Enhancing Mammography Use in Korean American Immigrant Women: The Role of Views on Breast Cancer and Screening

Background and Purpose: Korean American immigrant women (KAIW) are reported to have lower breast cancer screening rates than any other racial/ethnic groups. While a large body of research has been conducted to identify factors associated with screening use (e.g., sociodemographic characteristics and health care accessibility) in this population, there is limited research to understand their sociocultural context. The identified factors may have limitations in understanding of the cultural complexity and dynamics embedded in their screening behavior. This qualitative study with grounded theory method (Strauss & Corbin, 1990) aimed to explore 1) KAIW’s views on breast cancer and breast cancer screening and 2) how their views impact their screening participation. The study findings help public health efforts obtain a more comprehensive view of KAIW’s screening participation, as well as develop more culturally appropriate intervention strategies to promote mammography screening.

Methods: Semi-structured individual interviews were conducted with 30 KAIW aged 40-79 years old living in Los Angeles, California. As part of a larger mixed method study, the participants for this study were recruited using purposive sampling and theoretical strategies at a variety of community-based sites (e.g., churches and social service agencies). Their mammogram experience (e.g., no screening and multiple times) was the criterion to select study participants for interviews. The interviews elicited participants perspectives on breast cancer and screening, as well as their screening experiences. Each interview lasted approximately between one hour to three hours. All interviews were digitally recorded and transcribed verbatim. A grounded method (Glazer & Strauss, 1967) along with Charmaz (2006)’s constant comparative guideline was used to analyze the interview data.

Findings: Study participants had opposing views on breast cancer such as common versus uncommon, fearful versus less fearful, and preventable versus unpreventable. These contrasting views were linked to their direct and indirect experiences with cancer patients in the Korean American community. Exposure through observing and listening to cancer patients’ stories heightened participants’ awareness of breast cancer and screening. Participants who were fearful of breast cancer and considered it a common yet preventable disease in the Korean community got a mammogram. In terms of views on breast cancer screening, two contrasting views reported: effective versus ineffective and regular versus irregular. The study participants who did not believe mammogram machines were effective in detecting cancer relied on breast self-exams. In addition, participants who had strong preventative health orientation along with health insurance had regular screenings. 

Conclusion and Implications: Findings emphasize the key role of social networks in KAIW’s awareness of breast cancer and screening, as well as how their views on cancer and screening impact mammogram use. To promote mammography, several intervention strategies are suggested. For instance, it would be useful to have various case stories about KAIW with breast cancer in health education to increase their screening awareness on breast cancer screening. Also, health education should be combined with strategies to increase health care accessibility such as free or low-cost screening services given that health care resources link to screening participation.