Despite the increasing size of the Asian American population (17.3 million) and their growing rate of breast cancer, little attention is focused on Asian American (AA) breast cancer survivors' informational and psychological needs. More notably, we have located no randomized controlled trial conducted in this population to address the unmet needs of this understudied and underserved population. Due to their social, cultural, and linguistic barriers, culturally competent mental health care is largely unavailable. The lack o both the availability of culturally competent mental health care and studies to identify and address the physical, emotional, and social needs of Asian American cancer survivors' constitute unnecessary and avoidable disparities in cancer care. Chinese Americans comprise the largest subgroup (24 percent) among the estimated 17.3 million Asian Americans in the U.S. Our research and community partner team have designed a culturally sensitive social support intervention called the Joy Luck Academy (JLA) that provide education and peer mentor support for Chinese American breast cancer survivors (BCS). A single-arm pilot study recently completed by our team has shown that the JLA is highly valued by participants and is associated with better quality of life among Chinese American BCS. This study proposes a randomized controlled trial (RCT) to test the health benefits of the JLA program and to identify for whom and why the JLA works using a community based participatory research (CBPR) approach, and mixed deductive and inductive methods. Chinese American breast cancer survivors who have completed primary treatment (N=210) will be randomly assigned to either the JLA group or a control group to receive enhanced usual care while waiting for the JLA. Health outcomes are assessed at baseline, immediately post intervention, and 1 and 4 months follow-ups. We will use deductive quantitative methods to test health outcomes, theorized mediators, and baseline individual differences. We use inductive and deductive qualitative methods to explore and understand mechanisms explaining the benefits of the intervention and to enhance the interpretation of the quantitative data. Few tested psychosocial interventions exist for diverse ethnic groups. One of the major hypothesized barriers is the lack of understanding of unique cultural differences in the meaning of and appropriate emotional and social responses to breast cancer. Even fewer studies have tested evidence-based programs for their feasibility, applicability, and sustainability in communities of color. Existing communit efforts are often the result of trial and error without theoretical guidance and lack of scientific rigor. This proposed study is the first RCT social support intervention among AA BCSs. The intervention is innovative as it is culturally relevant to an AA group, using a theoretically grounded and CBPR approach, and mixed methods design. We expect that the proposed research guided by both theory and methods with an underserved and understudied population will inspire new directions in future research to address these scientific and practical needs in health disparities research.
Psychosocial interventions have been shown to be effective for the mainstream population of breast cancer survivors, but few psychosocial interventions have been successfully designed for ethnic groups of color. This proposed study is the first randomized controlled trial (RCT) to assess the impact of a culturally based social support program (i.e. Joy Luck Academy, JLA) among Chinese American breast cancer survivors, an underserved and understudied population. If the JLA is demonstrated to be effective in improving the well- being among Chinese American breast cancer survivors, it may be disseminated as an effective, low-cost intervention for other groups of Asian American breast cancer survivors across the country. The study will help to reduce or eliminate the unnecessary emotional and physical health disparities in cancer care among Asian American breast cancer survivors and potentially other ethnic groups of color as well.
