Development of a cervical cancer control intervention program for Cambodian American women

Southeast Asian immigrants have lower Icl;cls of Pap testing than any other racial/ethnic group in the US, and are particularly unfamiliar with wester n culture and biomedical concepts of prevention. We completed an ethnograph ic study (N = 42) focusing on cervical cancer screening among Cambodian Ame rican women. We also conducted a community-based survey (N = 413) to examin e the generalizability of our qualitative results. This report summarizes t he results, and describes how we used our findings to influence the content of a multifaceted intervention program targeting Cambodian immigrants. The following constructs were found to be barriers to cervical cancer control: a traditional orientation to the prevention, causation, and treatment of d isease; lack of familiarity with western early detection concepts; low leve ls of knowledge about cervical cancer; concerns is about the Pap testing pr ocedure; and health cal-E access issues. In general, the quantitative resul ts confirmed our ethnographic findings. The intervention program, which is delivered by bicultural outreach workers, includes home visits, presentatio ns at small group meetings, barrier-specific counseling, use of a Khmer-lan guage video, and tailored logistic assistance (e.g., transportation and med ical interpretation). Both the video and presentation provide cultural cont ext while simultaneously addressing multiple barriers to screening (e.g., w omen's fear of surgery and preference for female providers). Outreach worke rs are trained to counsel women about 10 potential barriers including avoid ance of biomedicine, perceptions that gynecologic exams are embarrassing, a nd lack of English proficiency. Our results reinforce the importance of con sidering health problems within the context of a population's traditional b elief systems and daily routines.