Journal of General Internal Medicine

, Volume 28, Issue 11, pp 1463–1468

Decreasing Disparities in Breast Cancer Screening in Refugee Women Using Culturally Tailored Patient Navigation

  • Sanja Percac-Lima
  • Jeffrey M. Ashburner
  • Barbara Bond
  • Sarah A. Oo
  • Steven J. Atlas
Original Research

ABSTRACT

BACKGROUND

Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective.

OBJECTIVE

Evaluate whether a PN program for refugee women decreases disparities in breast cancer screening.

DESIGN

Retrospective program evaluation of an implemented intervention.

PARTICIPANTS

Women who self-identified as speaking Somali, Arabic, or Serbo-Croatian (Bosnian) and were eligible for breast cancer screening at an urban community health center (HC). Comparison groups were English-speaking and Spanish-speaking women eligible for breast cancer screening in the same HC.

INTERVENTION

Patient navigators educated women about breast cancer screening, explored barriers to screening, and tailored interventions individually to help complete screening.

MAIN MEASURES

Adjusted 2-year mammography rates from logistic regression models for each calendar year accounting for clustering by primary care physician. Rates in refugee women were compared to English-speaking and Spanish-speaking women in the year before implementation of the PN program and over its first 3 years.

RESULTS

There were 188 refugee (36 Somali, 48 Arabic, 104 Serbo-Croatian speaking), 2,072 English-speaking, and 2,014 Spanish-speaking women eligible for breast cancer screening over the 4-year study period. In the year prior to implementation of the program, adjusted mammography rates were lower among refugee women (64.1 %, 95 % CI: 49–77 %) compared to English-speaking (76.5 %, 95 % CI: 69 %–83 %) and Spanish-speaking (85.2 %, 95 % CI: 79 %–90 %) women. By the end of 2011, screening rates increased in refugee women (81.2 %, 95 % CI: 72 %–88 %), and were similar to the rates in English-speaking (80.0 %, 95 % CI: 73 %–86 %) and Spanish-speaking (87.6 %, 95 % CI: 82 %–91 %) women. PN increased screening rates in both younger and older refugee women.

CONCLUSION

Linguistically and culturally tailored PN decreased disparities over time in breast cancer screening among female refugees from Somalia, the Middle East and Bosnia.

KEY WORDS

breast cancer screening patient navigation vulnerable populations disparities 

REFERENCES

  1. 1.
    Deavenport A, Modeste N, Marshak HH, et al. Closing the gap in mammogram screening: an experimental intervention among low-income Hispanic women in community health clinics. Health Educ Behav. 2011;38(5):452–61.PubMedCrossRefGoogle Scholar
  2. 2.
    Nelson HD, Tyne K, Naik A, et al. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151(10):727–37.PubMedCrossRefGoogle Scholar
  3. 3.
    Cho YI, Johnson TP, Barrett RE, et al. Neighborhood changes in concentrated immigration and late stage breast cancer diagnosis. J Immigr Minor Health. 2010;13(1):9–14.CrossRefGoogle Scholar
  4. 4.
    Dai D. Black residential segregation, disparities in spatial access to health care facilities, and late-stage breast cancer diagnosis in metropolitan Detroit. Health Place. 2010;16(5):1038–52.PubMedCrossRefGoogle Scholar
  5. 5.
    Bradley CJ, Given CW, Roberts C. Disparities in cancer diagnosis and survival. Cancer. 2001;91(1):178–88.PubMedCrossRefGoogle Scholar
  6. 6.
    Flores G. Language barriers to health care in the United States. N Engl J Med. 2006;355(3):229–31.PubMedCrossRefGoogle Scholar
  7. 7.
    Goel MS, Wee CC, McCarthy EP, et al. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med. 2003;18(12):1028–35. PMC1494963.PubMedCrossRefGoogle Scholar
  8. 8.
    Kandula NR, Wen M, Jacobs EA, et al. Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic whites: cultural influences or access to care? Cancer. 2006;107(1):184–92.PubMedCrossRefGoogle Scholar
  9. 9.
    Porter P. “Westernizing” women’s risks? Breast cancer in lower-income countries. N Engl J Med. 2008;358(3):213–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Martin DC. Refugees and Asylees: 2011. http://www.dhs.gov/xlibrary/assets/statistics/publications/ois_rfa_fr_2011.pdf. Accessed April 07, 2013.
  11. 11.
    Barnes DM, Harrison CL. Refugee women’s reproductive health in early resettlement. J Obstet Gynecol Neonatal Nurs. 2004;33(6):723–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Dohan D, Levintova M. Barriers beyond words: cancer, culture, and translation in a community of Russian speakers. J Gen Intern Med. 2007;22(Suppl 2):300–5. PMC2078549.PubMedCrossRefGoogle Scholar
  13. 13.
    Carroll J, Epstein R, Fiscella K, et al. Knowledge and beliefs about health promotion and preventive health care among somali women in the United States. Health Care Women Int. 2007;28(4):360–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Kawar LN. Jordanian and Palestinian immigrant women’s knowledge, affect, cultural attitudes, health habits, and participation in breast cancer screening. Health Care Women Int. 2009;30(9):768–82.PubMedCrossRefGoogle Scholar
  15. 15.
    Kobetz E, Menard J, Barton B, et al. Barriers to breast cancer screening among Haitian immigrant women in Little Haiti, Miami. J Immigr Minor Health. 2010;12(4):520–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Koh C, Nelson JM, Cook PF. Evaluation of a patient navigation program. Clin J Oncol Nurs. 2011;15(1):41–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Ellis BH, MacDonald HZ, Lincoln AK, et al. Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination. J Consult Clin Psychol. 2008;76(2):184–93.PubMedCrossRefGoogle Scholar
  18. 18.
    Wissink L, Jones-Webb R, DuBois D, et al. Improving health care provision to Somali refugee women. Minn Med. 2005;88(2):36–40.PubMedGoogle Scholar
  19. 19.
    Shah SM, Ayash C, Pharaon NA, et al. Arab American immigrants in New York: health care and cancer knowledge, attitudes, and beliefs. J Immigr Minor Health. 2008;10(5):429–36.PubMedCrossRefGoogle Scholar
  20. 20.
    Migration Information Source. http://www.migrationinformation.org/index.cfm. Accessed April 7, 2013.
  21. 21.
    Freeman HP, Muth BJ, Kerner JF. Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract. 1995;3(1):19–30.PubMedGoogle Scholar
  22. 22.
    Paskett ED, Harrop JP, Wells KJ. Patient navigation: an update on the state of the science. CA Cancer J Clin. 2011;61(4):237–49.PubMedCrossRefGoogle Scholar
  23. 23.
    Phillips CE, Rothstein JD, Beaver K, et al. Patient navigation to increase mammography screening among inner city women. J Gen Intern Med. 2010;26(2):123–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Robinson-White S, Conroy B, Slavish KH, et al. Patient navigation in breast cancer: a systematic review. Cancer Nurs. 2010;33(2):127–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Wells KJ, Battaglia TA, Dudley DJ, et al. Patient navigation: state of the art or is it science? Cancer. 2008;113(8):1999–2010.PubMedCrossRefGoogle Scholar
  26. 26.
    Percac-Lima S, Milosavljevic B, Oo SA, et al. Patient navigation to improve breast cancer screening in Bosnian refugees and immigrants. J Immigr Minor Health. 2012;14(4):727–30.PubMedCrossRefGoogle Scholar
  27. 27.
    Refugee Arrivals to Massachusetts by Country of Origin. http://www.mass.gov/eohhs/gov/departments/dph/programs/id/public-health-cdc-refugee-arrivals.html Accessed April 07, 2013.
  28. 28.
    Donelan K, Mailhot JR, Dutwin D, et al. Patient perspectives of clinical care and patient navigation in follow-up of abnormal mammography. J Gen Intern Med. 2011;26(2):116–22. PMC3019311.PubMedCrossRefGoogle Scholar
  29. 29.
    U. S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151(10):716–26. W-236.CrossRefGoogle Scholar
  30. 30.
    Murphy SN, Chueh HC. A security architecture for query tools used to access large biomedical databases. Proc AMIA Symp. 2002;552–6. PMC2244204.Google Scholar
  31. 31.
    Dietrich AJ, Tobin JN, Cassells A, et al. Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial. Ann Intern Med. 2006;144(8):563–71.PubMedCrossRefGoogle Scholar
  32. 32.
    Saadi A, Bond B, Percac-Lima S. Perspectives on preventive health care and barriers to breast cancer screening among Iraqi women refugees. J Immigr Minor Health. 2012;14(4):633–9.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Sanja Percac-Lima
    • 1
    • 2
    • 5
  • Jeffrey M. Ashburner
    • 2
  • Barbara Bond
    • 3
    • 4
  • Sarah A. Oo
    • 1
    • 5
  • Steven J. Atlas
    • 2
  1. 1.Massachusetts General Hospital Chelsea HealthCare CenterChelseaUSA
  2. 2.Department of MedicineMassachusetts General Hospital General Medicine DivisionBostonUSA
  3. 3.Massachusetts General Hospital Cancer CenterBostonUSA
  4. 4.Bridgewater State UniversityBridgewaterUSA
  5. 5.Massachusetts General Hospital Center for Community Health ImprovementBostonUSA

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