Departments of Economics and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
BMC Public Health. 2012 Jun 7;12:413. doi: 10.1186/1471-2458-12-413.
The Asian population is one of the fastest growing ethnic minority groups in western countries. However, cancer screening uptake is consistently lower in this group than in the native-born populations. As a first step towards developing an effective cancer screening intervention program targeting Asian women, we conducted a comprehensive systematic review, without geographic, language or date limitations, to update current knowledge on the effectiveness of existing intervention strategies to enhance breast and cervical screening uptake in Asian women.
This study systematically reviewed studies published as of January 2010 to synthesize knowledge about effectiveness of cancer screening interventions targeting Asian women. Fifteen multidisciplinary peer-reviewed and grey literature databases were searched to identify relevant studies.
The results of our systematic review were reported in accordance with the PRISMA Statement. Of 37 selected intervention studies, only 18 studies included valid outcome measures (i.e. self-reported or recorded receipt of mammograms or Pap smear). 11 of the 18 intervention studies with valid outcome measures used multiple intervention strategies to target individuals in a specific Asian ethnic group. This observed pattern of intervention design supports the hypothesis that employing a combination of multiple strategies is more likely to be successful than single interventions. The effectiveness of community-based or workplace-based group education programs increases when additional supports, such as assistance in scheduling/attending screening and mobile screening services are provided. Combining cultural awareness training for health care professionals with outreach workers who can help healthcare professionals overcome language and cultural barriers is likely to improve cancer screening uptake. Media campaigns and mailed culturally sensitive print materials alone may be ineffective in increasing screening uptake. Intervention effectiveness appears to vary with ethnic population, methods of program delivery, and study setting.
Despite some limitations, our review has demonstrated that the effectiveness of existing interventions to promote breast and cervical cancer screening uptake in Asian women may hinge on a variety of factors, such as type of intervention and study population characteristics. While some studies demonstrated the effectiveness of certain intervention programs, the cost effectiveness and long-term sustainability of these programs remain questionable. When adopting an intervention program, it is important to consider the impacts of social-and cultural factors specific to the Asian population on cancer screening uptake. Future research is needed to develop new interventions and tools, and adopt vigorous study design and evaluation methodologies to increase cancer screening among Asian women to promote population health and health equity.
亚洲人群是西方国家中增长最快的少数民族群体之一。然而，与本土出生的人群相比，亚洲人群接受癌症筛查的比例一直较低。作为制定针对亚裔女性的有效癌症筛查干预计划的第一步，我们进行了一次全面的系统综述，不限制地理位置、语言或日期，以更新目前关于增强亚裔女性乳腺癌和宫颈癌筛查参与度的现有干预策略的有效性的知识。
本研究系统地综述了截至 2010 年 1 月发表的研究，以综合了解针对亚裔女性的癌症筛查干预措施的有效性。共检索了 15 个多学科同行评议和灰色文献数据库，以确定相关研究。
我们的系统综述结果按照 PRISMA 声明进行了报告。在 37 项入选的干预研究中，只有 18 项研究包含有效的结局测量指标（即自我报告或记录的接受乳房 X 光检查或巴氏涂片检查）。在 18 项有有效结局测量指标的干预研究中，有 11 项研究采用了多种干预策略针对特定的亚裔族群中的个体。这种干预设计模式支持以下假设，即采用多种策略的组合比单一干预更有可能成功。当提供额外的支持，如协助安排/参加筛查和移动筛查服务时，基于社区或工作场所的团体教育计划的有效性会增加。将医疗保健专业人员的文化意识培训与可以帮助医疗保健专业人员克服语言和文化障碍的外展工作人员相结合，可能会提高癌症筛查的参与度。单独使用媒体宣传活动和邮寄文化敏感的印刷材料可能无法有效提高筛查参与度。干预效果似乎因族裔群体、方案实施方法和研究环境而异。
尽管存在一些限制，但我们的综述表明，增强亚裔女性乳腺癌和宫颈癌筛查参与度的现有干预措施的有效性可能取决于多种因素，如干预类型和研究人群特征。虽然一些研究证明了某些干预方案的有效性，但这些方案的成本效益和长期可持续性仍存在疑问。在采用干预方案时，重要的是要考虑到特定于亚裔人群的社会和文化因素对癌症筛查参与度的影响。需要开展进一步的研究，以开发新的干预措施和工具，并采用有力的研究设计和评估方法，以提高亚裔女性的癌症筛查率，促进人口健康和健康公平。
