Samoans and Cancer: Evaluation of a Culturally Appropriate P

Institution: National Office of Samoan Affairs
Investigator(s): Pat  Luce , M.S. - Shiraz  Mishra , M.B.B.S., Ph.D -
Award Cycle: 1998 (Cycle IV) Grant #: 4BB-1400 Award: $430,536
Award Type: CRC Full Research Award
Research Priorities
Community Impact of Breast Cancer>Health Policy and Health Services: better serving women's needs

This is a collaboration with: 4BB-1401 -

Initial Award Abstract (1998)
We address the California Breast Cancer Research Programís priority area of public education and early detection through the use of new methods of dissemination of information about breast cancer to Samoan women, the indigenous people of the U.S. Territory of American Samoa. Despite the high site-specific incidence of breast cancer and low levels of both awareness and utilization of screening and early detection examinations, no educational programs have been tested in this population. We will implement and evaluate an innovative, theory-based, culturally sensitive and linguistically appropriate breast cancer control educational program ("intervention") specially developed for Samoan women. The specific aims are, first, to implement and evaluate (using behavior change theory) the interventionís effectiveness in enhancing knowledge, modifying attitudes, and most importantly, effecting positive behavior change. Second, to identify individual and structural factors that facilitate or impede behavior change. We build on an ongoing National Cancer Institute (NCI) sponsored cancer control research study among Samoans conducted collaboratively by the University of California, Irvine (UC Irvine) and the National Office of Samoan Affairs (NOSA), a community-based Samoan service organization situated in Carson, California.

The intervention consists of three components: specially developed English- and Samoan-language educational materials; skills building exercises; and, interactive group discussions. The intervention, designed in four modules, address different aspects of breast cancer (i.e., risk, severity, susceptibility, screening and early detection exams). The materials and the skills building exercises necessary to model and role play new behaviors will supplement group discussions. The outcome of primary interest is the receipt of a mammogram between the pretest and posttest survey. Outcomes of secondary interest are the appropriate conduct of breast self-exams, receipt of clinical breast exams, and positive changes in knowledge and attitudes.

We will conduct the study in two contiguous Southern California counties, Los Angeles and Orange. Samoan-speaking churches located in these two counties will form the study sites. We will randomly assign matched and paired study sites to the two study groups, Experimental and Control. Initially, we will select 600 Samoan women from the study sites. At the studyís end, we expect the final sample size to include approximately 480 women (240 women per study group). We will conduct a pretest and posttest survey. Between the pretest and posttest surveys, we will administer the intervention to the Experimental group. We will administer the posttest survey eight months after the pretest survey. Analysis of the survey data will provide a quantitative evaluation of the programís effectiveness. After the posttest survey, we will conduct focus groups with women who changed their behaviors and those who did not. The focus group data will provide more in-depth explanations about factors important for behavior change.

This collaborative research project has several benefits. It addresses a crucial community identified cancer control need of Samoan women. The project enhances NOSAís research capacity providing it with additional skills and experience to develop procedures and infrastructure needed for in-house monitoring of prevention efforts. Due to the unique study design, Samoan women have an opportunity to make an impact on various aspects of the study as program developers, implementers and evaluators. Furthermore, the research project will provide crucial insights into the applicability and appropriateness of the behavior change theory and research methods for this community. Lastly, the behavior change theory, educational program, evaluation protocol and associated methods will be presented in a didactic monograph designed to be used as a guidebook for other cancer control programs through relevant community-based organizations that work with minority, hard-to-reach populations.


Final Report (2001)
Despite the high site-specific incidence of breast cancer and low levels of both awareness and utilization of screening and early detection examinations, no educational programs have been tested among Samoan women. We implemented and evaluated an innovative, theory-based, culturally sensitive and linguistically appropriate breast cancer control educational program (ďinterventionĒ) specially developed for Samoan women. Specific aims were, first, to implement and evaluate (using behavior change theory) the interventionís effectiveness in enhancing knowledge, modifying attitudes, and most importantly, effecting positive behavior change. Second, to identify individual and structural factors that facilitate or impede behavior change. The outcome of primary interest is the receipt of a mammogram.

We prospectively followed eligible Samoan women recruited from randomly assigned to two study groups (experimental and control), study sites (61 Samoan-speaking churches) in Los Angeles and Orange counties. Over a period of eight months, we administered two surveys (pretest and posttest) and the intervention (to experimental group women after the pretest survey). Eligibility criteria for inclusion included Samoan heritage, age 42 years or older, and no mammogram utilization (never or not within the prior two years). The intervention consisted of three components: specially developed English- and Samoan-language educational materials, skills building exercises, and, interactive group discussions. The intervention addressed different aspects of breast cancer (i.e., risk, severity, susceptibility, screening and early detection exams). We surveyed 809 eligible women (Experimental group = 406, Control group = 403) at the pretest and resurveyed 776 women (Experimental group = 391, Control group = 385) at the posttest. In addition, we conducted the intervention among 389 Experimental group women.

Preliminary analyses revealed that, at the pretest, 58.7% of women aged 42 years or older had never had a mammogram and 59.7% of women had never had a clinical breast exam (CBE). Bivariate analyses of socio-demographic variables and mammography utilization revealed that women proportionally more likely to have never had a mammogram were those who were: older (aged ≥ 65 years), less educated (8 years or fewer), uninsured, unemployed, with <$10,000 yearly family income, and, interviewed in Samoan. Furthermore, multivariate analyses revealed that Samoan women were more likely to have ever had a mammogram if they had: positive group norms for obtaining a mammogram, health insurance, positive belief in the efficacy of mammography, fewer misconceptions regarding the causes of breast cancer, fewer culture-specific beliefs regarding the causes of breast cancer, and higher self-efficacy. Analyses to assess the efficacy of the intervention are in progress.

This study underscores the disparate under-utilization of breast cancer screening and early detection examinations by Samoan women. This project enhances breast cancer awareness, increase screening and early detection rates, and over time, could potentially lower morbidity and mortality from the disease in this marginalized community.

Results of a Randomized Trial to Increase Mammogram Usage among Samoan Women
Periodical:Breast Cancer Education Program for Samoan Women
Index Medicus:
Authors: Shiraz Mishra, Roshan Bastani, Catherine Crespi, Cindy Chang, Pat Luce, and Claudia Baquet
Yr: 2007 Vol: 16 Nbr: 12 Abs: Pg:

Mammography Screening and Pacific Islanders: Role of Cultural and Psychosocial Factors
Periodical:Journal of Cancer Education
Index Medicus:
Authors: Shiraz Mishra, Roshan Bastani, David Huang, Pat H. Luce, and Claudia R. Baquet
Yr: 2007 Vol: 22 Nbr: Abs: Pg:32-36