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According to medical research and records, breast cancer prevalence in the USA ranges between 4 to 7 times that of Asian populations (Quine, et al., 2007). However, that data has been changing through the years, showing increased or decreased rates (Sutton, et, al., 1994). However, inspite of the routine and numbers, Asian immigrants and Asian-Americans’ breast cancer prevalence is approaching that of the US. Initiatives, articles, and non-governmental agencies have been in the forefront to limit the high number of South Asia women choosing to avoid breast cancer screening (Sutton, Saidi & Bickler, 1993). Through educating them to learn English for the sake of abolishing the language barrier, referring the poverty-stricken group to free agencies who provide mammograms, these women learn the benefits of breast cancer screening. Inspite of all these efforts by agencies and initiatives, very little concerning the perception, knowledge, and beliefs is known (Rutter, 2000). The educated and insured lot perceives them to be at a low risk for breast cancer, hence ignoring breast cancer screening. On other occasions, these women fear that if they were found with cancer, they may delay marriage because of the genetic factors. Women perceiving themselves as high risk and those who perceive that early screening can detect cancer and afford them time to fight it are more engaged in breast cancer screening that their counterparts that consider themselves low risk (Betsch, et al., 2004; Urbaniak & Plous, 2007).

Research Question

This research is aimed at answering the main research question which is: What is South Asian women’s perception, belief, and knowledge about breast cancer screening?

Significance

According to the U.S census of 2000, Asian-American community was found to be the largest minority group living in the US with a population exceeding 11 million people (Lavin & Groarke, 2005). As we speak, this population has almost doubled over the last one decade (Sheeran, Webb & Gollwitzer, 2005). The American population and the Asian-American population have had a significant imbalance in increase. In 2000, the Asian-American population was almost 4.2% of the total population while in 2010 this number had grown to 6.8 of the total population (Steadman, & Quine, 2004). The reason that has resulted to this magnificent change is the one-child policy exercised in China (the most populated nation in the world) that has forced some people to change citizenship to live a democratic nation (Milne, Orbell & Sheeran, 2002). Generally, health issues originating from their culture, lack of jobs, unfair treatment along racial lines, and language barriers challenge the Asian population migrating to the USA. In this context, death, disability and diseases are some of the issues this population is faced with. For the case of the women, the unequal treatment extends to the health facilities hence limiting their access to screening for different diseases like cancer (NHS Breast Screening Programme, 2006; Steadman, Rutter, & Field, 2002).

Considering sex, Asian-American Men are more vulnerable to heart diseases while their female counterparts are vulnerable to breast cancer (Orbell, Hodgkins, & Sheeran, 1997). With the issue of cancer the prioritized task of this paper, it was found that cost of living and medical services, fear, and absence of physician referrals are some of the major barrier to screening for breast cancer in women (Parkin, Bray & Devesa, 2001).

From public health view the better and deeper understanding of the influence of the women’s perception of  breast cancer susceptibility  and screening practice is relevant for clinical practice. Also if physicians have better awareness of these factors, they can handle patient related issues in a more effective way. The finding from this study will emphasis the need to address  women’s perception ,emotional and social perspective in standards for breast cancer diagnosis  , and can provide basis for the development of user – designed health services.

Finally by achieving the goal of understanding how the south Asian women perceive their risk for breast cancer and by implementing an intervention to address women’s perception of susceptibility from our study. It would prove to be beneficial in overcoming the commonly reported barrier. We expect to report a higher rate of adherence to breast screening guide lines and consequently to improve the overall health status of the nation.

Specific Aims

Breast cancer is the most common cancer in women all over the world (Verplanken & Faes 1999). In south Asian women in the U.S cancer breast is the leading cause of death among women, it is not only diagnosed at advanced stages but also diagnosed at earlier stages. The delay in diagnosis is attributed to many barriers such as lack of knowledge, poverty, language barrier, lack of insurance, lack of physician referral, fear, and influence of women’s perception of cancer breast screening (Gollwitzer, 1999). Even though many of these barriers have been addressed, there still is a high rate of breast cancer among those women and is attributed to the influence of women’s perception for breast cancer screening and treatment. Many of the recent research concentrate of how they can improve women awareness and knowledge, provide free mammogram, and increase physician referral alleviate fear, but still there is scant literature that addresses the influence of women’s perception, belief and knowledge about breast cancer screening. We are going to conduct a qualitative research among those women for better and deeper understanding of women’s perception on the risks of getting breast cancer and of breast cancer screening practice, in which the feedback from the study may be used to implement an intervention that improves screening measures for breast cancer. A qualitative research design using focus group interviews as a method for collection of data. This method will suit the study aims which is identify and explore the influence of women’s perception , belief and knowledge about breast cancer screening .

Our purposive sample will be recruited from south Asian women community in the U.S - mostly from Bangladesh and Pakistan from different professional and educational background.  For example, schoolteachers, homemakers, and other professionals of the age group between 25 and 65 years without breast cancer and speaking English.  The questions that will be asked during the interview are about breast cancer causation, risk factors, how they perceive susceptibility and seriousness of breast cancer, what the methods for breast cancer screening are, and cultural and social perspective to breast cancer.

The Approach methods

Setting:

This is a qualitative study which used the semi structured interviews where a total of 80 participants were recruited from a qualified health center and from a community center. The individual participants were approached by staff and the staff had to get their personal consent as to whether they were willing to participate in the interview which was planned to take place for a period of about 45 minutes about Breast cancer in South Asian community in the NYC of the U.S. Sample will be from Bangladeshi women live in Bronx NY.

Participants

This study was mainly limited to adult women who were aged between 20-65 years because breast cancer present at earlier age in south Asian immigrant in comparison to American women in the US. The study will be aimed at investigating the perception, health belief, knowledge and attitude regarding breast cancer screening practice for south Asian women. For this case, participants will include Bangladeshi women who speak Bengali and who do not suffer from breast cancer from the south Asian community in the NYC. They will be of different socio-economic status, different professional, and educational background.  Some of these will be schoolteachers, homemakers, and other professions

Recruitment and Informed Consent

Participants will be recruited through the telephone and from women who attend health education classes at community based health education agencies. Respondents will be informed in advance about the topics of the interview by sending outlines about the topics describing purpose, sponsorship, goals, and the general aim of the study. Ethics of research will be observed by taking into consideration privacy and anonymity of participants and relying on their consents to record, tape, or quote them.

Data collection

Focus Group Interview

We are going to conduct a focus group interview among South Asian women by recruiting around 80 women and conducting eight focus groups, which will consist of 10 women in each.  This group size is obligatory to make discussion lively.  A number of women should be bigger than 10 per group. This will prevent all women from participating lively hence the reason for restricting the maximum number to 10.  We will try to organize the focus groups of women so that participants will not know each other to encourage discussion that is more open and to prevent prior personal relationships that can inhibit or affect the discussion. This way, we protect the privacy of the participants. Data collection will follow an iterative process in which data collected will have a preliminary analysis and the interview guide will be modified as needed if it does not generate the required information.

Participant observation

There will be an observer to watch the discussion from behind a two-way mirror. The observer will take note of his observation consisting of verbatim transcript of verbal interaction. The note will be typed in a computer directly after each focus group interview.

Analysis

The aim of this study is the exploration of South Asian women’s perception, health and cultural beliefs, and knowledge about the breast cancer screening in the NYC, US. Relative to this object aim, analysis will be done by focus group interview data. Notes will be collected amidst women’s conversation with the moderator and their interaction with each other. This will be translated to English and transcript will be read through for themes related to women perception, belief, and attitude toward breast cancer screening practice. To facilitate this process of analysis a qualitative computer analysis program, N- Vivo will be used. A coding scheme is generated during the reading of the note transcripts and development of the themes.

Breaking down the aim of the study to its specific objectives, formulation and implementation of a mechanism to change the negative perceptions by the south Asian women would be depending on the variables that would be making up the thematic results of the coding scheme. The variables that make up these themes can be interpreted through the lines of knowledge that involves information and misinformation; perceptions that include fear, negative attitude, and ignorance; and beliefs that include traditional and religious confinements. In this case, the expected outcome of the study would be finding a link between the variables and trying to alter them as a way of changing the overall knowledge, beliefs, and perception of breast cancer screening for south Asian women.

Proposal of a method that would free south Asian women from the constraints of language, poverty, religious beliefs, and traditions in order to change the general perceptions of these women will depend on the flexibility of the intervention method. Breast cancer screening knowledge, perception and beliefs would be weighed along the variables of willingness to learn, change, and modify respectively. The expected result of exploring this objective would be to limit the negative variables or increasing the positive one (Bankhead, 2001; Menon, et al. 2003).

Future Research

The goal of this qualitative research is to identify the underlying factors which cause Bangladeshi women not engaging in breast cancer screening practice and also help to develop a hypothesis for other testing studies. By providing physicians with better awareness of these factors, they will be able handle patient related issues in a more effective way. Also on the public health side, the outcome from this study will help in implementing more effective intervention measures in the community to help increase breast cancer screening among these ethnic minorities (Koestner, et, al., 2002; Aiken, et, al., 1994).  We expect to report a higher rate of adherence to breast cancer screening guidelines and consequently to improve the overall health status of the nation (Armitage, 2004; Quinn & Babb, 2000).

Relevance for clinical practice is drawn from the public health views that better and deeper understanding of the influence of the women’s perception of breast cancer susceptibility and screening practice (Vaile, et, al., 1993). For physicians, if they understand patient related issues they would be in a position to deal with them much effectively. The finding from this study will emphasis the need to address women’s perception, emotional and social perspective in standards for breast cancer diagnosis, and can provide basis for the development of user-designed health services (Sankila & Parkin, 2003).

By achieving the goals of understanding the perceptions of South Asian women concerning breast cancer, implementation of an intervention to address their perceptions will be made to happen. For this case, the common barrier of negative perception on breast cancer screening will be addressed and done away with (Dewitte, Verguts & Lens, 2003).

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