Cervical cancer screening behavior of Hmong women: a social network analysis

Abstract

This study examined the relationship between health and cervical cancer networks of Hmong American women and their cervical cancer screening practices. Incidence of cervical cancer and cervical cancer mortality rates are high for Hmong American women (Mills, Yang & Riordan, 2005; Ross, Xie, Kiffmeyer, Bushhouse & Robinson, 2003). Cervical cancer mortality rates for Hmong American women are three times higher than Asian American and Pacific Islander women and four times higher than non-Hispanic White women (Yang, Mills & Riordan, 2005). Despite high cancer related mortality rates, the utilization of cervical cancer screening is low (Yang, Mills & Dodge, 2006). Regular screening is important as it helps to detect cancer early when the treatment is most effective (Tanne, 2012). Barriers to cancer screening in the Hmong community include a lack of education, low income, cultural beliefs, language, traditional health practices, and mistrust of the Western health system (Lee & Vang, 2010). Hmong people value social cohesion and community living and often consult community members for making health related decisions (Barrett et. al., 1998). Using network analysis and logistic regression, this study explored the relationship between specific characteristics of the cervical cancer network and cervical cancer screening practices of Hmong American women. The health networks of study participants included all friends, family, health care providers, or co-workers with whom they had discussed their health in the last one year. Likewise, cervical cancer networks included everyone with whom the study participants had discussed cervical cancer in the last one year. Analysis found that Hmong American women who had a cervical cancer network were more likely to be aware of pap tests, receive pap tests and be aware of human papillomavirus (HPV) vaccines than Hmong American women who did not have a cervical cancer network. Having a cervical cancer network was not significantly associated with receiving HPV vaccines or Hmong American woman's perceived need for cancer screening. When controlled for demographic variables, a cervical cancer network was not found to be a significant predictor of cancer screening practices. With regard to characteristics of members within the cervical cancer network, education was found to be significantly associated with the awareness of HPV vaccines. Analysis also found that income, number of years in the United States and ability to speak English were significant predictors of Hmong American women having a cervical cancer network. Further, income, education, and having a regular health care provider were also significantly associated with cervical cancer screening practices of Hmong American women. It is important that practitioners and policy makers use social networks as a resource to improve the utilization of screening services. Programs for encouraging screening should target clients and their networks. For developing culturally appropriate screening programs, policy makers should consult local leaders. Programs developed in consultation with community may be efficacious in convincing Hmong American women to utilize services regularly (Lee & Vang, 2010).