacific Islander communities (through our network of professional and community contacts).

This study continues a close community-based collaboration established five years ago between Guam Communications Network, Inc., and the University of California, Irvine, and broadens it to include two other Chamorro social groups, the Famalao’an (Chamorro for "the women") and the Bay Area Women’s Social Club. While this study will provide vital information on breast health promotion for Chamorro women, we also believe the results will help in the development of the successful strategies for the promotion and evaluation of breast cancer screening to ethnic minority women who are from relatively smaller, tightly-knit communities across California.


Final Report (2005)
This three-year, community-based study applies social network theory to test the effectiveness of a culturally tailored, Chamorro lay health advocate intervention to increase breast cancer screening rates among Chamorro women age 50 years and older in the counties of Los Angeles and Orange. The study employs a quasi-experimental (intervention and control group), prospective cohort, pretest/posttest design, with Chamorro women from Northern California (specifically Alameda, Solano and Santa Clara Counties) agreeing to serve as the comparison group. This project hypothesizes that the intervention will significantly increase the rates of appropriate breast cancer screening (baseline and regular breast self-examination, clinical breast examination, and mammography), and that the increased screening rates will be related to increased diffusion of information and skills through the network of Chamorro women in the intervention vs. control communities.

During the third year of the study, we accomplished all of the proposed major activities: 1) recruited and surveyed a total of 422 women in Northern and Southern California about their breast cancer knowledge, attitudes, and behaviors as well as their social networks; 2) developed a training curriculum for lay health advocates in Southern California; 3) recruited and trained 11 Chamorro women (5 in Southern California, and 6 in Northern California) in basic breast cancer knowledge as well as educational skills; 4) developed incentive and educational tools, including a “bingo” card game to educate women in small social settings; 5) developed a draft follow-up survey to assess changes in women’s knowledge, attitudes and behaviors; 6) administered the follow-up survey with a total of 324 women (for a total response rate of 76.8%); and 7) disseminated all of the data and training/education materials to the comparison site (Northern California). While this study will provide vital information on breast health promotion for Chamorro women, the results will help inform the development of successful network-based strategies for the promotion and evaluation of breast cancer screening among ethnic minority women from similarly small, tight-knit populations across California.


Symposium Abstract (2003)
This three-year, community-based study applies social network theory to test the effectiveness of a culturally tailored, Chamorro lay health advocate intervention to increase breast cancer screening rates among Chamorro women age 50 years and older in the counties of Los Angeles and Orange. The study employs a quasi-experimental (intervention and control group), prospective cohort, pretest/ posttest design, with Chamorro women from Northern California (specifically Alameda, Solano and Santa Clara Counties) agreeing to serve as the comparison group. This project aims to significantly increase the rates of appropriate breast cancer screening (baseline and regular breast self-examination, clinical breast examination, and mammography), and that the increased screening rates will be related to increased diffusion of information and skills through the network of Chamorro women in the intervention vs. control communities.

Baseline data from women in Southern California indicate that despite high rates of insurance coverage, only 59.3% of women were getting yearly CBEs, and 54.9% were getting yearly mammograms. We will discuss factors on screening such as knowledge, attitudes, as well as perceived social norms for breast health and cancer screening. In addition, we will present novel elements of our intervention that capitalize on informal contacts between leaders and members in order to diffuse breast cancer screening throughout the community. This study continues a close community-based collaboration established four years ago between Guam Communications Network, Inc. (GCN), and the University of California, Irvine (UCI), and broadens it to include two other Chamorro social groups: I Famalao’an (IF) and the Bay Area Women’s Social Club (BAWSC).


Supplement Award Abstract (2003)
Training Supplement to "A Network-Based Intervention for Chamorros in Southern CA"
Tina Vacharkulksemsuk
University of California, Irvine

Planning for culturally sensitive community resources for the Chamorro breast cancer survivors has been a concern of the community partners for over four years, since there has been no research conducted specifically on Chamorro breast cancer survivors. Even though breast cancer remains the most common type of cancer for Asian American women, information on the incidence and prevalence among Pacific Islander women is nearly nonexistent.

This research project, undertaken as a trainee supplement to the parent grant ('A Network-Based Intervention for Chamorros in Southern California") addressed the need for culturally sensitive community services and educational resources for breast cancer survivors in the Chamorro community. The study utilized qualitative research methods, which consisted of a focus group and four key informant interviews. Both the focus group and the interviews were tape recorded with the consent of the participants for further analysis by the lead researcher.

A total of 11 respondents were interviewed, all tape recordings were transcribed, and the transcripts analyzed using the qualitative program Ethnograph. Findings included: the idea that cancer is a private matter and the lack of awareness and education on breast cancer within the Chamorro community, the idea that disease is a punishment from God, the immediate family as the main source of social support, frustration in dealing with the health care system, and the lack of awareness to minorities developing diseases such as breast cancer.

From this research project, it is evident that there is a need for culturally sensitive community services and educational resources for the Chamorro community. The need for the Chamorro community to be educated on issues such as breast cancer is also seen through their adherence to certain cultural barriers. The development of groups within the Chamorro community can serve as a strong foundation for future programs and research projects if more members of the Chamorro community become involved after participating in the groups. Community involvement in all phases of the project is essential to facilitate community acceptance and an effective intervention. Through more research conducted on the API community, more outreach and education programs tailored specifically toward API communities, such as the Chamorro can be developed.