Breast Cancer Screening Behaviors in Korean American Immigrant Women: Does Fatalism Matter?

Background and Purpose: Fatalism has been reported as a noteworthy cultural health belief that influences cancer screening participation (Jun & Oh, 2013), preventive behaviors (Niederdeppe & Levy, 2007), and treatment-seeking behaviors (Drew & Schoenberg, 2011). Although some research has examined fatalistic beliefs in ethnic minority groups compared to Whites at a national level (Niederdeppe & Levy, 2007), Korean American immigrant women’s (KAIW) fatalistic views on cancer and their link to breast cancer screening behaviors have been understudied. This investigation examined the role of fatalism as a mediator between regular health check-ups, health insurance and family history of cancer and three types of breast cancer screening behaviors (breast self-exam, clinical breast exam, and mammogram) in KAIW. Given that a fatalistic belief of cancer is one of the frequently cited barriers to health care access in KAIW, the aim of this study was to expand our understanding of how cultural health beliefs influence KAIW’s screening behaviors.

Methods: A cross-sectional survey in Korean was conducted with a convenience sample of 538 KAIW ages 40-79 years residing in North Carolina. The survey was either conducted face-to-face by the researcher or self-administered. The participants’ mean age was 55.6 years old (SD=9.3) and their average length of time in the United States was 23.8 years (SD=12.1). About two-thirds (63.1%) completed undergraduate or graduate education, and 37.9% reported their income was less than $50,000 per year. Exploratory factor analysis and structural equation modeling (SEM) were used to identify direct and indirect effects of fatalism on screening behaviors. Using the AMOS 26, the model estimation terminated normally within the default convergent criterion (X²₃₃=151.625, p=0.00; RMSEA=0.048, CI (0.038, 0.059); CFI=0.930). The model fit values exceed or are close to the criteria recommended by Hu and Bentler (1999), which confirms that the hypothesized model globally fits our data.

Results: SEM results indicated that regular health check-ups influenced all three types of screening methods (breast self-exam, clinical breast exam, and mammogram)(effect size=.061, p<.001). Health insurance and family history of cancer were associated with clinical breast exam and breast self-exam, respectively (effect size=.104, p<.001). However, there was no effect of fatalistic beliefs on the three screening behaviors.

Conclusions and Implications: This study described the influence of regular health check-ups, health insurance, family history of cancer, and fatalistic beliefs on KAIW’s breast cancer screening behaviors. The findings highlight the primacy of regular health check-ups for KAIW when designing breast health interventions for this population, and the lack of relationship between having health insurance and having a mammogram. Interestingly, the absence of a direct or indirect effect of fatalistic beliefs on screening behaviors to reduce cancer risk may offer some promise to medical professionals and public health educators who work with this population. Specifically, community-based efforts and financial resources can be focused on helping KAIW maintain routine health care as a mechanism to increase the uptake of breast cancer screening, rather than trying to change culturally anchored and often immutable belief systems.