A Latent Class Analysis of Cancer Fatalism with Korean American Immigrant Women

Background and Purpose: Cancer fatalism has been reported as a cultural health belief that influences cancer screening participation, preventive approaches, and treatment-seeking behaviors. There exists an extensive body of research that examines factors associated with cancer fatalism in African American and Latinx groups, however, few studies have reported on Korean American immigrants. Although previous investigations provide a range of measures and descriptions of cancer fatalism (e.g., predetermination, luck, pessimism), no studies to our knowledge have analyzed how fatalistic views cluster together within subgroups to form distinct profiles, and how these profiles can be predicted. This study aims to (1) identify subgroups of Korean American immigrants with similar fatalistic beliefs toward cancer and (2) determine how subgroups are predicted based on sociodemographic characteristics, health literacy, and health belief variables (e.g., preventive health orientation, perceived susceptibility).

Methods: Data were collected using a cross-sectional survey with a convenience sample of 240 Korean American immigrant women residing in Los Angeles, California. The participants’ mean age was 58.6 years old and their average length of time in the United States was 23.1 years. About two-thirds (67.3%) completed undergraduate or graduate school, 34.5% reported their income was less than $25,000 per year, 62.2% had a mammogram within the two years prior to survey completion, and 9.9% were never screened for breast cancer. The following key constructs were measured in this study: fatalism (Liang et al., 2008), health literacy (CDC, 2016), preventive orientation (Kwork et al., 2015), and perceived susceptibility to breast cancer (Champion, 1999). Latent Class Analysis (LCA) was used to identify the level of fatalistic views on cancer and their correlated determinants. For all outcomes, analyses were performed using Mplus version 8.2.

Results: LCA identified a model comprised of three cancer fatalism subgroups: (1) high (26.7% of the sample), (2) moderate (41.4%), and (3) low (31.9%). Compared to the low fatalism subgroup, the high subgroup was positively associated with age (p=.038), preventive orientation–i.e., health checkups are not necessary if feeling well (p=.001), and perceived susceptibility–i.e., I will likely get breast cancer (p=.008) and negatively linked to preventive orientation–i.e., doctor visits are not necessary if feeling healthy (p=.001). In addition, the moderate fatalism subgroup was positively associated with length of time in the United States (p=.021) and preventive orientation–i.e., health checkups are not necessary if feeling well (p=.001), compared to the low subgroup.

Conclusions and Implications: This study provides important insights into the correlates of cancer fatalism among Korean American immigrant women. The findings highlight the need for health education efforts that emphasize the importance of routine health checkups, especially among older women and those who believe cancer screening and prevention behaviors cannot change their fate. Exploratory research is needed to understand why doctor visits, as compared to health checkups, were negatively associated with high cancer fatalism. For public health education efforts to be successful with Korean American immigrant women, practitioners need to engage the community through culturally attuned messaging to address fatalistic beliefs that impede cancer screening behaviors.