Korean American Immigrant Women's Perceptions of the U.S. and Korean Healthcare Systems and Their Influence on Breast Cancer Screening Behavior

Background and Purpose: Korean American immigrant women (KAIW) report lower mammography screening rates than other racial/ethnic groups, despite breast cancer being commonly diagnosed in this population (Lee et al., 2018). While existing research focuses on the barriers to mammography completion among KAIW in the United States (US), emerging research indicates that some KAIW continue to obtain mammograms in Korea instead of the US (Lee & Schwartz, 2021). In particular, KAIW who had their first mammogram in Korea were more likely to return to Korea for subsequent screenings (Lee et al., 2021). This study explores KAIW’s perceptions of the US and Korean healthcare systems and how these perceptions influence their mammography utilization in the US.

Methods: A qualitative research design was employed whereby participants were obtained using purposive sampling methods. Semi-structured phone interviews were conducted in Korean with 25 KAIW to explore their perceptions of the US and Korean healthcare systems and breast cancer screening experiences. Interviews were completed between October 2020 and July 2021, lasted 60-90 minutes, and were transcribed verbatim. A constant comparative method (Charmaz, 2006) was used to analyze the data.

Findings: Participants' mean age was 49.32 years old (SD=7.60), their average time of US residency was 20.17 years (SD=7.85), and about 80% (n=20) had a college education. KAIW’s perceptions of US and Korean healthcare systems included: (1) the high cost of healthcare in the US compared to Korea; (2) using US health insurance was complicated compared to Korea’s single-payer system; (3) referral to a specialist in the US is slow and time-consuming compared to Korea where no referral is required; (4) US healthcare providers are more friendly, supportive, and specialized than in Korea; and (5) US health guidelines do not reflect Korean values and culture. KAIW’s mammography use in the US reflected their perceptions of the two healthcare systems. Specifically, KAIW reported: (1) intent to screen in the US as long as it is covered by insurance or free, (2) mammogram and follow-up screening in the US is inconvenient and complicated, (3) having a US family doctor’s recommendation is helpful to initiate the first mammogram, and (4) US mammography technicians create a comfortable atmosphere for screening.

Conclusion: KAIW’s perceptions of mammography in the context of two healthcare systems reveal that healthcare financing and administrative procedures required to obtain a mammogram in the US represent significant barriers to completing breast cancer screening and follow-up testing when needed. While KAIW view their US mammography experiences positively compared to those in Korea, US providers' lack of knowledge of Korean culture and cancer screening guidelines may adversely affect KAIW’s perception of their care. KAIWs are receptive to completing breast cancer screening, and some would prefer to complete screening in the US, but the organization of the US healthcare system may lead women to stop screening or to delay screening until they can return to Korea. Novel interventions to increase breast cancer screening among KAIW are needed to address system-level barriers and promote mammography uptake in the US.