A General Pathway Model for Improving Health Disparities: Lessons from Community and Cultural Involvement in Improving Cervical Cancer Screening in Vietnamese Women
Abstract
:1. Introduction
2. Background
- a)
- What are the modifiable predisposing factors for these observations?
- b)
- What are the barriers, facilitators, feasibilities, and interventions with their success rates?
- c)
- Can these techniques be generalized to delivering other health messages to Vietnamese women, and possibly to other populations?
3. Genesis of a Community Action Plan based upon a Pathways Model
4. Components of the Program
5. Results of the Model
6. Discussion
7. Conclusions
- a)
- Predisposing factors contributing to the prevalence of low Pap tests initially included participant misinformation concerning the disease, testing, and effects upon outcomes, but also concerning cultural beliefs, awareness and attitudes, all of which were modifiable.
- b)
- Individual participants identified important perceived barriers listed in Table 2. Those assigned to the community were addressed by lay health workers, educational and nonmedical staff individually. One of the most important conduits of transformation was a bond formed by the staff that spoke Vietnamese and could relate with their culture.
- c)
- Techniques used in the pathway model can be used to deliver other health messages to Vietnamese women. However, specific data from each application, health delivery system, new population and location will be required in each instance.
Author Contributions
Conflicts of Interest
Compliance with Ethical Standards
References
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Period (years) | Test | Age Range(s) | Recommendation |
---|---|---|---|
1987–2002 | Pap test | 18 and over or sexually active | Yearly, but after 3 consecutive normal exams, less frequently at the discretion of the doctor |
2003–2012 | Pap test | Start 3 years after first vaginal intercourse but no later than 21 | Yearly with conventional Pap test or every 2 years with liquid-based Pap test |
30 and over | After 3 normal results in a row, screening can be every 2 to 3 years. An alternative is a Pap test plus HPV DNA testing every 3 years. | ||
70 and over | After 3 normal Pap tests in a row within the past 10 years, women may choose to stop screening. |
Barrier | % |
---|---|
Feeling well | 3.8 |
No insurance | 5.5 |
Not suggested by physician | 5.5 |
High cost | 8.6 |
Lack of time | 5.2 |
Shame/embarrassment | 4.8 |
Lack of knowledge | 3.5 |
No physician | 3.5 |
Did not know where to go | 2.8 |
Physician not speaking Vietnamese | 1.4 |
Uncertain insurance covered Pap | 1.4 |
No female physician | 0.7 |
Other | 2.1 |
Barrier, as Defined by Patient | Pathway Chosen for Resolution |
---|---|
Poor physician recommendations | Medical |
Cultural incompetence by physician, e.g., insensitivity | Medical |
Lack of health insurance | Medical |
Cost | Medical |
Poor resources for follow-up treatment | Medical |
Excessive paperwork load by staff, decreasing face-to-face time | Medical |
Lack of knowledge within the community | Community |
Social stigma of cancer as an STD | Community |
Child, elder, or sick care during appointment time | Community |
Concern about the diagnosis of cancer | Community |
Directions and appointment for a Pap test | Both Medical and Community |
Excessive patient paperwork | Both Medical and Community |
Language barrier | Both Medical and Community |
Transportation need | Both Medical and Community |
Desire for female physician | Both Medical and Community |
Excessive appointment waiting time | Both Medical and Community |
Need for different appointment time frame (unstructured) | Both Medical and Community |
Modesty and other special needs | Both Medical and Community |
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Kones, R.; Rumana, U.; Arain, F. A General Pathway Model for Improving Health Disparities: Lessons from Community and Cultural Involvement in Improving Cervical Cancer Screening in Vietnamese Women. J. Clin. Med. 2019, 8, 154. https://doi.org/10.3390/jcm8020154
Kones R, Rumana U, Arain F. A General Pathway Model for Improving Health Disparities: Lessons from Community and Cultural Involvement in Improving Cervical Cancer Screening in Vietnamese Women. Journal of Clinical Medicine. 2019; 8(2):154. https://doi.org/10.3390/jcm8020154
Chicago/Turabian StyleKones, Richard, Umme Rumana, and Fauzia Arain. 2019. "A General Pathway Model for Improving Health Disparities: Lessons from Community and Cultural Involvement in Improving Cervical Cancer Screening in Vietnamese Women" Journal of Clinical Medicine 8, no. 2: 154. https://doi.org/10.3390/jcm8020154