Abstract
Southeast Asian immigrants have lower levels of Pap testing than any other racial/ethnic group in the US, and are particularly unfamiliar with western culture and biomedical concepts of prevention. We completed an ethnographic study (N = 42) focusing on cervical cancer screening among Cambodian American women. We also conducted a community-based survey (N = 413) to examine the generalizability of our qualitative results. This report summarizes the results, and describes how we used our findings to influence the content of a multifaceted intervention program targeting Cambodian immigrants. The following constructs were found to be barriers to cervical cancer control: a traditional orientation to the prevention, causation, and treatment of disease; lack of familiarity with western early detection concepts; low levels of knowledge about cervical cancer; concerns about the Pap testing procedure; and health care access issues. In general, the quantitative results confirmed our ethnographic findings. The intervention program, which is delivered by bicultural outreach workers, includes home visits, presentations at small group meetings, barrier-specific counseling, use of a Khmer-language video, and tailored logistic assistance (e.g., transportation and medical interpretation). Both the video and presentation provide cultural context while simultaneously addressing multiple barriers to screening (e.g., women's fear of surgery and preference for female providers). Outreach workers are trained to counsel women about 10 potential barriers including avoidance of biomedicine, perceptions that gynecologic exams are embarrassing, and lack of English proficiency. Our results reinforce the importance of considering health problems within the context of a population's traditional belief systems and daily routines.
Similar content being viewed by others
REFERENCES
Department of Commerce. We the Asian Americans. Washington DC: Department of Commerce, 1993.
Kulig JC. Sexuality beliefs among Cambodians: implications for health care providers. Health Care Women Int 1994; 15:69-74.
Rumbaut RG, Weeks JR. Fertility and adaptation: Indochinese refugees in the United States. Int Migrat Rev 1986; 20:428-465.
Kiernan B. Genocide and democracy in Cambodia: the Khmer Rouge, the United States, and the international community. New Haven: Yale University Press, 1993.
Frye BA. Cultural themes in health care decision-making among Cambodian refugee women. J Comm Health Nurs 1991; 8:33-44.
Hoang GN, Erickson RV. Cultural barriers to effective medical care among Indo-Chinese patients. Ann Rev Med 1985; 36:229-239.
Muecke MA. Caring for Southeast Asian refugees in the US. Am J Public Health 1983; 73:431-438.
Uba L. Cultural barriers to health care for Southeast Asian refugees. Public Health Rep 1992; 107: 544-548.
Perkins CI, Morris CR, Wright WE, Young L. Cancer incidence and mortality in California by detailed race/ethnicity. Sacramento: California Department of Health Services, 1995.
Kelly AW, Chacori MDF, Wollan PC et al. A program to increase breast and cervical cancer screening for Cambodian women in a midwestern community. Mayo Clin Proc 1996; 71:437-444.
Yi JK. Factors affecting cervical cancer screening behavior among Cambodian women in Houston, Texas. Fam Comm Health 1996; 18:49-57.
Hubbell FA, Chavez LR, Mishra SI, Magana JR, Valdez RB. From ethnography to intervention: developing a breast cancer control program for Latinas. Monogr Natl Cancer Inst 1995; 18:109-115.
Olsen SJ, Frank-Stromberg M. Cancer prevention and early detection in ethnically diverse populations. Sem Oncol Nurs 1993; 9:198-209.
Gittelsohn J, Pelto PJ, Bentley ME et al. Qualitative methodological approaches for investigating women's heallth in India. In: J Gittelson, ME Bentley, PJ Pelto et al. (Eds). Listening to women talk about their health-issues and evidence from India. New Delhi: Har-Arand Publications, 1994.
Steckler A, McLeroy KR, Goodman RM, Bird TL, McCormick L. Toward integrating qualitative and quantitative data for health education planning, implementation, and evaluation. Health Educ Quart 1992; 19:101-115.
Sensky T. Eliciting lay beliefs across cultures: principles and methodology. Br J Cancer (Supplement) 1996; 74:63-65.
Taylor VM, Jackson JC, Schwartz SM, Yasui Y, Tu SP, Thompson B. Cervical cancer control in a Cambodian American population. Asian Am Pacific Isl J Health (Conference Proceedings) 1998; 6:368-377.
Department of Commerce. 1990 census of population and housing: population and housing characteristics for census tracts and blocknumbering areas-Seattle, WA PMSA. Washington DC: Department of Commerce, 1993.
Fasano P. Seattle Housing Authority annual population report 1995. Seattle: Seattle Housing Authority, 1996.
Montes JH, Eng E, Braithwaite RL. A commentary on minority health as a paradigm shift in the United States. Am J Health Prom 1995; 9:247-250.
National Institutes of Health. Health behavior research in minority populations: access, design, and implementation. Bethesda: National Institutes of Health, 1992.
Spradley JP. The ethnographic interview. New York: Harcourt Brace Jovanovich, 1979.
Kanani S, Latha K, Shah M. Applications of qualitative methodologies to investigate perceptions of women and health practitioners regarding health disorders in Baroda slums. In: J Gittelson, ME Bentley, PJ Pelto et al. (Eds). Listening to women talkabout their health-issues and evidence from India. editors. New Delhi: Har-Arand Publications, 1994.
Chavez LR, Hubbell FA, McMullen JM, Martinez RG, Misha SI. Structure and meaning in models of breast and cervical cancer risk: a comparison of perceptions among Latinas, Anglo women, and physicians. Med Anthropol Quart 1995; 9:40-76.
Taylor VM, Schwartz S, Jackson JC, Kuniyuki A, Fischer M, Yasui Y, Tu SP, Thompson B. Cervical cancer screening among Cambodian American women. Cancer Epidemiol Biomark Prev 1999; 8:541-546.
Buchwald D, Panwala S, Hooton TM. Use of traditional health practices by Southeast Asian refugees in a primary care clinic. West J Med 1992; 156:507-511.
Nguyen MD. Culture shock-a review of Vietnamese culture and its concepts of health and disease. West J Med 1985; 142:409-412.
McPhee SJ, Bird JA, Ha NT, Jenkins CNH, Fordham D, Le B. Pathways to early cancer detection for Vietnamese women: health is gold. Health Educ Quart (Supplement) 1996; 23:60-75.
Jackson-Carroll LM, Jackson JC, Graham E. Beyond medical interpretation: the role of interpreter cultural mediators-selecting, training, and supporting the outreach staff. Seattle: Harborview Medical Center, 1995.
Chen MS, Zaharlick A, Kuun P, Li WL, Guthrie R. Implementation of the indigenous model for health education programming among Asian minorities: beyond theory and into practice. J Health Educ 1992; 23:400-403.
Mahloch J, Jackson JC, Chitnarong K, Sam R, Ngo LS, Taylor VM. Bridging cultures through the development of a Cambodian cervical cancer screening video.J Cancer Educ 1999; 14:109-114.
King ES, Rimer BK, Seay J, Balshem A, Engstrom PF. Promoting mammography use through progressive interventions: is it effective? Am J Public Health 1994; 84:104-106.
Coyne CA, Hohman K, Levinson A. Reaching special populations with breast and cervical cancer public education. J Cancer Educ 1992; 7:293-303.
Michielutte R, Sharp PC, Dignan MB, Blinson K. Cultural issues in the development of cancer control programs for American Indian populations. J Health Care Poor Underserv 1994; 5:280-296.
Bird JA, Otero-Sabogal R, Ha NT, McPhee SJ. Tailoring lay health worker interventions for diverse cultures: lessons learned from Vietnamese and Latina communities. Health Educ Quart (Supplement) 1996; 23:105-122.
Pasick RJ, D'Onofrio CN, Otero-Sabogal R. Similarities and differences across cultures: questions to inform a third generation for health promotion research. Health Educ Quart (Supplement) 1996; 23:142-161.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jackson, J.C., Taylor, V.M., Chitnarong, K. et al. Development of a Cervical Cancer Control Intervention Program for Cambodian American Women. Journal of Community Health 25, 359–375 (2000). https://doi.org/10.1023/A:1005123700284
Issue Date:
DOI: https://doi.org/10.1023/A:1005123700284