Breast Cancer Risk and Mammograms: Korean-American Spousal Interactions

Monday, 30 July 2012

Usha Menon, PhD, RN, FAAN
College of Nursing, Ohio State University, Columbus, OH
Eunice Lee, PhD, RN
College of Nursing, University of California Los Angeles, Los Angeles, CA
Arlene Miller, RN, PhD, FAAN
College of Nursing, Rush University, Chicago, IL

Learning Objective 1: The learner will be able to articulate themes related to spousesí perceptions of breast cancer screening.

Learning Objective 2: The learner will be able to discuss cultural processes to husbandsí support of wivesí breast cancer screening.

Purpose: Breast cancer remains a leading cause of death for KA women, and screening is suboptimal. The purpose of this report is to describe interactions between Korean American (KA) spouses that may underlie mechanisms through which an educational program on mammography influenced behavior change.

Methods: 428 KA couples participated in a clinical trial of an intervention conducted at faith-based organizations. Half received a culturally targeted breast cancer screening educational program and half receiving dietary education. The cultural education significantly increased mammography uptake among women. A random 10% of spousal couples (n = 44) were asked to audio-record their at-home personal interactions as part of the intervention “homework.” Discussions were transcribed verbatim and translated to English. Three team members read the same 3 transcripts and developed codes for themes. When consensus was achieved, remaining interviews were coded by two members and final themes identified.

Results: Emergent main themes were broadly organized into: discussion leader and conversation style (husband or wife; directive, supportive, avoidant), relationship characteristics (husband’s awareness of wife’s health habits), barriers to mammograms (fear, time, cost) and strategies for obtaining mammograms (reminders, transportation, supportive presence). Primary sub-themes of cultural beliefs were: fatalism, power of prayer, men usually not engaged with women’s health/body issues; and tone of discussion/relationship (sad, happy, blaming, supportive).

Conclusion: Many interventions in immigrant minority communities are conceptualized from Western cultural perspectives. Additionally, it may be hubris to assume we can change cultural norms through education. Rather, our focus must be on leveraging such norms to maximize intervention effect, such as including spouses in efforts to educate Korean women and capitalizing on the importance of interpersonal context in Korean culture. Findings will inform refinement of the original educational intervention.

Next steps include community-wide dissemination of the refined intervention with attention to cultural and environmental context.