How do older Chinese women view health and cancer screening? Results from focus groups and implications for interventions

Objective. To qualitatively assess Chinese American women's views of health and illness and the potential influences of culture and language on cancer screening behavior. Design. Data were generated by five focus groups, each consisting of 9-12 Chinese American women aged 50 and older. Participants responded to open-ended questions assessing their perceptions of health and illness, knowledge about cancer, beliefs about and barriers to cancer screening, and screening and healthcare experiences in the USA. All conversations were tape-recorded and analyzed in the context of PRECEDE framework concepts of predisposing, enabling, and reinforcing factors. Results. The 54 participants had a mean age of 65 years, with an average age of immigration to the USA at 51 and average length of residence in the USA of 15 years. Participants considered outdoor exercise in the morning for fresh air and a hot-cold balanced diet as important means to health. None mentioned the importance of regular medical checkups or cancer screening. When talking about cancer prevention, a sense of fatalism was evident, such as 'no control of life and death' and 'what will happen will happen'. Lack of English capability was a major enabling barrier to healthcare. In addition, these women reported the need for help with transportation, especially for those living in suburban areas where public transportation is not readily available. Physician recommendation was identified as the most important reinforcing factor for cancer screening. Conclusion. Our results suggest traditional Chinese beliefs, such as those pertaining to fatalism, self-care, and the hot and cold balance, influence the perceptions of older Chinese women regarding health, illness, and use of preventive healthcare. Interventions to improve cancer screening in this population should be tailored to the specific predisposing, enabling, and reinforcing factors of this population, including cultural views, language barriers, doctor-patient communication, and access to healthcare.