Methods: The parent study that was the basis for this presentation was a randomized repeated measures pretest/posttest control group study among 330 Asian American breast cancer survivors. The intervention group was asked to use the intervention and the American Cancer Society (ACS) website on breast cancer for 3 months, and the control group was asked to use only the ACS website for 3 months. The instruments were: the Support Care Needs Survey-34 Short Form, the Memorial Symptom Assessment Scale-Short Form, and the Functional Assessment of Cancer Therapy Scale-Breast Cancer. The reliability and validity of the instruments were established in Asian Americans; Cronbach’s alphas were .76~.96. The data were analyzed using inferential statistics including an intent-to-treat linear mixed-model growth curve analysis. To identify the themes reflecting the challenges in using the culturally tailored technology-based intervention, a content analysis by Weber was used; the minutes of research team meetings and research diaries of research team members were analyzed using line-by-line coding and categorization. Throughout the research process, the research team kept the written records of team meetings and research diaries.
Results: The identified challenges included: (a) technology literacy; (b) language issues; (c) cultural barriers; (d) interventionists’ competence; (e) security and confidentiality issues; and (f) time and geographical constraints. First of all, most of the participants did not have a computer, and those who were using smart phones did not want to access the project website to discuss their breast cancer survivorship experience using the project website because they did not want to login to the project website or they were uncomfortable of using the software and typing. Rather, they wanted to use their social networking site (SNS) programs to communicate with the interventionists and view the educational modules and links to the Internet resources. Also, most of the participants did not have an email account or rarely checked their emails. Even when they had email accounts, the participants rarely used or responded to emails. Second, in this study, we adopted four languages: English, Mandarin Chinese, Korean, and Japanese. The most prominent issue related to the use of multiple languages was that the four languages could not sometimes cover the diversities within languages. For instance, even among Chinese Americans, their languages were different depending on where they originally came from. Also, in all the Asian languages, we found that there existed phonetic translations. It was more prominent in Japanese language compared with other languages though. Third, Confucianism that was once prevalent in most Asian sub-cultures pursues the unity of the self and Tiān (the traditional high god), which subsequently prescribes people live in harmonious relationships. This cultural heritage makes Asian Americans to avoid conflict and uncertainty while pursuing harmonious relationships Subsequently, the participants were reluctant to discuss their personal experience and issues and had a tendency to give only positive and socially desirable answers. Fourth, because of unexpected difficulties in identifying bilingual RNs in the local area where the study was conducted, the qualifications of the interventionists needed to be changed at several times. Sometimes, the interventionists found it difficult to deal with some complicated questions asked by the participants on their health and emotional issues. Fifth, when some potential participants tried to enter the project website, they reported that they received security messages indicating that the website was unsafe (e.g., delays in security certifications during regular updates). Subsequently, the potential participants chose not to participate in the study when they were followed up by the research team members. Finally, because of difficulties in recruiting Asian Americans in the local area where the study was conducted, the participants were recruited nationally to have an adequate number of Asian American breast cancer survivors. With the national approach, we had several issues related time and geographical constraints. Because the research team was in a Southeastern area of the U.S., potential participants in other areas did not trust the contacts by the research team. Also, the participants’ adherence and retention rates during major holidays (e.g., Christmas, New Year’s Eve, Easter, Chinese Spring Festival) and vacations (summer and winter) were lower than those in non-holiday or vacation time periods. Many participants who originally came from different Asian countries also tended to make international trips, which sometimes inhibited the continuity of the intervention.
Conclusion: This presentation supports the feasibility of a culturally tailored Internet-based intervention among racial/ethnic minorities, but also suggests that researchers need to consider possible challenges in using it among racial/ethnic minorities.
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