Breast Health Literacy and Health Care Decision Making

Institution: San Diego State University Research Foundation
Investigator(s): Suzanne Lindsay, Ph.D., MSW, MPH - Joel San Juan, M.S. -
Award Cycle: 2006 (Cycle 12) Grant #: 12AB-2501 Award: $3,964
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: 12AB-2500 -

Initial Award Abstract (2006)
The proposal described below was awarded a $10,000 planning grant to enable the applicants to strengthen the scientific and community elements of their project, as detailed in the scientific review evaluation document, and incorporate these elements into a new application for the 2007 funding cycle.

Introduction to the research topics:
Operation Samahan has, for many years, been providing breast cancer screening services to many Asian immigrants. Relative to other major ethnic groups, the number of breast screenings provided to this group is low. Resources that address several barriers to and challenges for breast healthcare services specific for each Asian sub-population are scarce or nonexistent. Worse, judgment and health decision strategies within this population are not understood. As a result of these challenges, Samahan partnered with the Institute for Public Health (IPH) to help better understand the many breast health gaps within the Asian sub-population and consequently, provide the appropriate delivery of services as well as messages that uniquely address the needs of each sub-group.

The question(s) or central hypotheses of the research:
(1) Does each sub-Asian population (Chinese, Filipino, Laotian) possess unique judgment and decision-making styles related to breast health that affect their decision to undergo screening, diagnosis and treatment?
(2) How are we able to draw on these unique differences so that appropriate messages for each sub-population are made and properly disseminated?
(3) How can these unique differences be used so appropriate service delivery models are developed that will effectively address the needs of each sub-group?

The general methodology:
This effort will consist of three major steps: a preliminary assessment; development of surveys; and administration and validation of the results of the survey. A total of 6 focus groups will be conducted and stratified by Asian sub-group, levels of time in the US, and by personal experience along the continuum of breast screening, diagnosis and treatment. Focus group transcriptions will be used to construct a survey using a framework of 12 constructs related to Judgment and Decision-making and Health Beliefs. We define health beliefs as how a woman organizes knowledge and makes decisions in the face of new breast health information affects the breast health beliefs she forms and holds on to. The new survey will be pilot-tested with samples of Chinese, Filipina , and Laotian. Findings from the survey will be used to develop individual and community education interventions unique to each sub-group based on breast health belief systems.

Innovative elements of the project:
Research and information on breast health decision-making strategies as well as health beliefs among Asian women are scarce. This research will help us better understand the breast health beliefs of women in three different Asian sub-groups and how they make breast health decisions. We will use the finding of the research to develop individual and community breast health education to address different decision-making styles and health beliefs. As a result, it will help us develop the appropriate resources that will effectively address the needs of Asian women from education to screening, diagnosis and treatment.

Community involvement:
The whole project is community-driven from identification of issues and participants as well as shaping the overall research design. Representatives from the Asian community have met with IPH to bring to the table the many issues that confront them. A Community Advisory Council consisting of representatives from each sub-Asian group as well as advocates has been formed to conceptualize, plan, implement and disseminate the results of the research findings.

Final Report (2008)
Samahan (a primary care health clinic that serves a large and increasingly diverse Asian Pacific Islander (API) community in San Diego County and the Institute for Public Health (IPH) at San Diego State University) proposed to develop a community based collaborative to examine how cultural factors affect the breast health beliefs and behaviors of women in three API communities and to develop an intervention that utilizes a core set of breast health messages based on common beliefs that can then be tailored to address the needs of women in specific API sub-groups, specifically the Filipina, Laotian and Chinese communities.

This $10,000 planning grant was awarded in response to the CBCRP Councilís interest in the February 2006 grant application which was not funded, but was of sufficient interest that the Council thought it worthwhile to encourage a strong revised grant proposal in 2007. The specific aims of this planning grant were for the CO-PIís and community members to work together to strengthen both the research design and methodology and the working partnership in order to revise and resubmit a grant proposal for the 2007 cycle of CRC funding.

The work had as a focus the following research questions:
  1. Are there health beliefs or behaviors that encourage API women to seek breast health care? What are the similarities between women in the three groups, and what are the differences?
  2. Are there health beliefs or behaviors that keep API women from seeking breast health care? What are the similarities between women in the three groups, and what are the differences?
  3. How do we develop a breast health educational strategy and materials in collaboration with each API community that is based on the similarities across the groups yet addresses the specific health needs of women in the Chinese, Filipina and Laotian communities?

As a part of year-long the revision process, the collaborators conducted four focus groups in the Filipina, Chinese and Laotian communities and had eleven partnership meetings to discuss the project and work together on the revised application. An application was submitted for the 2007 funding cycle, but again was not funded.