Reducing Disparities among Korean American Women

Institution: University of California, Los Angeles
Investigator(s): Annette Maxwell, DrPH - Soo-Young Chin, Ph.D. -
Award Cycle: 2003 (Cycle IX) Grant #: 9AB-2101 Award: $70,943
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Disparities: eliminating the unequal burden of breast cancer

This is a collaboration with: 9AB-2100 -

Initial Award Abstract (2003)
The focus of this proposal is the low mammography rescreening rate among Korean American (KA) women served by KHEIR through "Cancer Detection Programs: Every Woman Counts" (previously known as Breast Cancer Early Detection Program - BCEDP). This is a concern, given that all the evidence on the effectiveness of mammography in reducing mortality is based on repeat screening at regular intervals. An intervention that is developed for and with significant input from KA women will be culturally sensitive and tailored towards the specific needs of this group, and therefore most likely to be effective in increasing regular screening.

We will explore misconceptions and barriers to regular screening among KA women, facts that may encourage women to get screened on a regular basis and how to best convey this information to KA women. Based on suggestions and feedback from KA women we will then develop one or more interventions and pilot test each intervention with 50 KA women who are due for rescreening. We will compare their rescreening rates with that of women who have not received any intervention (usual care), debrief women to find out if they perceived the intervention as helpful, and estimate how expensive it will be to implement the intervention on an ongoing basis.

This project is innovative in its focus on low-income KA women, who are underserved and underscreened. Other innovative features are our focus on repeat screening, the utilization of an established and very successful outreach program, and the collaboration between a well established research program at UCLA and KHEIR, the largest KA nonprofit organization in California. Finally, our focus on intervention development is innovative, given that most studies among Asian women are limited to survey research.

Final Report (2006)
Introduction: The study was conducted jointly by the Korean Health, Education, Information and Research Center (KHEIR) and the UCLA Division of Cancer Prevention and Control Research. The goal of the study was to develop and pilot test an intervention to increase the low mammography rescreening rate among low-income Korean American (KA) women served by KHEIR.

Progress towards Specific Aims : We developed a print information in Korean language based on in-depth interviews with KA women and focus groups with KA women and KHEIR staff and pilot tested it in 2 clinics, KHEIR and Koryo Health Foundation.

Impact : The process of developing the print intervention together with KA women worked well. Women provided valuable suggestions and feed back. Mailing of the print intervention was very feasible for the two participating clinics, since it could easily be inserted in the existing routine mailing and did not require extra staff time. Both clinics will continue to include the brochure into their reminder mailings. The effect that was achieved with the print intervention was small: clinic records show only a 6 percentage point increase at Koryo Health Foundation (from 32% to 38%) and no change at KHEIR (25%, probably due to the temporary loss of service at KHEIR just prior to the intervention period). This suggests that although a print intervention such as ours may encourage some women to obtain repeat screening, more intensive efforts are needed. Additional efforts such as phone calls could be focused on those women who did not respond to the print intervention. Such an approach has been used successfully in prior studies. Our findings also demonstrate the importance of validating self reported screening. At Koryo Health Foundation, self reported screening rates were 13 percentage points higher than clinic records (51% versus 38%). Reasons for this discrepancy could be social desirability bias, face-saving bias, or a telescoping effect, which is the tendency of subjects to report a more recent date than the actual date of screening. We have no explanation for the 12 percentage point discrepancy at KHEIR in the other direction (13% self report versus 25% clinic records). We have learned from this study that it is wise to pilot test an intervention in more than one clinic because unforeseen events can impact even a short pilot study such as this.

Future Direction : The project brought together a multi-ethnic and multi-disciplinary team from the community and academia and provided an important training opportunity for a KA junior investigator. Overall, the experience of working together in this study was positive and both partners are interested in joining forces again in a future study.