Academic journal article Health and Social Work

Testing the Feasibility of a Culturally Tailored Breast Cancer Screening Intervention with Native Hawaiian Women in Rural Churches

Academic journal article Health and Social Work

Testing the Feasibility of a Culturally Tailored Breast Cancer Screening Intervention with Native Hawaiian Women in Rural Churches

Article excerpt

Breast cancer is the most commonly detected neoplasm among women in the United States and accounts for about 15.2 percent of the nation's female cancer deaths (Healthy People, n.d.). The need to reduce breast cancer mortality is a recognized national priority and an objective of Healthy People 2010, the nation's blueprint for promoting health and eliminating health disparities. Participation of older women ([gt]40 years of age) in mammography is viewed as crucial to accomplishing this objective. Clinical trials of routine mammography demonstrate that this method effectively detects tumors at an early stage, when treatments are most likely to be successful in extending survival and enhancing quality of life (Kerlikowske, Grady, Rubin, Sandrock, & Emster, 1995). Among women ages 40 to 49 and 50 to 74 years, mammography reduced death by 17 percent and 20 percent, respectively, to 39 percent. Survival rates decline with delayed diagnosis; about 97 percent of women treated for early-stage breast disease survive five years or more, whereas only about 78 percent of women diagnosed with regional breast cancer (that is, disease has spread to pectoral muscles and lymph nodes) and about 23 percent of those with distant breast cancer (that is, disease metastasized to brain, bone, or other organs) survive beyond five years of initial diagnosis (Yu, 2009).

BACKGROUND

Although mammography is efficacious in early detection, the benefits of its routine use have not been realized by all women in the United States. Of significant concern are women of color, who tend to experience poorer breast cancer outcomes than white women (Karlinger & Kerikowske, 2007; Miller, Chu, Hankey, & Ries, 2008; Yu, 2009). Disparate mortality and survival outcomes are observed among ethnic minority and indigenous women, especially as race and ethnicity intersect with low socioeconomic status, residency in medically underresourced and rural communities, and culturally grounded beliefs that may disable participation in conventional, mainstream mammography programs. The current study resides in this larger context of social determinants of breast cancer disparities and focuses on promoting breast health with Native Hawaiian women, an indigenous group burdened by late diagnosis and poor survival outcomes.

Native Hawaiians (Hawaiians) are the descendents of Polynesian voyagers who settled the Hawaiian archipelago. They are the largest Pacific Islander population riving in the United States and in Hawai'i (U.S. Census Bureau, n.d.). Across major ethnic groups in Hawai'i, the breast cancer mortality rate for Hawaiian women is 1.2 times greater than the rate for white women and more than two times greater than the rate for Japanese women. Data from 1995 to 2000 suggest that greater percentages of Hawaiian women are diagnosed with regional and distant disease (35 percent of Hawaiian versus 29 percent of white and 22 percent of Japanese women), and 2005 data suggest that fewer Hawaiian women age 40 and older have mammograms every two years (65 percent of Hawaiian versus 77 percent of white and 84 percent of Japanese women) (Miller et al., 2008). Hawai'i data suggest that cultural issues may be at play and may inhibit acceptance of available screening services by Hawaiian women, particularly older or more traditionally oriented ones (Hawai'i State Department of Health, 2000). The need for research on culturally responsive screening promotions is recognized in the Cancer Awareness Strategic Plan for Native Hawaiian Communities, developed by a consortium of Hawaiian organizations (Santos et al., 2001). The plan calls for programs that integrate salient Hawaiian cultural values and practices that include attention to spirituality and the extended family system. Furthermore, NASW (n.d.) recognizes that members of the social work profession have long been engaged in efforts to address health inequities and has issued the call for social welfare research specific to eliminating health disparities. …

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