Concept Mapping with South Asian Immigrant Women: Barriers to Mammography and Solutions

Abstract

Despite benefits of screening mammography, many South Asian (SA) immigrant women in Canada remain under screened. We aimed to elicit their experiences and beliefs about barriers to mammography and possible solutions. SA immigrant women aged 50 years or over were eligible if they never had a mammogram or had one more than 3 years ago. We employed the participatory mixed-method approach of Concept Mapping. Sixty women participated with a mean age of 58 years. Participants brainstormed 150 items which were consolidated into 67 items. After sorting and rating, cluster analysis revealed eight clusters of barriers on knowledge, fear, language and transportation, access to mammogram center, access to doctor, beliefs and practices, self-care, and family dependence. Participants discussed possible solutions, and emphasized out-reach models to address knowledge gaps and issues of language and transportation. One example was a community-based shuttle bus to screening centres, hosted by trained co-ethnic workers. The results are discussed to enhance the socio-cultural sensitivity of breast screening programs.

Factors Influencing Breast Cancer Screening Practices Among Arabic Women Living in the State of Qatar: The Health Care Providers' Perspective

“…These findings are also similar to women's BCS experiences in Canada wherein knowledge, fear, shame and embarrassment, language, transportation, access to mammogram center, access to physician, client-clinician relationship, cultural beliefs and practices, self-care, socio-economic status, and family dependence were identified as factors influencing women's BCS practices (Ahmad, Mahmood, Pietkiewicz, McDonald, & Ginsburg, 2012;Donnelly, 2006Donnelly, , 2008Donnelly & McKellin, 2007;Vahabi, 2005).…”

A Population-Based Study of Ethnicity and Breast Cancer Stage at Diagnosis in Ontario

“…Most immigrants are from China and South Asia (including India, Pakistan, Sri Lanka, and Bangladesh) 36 . In Canada, cancer survival rates are comparable to those the United Kingdom, Australia, and European countries with similar health systems 37 ; coverage by primary care providers (particularly in urban communities in which most newcomers and immigrants settle) is adequate 9,12,21 ; female family practitioners and ethnic minority doctors constitute a high proportion of physicians 38 ; and information on breast cancer screening is provided in multiple languages-and yet screening uptake remains lowest in neighbourhoods with the highest proportion of ethnic minority and immigrant women, particularly those from South Asia 9,12 .…”

“…Moreover, cultural values, fears and stigma with respect to cancer could pose significant barriers to care-seeking for a breast problem and to participation in cancer screening after migration to countries with such programs 13,21,22,26,32 . Community-based programs that emphasize the value of maintaining individual health in the interests of the whole family and that capitalize on collectivist decision-making and goal orientation can be particularly useful for successful health promotion in certain ethnocultural groups.…”

“…Community-based programs that emphasize the value of maintaining individual health in the interests of the whole family and that capitalize on collectivist decision-making and goal orientation can be particularly useful for successful health promotion in certain ethnocultural groups. In Ontario, some Chinese and other ethnocultural community agencies, in collaboration with cancer agencies and public health and primary care groups have been very active in that regard, offering workshops, sociocultural tailoring of health promotion materials, and use of existing social advocacy platforms to encourage healthy lifestyles, including cancer screening 13,[20][21][22]40,52 .…”

“…Those priority populations include immigrants and ethnocultural minority communities [8][9][10][11][12][13] . Pilot programs have been implemented to improve breast cancer awareness and screening among immigrant and ethnocultural minority women in Ontario [14][15][16][17][18][19][20][21][22] , but it remains unclear whether such initiatives are making an impact; current trends would suggest otherwise 4,12,15 .…”