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A Community‐Based Participatory Research Approach to Understanding Pap Testing Adherence Among Vietnamese American Immigrants

https://doi.org/10.1111/j.1552-6909.2012.01414.xGet rights and content

ABSTRACT

Objective

To explore factors potentially influencing Pap testing practices among Vietnamese American immigrant women (VIW, foreign‐born) and describe their awareness of cervical cancer screening resources in their community.

Design

Descriptive study guided by the ecological model and community‐based participatory research principles.

Setting

Portland, Oregon, metropolitan area.

Participants

Vietnamese American immigrant women (211) who were age 21 and older.

Methods

We used descriptive statistics and logistic regression analyses to analyze a self‐administered questionnaire that was pretested and translated using a team approach.

Results

Approximately 74% of VIW who completed the survey reported at least one Pap test, and 69% reported Pap testing history adherent to national guidelines. The factor most strongly associated with Pap testing receipt was suggestion from a friend, followed by longer residency in the United States, lower perceived common barriers, and lower perceived cultural barriers, for example, lack of family support and use of Eastern/Asian medicine. The factor most strongly associated with guideline adherence was having health insurance, followed by a recommendation from a physician or nurse practitioner. Only 11% of VIW knew where to obtain a free or low‐cost Pap tests.

Conclusion

Nurses can influence rates of Pap testing among VIW by providing health education through outreach programs targeted at lay health workers and their social networks, identifying at‐risk patients such as recently immigrated women, reducing perceived common and cultural barriers to Pap testing, and helping women seek alternative payment options if they lack health insurance. Primary health care providers should be reminded of their essential role in increasing Pap testing adherence.

Section snippets

Theoretical Framework

We used the broad and comprehensive ecological model (EM) of health behavior as a theoretical framework to organize and explain the multiple factors that may influence Pap testing behavior in this study (Figure 1) (Sallis, Owen, & Fisher, 2008). A central concept of the EM is that health behavior is determined by multiple influencing factors. The EM consists of four principles: multiple levels of factors influence health behaviors (e.g., intrapersonal, interpersonal, organizational, health

Community‐Based Participatory Research Approach

We learned about the Vietnamese community from its members and through prolonged engagement. The first author participated in community projects and outreach activities (e.g., health fairs) from February 2007 to January 2010, before the study began. A partnership was developed between the Asian Family Center a program of Oregon's Immigrant & Refugee Community Organization (IRCO) and Oregon Health & Science University. Health educators at IRCO/Asian Family Center identified cervical cancer as a

Demographic Characteristics and Pap Testing Practices

The sample ranged from age 21 to 87 (M = 50 years). Table 1 summarizes information on demographic characteristics. Approximately 74% (n = 157) of participants had received a Pap test at least once within their lifetime, and 69% (n = 145) reported having adhered to Pap testing recommendations. Of the participants who were age 70 or older, seven had never received a Pap test within their lifetime.

Community Resources

Approximately 30% of participants knew of cervical cancer screening programs in the community.

Discussion

In this study, only 74% of VIW (foreign‐born) participants had received a Pap test at least once within their lifetime, and 69% had adhered to screening recommendations. Although these Pap testing rates were slightly higher than rates in most VAW (includes immigrants [foreign‐born] and U.S.‐born) studies (Ho et al., 2005; Tung et al., 2008; Xu et al., 2005), this study demonstrated that these rates were much lower than the proposed Healthy People 2020 objective (U.S. Department of Health and

Acknowledgment

Funded by the American Cancer Society Doctoral Degree Scholarship in Cancer Nursing (DSCN‐08‐208‐01); Sigma Theta Tau Research Awards; Oregon Health & Science University School of Nursing; Health Resources Service Administration (2A10HP0001309‐10); and U.S. Department of Education (P200A070437). The authors thank Jonathan Fine and Leslie Bienen for editorial assistance.

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