Effects of Perceived Discrimination and Trust on Breast Cancer Screening among Korean American Women

Purpose and Background/Significance: Korean American women continue to have a higher breast cancer prevalence rate, lower breast cancer screening rates, and lower survival rates due to diagnosis at later stage of breast cancer than other racial groups. Perceived discrimination, trust based patient-provider interaction and their influence on breast cancer screening have been identified as critical factors in other populations and may be able to explain some of the low utilization of breast cancer screening among Korean American women. Thus, the purpose of this study is to identify factors that influence breast cancer screening adherence among Korean American women including perceived discrimination in healthcare, trust in providers, and trust in healthcare system. Theoretical/ conceptual framework: Betancourt's Integrative Model of Culture, Psychological processes, and Behavior. Method: A cross-sectional survey design was used to examine the factors contributing to breast cancer screening adherence among 196 Korean American women aged between 50 to 74 years. Participants were recruited from four Korean Churches in Chicago and the metropolitan area. The Perceived discrimination in healthcare, Trust in physician, revised Healthcare System Distrust, and Ferrans Cultural Belief Scales were used to identify the factors influencing breast cancer screening among Korean American women. Results: The majority of participants reported ever having a mammogram (85%), but reports of having mammogram in past 2 years were low (54%). Predictors of ever having a mammogram were whether they were US citizens or not, and higher trust in healthcare providers. Predictors of screened in past 2 years were knowing where to go for mammograms, having a regular doctor, higher trust in healthcare providers, and lower distrust in healthcare system. Perceived discrimination and cultural beliefs had an indirect effect on breast cancer screening in past 2 years through trust. Conclusions: Study findings suggest the need for efforts to increase trust in healthcare providers and trust in healthcare system to enhance breast cancer screening adherence among Korean American women. The findings of this study would lay the foundation for future work to understand breast cancer screening adherence among Korean American women and to develop the education programs for healthcare providers.