Advertisement

Journal of Immigrant and Minority Health

, Volume 14, Issue 2, pp 242–250 | Cite as

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

  • Farah Ahmad
  • Sadia Mahmood
  • Igor Pietkiewicz
  • Laura McDonald
  • Ophira Ginsburg
Original Paper

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.

Keywords

Breast cancer screening South Asian Immigrant Qualitative Canada 

Notes

Acknowledgments

The study was conducted in collaboration with Brampton Multicultural Community Centre (BMCC). We are thankful to the BMCC staff for their support and advice, in particular Ms. Dima Amad and Tayyaba Tanveer. We also thank, Deborah Fisher-Holmes from Ontario Breast Screening Program for assistance. The project funds were provided by the Greater Toronto Area (GTA) Cancer Prevention and Screening Network, and the Canadian Cancer Society, Ontario Division.

References

  1. 1.
    Cancer Care Ontario. Breast cancer prevention and care: screening. Cancer Care Ontario. 2009. Available from: http://www.cancercare.on.ca/pcs/screening/.
  2. 2.
    Cancer Care Ontario. Cancer fact: breast cancer incidence stable in Ontario, mortality declining October 2007. Cancer Care Ontario. 2007. Available from: http://www.cancercare.on.ca/ocs/snapshot/ont-cancer-facts.
  3. 3.
    Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. NEJM. 2005;353:1784–92.PubMedCrossRefGoogle Scholar
  4. 4.
    Cancer System Quality Index. Breast cancer screening mammography participation. Cancer System Quality Index 2009. Available from: http://www.csqi.cancercare.on.ca/cms/One.aspx?portalId=40955&pageId=41070.
  5. 5.
    Maxwell CJ, Bancej CM, Snider J. Predictors of mammography use among Canadian women aged 50–69: findings from the 1996/97 national population health survey. CMAJ. 2001;164(3):329–34.PubMedGoogle Scholar
  6. 6.
    Choudhry UK, Srivastava R, Fitch MI. Breast cancer detection practices of south Asian women: knowledge, attitudes, and beliefs. Oncol Nurs Forum. 1998;25(10):1693–701.PubMedGoogle Scholar
  7. 7.
    Ahmad F, Cameron J, Stewart DE. Tailored promotion of breast cancer screening among South Asian immigrant women. Soc Sci Med. 2005;60(1):558–75.Google Scholar
  8. 8.
    Hanson K, Montgomery P, Bakker D, Conlon M. Factors influencing mammography participation in Canada: an integrative review of the literature. Curr Oncol. 2009;16(5):65–75.PubMedGoogle Scholar
  9. 9.
    Bottorff JL, Johnson JL, Bhagat R, Grewal S, Balneaves LG, Clarke H, et al. Beliefs related to breast health practices: the perceptions of South Asian women living in Canada. Soc Sci Med. 1998;47(12):2075–85.PubMedCrossRefGoogle Scholar
  10. 10.
    Meana M, Bunston T, George U, Wells L, Rosser W. Older immigrant Tamil women and their doctors: attitudes toward breast cancer screening. J Immigr Health. 2001;3(1):5–13.PubMedCrossRefGoogle Scholar
  11. 11.
    Statistics Canada. Census of Population Immigration, birthplace and birthplace of parents, citizenship, ethnic origin, visible minorities and Aboriginal peoples. The Daily 2003, Issue Jan 21.Google Scholar
  12. 12.
    Statistics Canada. 2006 Census: ethnic origin, visible minorities, place of work and mode of transportation. The Daily 2008, Issue April 2.Google Scholar
  13. 13.
    Trochim WMK. Pattern matching, validity, and conceptualization in program evaluation. Eval Rev. 1985;9(5):575–604.CrossRefGoogle Scholar
  14. 14.
    Trochim WMK. An introduction to concept mapping for planning and evaluation. Eval Program Plann. 1989;12(1):1–16.CrossRefGoogle Scholar
  15. 15.
    Weller SC, Romney A. Systematic data collection. Newbury Park: Sage Publications; 1988.Google Scholar
  16. 16.
    Coxon A. Sorting data: collection and analysis. Thousand Oaks: Sage Publications; 1999.Google Scholar
  17. 17.
    Kruskal JB, Wish M. Multidimensional scaling. Beverly Hills: Sage Publications; 1978.Google Scholar
  18. 18.
    Aldenderfer MS, Blashfield RK. Cluster analysis. (Sage University paper series in quantitative applications in the social sciences No. 44). Newbury Park: Sage Publication; 1984.Google Scholar
  19. 19.
    Johnsen J, Biegel R, Schafran D. Concept mapping in mental health: uses and adaptations. Eval Program Plann. 2000;23(1):67–75.CrossRefGoogle Scholar
  20. 20.
    O’Campo P, Salmon C, Burke J. Neighbourhoods and mental well-being: what are the pathways? Health Place. 2009;15:56–68.PubMedCrossRefGoogle Scholar
  21. 21.
    O’Campo P, Burke J, Peak GL, McDonnell KA, Gielen AC. Uncovering neighbourhood influences on intimate partner violence using concept mapping. Epidemiol Community Health. 2005;59:603–8.CrossRefGoogle Scholar
  22. 22.
    Burke JG, O’Campo P, Peake GL. Neighborhood influences and intimate partner violence: does geographic setting matter? J Urban Health. 2006;83:182–94.PubMedCrossRefGoogle Scholar
  23. 23.
    Matheson FI, O’Campo P, Salmon C, Zangeneh M, White H, Ahmad F, et al. Gender and perceptions of gambling: a pilot study using concept mapping. Report for Ontario Problem Gambling Research Centre 2009.Google Scholar
  24. 24.
    Brown J, Calder P. Concept-mapping the challenges faced by foster parents. Child Youth Serv Rev. 1999;21(6):481–95.Google Scholar
  25. 25.
    Borden LM, Perkins DF, Villarruel FA, Carleton-Hug A, Stone MR, Keith JG. Challenges and opportunities to Latino youth development: increasing meaningful participation in youth development programs. Hisp J Behav Sci. 2006;28(2):187–208.CrossRefGoogle Scholar
  26. 26.
    Trochim WMK, Stillman F, Clark P, Schmitt C. Development of a model of the tobacco industry’s interference with tobacco control programs. Tob Control. 2003;12:140–7.PubMedCrossRefGoogle Scholar
  27. 27.
    VanderWall MAE, Casparie F, Lako CJ. Quality of care: a comparison of preferences between medical specialists and patients with chronic diseases. Soc Sci Med. 1996;42(5):643–9.CrossRefGoogle Scholar
  28. 28.
    Batterham R, Southern D, Appleby N, et al. Construction of a GP integration model. Soc Sci Med. 2002;54(8):1225–41.PubMedCrossRefGoogle Scholar
  29. 29.
    Statistics Canada. Canada’s Ethnocultural Mosaic, 2006 Census: Canada’s major census metropolitan areas. Statistics Canada 2008. Available from: http://www12.statcan.ca/english/census06/analysis/ethnicorigin/toronto.cfm.
  30. 30.
    Ahmad F, Stewart DE. Predictors of clinical breast examination in South Asian immigrant women. J Immigr Health. 2004;6(3):119–26.PubMedCrossRefGoogle Scholar
  31. 31.
    Kernohan EEM. Evaluation of a pilot study for breast and cervical cancer screening with Bradford’s minority ethnic women; a community development approach, 1991–1993. Br J Cancer. 1996;29:s42–6.Google Scholar
  32. 32.
    South Riverdale Community Health Centre, Mount Sinai Hospital, Toronto Public Health. Engaging seldom or never screened women in cancer screening: a compendium of pan-Canadian best and promising practices. Toronto, Canada: South Riverdale Community Health Centre; 2010.Google Scholar
  33. 33.
    Bell TS, Branston LK, Newcombe RG, Barton GR. Interventions to improve uptake of breast screening in inner city Cardiff general practices with ethnic minority lists. Ethn Health. 1999;4(4):277–84.PubMedCrossRefGoogle Scholar
  34. 34.
    Hofstede G. Culture’s consequences: international differences in work-related values. Beverly Hills: Sage; 1980.Google Scholar
  35. 35.
    Grewal S, Bottorf JL, Hilton AB. The influence of family on immigrant South Asian women’s health. J Fam Nurs. 2005;11(3):242–63.PubMedCrossRefGoogle Scholar
  36. 36.
    Tanjasari SP, Kawaga-Singer M, Foo MA, Chao M, Linayao-Putman I, Nguyen T, et al. Designing culturally and linguistically appropriate health interventions: the “Life is Precious” Hmong breast cancer study. Health Educ Behav. 2007;34:140–53.CrossRefGoogle Scholar
  37. 37.
    Ahmad F, Shik A, Vanza R, Cheung A, George U, Stewart D. Popular modes of health promotion among East Indian and Chinese immigrant women. Women Health. 2004;40(1):21–40.PubMedCrossRefGoogle Scholar
  38. 38.
    Pietkiewicz I. Culture, religion, and ethnomedicine: the Tibetan Diaspora in India. Lanham: University Press of America; 2008.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Farah Ahmad
    • 1
  • Sadia Mahmood
    • 1
  • Igor Pietkiewicz
    • 2
  • Laura McDonald
    • 3
  • Ophira Ginsburg
    • 4
    • 5
  1. 1.Dalla Lana School of Public Health, Social and Behavioral Health Sciences DivisionUniversity of TorontoTorontoCanada
  2. 2.Warsaw School of Social Sciences and HumanitiesWarsawPoland
  3. 3.Health Promotion, Ontario Breast Screening Program, Cancer Care OntarioTorontoCanada
  4. 4.Women’s College Research InstituteTorontoCanada
  5. 5.Central East Regional Cancer ProgramLondonCanada

Personalised recommendations