Results of a Randomized Controlled Trial Testing the Efficacy of a Culturally Targeted and a Generic Video on Mammography Screening among Chinese-American Immigrants

Abstract

Background Research comparing the effects of culturally-targeted and generic but linguistically appropriate intervention programs is limited. We conducted a randomized controlled trial comparing the efficacy of a culturally-targeted video, a generic video, and a fact sheet (control) in promoting mammography screening among Chinese-American immigrants. Methods We randomized 664 Chinese-American women from the Washington, DC and New York City areas who were >40 years and non-adherent to annual mammography screening guidelines to three study arms (each with ~221 women). The outcome was self-reported mammography screening six months post intervention. Measures of knowledge, Eastern cultural views, and health beliefs were administered before and after the intervention. Results The culturally-targeted video, the generic video, and the fact sheet increased mammography utilization by 40.3%, 38.5%, and 31.1% from baseline, respectively. A significant intervention effect was observed only in one subgroup: The culturally-targeted video significantly increased mammography screening among low-acculturated women over the fact sheet (OR=1.70, 95% CI=1.04, 2.78). Overall, women who obtained a mammogram during the follow-up period reported significantly fewer barriers to screening after intervention than those who had not obtained screening. Both of the video groups reported fewer barriers after intervention than the control group. Conclusions Both theoretically-guided videos increased the likelihood of mammography use to a similar extent. Cultural targeting was only effective for low-acculturated women. Both videos reduced perceived barriers to screening and consequently increased screening behavior. Impact The results of this study provide empirical evidence on the efficacy of cultural targeting for minority immigrants.

A systematic review of randomised controlled trials examining the effectiveness of breast and cervical cancer screening interventions for ethnic minority women

“…The studies included were published between 2002 and 2014 and were conducted in the United States (US) (n ¼ 9) (Byrd et al, 2013;Deavenport et al, 2011;Hall et al, 2007;Kreuter et al, 2005;Mishra et al, 2009;O'Brien et al, 2010;Wang et al, 2012a;Wu and Lin, 2015;Zhu et al, 2002), and in the US and Canada (n ¼ 1) (Taylor et al, 2002), focusing on either breast cancer (n ¼ 6) (Deavenport et al, 2011;Hall et al, 2007;Kreuter et al, 2005;Wang et al, 2012a;Wu and Lin, 2015;Zhu et al, 2002) Original research studies with full text available Exclusion criteria: Abstracts, unpublished studies or those in languages other than English were excluded as this review aimed to examine the effects and characteristics of interventions in detail.…”

“…1 2 3 4 5 6 7 8 9 10 Score Zhu et al (2002) e e e ✓ ✓ x ✓ ✓ e ✓ 5 Kreuter et al (2005) ✓ e e ✓ ✓ x ✓ ✓ ✓ ✓ 7 Hall et al (2007) ✓ ✓ e ✓ e e ✓ ✓ ✓ ✓ 7 Deavenport et al (2011) e e e ✓ e ✓ ✓ ✓ ✓ ✓ 6 Wang et al (2012a;2012b) ✓ e e ✓ e ✓ ✓ ✓ ✓ ✓ 7 Wu and Lin (2015) e e e e e ✓ ✓ ✓ ✓ ✓ 5 Taylor et al (2002) ✓ e e ✓ e ✓ ✓ ✓ ✓ ✓ 7 Mishra et al (2009) e e e ✓ ✓ x ✓ ✓ e ✓ 5 O' Brien et al (2010) ✓ e x ✓ e ✓ ✓ ✓ e ✓ 6 Byrd et al (2013) ✓ e e ✓ e e ✓ ✓ ✓ ✓ 6 ✓: Yes; X: No; e: Unclear.…”

“…The participants' mean age ranged from 29.8 to 55.8. The sample size ranged from 31 to 1241, with participants recruited from either community (n ¼ 8) (Byrd et al, 2013;Hall et al, 2007;Mishra et al, 2009;O'Brien et al, 2010;Taylor et al, 2002;Wang et al, 2012a;Wu and Lin, 2015;Zhu et al, 2002) or healthcare settings (n ¼ 2) (Deavenport et al, 2011;Kreuter et al, 2005).…”

“…Four studies employed multiple models to guide intervention development (Byrd et al, 2013;Kreuter et al, 2005;Mishra et al, 2009;Zhu et al, 2002). Among all studies, the health belief model (HBM) (n ¼ 8) was the most commonly used (Byrd et al, 2013;Deavenport et al, 2011;Hall et al, 2007;Kreuter et al, 2005;O'Brien et al, 2010;Wang et al, 2012a;Wu and Lin, 2015;Zhu et al, 2002). HBM includes six main constructs that explain one's attitude and perceptions in relation to health behaviour.…”

“…The programme content played an important role in increasing participants' knowledge and changing their behaviour, mainly covering key messages on breast or cervical cancer and screening: the facts of the disease, information on the importance and effectiveness of screening, pap test demonstration, screening recommendations, myths and misconceptions, and health beliefs about cancer and screening (All but Zhu et al, 2002). In addition to language, other culturally relevant strategies were integrated to address participants' needs, including: materials appropriate to reading and literacy levels (n ¼ 3) (Hall et al, 2007;Mishra et al, 2009;Zhu et al, 2002), with relevant graphics, typefaces or terms familiar to women (n ¼ 5) (Hall et al, 2007;Kreuter et al, 2005;Mishra et al, 2009;Taylor et al, 2002;Zhu et al, 2002), a lay health instructor (n ¼ 4) (Byrd et al, 2013;O'Brien et al, 2010;Taylor et al, 2002;Zhu et al, 2002), role models, and cancer survivors from the target population (n ¼ 7) (Byrd et al, 2013;Deavenport et al, 2011;Kreuter et al, 2005;Mishra et al, 2009;Taylor et al, 2002;Wang et al, 2012a;Zhu et al, 2002). Furthermore, social and cultural values were incorporated in four studies.…”