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Presented by: Mavis Nitta, MPH, CHES

Culturally Appropriate Communication for the Asian Americans, Native Hawaiians and Pacific Islanders. Presented by: Mavis Nitta, MPH, CHES. Advisory Committee on Breast Cancer in Young Women Meeting September 21-23, 2011. AAs and NHPIs in the U.S. are Diverse Populations.

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Presented by: Mavis Nitta, MPH, CHES

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  1. Culturally Appropriate Communication for the Asian Americans, Native Hawaiians and Pacific Islanders Presented by: Mavis Nitta, MPH, CHES Advisory Committee on Breast Cancer in Young Women Meeting September 21-23, 2011

  2. AAs and NHPIs in the U.S. are Diverse Populations ~30 distinct Asian ethnic and cultural groups1 60% of Asians in U.S. foreign born in 20092 • ~50 distinct Native Hawaiian and Pacific Islander ethnic and cultural groups1 • 12% of NHPIs in U.S. foreign born in 20092 • >2,000 distinct Asian and Pacific languages and dialects3 • >100 Asian or Pacific Island languages/dialects commonly spoken in the U.S.4 1U.S. Census: The Native Hawaiian and Other Pacific Islander Population: 2000, Census 2000 Brief, issued December 2001; Asian & Pacific Islander American Health Forum, 2000. 2U.S. Census 2009 Estimates. 3Boeree CG: The Language Families of the World, http://webspace.ship.edu/cgboer/languagefamilies.html. 4AAPCHO: Asian Americans, Native Hawaiians and other Pacific Islanders (AA and NHOPIs), http://www.aapcho.org/site/aapcho/section.php?id=10950.

  3. Who are • Asian Americans • and how do they differ?

  4. Map of ASIA SOUTH ASIA Graphic Maps, 2005, http://worldatlas.com/webimage/countrys/as.htm

  5. ASIANSPersons “having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent”.1 1U.S. Census definition. 2These groups are sometimes included in a broader definition of South Asian or South-east Asian; although they are not always identified as being of “Asian origin”. 3Although the People’s Republic of China claims sovereignty over the Tibetan people, Tibet maintains its independence as a government-in-exile. Officially, the U.S. government considers Tibet to be part of China. However, Tibet’s exiled spiritual leader, the Dalai Lama, has many supporters in the U.S. and the Congress, and Tibet’s political status remains controversial in the U.S. Asian American Network for Cancer Awareness, Research & Education, 2000, http://aancart.org/whoareasianamericans.html; Leadership Education for Asian Pacifics, Inc. (LEAP), 2000; South Asian Public Health Association (SAPHA), 2002; U.S. Census, 2000 and 2004; U.S. Department of State: Background Notes: Taiwan, U.S. Relations, Oct 2009, http://www.state.gov/r/pa/ei/bgn/35855.htm#relations.

  6. Who are Native Hawaiians and Pacific Islanders and how do they differ?

  7. THE PACIFIC WorldAtlas.com (http://worldatlas.com/aatlas/infopage/oceans/pacificocean.htm); Pacific Resources for Education and Learning (http://www.prel.org/pacserv/pacserv_top.asp)

  8. NATIVE HAWAIIANS andPACIFIC ISLANDERSPersons “having origins in any of the original peoples of Hawai`i, Guam, Samoa, or other Pacific Islands” U.S. Census: The Native Hawaiian and Other Pacific Islander Population: 2000, Census 2000 Brief, issued December 2001; Asian & Pacific Islander American Health Forum, 2000

  9. U.S. Census by Race/Ethnicity Inclusive Population in Thousands, 2000 and 2010 Population in Thousands 46%  40% U.S. Census2000 and 2010

  10. Im/migrant Populationsare more likely to: Be socially isolated Holding on to their native cultures Often exacerbated by language isolation Experience significant language barriers Non-English speaking Limited English Proficient (LEP) Be socioeconomically disadvantaged High poverty rates Medically uninsured Despite being employed full-time (often working 2 or more full-time and/or part-time jobs)

  11. Impact of AA and NHPI Culture • Causes of physical illness: • Sins of past life • Physical ailment is caused by the “supernatural” • Home and folk remedies (CAM): • Herbal and plant medicines common • Use of massage • Faith: • Look to religion for assistance • Praying as a cure • Medicine healers to treat illness • Stigma of cancer • Fatalism • Fear of knowing • Social & cultural obligations (i.e. funerals)

  12. Structural Challenges Faced by AAs and NHPIs • Lack of health insurance • Undocumented status • Low socioeconomic status • Distorted conclusions from being categorized with API • Data • Cultural beliefs • Lack of Asian and Pacific Islander interpreters • Need for health navigation • Lack of culturally competent health care providers

  13. Culturally and Linguistically Appropriate Messages • Use positive pictures and messages • Connection with family • Pictures of their people, relatable • Cancer survivor’s story to put a face to the issue • Eye catching photos • Respectful tone • Positive feeling, happy message, nothing scary or not directing blame at individual

  14. Culturally and Linguistically Appropriate Messages • Message affirms belief that mammograms can be lifesaving • Encourages responsibility to take care of self in order to care for family • Consider using this message with a family photo • Clear message on when you should get mammograms • Messages need to be direct, but not too detailed

  15. Language issues • Chinese: • Mandarin vs Cantonese • Simplified vs Traditional • Filipinos: • Tagalog vs English vsIlocano • Terminology: • Layman’s terms vs medical terminology • Word for cancer may not exist in Asian or Pacific Islander language • Mammogram is difficult to translate in various Asian or Pacific Islander languages (description is needed)

  16. Examples of Educational Materials

  17. Examples of Educational Materials

  18. Breast Cancer Awareness for Tongans Project 3 media messages were used for project: 1. Life is a gift, Take good care of it, Get a mammogram 2. A woman’s good health is her most precious gift to her family. Remember your annual mammogram. 3.Educate & motivate. Screening saves lives.

  19. Filipino Breast Cancer Project 5 print media messagesusing family, individual Filipina, health provider images and messages: • Do it for yourself, Do it for your family. • Taking care of yourself is showing love to your family • Take care of your health now, so you can be there for your family later. • Mammograms…Not just once, but for a lifetime • Ate, Get your mammogram. It could save your life.

  20. Work with Community to Outreach and Maintain Communication • Use ethnic and mainstream newspapers, radio, and television • Use community lay health workers • Work with church leaders

  21. Chinese Radio Station Print ad in Vietnamese Photonovella in Bengali

  22. Messenger • Trusted member of the community • Physician vs nurse vs public health navigator/lay health worker • Minister vs minister’s wife • Male vs Female • Women they can relate to • Age/generation • Color of skin • Cancer survivors

  23. Take Home Messages • One size doesn’t fit all approach • Get feedback from community • Tailor and adapt • Evaluate effectiveness of the message

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