Breast and cervical cancer are highly prevalent among immigrant and minority women due to limited screening of the two types of cancer. According to Bhargava et al. (2018), immigrant and minority women had a lower mammographic screening attendance at 52% and 46.2%, with non-western immigrants having the lowest attendance rate. From the statistics, immigrant, and minority women have the highest breast cancer rates due to limited knowledge. Comparatively, Endeshaw et al. (2018) determined that foreign-born women’s screening rate was 6.8% compared to the US-born, which was 18.6%. Such means that immigrants US women were less likely to get pap screening than US-born women. The limited knowledge is due to the limited understanding of the available screening tools for breast and cervical cancer among women. Therefore, culturally competent sensitization is critical to improving the screening rate and implementing mitigative interventions early to reduce cervical and breast cancer prevalence. To this end, the paper answers the research question, in immigrant women over the age of 40 years in Western countries(P), how does Culturally tailored education (I) compared to no education (C) affect breast and cervical cancer screening O) over three months (T)?
Background and Significance
Breast and cervical cancer prevalence evaluation among immigrants is critical to focus on because it is preventable. That is because cervical and breast cancer prevalence is due to the limited knowledge and lack of information from Bhargava et al. (2018); and Endeshaw et al. (2018), as outlined above. The limited knowledge and lack of information from Bhargava et al. (2018); and Endeshaw et al. (2018) are because most of the details are incomprehensible as they are in a language other than the immigrants. Therefore, if culturally competent education is not implemented, there will be a high prevalence of cancer among American women of Ethiopian and Eritrean descent. The liability of not implementing culturally competent education programs is the death rate increase among at-risk patients. As per Monica and Mishra (2020), India has 1671149 breast cancer and 527624 cervical cancer, with a cumulative risk of death at 1.5% and 1.0%, respectively. That means the aggregation in cancer prevalence increases mortality rates among the infected. The financial consequence of not implementing culturally competent breast and cervical cancer education includes increased healthcare expenses. Monica and Mishra (2020) determined that an increase in cancer prevalence increased spending on cancer by $1.6 trillion. Therefore, not implementing the program will increase cancer prevalence. According to Monica and Mishra (2020), the increase in cancer prevalence will increase the cost of care for Eritrean and Ethiopian immigrants.
Literature Review
Kwok and Lim (2015) determined that linguistically appropriate and culturally sensitive educative programs increased cervical and breast cancer knowledge, mammogram and pap smear screening intention, and participation, improving early detection of cancers among Chinese-Australian women. That means that providing education on cervical and breast cancers that reflects the cultures of Chinese-Australian women in a language that they best understand improves their awareness of cancer and breast cancer prevalence and preventive strategies such as pap smears and mammogram screening. Also, providing culturally competent education in a language that Australian women of Chinese descent understood improved their intention to apply these interventions to detect cervical and breast malignancies early and reduce their prevalence. Therefore, for cervical and breast malignant early detection among at-risk immigrant women through increased pap tests and mammogram screening, it is critical to provide culturally competent education in a language the target immigrant population understands.
Cha and Chun (2021) posit that American women between 21-65 years of Asian descent have limited knowledge of the US healthcare system, including health insurance, limited access, limited cervical cancer screening, psychosocial and cultural preventative beliefs due to limited Korean language translation, and providers. That means that the language inappropriateness of the US healthcare system limited its understanding. The limited comprehension of the constituents of the healthcare system limited access to healthcare among American women of Asian descent. From Cha and Chun (2021), cultural and linguistic appropriateness are among the primary considerations in designing a healthcare system to promote positive health outcomes among American women of Ethiopian and Eritrean descent.
According to Calderón-Mora et al. (2019), providing culturally competent education in groups is more effective than individually focused education of Mexican women living along the US-Mexico border on pap tests to reduce cervical cancer prevalence, which had more perceived seriousness, knowledge, and benefits. From Calderón-Mora et al. (2019), group-based sensitization is more efficient in improving cervical malignant pap knowledge and screening. Consequently, it is critical to offer culturally and linguistically appropriate education among immigrant women in groups about cervical cancer pap tests to increase their seriousness, knowledge, and implementation of screening tools.
According to Brevik et al. (2020), non-Western immigrant women with culturally competent education increased their pap test attendance by 54% and mammography by 18%, with substantial and low heterogeneity, respectively. The findings above indicate that provided cervical and breast cancer education programs were to be designed to reflect the cultural values of the target minority groups, which will increase their attendance. Therefore, it is critical to consider their cultural beliefs and practices in designing educational interventions to increase attendance to educative programs on cervical and breast malignant screening among foreigners.
As per Joo and Liu (2020), the strength of culturally competent care includes promoting healthy lifestyle practice, increased knowledge, timely and efficient care due to technology use, increasing community and family support, and providing ethnic minority patient-centered care. On the other hand, healthcare providers’ inadequate training, low retention and attention rate, and unclear guidelines were the weaknesses of culturally designed interventions (Joo & Liu, 2020). Consequently, it is critical to alleviate the weaknesses to improve the effectiveness of culturally tailored interventions. Notably, it is critical to educate the healthcare providers, assess the educative process, and improve the retention and attention rates among non-western immigrants while implementing linguistically appropriate and culturally competent education.
Qureshi et al. (2021) share that educational interventions that are linguistically and culturally sensitive motivate Somali and Pakistani immigrants to participate in cervical screening in Norway and increase their awareness of the interventions. From Qureshi et al. (2021), providing culturally sensitive and linguistically appropriate education improves the immigrants’ cervical and breast malignant awareness and increases their willingness to participate in screening for malignant growth. It is critical, therefore, to provide culturally and linguistically sensitive malignant sensitization to increase immigrant women’s awareness and screening intention.
Tatari et al. (2021) determined that ethnic minority women prefer face-to-face education, concrete, optimistic and straightforward messaging in their local dialect, and involvement in drafting the strategy and providing education. Therefore, providing culturally appropriate and linguistically sensitive sensitization developed from the women’s perspective is critical in drafting educational programs for women to increase the malignant manifestation and prevention awareness.
Commonality
Kwok and Lim (2015); Cha and Chun (2021); Brevik et al. (2020); Qureshi et al. (2021), and Tatari et al. (2021) agree that linguistically appropriate and culturally sensitive sensitization programs motivate foreign women to participate in cervical and breast malignant education programs. However, the weakness of this intervention is poor attention and retention rate among the target population (Joo & Liu, 2020). It is critical to provide culturally and linguistically appropriate education in groups, as per Calderón-Mora et al. (2019), to improve the seriousness of education interventions to improve attention and information retention.
Change Project Process: Planning
The program will be implemented in churches for Christians and mosques for Muslims in Dallas. The data required to justify the change is warranted, including the limited cancer and breast malignant prevalence knowledge effects, as shared by Bhargava et al. (2018); and Endeshaw et al. (2018) above. Indicating the prevalence due to limited education will necessitate providing culturally competent and linguistically sensitive interventions to manage the adverse health outcomes. One primary care physician and one female OBGYN physician with a private practice in Dallas will be actively involved in the project. These facilities will be recommended to patients willing to participate in the screening. Two bilingual acute nurses who speak both Eritrean and Ethiopian. Public health professionals working in insurance and immigrant communities, such as the Catholic Charities of Dallas and Refugee Medical Assistance, can aid in spreading the news and direct people.
I must seek permission from pastors, elders, and women’s ministry leaders of the Eritrean and Ethiopian churches to educate immigrant women in their congregations. I have nurses equipped to help teach acute care nurses from Ethiopian and Eritrean cultures. They are familiar with the culture and expectations of immigrants. The barriers I foresee include the limited involvement of immigrant women in the program. Providing group culturally and linguistically sensitive education is more effective than individual education as it improves concentration and seriousness, maximizing the benefits (Calderón-Mora et al., 2019). Therefore, I will provide group education to mitigate limited involvement. Resources are essential to cover the costs of transportation, gas, the video creation of the lesson, and refreshments for the attendees. The program will also require a pre-and post-survey using SurveyMonkey and SAS software.
The associated cost of bringing this change into my organization will be increased healthcare spending in settling the expenses related to transportation, gas, the video creation of the lesson, and refreshments for the attendees. I do not have a dollar estimate of the costs. Over time, the benefits are reduced malignant prevalence and improved healthcare outcomes. The cost of the settlement of the expense, including transportation, gas, the video creation of the lesson, and refreshments for the attendees. Improvement of clinical outcomes outweighs the expense incurred while providing culturally competent and linguistically appropriate educational programs. Catholic and Muslim charities in Dallas and two acute care nurses will help recruit immigrants.
Implementation
The primary implementation phases include sensitizing the Eritrean and Ethiopian church leaders, Muslim elders’ and healthcare practitioners on cultural competency. The other phase is the voluntary recruitment of participants, education of the participants, assessment of the program and conducting follow-up studies. Parallel to the community training, I will reach out to the primary doctors, oncologists, and gynecologists that work in a clinic or have their practice who are willing to work with this population and give one day workshop on how to screen minority immigrants effectively, how to communicate with immigrant women and to create awareness on the consequences of sexual health misconceptions and to promote culture friendly approaches to preventative measures. Also, if possible, to accommodate female providers for these patients and provide teaching HPV testing and self-sampling as an alternative to screening. The education program will take the shape of an hour-long lecture that will begin with a basic explanation of the project’s goals before moving on to a quick discussion of a healthy lifestyle and ways to avoid breast and cervical cancer. The presentation will cover the definitions of breast and cervical cancer, their anatomical sites, and the causes, risk factors, and progression of these diseases using diagrammatic graphics. Additionally, a brief video clip will outline the specifics of breast and cervical cancer screenings, including the process and tools employed. The presentation’s content (powerpoint) will be in English and respected languages (Eritrean, Ethiopian). The program will run every Saturday for eight weeks.
Change Project Process: Evaluation
The data that will be needed to reflect the outcomes to determine the change will include lifestyle change and the knowledge of pap and mammogram tests. An increase in awareness, willingness to take pap and mammogram tests, and change in lifestyle will indicate success with the intervention implementation. The plan to evaluate the process includes primary doctors, oncologists, and gynecologists that work in a clinic or have their practice and are willing to work with this population; church and mosque leaders will assess the program’s effectiveness before, during, and after implementation.
EBP Change Model
My model of choice is the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare by Dang et al. (2022). It is an influential model because it provides a rigorous yet appropriate evidence-based implementation framework. Remarkably, The Iowa Model Revised permits using evidence-based and pilot programs before the intervention roll (Dang et al., 2022). The evidence-based program is accurate and practical interventions are thoroughly assessed to determine suitability. The pilot program facilitates the assessment for errors before full-scale implementation, hence the choice.
Conclusion
Cervical and breast cancer is highly prevalent among Eritrean and Ethiopian immigrant women due to lack of awareness. Culturally competent and linguistically appropriate education in a church and a mosque in Dallas overseen by Ethiopian and Eritrean religious leaders and healthcare practitioners through the Iowa Model Revised is the most effective intervention to address the issue. Failure to implement this include high healthcare cost and loss of lives due to cancer prevalence among immigrant women. The weakness in addressing this includes limited concentration and involvement of the target participants. Group education is the most effective intervention to address this weakness. The healthcare practitioners and religious leaders will evaluate the process’s effectiveness. The benefits of the program outweigh the costs necessitating its implementation.
References
Bhargava, S., Moen, K., Qureshi, S. A., & Hofvind, S. (2018). Mammographic screening attendance among immigrant and minority women: a systematic review and meta-analysis. Acta Radiologica, 59(11), 1285–1291. https://doi.org/10.1177/0284185118758132
Brevik, T. B., Laake, P., & Bjørkly, S. (2020). Effect of culturally tailored education on attendance at mammography and the Papanicolaou test. Health Services Research, 55(3), 457–468. https://doi.org/10.1111/1475-6773.13271
Calderón-Mora, J., Byrd, T. L., Alomari, A., Salaiz, R., Dwivedi, A., Mallawaarachchi, I., & Shokar, N. (2019). Group Versus Individual Culturally Tailored and Theory-Based Education to Promote Cervical Cancer Screening Among the Underserved Hispanics: A Cluster Randomized Trial. American Journal of Health Promotion, 34(1), 15–24. https://doi.org/10.1177/0890117119871004
Cha, E. Y., & Chun, H. (2021). Barriers and Challenges to Cervical Cancer Screening, Follow-Up, and Prevention Measures among Korean Immigrant Women in Hawaii. Asia-Pacific Journal of Oncology Nursing, 8(2), 132–138. https://doi.org/10.4103/2347-5625.308302
Endeshaw, M., Clarke, T., Senkomago, V., & Saraiya, M. (2018). Cervical Cancer Screening Among Women by Birthplace and Percent of Lifetime Living in the United States. Journal of Lower Genital Tract Disease, 22(4), 280–287. https://doi.org/10.1097/lgt.0000000000000422
Joo, J. Y., & Liu, M. F. (2020). Culturally tailored interventions for ethnic minorities: A scoping review. Nursing Open, 8(5). https://doi.org/10.1002/nop2.733
Kwok, C., & Lim, D. (2015). Evaluation of a Culturally Tailored Education to Promote Breast and Cervical Cancer Screening Among Chinese-Australian Women. Journal of Cancer Education, 31(3), 595–601. https://doi.org/10.1007/s13187-015-0859-3
Dang, D., Melnyk, B. M., Fineout-Overholt, E., Yost, J., Cullen, L., Cvach, M., Larabee, J. H., Rycroft-Malone, J., Schultz, A. A., Stetler, C. B., & Stevens, K. B. (2022). Evidence-Based Practice in Nursing & Healthcare. Lippincott Williams & Wilkins.
Monica & Mishra, R. (2020). An epidemiological study of cervical and breast screening in India: district-level analysis. BMC Women’s Health, 20(1). https://doi.org/10.1186/s12905-020-01083-6
Qureshi, S. A., Igland, J., Møen, K., Gele, A., Kumar, B., & Diaz, E. (2021). Effect of a community-based intervention to increase participation in cervical cancer screening among Pakistani and Somali Women in Norway. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-11319-1
Tatari, C. R., Andersen, B., Brogaard, T., Badre‐Esfahani, S., Jaafar, N., & Kirkegaard, P. (2021). The SWIM study: Ethnic minority women’s ideas and preferences for a tailored intervention to promote national cancer screening programs—A qualitative interview study. Health Expectations, 24(5), 1692–1700. https://doi.org/10.1111/hex.13309
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