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Pre- and Postintervention Differences in Acculturation, Knowledge, Beliefs, and Stages of Readiness for Mammograms Among Korean American Women

Jin Hee Kim

Usha Menon

Korean American, mammography
ONF 2009, 36(2), E80-E92. DOI: 10.1188/09.ONF.E80-E92

Purpose/Objectives: To assess differences in acculturation, knowledge, beliefs, and stages of readiness for mammograms from pre- to postintervention among Korean American women aged 40 years or older.

Design: Prospective, repeated measures, quasi-experimental.

Setting: A Korean American senior center in the midwestern United States.

Sample: 300 Korean American women aged 40 years or older with no breast cancer diagnoses and who were non-adherent with mammography screening.

Methods: Following completion of the preintervention questionnaire, the women attended a 45-minute interactive breast cancer early screening education session (GO EARLY) organized according to stages of readiness for mammography use (i.e., not thinking about having one, thinking about having one, and had one in the past). Postintervention data were collected six weeks following the educational session.

Main Research Variables: Acculturation, knowledge, beliefs (perceived risk, pros, cons, fear, self-efficacy, modesty, fatalism), and stages of readiness for mammography use.

Findings: At preintervention stages of readiness, women thinking about having a mammogram (contemplators) had significantly lower knowledge scores and higher cons to mammography use than women who had mammograms in the past (relapsers). Women not thinking about having a mammogram (precontemplators) had significantly lower self-efficacy for having a mammogram and higher cons than relapsers. The GO EARLY session was most effective in increasing knowledge, decreasing perceived cons, and increasing perceived self-efficacy. No statistically significant intervention effect was noted on upward shift in stage of readiness for mammography use postintervention.

Conclusions: The GO EARLY intervention, the first study to assess stages of readiness for mammography use among Korean American women, was feasible and culturally sensitive and can be replicated in various Korean American communities.

Implications for Nursing: Culturally appropriate educational programs can serve to change women's perceptions and knowledge, and such changes may lead to changes in health behavior.

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    References

    American Cancer Society. (2008). Cancer facts and figures 2008. Atlanta, GA: Author.
    Centers for Disease Control and Prevention. (2004). Breast and cervical cancer screening among Korean women—Santa Clara County, California, 1994 and 2002. Morbidity and Mortality Weekly Report, 53(33), 765-767.
    Champion, V. L. (1999). Revised susceptibility, benefits, and barriers scale for mammography screening. Research in Nursing and Health, 22(4), 341-348.
    Champion, V. L., Maraj, M., Hui, S., Perkins, A. J., Tierney, W., Menon, U., et al. (2003). Comparison of tailored interventions to increase mammography screening in nonadherent older women. Preventive Medicine, 36(2), 150-158.
    Champion, V. L., & Menon, U. (1997). Predicting mammography and breast self-examination in African American women. Cancer Nursing, 20(5), 315-322.
    Champion, V. L., Ray, D. W., Heilman, D. K., & Springston, J. K. (2000). A tailored intervention for mammography among low-income African American women. Journal of Psychosocial Oncology, 18(4), 1-13.
    Champion, V. L., & Scott, C. R. (1997). Reliability and validity of breast cancer screening belief scales in African American women. Nursing Research, 46(6), 331-337.
    Champion, V. L., & Skinner, C. S. (2003). Differences in perceptions of risk, benefits, and barriers by stage of mammography adoption. Journal of Women's Health, 12(3), 277-286.
    Champion, V. L., Skinner, C. S., Hui, S., Monahan, P., Juliar, B., Daggy, J., et al. (2007). The effect of telephone versus print tailoring for mammography adherence. Patient Education and Counseling, 65(3), 416-423.
    Champion, V. L., Skinner, C. S., Menon, U., Rawl, S., Giesler, R. B., Monahan, P., et al. (2004). A breast cancer fear scale: Psychometric development. Journal of Health Psychology, 9(6), 753-762.
    Champion, V. L., Skinner, C. S., Menon, U., Seshadri, R., Anzalone, D. C., & Rawl, S. M. (2002). Comparisons of tailored mammography interventions at two months postintervention. Annals of Behavioral Medicine, 24(3), 211-218.
    Chang, Y. (1983). Women in a Confucian society: The case of Chosun Dynasty Korea (1392-1910). In E. Y. Yu & E. H. Phillips (Eds.), Traditional thoughts and practices in Korea (pp. 63-93). Los Angeles: Center for Korean American and Korean Studies.
    Consedine, N. S., Magai, C., & Neugut, A. I. (2004). The contribution of emotional characteristics to breast cancer screening among women from six ethnic groups. Preventive Medicine, 38(1), 64-77.
    Deapen, D., Liu, L., Perkins, C., Bernstein, L., & Ross, R. K. (2002). Rapidly rising breast cancer incidence rates among Asian American women. International Journal of Cancer, 99(5), 747-750.
    Gomez, S. L., Le, G. M., Clarke, C. A., Glaser, S. L., France, A. M., & West, D. W. (2003). Cancer incidence patterns in Koreans in the United States and in Kangwha, South Korea. Cancer Causes and Control, 14(2), 167-174.
    Ham, O. K. (2006). Factors affecting mammography behavior and intention among Korean women. Oncology Nursing Forum, 33(1), 113-119.
    Han, Y., William, R. D., & Harrison, R. A. (2000). Breast cancer screening knowledge, attitudes, and practices among Korean American women. Oncology Nursing Forum, 27(10), 1585-1591.
    Hedeen, A. N., White, E., & Taylor, V. (1999). Ethnicity and birthplace in relation to tumor size and stage in Asian American women with breast cancer. American Journal of Public Health, 89(8), 1248-1252.
    Hurh, W. M., & Kim, K. C. (1984). Korean immigrants in America. Rutherford, NJ: Associated University Press.
    Juniper, K. C., Oman, R. F., Hamm, R. M., & Kerby, D. S. (2004). The relationships among constructs in the health belief model and the transtheoretical model among African American college women for physical activity. American Journal of Health Promotion, 18(5), 354-357.
    Juon, H. S., Choi, S., Klassen, A., & Roter, D. (2006). Impact of breast cancer screening intervention on Korean American women in Maryland. Cancer Detection and Prevention, 30(3), 297-305.
    Juon, H. S., Choi, Y., & Kim, M. T. (2000). Cancer screening behaviors among Korean American women. Cancer Detection and Prevention, 24(6), 589-601.
    Juon, H. S., Kim, M., Shankar, S., & Han, W. (2004). Predictors of adherence to screening mammography among Korean American women. Preventive Medicine, 39(3), 474-481.
    Juon, H. S., Seo, Y. J., & Kim, M. T. (2002). Breast and cervical cancer screening among Korean American elderly women. European Journal of Oncology Nursing, 6(4), 228-235.
    Kandula, N. R., Wen, M., Jacobs, E. A., & Lauderdale, D. S. (2006). Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic whites: Cultural influences or access to care? Cancer, 107(1), 184-192.
    Kendall, L. (1988). Healing thyself: A Korean shaman's afflictions. Social Science and Medicine, 27(5), 445-450.
    Kim, K. I. (1972). Traditional attitudes on illness in Korea. Modern Medicine, 15(1), 49-51.
    Kim, Y. H., & Sarna, L. (2004). An intervention to increase mammography use by Korean American women. Oncology Nursing Forum, 31(1), 105-110.
    Kobetz, E., Vatalaro, K., Moore, A., & Earp, J. A. (2005). Taking the transtheoretical model into the field: A curriculum for lay health advisors. Health Promotion Practice, 6(3), 329-337.
    Lee, E. E., Fogg, L. F., & Sadler, G. R. (2006). Factors of breast cancer screening among Korean immigrants in the United States. Journal of Immigrant and Minority Health, 8(3), 223-233.
    Lee, S. K., Sobal, J., & Frongillo, E. A. (2000). Acculturation and health in Korean Americans. Social Science and Medicine, 51(2), 159-173.
    Lew, A. A., Moskowitz, J. M., Ngo, L., Wismer, B. A., Wong, J. M., Ahn, Y., et al. (2003). Effects of provider status on preventive screening among Korean American women in Alameda County, California. Preventive Medicine, 36(2), 141-149.
    Maxwell, A. E., Bastani, R., & Warda, U. S. (2000). Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States. American Journal of Preventive Medicine, 18(1), 62-68.
    Mayo, R. M., Ureda J. R., & Parker, V. G. (2001). Importance of fatalism in understanding mammography screening in rural elderly women. Journal of Women and Aging, 13(1), 57-72.
    McCracken, M., Olsen, M., Chen, M. S., Jemal, A., Thun, M., Cokkinides, V., et al. (2007). Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA: A Cancer Journal for Clinicians, 57(4), 190-205.
    Menon, U., Belue, R., Skinner, C. S., Rothwell, B. E., & Champion, V. (2007). Perceptions of colon cancer screening by stage of screening test adoption. Cancer Nursing, 30(3), 178-185.
    Menon, U., Champion, V. L., Larkin, G. N., Zollinger, T. W., Gerde, P. M., & Vernon, S. W. (2003). Beliefs associated with fecal occult blood test and colonoscopy use at a worksite colon cancer screening program. Journal of Occupational and Environmental Medicine, 45(8), 891-898.
    Menon, U., Champion, V. L., Monahan, P. O., Daggy, J., Hui, S., & Skinner, C. S. (2007). Health belief model variables as predictors of progression in stage of mammography adoption. American Journal of Health Promotion, 21(4), 255-261.
    Min, P. G. (1992). The structure and social functions of Korean immigrant churches in the United States. International Migration Review, 26(4), 1370-1394.
    Moskowitz, J. M., Kazinets, G., Wong, J. M., & Tager, I. B. (2007). "Health is strength": A community health education program to improve breast and cervical cancer screening among Korean American Women in Alameda County, California. Cancer Detection and Prevention, 31(2), 173-183.
    Olsen, S. J., & Frank-Stromborg, M. (1993). Cancer prevention and early detection in ethnically diverse populations. Seminars in Oncology Nursing, 9(3), 198-209.
    Osburn, H. G. (2000). Coefficient alpha and related internal consistency reliability coefficients. Psychological Methods, 5(3), 343-355.
    Par, I. S., & Cho, L. J. (1995). Confucianism and the Korean family. Journal of Comparative Family Studies, 26(1), 117-134.
    Park, S. I. (1987). Rural Korean housewives' attitudes toward illness. Yonsei Medical Journal, 28(2), 105-111.
    Phillips, J. M., Cohen, M. Z., & Moses, G. (1999). Breast cancer screening and African American women: Fear, fatalism, and silence. Oncology Nursing Forum, 26(3), 561-571.
    Powe, B. D. (1995). Cancer fatalism among elderly Caucasians and African Americans. Oncology Nursing Forum, 22(9), 1355-1359.
    Prieto, A. J. (1992). A method for translation of instruments to other languages. Adult Education Quarterly, 43(1), 1-14.
    Prochaska, J. O., Redding, C. A., & Evers, K. E. (2002). The transtheoretical model and stages of change. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.), Health behavior and health education: Theory, research, and practice (pp. 99-120). San Francisco: Jossey-Bass.
    Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38-48.
    Rakowski, W., Ehrich, B., Goldstein, M. G., Rimer, B. K., Pearlman, D. N., Clark, M. A., et al. (1998). Increasing mammography among women aged 40-74 by use of a stage-matched, tailored intervention. Preventive Medicine, 27(5), 748-756.
    Russell, K. M., Monahan, P., Wagle, A., & Champion, V. (2007). Differences in health and cultural beliefs by stage of mammography screening adoption in African American women. Cancer, 109(2, Suppl.), 386-395.
    Sadler, G. R., Ryujin, L. T., Ko, C. M., & Nguyen, E. (2001). Korean women: Breast cancer knowledge, attitudes, and behaviors. BMC Public Health, 1(1), 7-12.
    Sarna, L., Tae, Y. S., Kim, Y. H., Brecht, M. L., & Maxwell, A. E. (2001). Cancer screening among Korean Americans. Cancer Practice, 9(3), 134-140.
    Shin, H., Kim, M. T., Juon, H. S., Kim, J., & Kim, K. B. (2000). Patterns and factors associated with health care utilization among Korean American elderly. Asian American and Pacific Islander Journal of Health, 8(2), 116-129.
    Skinner, C. S., Arfken, C. L., & Sykes, R. K. (1998). Knowledge, perceptions, and mammography stage of adoption among older urban women. American Journal of Preventive Medicine, 14(1), 54-63.
    Skinner, C. S., Champion, V. L., Gonin, R., & Hanna, M. (1997). Do perceived barriers and benefits vary by mammography stage? Psychology, Health, and Medicine, 2(1), 65-75.
    Sohn, L., & Harada, N. D. (2005). Knowledge and use of preventive health practices among Korean women in Los Angeles County. Preventive Medicine, 41(1), 167-178.
    Spencer, L., Pagell, F., & Adams, T. (2005). Applying the transtheoretical model to cancer screening behavior. American Journal of Health Behavior, 29(1), 36-56.
    Stoddard, A. M., Rimer, B. K., Lane, D., Fox, S. A., Lipkus, I., Luckmann, R., et al. (1998). Underusers of mammogram screening: Stage of adoption in five U. S. subpopulations. The NCI Breast Cancer Screening Consortium. Preventive Medicine, 27(3), 478-487.
    Suinn, R. M., Khoo, G., & Ahuna, C. (1995). The Suinn-Lew Asian Self-Identity Acculturation Scale: Cross-cultural information. Journal of Multicultural Counseling and Development, 23(3), 139-150.
    Swan, J., Breen, N., Coates, R. J., Rimer, B. K., & Lee, N. C. (2003). Progress in cancer screening practices in the United States: Results from the 2000 National Health Interview Survey. Cancer, 97(6), 1528-1540.
    Tang, T. S., Solomon, L. J., & McCracken, L. M. (2000). Cultural barriers to mammography, clinical breast examination, and breast self-exam among Chinese American women 60 and older. Preventive Medicine, 31(5), 575-583.
    Tolma, E. L., Reininger, B. M., Evans, A., & Ureda, J. (2006). Examining the theory of planned behavior and the construct of self-efficacy to predict mammography intention. Health Education and Behavior, 33(2), 233-251.
    U. S. Census Bureau. (2006). Selected population profile in the United States: American Community Survey. Retrieved March 11, 2008, from http://factfinder.census.org
    Velicer, W. F., Prochaska, J. O., & Redding, C. A. (2006). Tailored communications for smoking cessation: Past successes and future directions. Drug and Alcohol Review, 25(1), 49-57.
    Wismer, B. A., Moskowitz, J. M., Min, K., Chen, A. M., Ahn, Y., Cho, S., et al. (2001). Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women. Journal of Public Health Management and Practice, 7(2), 61-70.
    Yu, M. Y., Hong, O. S., & Seetoo, A. D. (2003). Uncovering factors contributing to underutilization of breast cancer screening by Chinese and Korean women living in the United States. Ethnicity and Disease, 13(2), 213-219.
    Ziegler, R. G., Hoover, R. N., Pike, M. C., Hildesheim, A., Nomura, A. M., West, D. W., et al. (1993). Migration patterns and breast cancer risk in Asian American women. Journal of the National Cancer Institute, 85(22), 1819-1827.