Hmong women in the U.S. get screened for breast and cervical cancer (BCC) at remarkably low rates. Cultural and social factors, including those reflecting the Hmong's unique history and experience, are thought to affect BCC screening behavior among Hmong women. The health care system may also pose barriers to screening for this ethnic group, particularly given low levels of health literacy. Yet, we could identify no studies that have examined these potential influences on BCC screening for Hmong women. We propose a 2-year exploratory study with the following specific aims: 1) examine how historical discrimination, medical mistrust, and perceptions of and experiences with the health care system influence Hmong women's attitudes and behavior related to breast and cervical cancer screening;2) identify health care system factors that are barriers to breast and cervical cancer screening for Hmong women, the interface between those factors and health literacy, and how those factors contribute to mistrust and other negative perceptions of medicine and health care;and 3) explore the influence of primary groups, especially men (e.g., husbands, sons, fathers, elders), on Hmong women's attitudes, decision-making and behavior related to breast and cervical cancer screening, including the ways primary groups reinforce or help overcome barriers to screening. We propose to conduct approximately 20 key informant interviews with community leaders, health care providers, and other knowledgeable persons. Building on those interviews, we will then conduct in-depth interviews with approximately 80 Hmong men and women (aged 18+ yrs) living in the Portland metropolitan and Marion County areas of Oregon. Interviews will be digitally recorded, translated, and transcribed. Qualitative data will be analyzed using an iterative review process and content analysis techniques. The data generated by this R21 project will be used as the basis of an R01 application. Identifying the factors that affect BCC screening among Hmong women is an essential step toward creating effective interventions and improving services for this ethnic population. With the current state of knowledge, exploratory research is needed to advance research in this area. In particular, qualitative research that focuses on the potential influence of factors known to be important in Hmong culture, as well as health care system barriers that may be especially challenging for this population, will generate new insights into BCC screening behavior among the Hmong and provide direction for future research.
The limited research available suggests that Hmong women get screened for breast and cervical cancer at remarkably low rates, substantially below the national objectives listed in Healthy People 2010 and much lower than the rates for other racial/ethnic groups. The proposed exploratory research will improve understanding of the social, cultural, and health care system factors that influence breast and cervical cancer screening among the Hmong, a growing ethnic population that has a unique history, distinct culture, and unmet needs. The proposed study will inform future research on breast and cervical cancer screening with the Hmong and, ultimately, the design of interventions and programs directed at improving screening rates for this population.
