Journal of Cancer Education

, Volume 30, Issue 3, pp 482–489 | Cite as

Breast Health Intervention Effects on Knowledge and Beliefs Over Time Among Chinese American Immigrants—a Randomized Controlled Study

  • Frances Lee-LinEmail author
  • Nisreen Pedhiwala
  • Thuan Nguyen
  • Usha Menon


Chinese American immigrant women, nonadherent with mammography in the past 12 months, (N = 300) were enrolled in a randomized controlled trial designed to change knowledge and beliefs and increase mammogram use. This report describes intervention effects on changes in knowledge and beliefs between the control and educational groups over four time points (baseline and 3, 6, and 12 months). Variables measured included knowledge, perceived susceptibility, perceived general barriers to mammography, perceived benefits to mammography, and four cultural barriers to mammography (crisis orientation, modesty, use of Eastern medicine, reliance on others). At all three post-intervention time points, women in the education group had significantly higher knowledge scores than those in the control group, regardless of whether they had completed a mammogram during the study. Women in the education group reported higher perceived susceptibility to breast cancer at 3-month post-intervention. At 3- and 6-month post-intervention, regardless of mammogram screening completion, women reported lower concerns about modesty related to mammography when compared to the control group. By the 12-month post-intervention, women in the education group reported significantly fewer perceived barriers than the control group. A targeted breast health program successfully changed breast health knowledge and beliefs that were sustained for up to 6–12 months. Education targeted to women’s knowledge and beliefs has significant potential for decreasing disparity in mammogram use among Chinese American immigrant women.


Mammography screening Chinese immigrant women Cancer screening promotion Randomized controlled study Targeted intervention Culturally targeted education 



This study was supported by the American Cancer Society (MRSGT-09-090-01-CPPB). We thank the Chinese community and the Asian Health Service Center (AHSC) for their support and participation in this project and also Judith Gedney Baggs, PhD, RN, for the scientific editing.


This study was supported by the American Cancer Society (MRSGT-09-090-01-CPPB).

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. 1.
    American Cancer Society (2013) Breast cancer facts & figures 2013–2014. American Cancer Society, Inc., AtlantaGoogle Scholar
  2. 2.
    Healthy (n.d.b.) (2014) Healthy people 2020 objective target areas and page numbers. Retrieved January 13, 2014. Retrieved from
  3. 3.
    Gomez SL, Noone AM, Lichtensztajn DY et al (2013) Cancer incidence trends among Asian American populations in the United States, 1990-2008. J Natl Cancer Inst 105(15):1096–1110PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Gomez SL, Quach T, Horn-Ross PL et al (2010) Hidden breast cancer disparities in Asian women: disaggregating incidence rates by ethnicity and migrant status. Am J Public Health 100(Suppl 1):S125–31. doi: 10.2105/AJPH.2009.163931 PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    American Cancer Society (2009) Breast cancer facts & figures 2009–2010. American Cancer Society, Inc., AtlantaGoogle Scholar
  6. 6.
    U.S. Census Bureau (2011) Overview of race and Hispanic origin: 2010. U S Census Bureau C2010BR-02(Issued March 2011)Google Scholar
  7. 7.
    Lee-Lin F, Menon U (2005) Breast and cervical cancer screening practices and inventions among Chinese, Japanese, and Vietnamese Americans. Oncol Nurs Forum 32(5):995–1003CrossRefPubMedGoogle Scholar
  8. 8.
    Lee M, Lee F, Stewart S (1996) Pathways to early breast and cervical detection for Chinese American women. Health Educ Quart 23:76–88Google Scholar
  9. 9.
    Lee-Lin F, Menon U, Pett M, Nail L, Lee S, Mooney K (2007) Breast cancer beliefs and mammography screening practices among Chinese American immigrants. J Obstet Gynecol Neonatal Nurs 36(3):212–221CrossRefPubMedGoogle Scholar
  10. 10.
    Tang TS, Solomon LJ, McCracken LM (2000) Cultural barriers to mammography, clinical breast exam, and breast self-exam among Chinese-American women 60 and older. Prev Med 31(5):575–583CrossRefPubMedGoogle Scholar
  11. 11.
    Tu SP, Yasui Y, Kuniyuki AA et al (2003) Mammography screening among Chinese-American women. Cancer 97(5):1293–1302PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Yu ES, Kim KK, Chen EH, Brintnall RA (2001) Breast and cervical cancer screening among Chinese American women. Cancer Pract 9(2):81–91CrossRefPubMedGoogle Scholar
  13. 13.
    Kandula NR, Wen M, Jacobs EA, Lauderdale DS (2006) Low rates of colorectal, cervical, and breast cancer screening in Asian Americans compared with non-Hispanic Whites. Cancer 107(1):184–192CrossRefPubMedGoogle Scholar
  14. 14.
    Ma GX, Shive SE, Wang MQ, Tan Y (2009) Cancer screening behaviors and barriers in Asian Americans. Am J Health Behav 33(6):650–660CrossRefPubMedGoogle Scholar
  15. 15.
    Yu MY, Seetoo AD, Tsai CK, Sun C (1998) Sociodemographic predictors of papanicolaou smear test and mammography use among women of Chinese descent in southeastern Michigan. Wom Health Issues 8(6):372–381CrossRefGoogle Scholar
  16. 16.
    Yu MY, Wu TY (2005) Factors influencing mammography screening of Chinese American women. J Obstet Gynecol Neonatal Nurs 34(3):386–394CrossRefPubMedGoogle Scholar
  17. 17.
    Liang W, Yuan E, Mandelblatt JS, Pasick RJ (2004) How do older Chinese women view health and cancer screening? Results from focus groups and implications for interventions. Ethn Health 9(3):283–304CrossRefPubMedGoogle Scholar
  18. 18.
    Lee-Lin F, Menon U, Leo MC, Pedhiwala N (2013) Feasibility of a targeted breast health education intervention for Chinese American immigrant women. Oncol Nurs Forum 40(4):361–372CrossRefPubMedGoogle Scholar
  19. 19.
    Ma GX, Fang C, Wang MQ, Shive SE, Ma XS (2013) Pathways of breast cancer screening among Chinese American women. J Commun Med Health Educ 3(209):1–13Google Scholar
  20. 20.
    Wu TY, Hsieh HF, West BT (2009) Stages of mammography adoption in Asian American women. Health Educ Res 24(5):748–759CrossRefPubMedGoogle Scholar
  21. 21.
    Kim JH, Menon U, Wang E, Szalacha L (2010) Assess the effects of culturally relevant intervention on breast cancer knowledge, beliefs, and mammography use among Korean American women. J Immigr Minor Health 12(4):586–597PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Lee-Lin F, Nguyen T, Pedhiwala N, Dieckmann N, Menon U (2014) A breast health educational program for Chinese American women: 3- to 12-month post-intervention effect. Am J Health PromotGoogle Scholar
  23. 23.
    Lee-Lin F, Menon U, Nail L, Lutz K (2012) Findings from focus groups indicating what Chinese American immigrant women think about breast cancer and breast cancer screening. JOGNN 41(5):627–637. doi: 10.1111/j.1552-6909.2012.01348.x PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Lee-Lin F, Menon U, Pett M, Nail L, Lee S, Mooney K (2008) Measuring breast cancer and mammography screening beliefs among Chinese American immigrants. West J Nurs Res 30(7):852–868CrossRefPubMedGoogle Scholar
  25. 25.
    Kim JH, Menon U (2009) Pre- and post-intervention differences in acculturation, knowledge, beliefs, and stages of readiness for mammograms among Korean American women. Oncol Nurs Forum 36(2):E80–92CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Frances Lee-Lin
    • 1
    Email author
  • Nisreen Pedhiwala
    • 1
  • Thuan Nguyen
    • 2
  • Usha Menon
    • 3
  1. 1.School of NursingOregon Health & Science UniversityPortlandUSA
  2. 2.School of Public HealthOregon Health & Science UniversityPortlandUSA
  3. 3.College of NursingThe Ohio State UniversityColumbusUSA

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