An examination of the implementation of a patient navigation program to improve breast and cervical cancer screening rates of Chinese immigrant women: a qualitative study

Abstract

Background Chinese Americans have lower breast and cervical cancer screening rates than the national average and experience multiple barriers to cancer care. Patient navigators have improved screening and follow-up rates for medically underserved populations, yet investigations of cancer navigation programs and their implementation among Chinese Americans are limited. To address this gap, we used the Consolidated Framework for Implementation Research (CFIR) to examine facilitators and barriers to implementing the Chicago-based Chinatown Patient Navigation Program (CPNP) for breast and cervical cancer screening, follow-up, and treatment. Methods Stakeholders from clinical care, supportive care services, and community organizations were invited to participate in qualitative interviews to illuminate implementation processes and stakeholder perspectives of facilitators and barriers to implementing the CPNP. Interviews were audio-recorded, transcribed, and deductively coded according to CFIR domains, including (1) intervention characteristics; (2) outer setting; (3) inner setting; and (4) the implementation process. Results We interviewed a convenience sample of 16 stakeholders representing a range of roles in cancer care, including nurses, clinical team members, administrators, physicians, a community-based organization leader, and a CPNP navigator. Findings detail several facilitators to implementing the CPNP, including patient navigators that prepared Chinese-speaking patients for their clinic visits, interpretation services, highly accessible patient navigators, and high-quality flexible services. Barriers to program implementation included limited regular feedback provided to stakeholders regarding their program involvement. Also, early in the program’s implementation there was limited awareness of the CPNP navigators’ roles and responsibilities, insufficient office space for the navigators, and few Chinese language patient resource materials. Conclusions These findings provide valuable information on implementation of future patient navigation programs serving Chinese American and other limited-English speaking immigrant populations.

Exploring the Landscape of Breast Cancer Prevention among Chinese Residents in Italy: An In-Depth Analysis of Screening Adherence, Breast Self-Examination (BSE) Practices, the Role of Technological Tools, and Misconceptions Surrounding Risk Factors and Symptoms

“…Cultural perceptions, lack of adequate awareness, logistical challenges, and possible language barriers might be playing significant roles in these worrisome statistics. Reflecting our findings, other studies [ 39 , 40 ] emphasize the profound effect of linguistic and cultural barriers on breast and cervical cancer screening uptake, highlighting the necessity for culturally sensitive communication strategies to improve access. It is also possible that the benefits and existence of the free screening programs are not well-publicized or understood.…”

Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

“…Across these studies, five reported using technology other than email or telephone calls. This included Google Hangouts and WhatsApp, 95 an online patient navigation tool, 96 social media and phone applications, 97 Zoom, 98 and web‐based tool and video conferencing 99 . Four implementation and feasibility studies were also included 95,100–102 .…”

“…Common barriers reported included the inconvenience of in‐person support 136 ; limited experience using technology 95 ; hesitance to use a patient navigator 137 ; logistical‐related, psychological‐related, and knowledge‐related barriers 138 ; the lack of social support and culturally and linguistically concordant patient navigators 139 ; limited regular feedback to stakeholders 98 ; and institutional barriers 131 . Facilitators included interpretation services, pre‐prepared patients, high‐quality flexible services, and highly accessible patient navigators 98 …”

“…131 Facilitators included interpretation services, pre-prepared patients, high-quality flexible services, and highly accessible patient navigators. 98 Summary of findings from primary studies as emerging literature…”

Lung Cancer Patients’ Conceptualization of Care Coordination in Selected Public Health Facilities of KwaZulu-Natal, South Africa

“…Research focusing on health care delivery has revealed the complexity of coordinating care for people with cancer and proposes some promising interventions [ 54 , 55 ]. Recent studies and reviews on cancer care coordination interventions have found that patient navigation, designated care coordinators, and collaborative care models are among the common approaches implemented [ 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. Multiple barriers to improving the provision of cancer care exist, including lack of social support, financial concerns, and problems with healthcare communications; in this context, effective care coordination is required [ 8 , 12 , 24 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ].…”