Cervical Cancer: Cultural Considerations for Vietnamese Women

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Cervical CancerCultural Considerations for
Vietnamese Women

• Thoa Nguyen
• Project Director

Vietnamese Community Health Promotion
Project University of California, San
Francisco NCI Cervical Cancer Seminar January 18,
2006 Supported by CDC REACH 2010 Grant
U50/CCU922156
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Sociodemographic Characteristics of Vietnamese
in the U.S.

• One of the fastest-growing ethnic groups in U.S.
• 1990 U.S. Census 614, 547
• 2000 U.S. Census 1.1 million
• 2030 projection 3.9 million
• Over 90 were born outside of the U.S.
• Concentrated in 9 states
• California, Texas, Virginia, Washington,
  Louisiana, Florida, Pennsylvania, New York and
  Massachusetts

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Cancer Cancer and Screening

• Compared to general U.S. population, Vietnamese
  American women
• - Have a cervical cancer incidence rate 5 times
  higher
• - Are more likely never to have received a Pap
  test (32 vs. 9)
• - Are more likely to be overdue for a Pap test
  (71 vs. 40)

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Particular Issues in Care of Vietnamese Women

• Communication problems with non-English-speaking
  Vietnamese patients
• Traditional health beliefs and practices
• Problems in accessing care
• Lack of preventive care experience, orientation
• Problems posed by cultural discordance between
  patient and physician
• Problems posed by gender discordance between
  patient and physician

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Communication Problems

• Many Vietnamese speak little or no English
• In 7 previous Vietnamese language surveys of
  nearly 5,000 Vietnamese-Americans, an average of
  75.5 had limited or no English-language
  proficiency

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Communication Problems

• Competent interpreters can allow clinicians and
  patients to communicate well
• Professional interpreters often unavailable in
  health care settings
• Sub-optimal alternatives
• Own language skills
• Family or friends acting as interpreters
• Ad hoc interpreters (e.g., staff)

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Traditional Health Beliefs and Practices of
Vietnamese

• Vietnamese believe that disease is caused by an
  imbalance of the humoral forces of âm (yin) and
  duong (yang)
• Vietnamese use Chinese herbal medicine (thu?c
  b?c) and Southern medicine (thu?c nam) to
  restore aâm/döông balance
• Illnesses may be caused by spirits or ghosts
  (th?n thánh hay ma qu?)

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Traditional Health Beliefs and Practices of
Vietnamese

• Western medicine sometimes seen as too strong or
  hot (duong)
• Denial or tolerance of physical pain considered a
  strong trait
• A tendency to accept illness as part of ones
  destiny or fate
• Fatalistic attitude towards illness
• Many Vietnamese patients think that Western
  medicines are too strong

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Traditional Health Beliefs and Practices of
Vietnamese

• Survey of 215 Vietnamese in San Francisco and
  Alameda Counties regarding use of traditional
  health practices
• 84 had used Southern medicine
• 47 had used Chinese herbs
• 43 had consulted a Chinese herbalist
• 24 had consulted an acupuncturist
• 1 had consulted other traditional practitioners
  (Jenkins, 1996)

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Problems in Accessing Care for Vietnamese

• Vietnamese underutilize health services
• Vietnamese contact physicians infrequently, and
  less often than other Southeast Asian refugee
  groups (Strong, 1983)
• National Health Interview Survey 1992-1995
• Asian immigrants, including Vietnamese, have less
  adequate access to medical care
• (Parker-Frisbee 2001)

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Problems in Accessing Carefor Vietnamese

• Aggregated data from previous surveys regarding
  various components of access to health care
• 30.7 had no medical insurance
• 11 had no regular place of medical care
• 24.3 had no regular doctor
• 30.5 had a non-Vietnamese doctor
• Marital and poverty status were most consistent
  predictors of health care access

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Problems in Accessing Carefor Vietnamese Women

• Additional barriers to accessing medical care
• Transportation
• Length of time until available appointments
• Language
• Length of time in waiting room
• Cost

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Lack of Preventive Care Experience, Orientation
among Vietnamese

• Many Vietnamese lack an orientation to preventive
  care
• Vietnamese-American women are less likely to have
  heard of cervical screening test
• gt 2/3 had not heard of Pap smear testing

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Lack of Preventive Care Experience, Orientation
among Vietnamese

• Vietnamese-American women are much less likely to
  report having had cervical screening test
• 50 had never had a Pap test
• Screening rates are below those for white women
  and well below national goals and guidelines

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Lack of Preventive Care Experience, Orientation
among Vietnamese

• Lack of screening due to
• Language difficulties
• Limited access to health care
• Lack of preventive care orientation
• Lack of knowledge
• Cost
• Modesty
• (McPhee,
  1997)

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Lack of Preventive Care Experience, Orientation
among Vietnamese

• Negative predictors of test receipt
• Unemployment
• Older age
• Low educational level
• Never married
• No health insurance
• No regular physician
• Short duration of residence in the U.S.
• Negative predictor of test currency
• Low educational level
• (McPhee, 1997)

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Lack of Preventive Care Experience, Orientation
among Vietnamese Women

• Marital status, sexual activity, and belief that
  only married women should have Pap smears were
  important predictors of self-reported Pap smears
• (Yi, 1998)

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Problems Posed by Cultural Discordance

• Different language and literacy
• Different culturally-based expectations of the
  encounter
• Different disease and treatment models
• Patients reluctant to discuss their beliefs and
  practices
• Fear of criticism or ridicule

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Problems Posed by Gender Discordance among
Vietnamese

• Modesty is important to Vietnamese women
• Reluctance to have pelvic exams
• Concern that Pap test ? losing virginity
• 43 wanted Pap test done by a female physician
• (McPhee, 1997)

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Problems Posed by Gender Discordance among
Vietnamese Women

• 75 Vietnamese physicians are male
• Male Vietnamese physicians may be
• More sensitive to issues of personal modesty
• More reluctant to suggest pelvic examinations
• Majority of Vietnamese women indicate they would
  have a Pap test if their physician recommended it
• (Cheek, 1999)

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CONCLUSION
One lone tree does not amount to much, but
three trees together is the start of a mountain
forest.