Factors Influencing Breast Cancer Screening Among Older Thai

Institution: Thai Health and Information Service
Investigator(s): Bulaporn Natipagon-Shah, Ph.D., R.N. - Mary Jo Clark, PhD, RN -
Award Cycle: 2006 (Cycle 12) Grant #: 12AB-1101 Award: $88,427
Award Type: CRC Pilot Award
Research Priorities
Detection, Prognosis and Treatment>Imaging, Biomarkers, and Molecular Pathology: improving detection and diagnosis

This is a collaboration with: 12AB-1100 -

Initial Award Abstract (2006)
Introduction to the research topics: Reducing the risk of breast cancer deaths requires early identification of women with breast cancer so treatment can begin when it is most likely to lead to a remission or cure. Unfortunately, some segments of the population do not take advantage of proven breast cancer screening opportunities such as breast self-examination (BSE), breast examination by a doctor (clinical breast examination), or x-ray examination of the breast (a mammogram). Asian women in general are among the least likely in the United States to participate in breast cancer screening activities. This is also true for older Thai American (TA) women in Southern California. However, there is very little information on why these women do not participate in breast cancer screening. The purpose of this study is to determine why older TA women in Southern California do or do not participate in breast cancer screening so strategies can be developed to encourage their participation.

Central hypotheses of the research:
The basic questions to be answered in this study are:
1. What are the factors that encourage or discourage breast cancer screening among older TA women?
2. To what extent are these factors present among older TA women in Southern California and how important are they in decisions about breast cancer screening participation?

General methodology: Stage 1: 30 to 40 TA women over 50 years of age will be asked to participate in group interviews of 6 to 8 women to identify factors that encourage and discourage them from participating in breast cancer screening. Three to five focus groups will be conducted. The women participants will be identified by Thai Health and Information Services, Inc. (THAIS, Inc.) as being knowledgeable about the Thai community in the Los Angeles area. They will be asked whether or not they perform BSE, and whether or not they have had a clinical breast exam or a mammogram. Those who have participated in these screening tests will be asked what factors led them to decide to participate. Those who have not participated will be asked what factors have prevented them from doing so. They will also be asked to describe factors that may affect screening decisions by other TA women in the community.

Stage 2: Based on the information obtained in stage 1, a group of 8 to 10 of the women who participated in the group interviews will be asked to help develop a questionnaire about factors that encourage and discourage TA women from participating in breast cancer screening. This questionnaire will then be used in telephone interviews with about 350 TA women to see how widespread and how important these factors are in the TA population in Southern California. The information obtained from these phone interviews will be used to develop programs that increase encouraging factors and decrease discouraging factors in an effort to increase beast cancer screening participation in the older TA population.

Innovative elements of the project: The project will provide information on factors that encourage and discourage screening specifically related to the TA population, for which there is very little information. Involvement of members of the TA population in the development of the phone interview questionnaire and in subsequent programs to promote screening in this population is also an innovative approach to promoting earlier breast cancer detection in this group of women.

Community involvement: A selected group of older TA women who participate in the focus groups will be invited to form an advisory committee, which will review the focus group findings and assist in developing a questionnaire to be used in phone interviews to determine the importance of these factors in breast screening decisions in a larger sample of TA women in Southern California. They will also assist with strategies for recruiting phone interview participants. It is anticipated that the committee would later assist in the development of culturally-sensitive programs to promote breast cancer screening participation in among TA women based on the study findings.


Final Report (2008)
Breast cancer is a leading cause of death among women in the US and its incidence increases significantly with age. Lower incidence in Asian women may be a function of lower rates of participation in mammography screening. Although some studies have investigated screening behaviors in women of various ethnic backgrounds, little is known regarding Thai women and breast cancer screening behaviors. The study was conducted in two stages. In the first stage, focus groups of Thai women shared their reasons for getting or not getting a mammogram. This initial information was used by a group of Thai women to develop a telephone questionnaire to determine the prevalence of these factors in mammography screening decisions in the larger population. In the second stage, telephone interviews were conducted with 360 Thai women aged 40 to 81 years from Los Angeles, Riverside, Orange, San Bernadino, and San Diego counties.

Although a majority of the women (84%) had had a mammogram at some time, almost half of the women (44%) did not get a mammogram annually as recommended by the American Cancer Society. Most of the women were knowledgeable about breast cancer, but perceived Thai women, particularly young women, to be at low risk. Older women and those who had been in the US more than 10 years were more likely to obtain mammograms. Major factors impeding screening included lack of health insurance, cost of screening, and language difficulties. Lack of time either due to family or work responsibilities and distance to services were other barriers. Certain beliefs and perceptions of breast cancer and mammography were also barriers to screening. For example, many women believed that younger (<50 years) and older women (> 70 years) and healthy women do not need mammograms and that annual screening is not needed with a prior normal mammogram. Health provider or family recommendations promoted screening.

These findings suggest avenues for intervention to increase mammography screening in this population. Education is needed to change perceptions of risk and services should be targeted to younger women and recent immigrants, as well as providers serving the Thai community. These interventions will be the focus of a proposed follow-up study.


Symposium Abstract (2007)
Introduction: Asian women have lower rates of breast cancer but higher mortality rates than other racial/ethnic groups due to late diagnosis. Little information has been obtained regarding breast cancer screening in subsets of Asian women such as Thai immigrant women.

Aim of the study: To identify factors that influence mammography screening among Thai immigrant women in Southern California.

Methodology: Focus groups were conducted with Thai immigrant women in Los Angeles and San Diego counties to identify factors that influence participation in mammography screening. Focus group findings were then used to construct a telephone survey questionnaire to determine the extent to which identified factors were present in the Thai population.

Innovative elements and community involvement: Members of the Thai community helped to identify factors influencing mammography use by Thai women. They also validated the researchers’ interpretation of the focus group findings and used those findings to construct a telephone survey questionnaire to examine the extent of identified factors in the population. The women also served as a source of contacts for obtaining telephone survey interview participants. Findings of both portions of the study will be used by community members to design subsequent interventions to promote mammography screening in this ethnic population.

Findings: Factors in each of six dimensions of health were found to influence mammography screening in this cultural population. For example, age (a biophysical factor) was found to influence women’s beliefs about their chances of developing breast cancer. Similarly, cultural beliefs in karma and family and work responsibilities, both sociocultural factors, limited participation in screening activities.

Potential impact: Knowledge of the extent of the identified factors in the Thai population will help us design programs to improve mammography screening and early diagnosis of breast cancer screening in this population and subsequently to reduce breast cancer mortality rates.


Symposium Abstract (2010)

In order to validate and further explore factors influencing mammography screening derived from a series of focus groups with Thai women in Southern California, telephone interviews were conducted with Thai women in four Southern California counties. Interviewees completed a survey instrument that focused on knowledge about breast cancer as experienced by Thai women and the need for breast cancer screening. The relative importance of factors motivating and impeding breast cancer screening, and perceived causes of cancer prevalent in the this ethnic population were also explored. Interviews were conducted by Thai-speaking nurses with women over 40 years of age who self-identified as Thai.  A convenience sample of women was recruited from agencies serving the Thai community and cluster sampling was used to obtain the target number of participants. Participants were asked to rate the relative importance of factors in promoting or impeding breast cancer screening as well as their intentions to obtain or not obtain a mammogram in the following year. Findings will lay the foundation for interventions to promote mammography screening in this ethnic population.