1. MENG ZHAO, PHD, RN COLLEGE OF NURSING & HEALTH SCIENCES TEXAS A&M UNIVERSITY-CC The role of culture on screening mammography utilization among Chinese-born immigrant women in the United States: an ethnographic approach

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3. Introduction 3 Chinese-born immigrant women, after immigrating to the United States, encounter cross-cultural challenges regarding their health care practices due to  different cultural beliefs, views, and attitudes about health and health care  the systematic and structural differences between the health care system in China and in the United States

4. Screening Mammography 4 Is recommended to women aged 50 and above as a regular practice in U.S. Is not a regular practice in China

5. Significance of the Study 5 Rapid growth of Chinese immigrants

6. Significance of the Study 6 Breast cancer is the leading diagnosed cancer and the 3rd leading cause of cancer death among Chinese American women (Miller et al., 2008) Chinese-born women, after immigrating in the United States, might have a higher risk to get breast cancer. Asian American women have the lowest screening mammography utilization rate. (CDC,1990-2010)

7. Gaps in literature 7 Research has not focused on Chinese-born immigrant women Research questions have not targeted culture and the influence of Chinese community

8. Purpose of the study Get in-depth understanding of how Chinese-born immigrant women view or perceive  Health or illness  Health promotion with a focus on breast cancer prevention  Health care practice Explore factors related to their screening mammography utilization with a focus on culturally specific factors

9. Theoretical framework 9 Practice CapitalHabitusField

10. Research design 10  Qualitative  Ethnography  semi-structured interview with open-ended questions (initial interviews with follow-ups)  Participant observation  April 2009- July 2010

11. Participants 11 N= 15 Age=40-68 (average=49) Married (separated)=9 Married=6 Education=all above associate Christian=4, Buddhist= 1, Polytheist=1, Atheist=9

12. Data management & analysis 12 Nvivo 8 Contact summary sheet Participant observation data sheet Coding:  descriptive codes  pattern codes Organizing codes:  tree codes  within-case or cross-case data display memos and journals

13. Major findings 13 There are conflict findings between participant observation and interviews.

14. “natural” food 14 ……even if the product is labeled as “natural”, I do not consider it as natural. Natural food by definition is the food that I can cook. It’s real food, not something that has been labeled as natural product, but is actually processed. That’s why I never eat processed food or take those health supplements. The natural food I am referring to is those grow by themselves, not artificially synthesized……I don’t buy semi-finished or finished food, since I don’t know what they are made of…… ……natural food is better. I mean the food that I can see and touch and grow in the nature……I worry about those semi-finished or finished food, since I don’t know what additives they (the makers) might put in the food……(that’s why) I rarely go out for eating……

15. Balanced diet 15 ……balanced diet is important……At our home, we usually eat some vegetables, fruits, rice, and flour. We also eat some meat and eggs each day…… ……for good health, we need to balance what we eat for the three meals per day. We should eat a lot of vegetables and fruits, but we also need to eat some meat or eggs. It is not healthy to eat only particular food. Every kind of food is beneficial in some way to our health……

16. Habitus about health 16 Health= physical health+ mental health Mental health is more valued than physical health Spiritual health is considered as part of mental health Broader concept of health  Diet  Life style  Little stress

17. Habitus about health promotion and illness prevention 17 Socialization (n=11) Exercise (n=12) Healthy food (n=8) Good sleep (n=10) Happiness (n=7) “God helps” (n=4)

18. Habitus about health care practice 18 AdvantagesDisadvantages U.S.more advanced equipment; better environment; kindness of health care providers, greater flexibility in choosing providers appointment system referral system language barrier ChinaTimeliness of service; Experienced physicians less advanced equipment long waiting time noisy, crowded environment

19. Factors related to screening mammography utilization 19 Economic factors  Health insurance (n=8)  Pay out-of-pocket (n=3) Regular check-up (n=8) Health care provider (n=6) Language barrier (n=6) Early detection and breast cancer incidence (n=3)

20. Capital, observation & health information seeking 20 Friends or family member (n=10) Internet (n=7) Health professionals (n=5) Newspaper (n=3) Job & colleagues (n=3)

21. Discussion 21 Strength of the study  The application of both in depth interview and participant observation Limitation of the study  Sample & setting confined to local Chinese community

22. Implications for practice 22 The understanding of the Chinese-born immigrant women’s use of screening mammography cannot be separated from their socio-cultural background. Educate these women for knowledge of breast cancer and screening mammography Assess these women’s social network, encourage them to make friends and participate in the community activities. Intervention programs to improve the use of screening mammography should be culturally-specific. Chinese language community education might be the an effective approach to improve Chinese-born immigrant women’s screening mammography utilization. Internet-based intervention program might be appropriate.

23. 23 Questions?