Vietnamese women living in Canada : contextual factors affecting Vietnamese women’s breast cancer and cervical cancer screening practices

The aims of this qualitative research were to explore (a) how Vietnamese women participate in breast cancer and cervical screening, what leads Vietnamese women to seek health care, from whom they seek help, and the social support networks that they draw upon to foster their health care practices, (b) whether Vietnamese women find the current preventative cancer services suitable and accessible to them, (c) how Vietnamese women's breast cancer and cervical cancer screening practices are influenced by social, cultural, political, historical, and economic factors which are shaped by the conceptualisation of race, gender, and class, and (d) how differences between Vietnamese women's perspectives and those of health care providers influence women's health care experiences. By 2001, the estimated number of Vietnamese immigrants living in Canada was 151,410, approximately half of them women. Data from the U.S. and Australia show that breast cancer and cervical cancer are major contributors to cancer morbidity and mortality among Vietnamese women. Studies also suggest that Vietnamese women are at risk due to their low participation rate in these cancer preventative screening programs. Informed by Kleinman's explanatory model, postcolonialism, and feminism, in-depth interviews were conducted with 15 Vietnamese Canadian women and 6 health care providers. The study reveals the following major factors determining how Vietnamese women participate in breast cancer and cervical cancer screening programs: cultural conceptualisations of health and illness, social values and beliefs about the woman's body and social relationships; gendered roles and expectations; diminished social support networks; low socioeconomic status; and inaccessibility of health care services. At the theoretical level, I propose that health care professionals should (a) recognise that women of different ethno-cultural background are active participants in health care, (b) put less emphasis on western rationality and more on the recognisation that women's health care decision making is a dynamic process that varies under different circumstances, and (c) recognise that women's health care behaviour is influenced not only by their cultural knowledge and values, but also by their socially constructed position, race, gender, and class. At the practical level, I propose (a) that collaborative working relationships with physicians and improved physician-patient relationships are essential for successful promotional strategies for Vietnamese women, and (b) that a health education strategy must incorporate Vietnamese women's different ways of knowing. At the institutional level, increasing accessibility to these cancer preventive programs demands that health care policy makers increase institutional funding to support programs that provide services to immigrant women. Recommendations for future research include (a) a population-based survey to assess the current status of Vietnamese Canadian women's breast and cervical cancer screening practices, and to investigate the relationship between identified factors and Vietnamese women's cancer screening practices, (b) the development and implementation of a health promotion and disease prevention program that incorporates the findings of this study into its promotional strategies, and (c) an experimental study to evaluate the effectiveness of the newly developed promotional strategies on breast and cervical cancer screening among Vietnamese Canadian women.

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