MECHANISMS AND DECISION MAKING ABOUT PAP TEST USE AMONG KOREAN AMERICAN WOMEN

Health literacy;cervical cancer screening;Korean American women;not listed

Kim, KyounghaeRoter, Debra L. ;

Johns Hopkins University

关键词: Health literacy;    cervical cancer screening;    Korean American women;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/44619/KIM-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background: Cervical cancer is the fourth common cancer in women worldwide. Health literacy has emerged as a critical factor in enabling individuals to endorse desirable health behaviors, including cervical cancer screening. Despite a growing body of research on the association between health literacy and cervical cancer screening, no known study has comprehensively examined links between health literacy and Pap test use among women of diverse racial/ethnic groups, such as Korean Americans (KA).Objectives: The objectives of this study were two-fold: 1) to examine the association between health literacy, theoretically selected psychosocial determinants (cervical cancer knowledge, decisional balance for a Pap test, worry related to cervical cancer examination, cervical cancer self-efficacy and perceived social support), and Pap test use within the preceding three years; and 2) to explore decision making regarding Pap test use among KA women.Design and Methods: This study utilized a cross-sectional correlational design and consists of a secondary analysis of data collected from a community-based controlled trial (hereafter ;;parent study”) to promote mammogram and Pap test use among KA women, along with semi-structured individual interviews. Descriptive statistics and structural equation modeling were used for analysis of quantitative aim. Qualitative data were analyzed using open, inductive coding.Sample: A total of 560 of KA women aged 21-65 years residing in the Baltimore-Washington metropolitan area participated in the parent study at baseline. Thirty women participated in a qualitative interview designed to elucidate further information about their decision-making process concerning Pap tests.Findings: The results from structural equation modeling showed that the association between health literacy and KA women’s Pap test use was mediated by cervical cancer knowledge, decisional balance for a Pap test, and cervical cancer self-efficacy. Cervical cancer worry and perceived social support were not mediators between the associations. Three main categories associated with decision making about a Pap test emerged from the qualitative interviews: decision types, barriers and facilitators in regard to a decision about a Pap test, and decision reflection. While types of decision making about a Pap test varied, most women claimed they made the decision autonomously. When women reflected on their decision, most felt glad that they got a Pap test and would make the same decision again, whereas some women with negative results felt ambivalent about their decision. Some women chose to live with their decision not to receive a Pap test. A number of participants noted that fear of cervical cancer could both promote and hinder Pap test use.Conclusions: Findings from this study indicate that health literacy is positioned to reduce disparities in cervical cancer screening by influencing theoretically driven psychosocial determinants. Understanding the decision-making process about Pap test use is the first step toward developing a patient-centered approach to improve compliance with cervical cancer screening guidelines. Research examining the influence of health literacy on Pap test use at the individual, community, and system levels is warranted to increase the rates of Pap test use among women from racial/ethnic minorities such as KA women.