Cultural Health Beliefs Research Articles

Design and evaluation of interprofessional cross-cultural communication sessions

The 2013 National Standards for Culturally and Linguistically Appropriate Services (CLAS) call for healthcare professionals to provide quality care and services that are responsive to diverse cultural health beliefs and practices. Accreditation organizations for health professional programs require their curriculum to adequately prepare future practitioners for serving culturally and linguistically diverse populations. Another common curricular need of health professional programs is interprofessional education (IPE). This study presents data that evaluates two IPE culturally competent communication sessions designed for pharmacy and nursing students. Teams of nursing and pharmacy students (n = 160) engaged in case studies focused on developing cross-cultural communication skills, using the LEARN model. Quantitative survey data collected pre-test and post-test measured cultural competency (including subscales of perceived skills, perceived knowledge, confidence in encounter, and attitude) and knowledge related to culturally competent communication. Univariate ANOVA results indicate that actual knowledge as measured by the test and all four Clinical Cultural Competency Questionnaire (CCCQ) subscales significantly increased after the IPE sessions. Pharmacy students scored higher than nursing students on the knowledge pre-test, and nursing students had a more positive attitude at pre-test. The IPE sessions effectively addressed all learning outcomes and will continue in future course offerings. Using cross-cultural communication as a thematic area for IPE program development resulted in educational benefits for the students. To further strengthen nursing and pharmacy students’ interprofessional practice, additional IPE opportunities are to be explored.

Abstract A31: Understanding colorectal cancer screening behaviors among five Asian-American subgroups

Abstract Objectives: Unlike other cancer screening tests, which rely on early detection, colorectal cancer screening (CRS) provides an opportunity for prevention since most colorectal cancer (CRC) begin as a benign polyp. However, over 20 million people age 50 to 75 in the U.S. have never undergone CRS. Furthermore, lower screening rates were observed among minority groups, especially immigrants with low English proficiency (LEP). Asian Americans are now the most rapidly growing minority and immigrant group in the U.S. The purpose of this study was to understand 5 different Asian subgroups' beliefs, attitudes, and perceived controls on CRS. Methods: This study is part of a larger government funded study to create an infrastructure for sustainable research and dissemination of evidence-based medicine. The partnerships include five different Asian-American subgroups in the Chicago Metropolitan area: Cambodian, Chinese, Korean, Laotian and Vietnamese. The focus groups were facilitated by partner community-based organization staffs using participants' native language and observed by two research team members. A training course was provided prior to the focus group. The focus group discussions were recorded and later transcribed into English by the facilitator. The contents were then analyzed using the Theory of Planned Behavior (TPB) by five research team members until consensus arrived. Themes were identified under three major categories as described in the TPB: behavioral beliefs, normative beliefs and control beliefs. Results: Six focus groups were conducted with a total of 56 participants from 5 different Asian-American subgroups. All participants were foreign-born and 66% were female. About one-third of the participants did not have any high school education. Only 64% of the participants had health insurance coverage and 59% had a regular place for health care. The average age was 55 years old and the average time in the U.S. was 21 years. About 71% of the participants have screened for cancer before. Although there were various beliefs and attitudes on cancer screening across the five subgroups, such as cancer can be contagious or proper diet can prevent cancer, they also shared some common beliefs and attitudes, such as early detection of cancer can save life. The common control beliefs across the five subgroups included, but not limited to, language barrier and unfamiliar with the U.S. healthcare systems Conclusion: Cancer has been the leading cause of death among Asian Americans since 1980; the first and only racial/ethnic group to experience cancer as the leading cause of death. In addition, the US Asian population is very diverse and differs with respect to country of origin, culture and beliefs, time in the USA, primary language spoken and socioeconomic status. If we are to extend the reach and address cancer disparities in this population, innovative dissemination strategies based on the understanding of cultural differences and traditional health beliefs are the priority. The focus group findings provide the first glance on the differences and similarities in cancer screening beliefs and attitudes among five Asian subgroups. Funding Source: AHRQ 1R24HS022063-01 Citation Format: Helen Lam, Michael Quinn, Edwin Chandraskar, Reena Patel, Karen Kim. Understanding colorectal cancer screening behaviors among five Asian-American subgroups. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A31.

Cultural Construction of Dementia Progression, Behavioral Aberrations, and Situational Ethnicity: An Orthogonal Approach.

Neurodegenerative diseases, such as Alzheimer's disease and related dementias, induce caregivers already struggling to cope with the behavioral aberrations of dementia to constantly update their cultural construction of the disease because the outward symptoms used to interpret it are in constant flux. For ethnic minority caregivers, particularly, coping is a process of tracking a moving set of symptoms, making cultural sense of them across time, and negotiating a medical environment that can be hostile to them because of their "nonstandard" cultural health beliefs. In the midst of a constantly changing disease, achieving optimal communications with the medical establishment causes the ethnic minority caregivers to change their behaviors to better fit the expectations of the clinic, then retreat to their own cultural comfort zone only to continue oscillating between cultures for the duration of their caregiving responsibilities. Ethnic minority dementia caregiving is conceptualized here from an orthogonal perspective in which the moving elements of the ethnic minority dementia experience intersect in numerous ways and produce many coping strategy permutations corresponding to the evolving disease and its cultural constructs.

Boundaries and conditions of interpretation in multilingual and multicultural elderly healthcare.

BackgroundElderly migrants who do not speak the official language of their host country have increased due to extensive international migration, and will further increase in the future. This entails major challenges to ensure good communication and avoid communication barriers that can be overcome by the use of adequate interpreter services. To our knowledge, there are no previous investigations on interpreting practices in multilingual elderly healthcare from different healthcare professionals’ perspectives. This study examines issues concerning communication and healthcare through a particular focus on interpretation between health professionals and patients of different ethnic and linguistic backgrounds. The central aim of the project is to explore interpretation practices in multilingual elderly healthcare.MethodsA purposive sample of 33 healthcare professionals with experience of using interpreters in community multilingual elderly healthcare. Data were collected between October 2013 and March 2014 by 18 individual and four focus group interviews and analysed with qualitative content analysis.ResultsThe main results showed that interpreting practice in multilingual elderly healthcare was closely linked to institutional, interpersonal and individual levels. On the organizational level, however, guidelines for arranging the use of interpreters at workplaces were lacking. Professional interpreters were used on predictable occasions planned long in advance, and bilingual healthcare staff and family members acting as interpreters were used at short notice in everyday caring situations on unpredictable occasions. The professional interpreter was perceived as a person who should interpret spoken language word-for-word and who should translate written information. Furthermore, the use of a professional interpreter was not adapted to the context of multilingual elderly healthcare.ConclusionThis study found that interpreter practice in multilingual elderly healthcare is embedded in the organizational environment and closely related to the individual’s language skills, cultural beliefs and socio-economic factors. In order to formulate interpreter practice in the context of multilingual elderly healthcare it is important to consider organizational framework and cultural competence, cultural health knowledge, beliefs and customs.

Cervical cancer screening behavior among Hmong-American immigrant women.

To investigate Hmong-American immigrant women's utilization of cervical cancer screening, including the impact of cultural health beliefs on screening use. Overall, 164 Hmong-American immigrant women 21 to 65 years of age were recruited from a large metropolitan area in the Midwest. We used logistic regression, guided by Andersen's Behavior Model, to examine factors associated with the receipt of Pap test. About 67.1% had received a Pap test within the last 3 years. Fatalism, modesty, education, and marital status were significantly correlated with receiving a Pap test. The provision of cervical cancer literacy education and related preventive guidelines to this population are urgently needed to reduce cancer-screening disparity.

Illness representations and cultural practices play a role in patient-centered care in childhood asthma: experiences of Mexican mothers

Objective: Patients’ cultural health beliefs and behaviors may conflict with biomedical healthcare values and practices potentially leading to non-adherence with asthma treatment regimens. To optimize shared decision-making, healthcare providers should understand and be sensitive to these cultural beliefs and behaviors and negotiate an asthma management plan acceptable to parents. The purpose of this study was to obtain the perspective of Mexican mothers regarding (1) their experiences of living with a child with asthma, (2) their understanding of the nature of asthma, and (3) how their cultural beliefs influence asthma management. Methods: A qualitative, phenomenological study design was employed to assess mothers’ lived experiences with and perceptions of their child’s asthma. Individual in-depth interviews were conducted with a purposeful sample of 20 Mexican mothers of children ages 5–17 years with asthma. An inductive, theory-driven, phenomenological analysis approach was used to elicit thematic findings. Results: Mothers expressed a symptomatic perception of asthma and limited understanding of the disease. Most believe the disease is present only when their child is symptomatic. Many are surprised and puzzled by the unpredictability of their child’s asthma attacks, which they report as sometimes “silent”. The inconsistency of triggers also leads to frustration and worry, which may reflect their concerns around daily controller medication use and preference for alternative illness management strategies. Conclusions: Our clinical encounters should be refocused to better understand the context of these families’ lives and the cultural lens through which they view their child’s asthma.

Incorporating Cultural Perspectives into Diabetes Self-Management Programs for East Asian Immigrants: A Mixed-Study Review.

It is important to understand East Asian immigrants (EAIs)' unique perspectives in managing diabetes in order to provide culturally-competent care. However, it is not known whether EAIs' perspectives are addressed in diabetes self-management interventions developed for EAIs. Therefore, a mixed-study review was conducted to identify EAIs' perspective from qualitative research (n=9 studies) and to evaluate the components of EAI diabetes self-management interventions (n=7). Themes from the qualitative synthesis demonstrated that EAIs have unique cultural values and traditional health beliefs while struggling with multi-contextual barriers due to immigration. The evaluation of EAI diabetes self-management interventions revealed that there was a lack of consensus on cultural strategies for EAIs' across the interventions. Addressing language barriers was the only factor consistently integrated in the cultural components of intervention by employing bilingual interventionists. EAIs' perspectives and experiences need to be incorporated in the future diabetes self-management interventions to better provide culturally-competent care.

Minority mothers' healthcare beliefs, commonly used alternative healthcare practices, and potential complications for infants and children.

Complementary and alternative healthcare practices have increased substantially in the United States especially with low-income ethnic minority mothers. These mothers often have provider mistrust, language barriers, differing health belief systems, and as a result are less likely to seek preventive health screening, access healthcare services, and use alternative remedies for their infants and children that are potentially harmful or lethal. Therefore, the purpose of this article is to examine healthcare beliefs, commonly used alternative healthcare practices, and their potential complications for infants and children. A search of CINAHL and PubMed (1980-2012) was conducted using the following terms: alternative healthcare practice, mothers' health beliefs, cultural health beliefs, folk remedies, and infant health practices. Given the changing U.S. population and an increasing immigrant population, examining alternative healthcare practices mothers use for their infants and children is especially important for providers in addressing healthcare for this group. The use of alternative healthcare practices is rarely discussed by parents with healthcare providers for fear of disapproval. When interviewing ethnic minority mothers and caregivers questions should include the use of alternative healthcare practices for infants and children and information regarding the potential dangers should be provided to them.

Health beliefs and carer burden in first episode psychosis.

BackgroundCarer burden is high during First Episode Psychosis (FEP) and evidence suggests that this is a predictor of poor long-term outcome. However our understanding of factors associated with higher burden is poor. We propose that carers’ cultural backgrounds and health belief models will influence their perceived burden of care, over and above that explained by severity of illness.MethodsPatients with FEP and their primary Carers were recruited from the Early Intervention Service. Patients and Carers completed a range of validated measures, self-report ethnicity and demographic information together with the Multidimensional Health Locus of Control and Caregiver Burden Inventory.ResultsSignificant correlations were found between carer burden and health beliefs, which differed by ethnicity and gender. High physical burden was experienced by Black carers with an external locus of control; time restrictions and emotional burden correlated with an external locus of control in Asian carers. For White carers, external locus of control correlated with time dependence burden. In all ethnic groups female carers experienced more time dependency, physical and developmental burden. No significant correlations were found between patient measures of severity or duration of illness and carer burden.ConclusionsThe type of burden experienced by carers differed between gender and ethnicity and was related to their health belief models. Thus the explanation and understanding of illness appears to be more salient than simply a patient’s severity of illness when considering the development of carer burden. Interventions to tackle high carer burden, and thus expressed emotion to improve outcome in patients, may need increasing focus here.

Cultural factors impacting asthma management in Asian Indian children

Introduction: Asthma is the most common chronic disease found in young children. Asian Indians are second largest Asian immigrant population and the fastest growing group in the United States. As this segment of the population in the US grows and utilizes the health care system, more physicians will encounter increased burden of asthma cases. Objective: To outline the cultural factors and health beliefs in the Asian Indian population which impact the care and outcome of these patients. Methods: Three cases are described in which the care of the child with asthma had been impacted due to cultural factors or limitations resulting from health beliefs. The common cultural factors researched in the reported literature along with the experiences of various physicians are outlined. Result: Reported beliefs include concern and denial in Asian Indian mothers when given a diagnosis of asthma in their child. Due to the fear of use of preventive medications such as inhaled corticosteroids and not being completely confident in the medical system, they may not feel comfortable with the recommendations that are made for control of their asthma. Conclusion: Enhanced knowledge with empowerment of the provider will improve communication and compliance of the patient and an improved collaboration between the patient and health care provider leading to better health outcomes in Asian Indian patients with asthma.

Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions

ObjectiveThis paper reviews available studies that applied the PEN-3 cultural model to address the impact of culture on health behaviors.MethodsWe search electronic databases and conducted a thematic analysis of empirical studies that applied the PEN-3 cultural model to address the impact of culture on health behaviors. Studies were mapped to describe their methods, target population and the health behaviors or health outcomes studied. Forty-five studies met the inclusion criteria.ResultsThe studies reviewed used the PEN-3 model as a theoretical framework to centralize culture in the study of health behaviors and to integrate culturally relevant factors in the development of interventions. The model was also used as an analysis tool, to sift through text and data in order to separate, define and delineate emerging themes. PEN-3 model was also significant with exploring not only how cultural context shapes health beliefs and practices, but also how family systems play a critical role in enabling or nurturing positive health behaviors and health outcomes. Finally, the studies reviewed highlighted the utility of the model with examining cultural practices that are critical to positive health behaviors, unique practices that have a neutral impact on health and the negative factors that are likely to have an adverse influence on health.DiscussionThe limitations of model and the role for future studies are discussed relative to the importance of using PEN-3 cultural model to explore the influence of culture in promoting positive health behaviors, eliminating health disparities and designing and implementing sustainable public health interventions.

Breast cancer experience and survivorship among Asian Americans: a systematic review

Breast cancer is the most common cancer in Asian American women, and the number of Asian American breast cancer survivors is rapidly increasing. Although Asian Americans are one of the fastest growing and most heterogeneous ethnic groups in the United States, limited data exist in regard to their breast cancer experience and survivorship. A systematic review of the breast cancer experience literature was conducted and included studies of Asian Americans or their subgroups as a major category of study participants. Of the 125 studies reviewed, 10 qualitative studies, 10 quantitative studies, 5 studies that used a mixed-method approach, and 1 intervention study met the criteria for inclusion. Qualitatively, Asian Americans reported unmet physical and emotional needs and challenges during survivorship. Quantitative studies consistently found that socioeconomic status, cultural health beliefs, immigration stress, acculturation level, English proficiency, social support, and spirituality associated with Asian American breast cancer patients' health behaviors and health-related quality of life (HRQOL). Studies also revealed significant variation in breast cancer reaction and HRQOL within Asian American subgroups. Although research on Asian American breast cancer experience and survivorship is sparse, we concluded that Asian Americans experience disrupted HRQOL following breast cancer diagnosis and treatment, interwoven with their cultural and socio-ecological system, and that programs focused on improving cancer survivorship outcomes among this ethnic minority group are limited. Most studies have concentrated on the West coast population, and there is significant underrepresentation of longitudinal and intervention studies. Implications for study design, measurement, and future research areas are also included. The results highlight a need to understand ethnic differences and to take into account social, cultural, and linguistic factors in breast cancer survivorship experiences among Asian American subgroups as a means to develop culturally relevant and linguistically appropriate interventions designed to improve HRQOL.

Diabetes self-management and leptin in Mexican Americans with type 2 diabetes: the Starr County border health initiative.

The purpose of the study was to (1) characterize leptin in Mexican Americans with poorly controlled type 2 diabetes, (2) examine relationships among leptin and indicators of diabetes status (body mass index and A1C), and (3) explore the effects of a culturally tailored diabetes self-management education intervention on leptin. In Starr County, an impoverished Texas-Mexico border community, 252 Mexican Americans with type 2 diabetes were recruited to test a diabetes self-management education intervention culturally tailored in terms of language, dietary recommendations, social emphasis, family participation, and incorporation of cultural health beliefs. Groups of 8 participants were randomized to experimental or wait-listed control conditions. Outcomes were measured at 3, 6, and 12 months; by 12 months, 109 had complete leptin data. Most participants were women and, on average, 55 years of age, diagnosed with diabetes for 8 years, obese, and in poor glycemic control. Three variables-body mass index, sex, A1C-explained 36% of the variance in baseline leptin; there were no intervention effects on leptin. Sex, time, and gender × time interaction effects on leptin were statistically significant; greater increases in leptin over time occurred in women compared to men. In women, fasting blood glucose changes from baseline to 12 months significantly predicted leptin changes from baseline to 12 months; in men, body mass index changes predicted leptin change. With increasing obesity rates, further research is warranted to determine if leptin is a useful intervention target in type 2 diabetes.

Cultural competence education for practicing physicians: lessons in cultural humility, nonjudgmental behaviors, and health beliefs elicitation.

Although numerous studies have examined cultural competence training, debate still exists about efficacious approaches to this training. Furthermore, little focus has been placed on training and evaluating practicing physicians. A skills-based course on culturally competent diabetes care was developed and subsequently tested in a controlled trial of primary physicians caring for patients enrolled in one state's Medicaid program. We hypothesized that physicians completing the course would show higher levels of self-reported cultural competence as measured by a Cultural Competence Assessment Tool (CCAT) than those in the control group. Differences in CCAT subscale scores were also compared. Ninety physicians completed the study, with 41 in the control and 49 in the intervention group. Most were female (66%), with an average age of 44, and 12 years in practice. There were no significant differences on total CCAT score (212.7 ± 26.7 for control versus 217.2 ± 28.6 for intervention, p = .444) or subscales measuring cultural knowledge. There were significant positive differences on the subscales measuring physicians' nonjudgmental attitudes/behaviors (subscale score 2.38 ± 0.46 for control versus 2.69 ± 0.52 for intervention, p = .004) and future likelihood of eliciting patients' beliefs about diabetes and treatment preferences (3.11 ± 0.53 for control versus 3.37 ± 0.45 for intervention, p = .014). There was, however, a significant negative difference on the subscale measuring cultural self-awareness (3.48 ± 0.36 for control versus 3.26 ± 0.48 for intervention, p = .018). A predominantly skills-based approach to training physicians did not change aggregate measures of cultural competence, but did affect key attitudes and behaviors, which may better reflect the goals of cultural competence training.

Parents' decision making and access to preventive healthcare for young children: applying Andersen's Model.

Implementing preventive health care for young children provides the best chance of improving health and changing a child's life course. In Australia, despite government support for preventive health care, uptake of preventive services for young children is low. Using Andersen's behavioural model of health-care utilization, we aimed to understand how parents conceptualized their children's preventive health care and how this impacted on access to preventive health-care services. Semi-structured telephone interviews conducted between May and July 2011. Twenty-eight parents of children aged 3-5 years from three diverse socio-economic areas of Melbourne, Australia. Thematic analysis showed parents' access to child preventive health care was determined by birth order of their child, cultural health beliefs, personal health practices, relationship with the health provider and the costs associated with health services. Parents with more than one child placed their own experience ahead of professional expertise, and their younger children were less likely to complete routine preventive health checks. Concerns around developmental delays required validation through family, friends and childcare organizations before presentation to health services. To improve child preventive health requires increased flexibility of services, strengthening of inter-professional relationships and enhancement of parents' knowledge about the importance of preventive health in early childhood. Policies that encourage continuity of care and remove point of service costs will further reduce barriers to preventive care for young children. Recent reforms in Australia's primary health care and the expansion of child preventive health checks into general practice present a timely opportunity for this to occur.

Roles of Illness Attributions and Cultural Views of Cancer in Determining Participation in Cancer-Smart Lifestyle among Chinese and Western Youth in Australia

The study investigated the influence of culturally-based health beliefs on engagement in healthy lifestyle behaviour. Specifically, the study compared levels of engagement between Western and Chinese youth in Australia and assessed the extent to which culture-specific attributions about the causes of illness, and health beliefs, predict engagement in healthy lifestyle behaviour. Ninety-four Western and 95 Chinese (N=189; Mean Age=20.8 years, SD=3 years) young adults completed an online questionnaire. Predictor variables were cultural health beliefs measured by the Chinese Cultural Views on Health and Illness scale (CCVH, Liang et al., 2008), and illness attributions beliefs measured by the Cause of Illness Questionnaire (CIQ, Armstrong and Swartzman, 1999). Outcomes variables were levels of engagement in healthy lifestyle behaviour. Results indicated that Chinese participants have a significantly lower exercising rate and healthy dietary habits compared to the Western sample. Moreover, Chinese participants were found to believe more strongly than Westerners that cancer was associated with factors measured by the Traditional-Chinese-Model (TCM). Finally, the observed relationship between cultural health beliefs and physical inactivity was mediated by attributions of illness, in particular to the supernatural subscale, with the Sobel Test showing a significant mediation (z=-2.63, p=0.004). Mainstream approaches to encourage healthy lifestyles are unlikely to be effective when educating Chinese youth. Instead, health promotion programs should attempt to address the illness attribution beliefs and educate Chinese youth about the role of diet and exercise in prevention of diseases such as cancer.

Testing the efficacy of culturally adapted coping skills training for Chinese American immigrants with type 2 diabetes using community‐based participatory research

Chinese Americans demonstrate greater prevalence of diabetes than non-Hispanic whites and find standard diabetes care disregards their cultural health beliefs. Academic researchers and Chinatown agencies collaborated to culturally adapt and test an efficacious cognitive-behavioral intervention using community-based participatory research. Using a delayed-treatment repeated-measures design, 145 adult Chinese immigrants with Type 2 diabetes completed treatment. Immediate benefits of treatment were evident in the improvement (p < .05) in diabetes self-efficacy, diabetes knowledge, bicultural efficacy, family emotional and instrumental support, diabetes quality of life, and diabetes distress. Prolonged benefits were evident in all changed variables 2 months post-intervention. The CBPR approach enabled the development of a culturally acceptable, efficacious behavioral intervention, and provides a model for working with communities that demonstrate health disparities.

Comparison of Child Obesity Prevention and Control Content in Mainstream and Spanish-Language US Parenting Magazines

Mass media coverage of child obesity is rising, paralleling the child obesity epidemic's growth, and there is evidence that parents seek parenting advice from media sources. Yet little to no research has examined the coverage of child obesity in parenting magazines or Spanish-language media. The purpose of this study was to use qualitative and quantitative content analysis methods to identify, quantify, and compare strategies for child obesity prevention and control presented in mainstream and Spanish-language US parenting magazines. Child obesity−related editorial content in 68 mainstream and 20 Spanish-language magazine issues published over 32 months was gathered. Magazine content was coded with a manual developed by refining themes from the sample and from an evidence-based child obesity prevention action plan. Seventy-three articles related to child obesity prevention and control were identified. Most focused on parental behavior change rather than environmental change, and only 3 in 10 articles referred to the social context in which parental behavior change takes place. Child obesity−focused articles were not given high prominence; only one in four articles in the entire sample referred to child obesity as a growing problem or epidemic. Key differences between genres reflect culturally important Latino themes, including family focus and changing health beliefs around child weight status. Given mass media's potential influence on parenting practices and public perceptions, nutrition communication professionals and registered dietitians need to work to reframe media coverage of childhood obesity as an environmental problem that requires broad-based policy solutions. Spanish-speaking media can be an ally in helping Latina women change cultural health beliefs around child weight status.

Factors affecting access to healthcare services by intermarried Filipino women in rural Tasmania: a qualitative study

Access to health care services is vital for every migrant's health and wellbeing. However, migrants' cultural health beliefs and views can hinder their ability to access available services. This study examined factors affecting access to healthcare services for intermarried Filipino women in rural Tasmania, Australia. A qualitative approach using semi-structured interviews was employed to investigate the factors affecting access to healthcare services for 30 intermarried Filipino women in rural Tasmania. The study used grounded theory and thematic analysis for its data analysis. Nvivo v8 (www.qsrinternational.com) was also used to assist the data coding process and analysis. Five influencing factors were identified: (1) language or communication barriers; (2) area of origin in the Philippines; (3) cultural barriers; (4) length of stay in Tasmania; and (5) expectations of healthcare services before and after migration. Factors affecting intermarried Filipino women in accessing healthcare services are shaped by their socio-demographic and cultural background. The insights gained from this study are useful to health policy-makers, healthcare professionals and to intermarried female migrants. The factors identified can serve as a guide to improve healthcare access for Filipino women and other migrants.

Abstract B66: Beliefs about cancer etiology, health behaviors, and treatment patterns among multiethnic breast cancer survivors.

Abstract Purpose: The aims of this study are to (1) explore similarities and differences in cultural beliefs concerning the causes of breast cancer among Chinese-, Korean-, and Mexican-American breast cancer survivors using focus group interview data, and (2) explore whether cultural beliefs influence health behaviors and treatment patterns, such as screening behaviors or follow-up care. Methods: An exploratory, descriptive, qualitative study consisting of Chinese- (n = 21, 51.2%), Korean- (n = 11, 26.8%), and Mexican-American (n = 9, 22%) women was conducted. Participants were recruited through community and hospital-based support groups or the City of Hope cancer registry. A total of six focus groups (two per ethnic group) were conducted. Discussions were tape-recorded, transcribed, and translated for content analysis of common themes and patterns through qualitative methodology. Qualitative analyses were conducted through NVivo 9.0 software, where the common themes and patterns that emerged among all three groups were categorized and used to conduct summary statements that capture participant's beliefs and address the aims of the study. Results: Preliminary results revealed that participants believe the cause of breast cancer is primarily due to stress-related factors, with some participant's highlighting family stressors and general lifestyle stress. Furthermore, the results indicated a mixture of both positive and negative feelings regarding overall breast cancer treatment experience. Specifically, patients reported their doctor's personal characteristics (inattentiveness) to have influenced their overall treatment experience. There were similar perceived barriers and facilitators to accessing proper care or treatment among the three ethnic minority groups, with some patients believing insurance influences accessibility. Conclusions/Implications: Themes extracted from these focus groups revealed cultural causal health beliefs such as diet, exercise and stress-related factors. Some cultural health beliefs about the causes of breast cancer appear to be significant barriers preventing Chinese-, Korean-, and Mexican- American women from seeking the most healthy behaviors and appropriate lifestyle changes regarding breast cancer diagnosis and treatment. Findings provide greater understanding of health behaviors and cancer beliefs among ethnic minority populations living in the U.S., which may guide the development of culturally and ethnically tailored breast cancer awareness strategies to ultimately improve the quality of life among these underserved subgroups. Findings may be used to inform medical practitioners about their patients' beliefs concerning their treatment preferences which may then guide how medical practioners address their patient's treatment needs within a culturally specific context. Citation Format: Patricia Gonzalez, Katrina Flores, Kristi Allen, Monica Rosales, Sheila Castaneda, Gregory Talavera, Jung-Won Lim, Ming Wang-Letzkus, Kimlin Ashing-Giwa. Beliefs about cancer etiology, health behaviors, and treatment patterns among multiethnic breast cancer survivors. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B66.