Journal of Cancer Education

, Volume 28, Issue 2, pp 325–334 | Cite as

Health Literacy, Health Communication Challenges, and Cancer Screening Among Rural Native Hawaiian and Filipino Women

  • Tetine SentellEmail author
  • May Rose Dela Cruz
  • Hyun-Hee Heo
  • Kathryn L. Braun


Native Hawaiians and Filipinos are disproportionately impacted by cancer and are less likely to participate in cancer screening than whites. Limited information exists about health information pathways and health communication challenges as they relate to cancer screening in these groups. Six focus groups (n = 77) of Native Hawaiian and Filipino women age 40 + years were conducted to investigate these research gaps. Participants noted many health information challenges. Challenges were both practical and interpersonal and included both written and oral health communication. Practical challenges included “big” words, complexity of terms, and lack of plain English. Interpersonal issues included doctors rushing, doctors not assessing comprehension, and doctors treating respondents as patients not people. Women noted that they would often not ask questions even when they knew they did not understand because they did not want the provider to think negatively of them. Overarching themes to improve cancer communication gaps included: (1) the importance of family and community in health information dissemination, (2) the key role women play in interpreting health information for others, (3) the importance of personal experience and relationships to the salience of health information, and (4) the desire for local cultural relevance in health communication. Findings are discussed in light of the 2010 National Action Plan for Health Literacy.


Hawaiian women Filipino women Cancer screening Health communication 



This study was supported by U54CA153459 from the National Cancer Institute. We thank JoAnn Tsark, Maria Anastario, and Natalie Young Albanese for their assistance with this project, as well as all the women who participated in the focus groups.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Miller BA, Chu KC, Hankey BF, Ries LA (2008) Cancer incidence and mortality patterns among specific Asian and Pacific Islander populations in the U.S. Cancer Causes Control 19(3):227–256, Epub 2007 Nov 27PubMedCrossRefGoogle Scholar
  2. 2.
    Tsark JU, Braun KL (2009) Eyes on the Pacific: Cancer issues of Native Hawaiians and Pacific Islanders in Hawai‘i and the US-associated Pacific. J Cancer Educ 24(Suppl 2):S68–S69PubMedCrossRefGoogle Scholar
  3. 3.
    McCracken M, Olsen M, Chen MS, Jemal A, Thun M, Cokkinides V, Deapen D, Ward E (2007) Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese Ethnicities. CA Cancer J Clin 57:190–205, Erratum in: CA Cancer J Clin. 2007 Nov-Dec, 57 (6): 380. PubMed PMID: 1762611PubMedCrossRefGoogle Scholar
  4. 4.
    Maxwell AE, Bastani R, Warda US (2000) Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States. Am J Prev Med 18(1):62–68PubMedCrossRefGoogle Scholar
  5. 5.
    Tran JH, Mouttapa M, Ichinose TY, Pang JK, Ueda D (2010) Tanjasiri SP. Sources of information that promote breast and cervical cancer knowledge and screening among native Hawaiians in Southern California. J Cancer Educ 25(4):588–594PubMedCrossRefGoogle Scholar
  6. 6.
    Tanjasiri SP, Tran JH, Palmer PH, Foo MA, Hanneman M, Lee C, Sablan-Santos L, Sripipatana A (2007) Developing a community-based collaboration to reduce cancer health disparities among Pacific Islanders in California. Pac Health Dialog 14(1):119–127PubMedGoogle Scholar
  7. 7.
    Watts T, Merrell J, Murphy F, Williams A (2004) Breast health information needs of women from minority ethnic groups. J Adv Nurs 47(5):526–535PubMedCrossRefGoogle Scholar
  8. 8.
    Aitaoto N, Tsark JU, Tomiyasu DW, Yamashita BA, Braun KL (2009) Strategies to increase breast and cervical cancer screening among Hawaiian, Pacific Islander, and Filipina women in Hawai‘i. Hawaii Med J 68(9):215–222PubMedGoogle Scholar
  9. 9.
    Gellert K, Braun KL, Morris R, Starkey V (2006) The ‘Ohana Day Project: a community approach to increasing cancer screening. Prev Chronic Dis 3(3):A99, Epub 2006 Jun 15PubMedGoogle Scholar
  10. 10.
    Kulukulualani M, Braun KL, Tsark J (2008) Using a four-step protocol to develop and test culturally targeted cancer education brochures. Heal Promot Pract 9:344–355CrossRefGoogle Scholar
  11. 11.
    Parker RM, Baker DW, Williams MV, Nurss JR (1995) The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J Gen Intern Med 10:537–554PubMedCrossRefGoogle Scholar
  12. 12.
    Pope C, Ziebland S, Mays N (2000) Analysing qualitative data. BMJ 320(7227):114–116, PMCID: PMC1117368PubMedCrossRefGoogle Scholar
  13. 13.
    Crabtree BF, Miller WL (1999) Doing qualitative research, 2nd edn. Sage Publications, Thousand OaksGoogle Scholar
  14. 14.
    StataCorp (2011) Stata statistical software: release 12. StataCorp, College StationGoogle Scholar
  15. 15.
    Aitaoto N, Braun KL, Estrella J, Epeluk A, Tsark J (2012) Woman to woman: a culturally appropriate cancer outreach project for and by Micronesian women. Preventing Chronic Disease 9:100262. doi: 10.5888/pcd9.100262 Google Scholar
  16. 16.
    Sentell T, Baker KK, Onaka A, Braun K (2011) Low health literacy and poor health status in Asian Americans and Pacific Islanders in Hawai’i. J Health Communic 16(3):279–294CrossRefGoogle Scholar
  17. 17.
    Davis TC, Williams MV, Marin E, Parker RM, Glass J (2002) Health literacy and cancer communication. CA Cancer J Clin 52:134, PMID: 11296623PubMedCrossRefGoogle Scholar
  18. 18.
    Bennett CL, Ferreira MR, Davis TC, Kaplan J, Weinberger M, Kuzel T, Seday MA, Sartor O (1998) Relation between literacy, race, and state of presentation among low-income patients with prostate cancer. J Clin Onc 16(9):3101–3104Google Scholar
  19. 19.
    Plain Writing Act of 2010 (H.R. 946/Public Law 111–274). Accessed 21 March 2013
  20. 20.
    Prevention and Health Promotion (2010) National action plan to improve health literacy. US Department of Health and Human Services, Washington, DCGoogle Scholar
  21. 21.
    Ness S (2012) Making the case for health literacy. J Cancer Educ 27(3):397–398PubMedCrossRefGoogle Scholar
  22. 22.
    Houts PS, Doak CC, Doak LG, Loscalzo MJ (2006) The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Educ Couns 61(2):173–190PubMedCrossRefGoogle Scholar
  23. 23.
    Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR (2005) The prevalence of limited health literacy. J Gen Intern Med 20(2):175–184PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Tetine Sentell
    • 1
    • 2
    Email author
  • May Rose Dela Cruz
    • 1
    • 2
  • Hyun-Hee Heo
    • 1
  • Kathryn L. Braun
    • 1
    • 2
  1. 1.Office of Public Health Studies, John A. Burns School of MedicineUniversity of Hawai‘iHonoluluUSA
  2. 2.‘Imi Hale Native Hawaiian Cancer Network (U54CA153459)HonoluluUSA

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