From seclusion to inclusion

An education program has been launched to meet the cultural needs of Chinese women with breast cancer.

Culture has a significant impact on the way women comply with breast screening measures.

For women of the Australian Chinese community, it is largely cultural factors which account for the low rate of compliance with preventative measures such as mammographic screening, says Dr Cannas Kwok, Research Fellow with the Cancer Institute of NSW and Sydney Nursing School, University of Sydney.

She argues that it is largely cultural factors which account for the low rate of compliance with preventative measures such as mammographic screening among women of the Australian Chinese community. She says while the rising incidence of breast cancer has attracted much attention, most resources have been focused on promoting prevention and early detection among women from the mainstream culture.

“The current screening services and cancer support and care services do not meet the cultural needs of Chinese women,’ says Kwok.

In an attempt to remedy this situation, she and a team of researchers recently conducted a series of culturally-sensitive programs to meet the needs of these women, who form part of the largest ethnic group from non-English speaking countries in Australia.

Led by Kwok and under the banner of ‘Healthy Screening and Healthy Living’, the team in 2009 launched a community partnership cancer screening program. In collaboration with a Chinese community organisation, they designed and implemented a culturally sensitive and linguistically appropriate program comprised of education sessions in which information about breast cancer and cervical cancer was provided.

Dr Fung Kuen Koo, one of the team members says the specific highlights of the program were taking Chinese tradition and beliefs into account.

“The program built on a previous breast health promotion project undertaken by us which proved to be very successful in helping women to improve their knowledge about breast cancer, thus positively impacting cancer screening behaviours in this community.”

Following the information sessions, those participants who expressed an interest in undergoing mammography could make appointments through the team and screening activities were organised with an interpreter. A Chinese-speaking registered nurse was also organised to perform pap smears on-site for women who decided to have this test right after the program.

To the team’s best knowledge, this is the first of its kind program in Sydney, Australia. Twenty of the 78 women who participated in the program had never before had a mammogram or Pap smear test.
What was particularly pleasing for the team was that the program was well received by the community.

“The program was so successful in which it has integrated both Western and Chinese concepts of health into screening program to serve minority women,” says Koo.

“One of the keys to success was the contribution of each team member’s expertise to the project and the bringing together of their experiences.”

For participants, one of the best features of the program was that it was conducted in culturally sensitive way which they found the program content considered their cultural values and also all sessions were conducted in Cantonese.

On the basis of what was learned in the screening program, the team then devised a program for Chinese breast cancer survivors, because it was obvious that they would be facing more cultural and language issues than the group who participated in the screening program.

“Some Chinese breast cancer survivors consistently expressed their frustration about the lack of culturally sensitive cancer support services and resources,” says Kwok. Thirty-seven women, recruited from a Chinese cancer support organisation, participated in this second program titled “Living in a healthy life”.

The program delivered by Kwok’s team, devised in collaboration with a Chinese cancer support group, involved the delivery over eight weeks of information sessions, each divided into two segments. In the first two-hour session, participants were provided with information and support by a professional with expertise in that area while the second hour involved support-group sharing.

The sessions were conducted by appropriate health professionals in Cantonese. At the end of each session, women were given printed information in Chinese script (both Mandarin and Cantonese-speakers use the same script).

The participants reported that they saw themselves as being marginalised in respect of cancer resources and support prior to participating in this program. They felt isolated from the health care settings. They said that “finding they had breast cancer was bad enough; however their feelings of being isolated and no having resources made the experience even worse”.

They could not understand the language and cancer information provided and consequently could not identify with any members of the health care team as a source of support in their cancer experience. In this regard, Kwok tells of a Chinese woman who could not speak enough English even to ask the nurses for a pain-killer after the surgery.

Being an oncology nurse and also a researcher in the cancer area, I feel vulnerable when it seems there is not much we can do to help cancer patients whose needs are not met,” says Kowk.