Journal of Cancer Education

, Volume 29, Issue 2, pp 358–365 | Cite as

Evaluating Teaching Techniques in the Hmong Breast and Cervical Cancer Health Awareness Project



Cancer health disparities are a reality for Hmong women who are often diagnosed at a later stage and have low literacy and experienced care that are not culturally appropriate. Lack of attention to cultural appropriateness and literacy levels of cancer screening materials may contribute to disproportionately low levels of cancer screening among Hmong women. The purposes of this study were to evaluate the Hmong Health Awareness Project (HHAP), a program designed to create awareness and acceptance of breast and cervical cancer screening, and to examine participants’ perceptions of the utility of the content of the workshops. Hmong researchers partnered with three Midwestern Hmong community centers to implement six workshops. Three teaching techniques: pictographs, videos, and hands-on activities were utilized to teach Hmong participants about cancer screening. Participants included 150 Hmong (male participants = 30 and female participants = 120). Teach-back method was used to assess the participants’ understanding of cancer screening throughout the workshops. Qualitative data were collected in focus groups to assess the feasibility of teaching methods and participants’ perceptions of the utility of the content of the workshops. Directed content analysis was used to analyze participants’ responses. The three teaching techniques were helpful in increasing the Hmong people’s understanding about breast and cervical cancer screening. Nearly, all participants perceived an increased in their understanding, greater acceptance of cancer screening, and increased willingness to be screened. Men expressed support for screening after the workshops. Findings can guide future interventions to improve health communications and screening and reduce diagnostic disparities among Hmong and immigrant populations.


Cancer health disparity Breast cancer screening Cervical cancer screening Hmong Culturally specific education 


  1. 1.
    Yang RC, Mills PK, Dodge JL (2006) Cancer screening, reproductive history, socioeconomic status, and anticipated cancer-related behavior among Hmong adults. Asian Pac J Cancer Prev APJCP 7:79–85PubMedGoogle Scholar
  2. 2.
    Yang RC, Mills PK, Riordan DG (2004) Cervical cancer among Hmong women in California, 1988 to 2000. Am J Prev Med 27:132–138. doi:10.1016/j.amepre.2004.04.003 CrossRefPubMedGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention (2010) Breast Cancer Screening Rates. Accessed 26 Jul 2013
  4. 4.
    CDC - Cervical Cancer Screening Rates. Accessed 9 Jan 2014
  5. 5.
    Schroepfer TA, Waltz A, Noh H et al (2010) Seeking to bridge two cultures: the Wisconsin Hmong cancer experience. J Cancer Educ Off J Am Assoc Cancer Educ 25:609–616. doi:10.1007/s13187-010-0102-1 CrossRefGoogle Scholar
  6. 6.
    Lor M, Khang PY, Xiong P et al (2013) Understanding Hmong Women’s Beliefs, Feelings, Norms, and External Conditions About Breast and Cervical Cancer Screening. Public Health Nurs. doi:10.1111/phn.12043 PubMedGoogle Scholar
  7. 7.
    Baisch MJ, Vang PC, Peterman BR (2008) An exploration of Hmong women’s perspectives on cancer. Asian Nurs Res 2:82–91. doi:10.1016/S1976-1317(08)60032-8 CrossRefGoogle Scholar
  8. 8.
    Lee HY, Vang S (2013) Cultural beliefs and clinical breast examination in Hmong American women: the crucial role of modesty. J Immigr Minor Health Cent Minor Public Health. doi:10.1007/s10903-013-9890-9
  9. 9.
    Fang DM, Baker DL (2013) Barriers and facilitators of cervical cancer screening among women of Hmong origin. J Health Care Poor Underserved 24:540–555. doi:10.1353/hpu.2013.0067 CrossRefPubMedGoogle Scholar
  10. 10.
    Wong CC, Mouanoutoua V, Chen M-J et al (2005) Adherence with hypertension care among Hmong Americans. J Community Health Nurs 22:143–156. doi:10.2307/3427855 CrossRefPubMedGoogle Scholar
  11. 11.
    Johnson SK (2002) Hmong health beliefs and experiences in the western health care system. J Transcult Nurs 13:126–132. doi:10.1177/104365960201300205 CrossRefPubMedGoogle Scholar
  12. 12.
    Shade BJR (1997) Culture, Style and the Educative Process: Making Schools Work for Racially Diverse Students. Second Edition. Charles C. Thomas Publisher, Ltd., 2600 South First St., Springfield, IL 62794–9265 (cloth: ISBN-0–398–06747–3, $57.95; paperback: ISBN-0–398–06748–1, $42.95)Google Scholar
  13. 13.
    Worthley KME (1987) Learning Style Factor of Field Dependence/Independence and Problem Solving Strategies of Hmong Refugee StudentsGoogle Scholar
  14. 14.
    Berry JW (1976) Human ecology and cognitive style: Comparative studies in cultural and psychological adaptation. Sage PublicationsGoogle Scholar
  15. 15.
    Duffy J, Harmon R, Thao B, Yang K. The Hmong. An introduction to their history and culture. Cent. Fo R Appl. LinguistGoogle Scholar
  16. 16.
    Lo K (2002) Across the ocean: The impact of immigration on Hmong womenGoogle Scholar
  17. 17.
    Lee G (2002) The religious presentation of social relationships: Hmong world view and social structure. Lao Studies Review 2:44–60Google Scholar
  18. 18.
    Park CC (2002) Cross-cultural differences in learning styles of secondary English learners. Biling Res J 26:443–459. doi:10.1080/15235882.2002.10668720 CrossRefGoogle Scholar
  19. 19.
    Duffy J (2000) Literacy and L’Armee Clandestine: the writings of the Hmong military scribes. Hmong Stud J 3:1–32Google Scholar
  20. 20.
    Stillwater B, Echavarria VA, Lanier AP (1995) Pilot test of a cervical cancer prevention video developed for Alaska native women. Public Health Rep 110:211–214PubMedCentralPubMedGoogle Scholar
  21. 21.
    Calderon Y, Leider J, Hailpern S et al (2009) A randomized control trial evaluating the educational effectiveness of a rapid HIV posttest counseling video. Sex Transm Dis 36:207–210. doi:10.1097/OLQ.0b013e318191ba3f PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Dowse R, Ehlers M (2005) Medicine labels incorporating pictograms: do they influence understanding and adherence? Patient Educ Couns 58:63–70. doi:10.1016/j.pec.2004.06.012 CrossRefPubMedGoogle Scholar
  23. 23.
    Dowse R, Ehlers MS (2001) The evaluation of pharmaceutical pictograms in a low-literate South African population. Patient Educ Couns 45:87–99CrossRefPubMedGoogle Scholar
  24. 24.
    Kim H, Nakamura C, Zeng-Treitler Q (2009) Assessment of pictographs developed through a participatory design process using an online survey tool. J Med Internet Res 11:e5. doi:10.2196/jmir.1129 PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Houts PS, Witmer JT, Egeth HE et al (2001) Using pictographs to enhance recall of spoken medical instructions II. Patient Educ Couns 43:231–242. doi:10.1016/S0738-3991(00)00171-3 CrossRefPubMedGoogle Scholar
  26. 26.
    Carbone E, Lennon K, Torres M, Rosal M (2006) Testing the feasibility of an interactive learning styles measure for U.S. Latino adults with type 2 diabetes and low literacy. Int Q Community Health Educ 25:315–335. doi:10.2190/88J7-1432-2377-55K7 CrossRefGoogle Scholar
  27. 27.
    Hsieh H-F, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15:1277–1288. doi:10.1177/1049732305276687 CrossRefPubMedGoogle Scholar
  28. 28.
    Johnson JE (1973) Effects of accurate expectations about sensations on the sensory and distress components of pain. J Pers Soc Psychol 27:261CrossRefPubMedGoogle Scholar
  29. 29.
    Leventhal H, Singer R, Jones S (1965) Effects of fear and specificity of recommendation upon attitudes and behavior. J Pers Soc Psychol 34:20–29CrossRefGoogle Scholar
  30. 30.
    Leventhal H, Watts JC, Pagano F (1967) Effects of fear and instructions on how to cope with danger. J Pers Soc Psychol 6:313–321CrossRefPubMedGoogle Scholar
  31. 31.
    Johnson JE, Leventhal H (1974) Effects of accurate expectations and behavioral instructions on reactions during a noxious medical examination. J Pers Soc Psychol 29:710–718CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.School of NursingUniversity of Wisconsin-MadisonMadisonUSA

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