Older Korean American Men’s Prostate Cancer Screening Behavior: The Prime Role of Culture

Abstract

East and South Asian male immigrants show markedly low odds of prostate cancer screening as compared to U.S.-born men. However, knowledge about these immigrants' culture-based screening behavior and barriers to screening is extremely limited. This study investigates factors influencing receipt of prostate cancer screening among Korean American immigrant men, particularly investigating culture's impact on screening behaviors. Data were collected through a convenience and purposive sampling technique from 134 Korean American males aged 50 and older recruited in New York City. A structured questionnaire was used and cultural variables were measured by adopting items from Tang and colleagues' work. Approximately 60 % of the sample had received a prostate-specific antigen (PSA) test in their lifetime, and of these, about 66 % reported having done so in the previous 12 months. Logistic regression analysis revealed that a crisis-oriented intervention approach was associated with a substantially reduced likelihood of screening. A positive correlation was noted between the use of Eastern medicine and PSA test receipt. Further analysis revealed a significant interaction effect between use of Eastern medicine and age in predicting PSA test uptake. Culture-specific intervention strategies for increasing prostate cancer screening in this group are discussed, with particular attention to increasing pertinent health literacy. Health professionals should consider the cultural domain when working with Korean immigrant men in order to provide culturally competent care.

Health literacy in selected populations: Individuals, families, and communities from the international and cultural perspective

“…Another immigrant group, Chinese Americans, demonstrated similar behavior. This finding suggests that in addition to culture, age also influences health screening and preventive behaviors [26]. …”

“…For example, how comfortable one feels to discuss their body with a physician (physical modesty), whether one visits a physician only when there is a presenting symptom, such as pain (crisis intervention approach) or alternatively for regular symptom-free visits, as would be the case for one to seek Eastern medicine. In a study of American Korean men [26], their cultural beliefs about cancer were found to significantly determine their recent uptake of prostate cancer screening tests. The men who used crisis intervention were less likely to seek cancer screening than those who used preventive approach; those who preferred to use Eastern medicine for health care were more likely to seek for prostate cancer screening.…”

Disparities in Potentially Preventable Hospitalizations for Chronic Conditions Among Korean Americans, Hawaii, 2010–2012

“…Before the full implementation of the Patient Protection and Affordable Care Act (ACA), Korean Americans have had one of the highest uninsured rates among Asian Americans and tend to underutilize health services more than whites and other Asian groups (7). Of Asian American subgroups, Korean Americans have the lowest colorectal cancer screening rates, and Korean American men tend to have prostate cancer diagnosed at a later and more severe stage than do men of other racial/ethnic groups (8,9). Although the pattern of low usage of primary care is persistent in the area of preventive care and chronic disease management in Korean Americans, to our knowledge there has been no research examining preventable hospitalizations among Korean Americans.…”

Ethnic differences and predictors of colonoscopy, prostate-specific antigen, and mammography screening participation in the multiethnic cohort

“…In 2008, 44% of men 50 years of age and older reported having had a PSA test in the last year [3]. As with colorectal cancer screening, lower rates of PSA screening were noted in African Americans, Latinos, and some Asian groups [11–13]. In 2010, 72% of women ages 50–74 reported having a mammogram in the past 2 years with the lowest rates occurring among Asian American women (64%) [14].…”

“…Family and personal medical history, access to medical care, and physician recommendations for cancer screening have all been shown to affect screening behaviors [8,11,13,16–21]. Interactions between ethnicity and these factors have emerged as areas of interest [13,22–25].…”