Chat with us, powered by LiveChat Personal, social, enviromental, health services that prevent them from getting a Colorectal Cancer Screening among Asians | Abc Paper
+1(978)310-4246 credencewriters@gmail.com
  

APA Formatcan use the http://www.healthypeople 2020.gov for some infoCite 4 current ( 2014 or newer) professional journals , use the articles listed below for as some that you cite Https://doi.org/10.1016/j.nutres.2017.10.003Https://doi.org/10.1186/s13104-017-3098-3discuss factors like :physical environment, financials , social environment , biology and genetics , health services as to why Asians people ( Japanese ,Koreans ,Chinese,etc ) do not get routine colon rectal cancer screening or the risk of colon/gastric cancer in this cultural groupWhat local agencies are available to assist this culturally diverse population?
final_professional_paper_health_disparities_1__2___1___6_.docx

colorectal_cancer_screening_among_korean_americans.pdf

Unformatted Attachment Preview

NURS 3355 Final Professional Health Disparities Paper
Purpose Statement:
Harkness & DeMarco (2017) define healthcare disparities as “gaps in care experienced
by one population, as compared to another,” p. 4. This has been identified by Healthy
People 2020 (http://www.healthypeople2020.gov/) as one of their benchmark goals to
decrease healthcare disparities. Using the culture specific to your interviewee,
determine how his/her culture access healthcare to include the social determinants
embedded within HP 2020 framework.
Steps to Guide You in the Writing Process
1. Use your interviewee who represents a member of a disparate population within
your community. All rules of confidentiality and HIPAA apply.
Determine the “problem” of focus using the benchmark goals from HP 2020.
An example of this would be noncompliance with immunizations.
a Perform a database search using the WTAMU Library link and find 5 evidencebased practice/research articles that are peer-reviewed using your “problem”
as the subject. You can use limiters to help refine your search. When you are in
the CINAHL portal, you can click on “research” in the left column and “peerreviewed” in the right column to make for more meaningful search results.
T The paper should be written in APA format; i.e. includes title page, abstract with
key words, body of report and reference page. Make sure that direct quotes
include a page number for citations and quotation marks around the quote. If
you need assistance with APA formatting, please refer to “Resources/Purdue
OWL (Online Writing Lab) link. The length of the paper should be 5 to 7 pages,
excluding your title page, abstract and reference page. You need a minimum of
5 references (articles) plus textbook reference.
. Using the Healthy People 2020 “Determinants” describe the following specific
to your patient.
a. Physical Environment, Social Environment, Individual Behavior, Biology &
Genetics and Health Services; what local agencies are available to assist this
culturally diverse patient population?
P Proofread your paper for typographical errors, grammar errors, and citation
errors. It is often helpful to get another set of eyes to look at your paper.
Due date for the paper is 5/6 at 11:59 p.m. Submit paper to Safe Assign and
review originality report prior to going to “Assignments” and submitting your
paper as an attachment (Word document) to the text box. A good rule of thumb
is to limit similarity to fewer than 15%. If your reference page is what is
highlighted for similarity, you are okay. If for any reason, you are unable to
submit your paper, please notify me immediately via text message to 309-3974441.
DOI:10.22034/APJCP.2018.19.5.1387
Location of Colorectal Cancer Screening Utilization
RESEARCH ARTICLE
Editorial Process: Submission:01/31/2018 Acceptance:05/03/2018
Colorectal Cancer Screening among Korean Americans in
Chicago: Does It Matter Whether They had the Screening in
Korea or the US?
Shin Young Lee*
Abstract
Background: Colorectal cancer (CRC) is one of the most common cancers in Korean Americans (KAs) and CRC
screening can detect CRC early and may reduce the incidence of CRC by leading to removal of precancerous polyps.
Many KAs in the US leave the country, primarily to travel to Korea, for health screening. The aim of this study was
to (a) assess CRC screening rates, including fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy
and (b) explore factors related to these tests among KAs by location of CRC screening. Methods: Descriptive and
correlational research design with cross-sectional surveys was used with 210 KAs. Socio-demographics (age, gender,
years in the US, marital status, education, employment, household income, and proficiency in spoken English), access
to health care (health insurance and usual source of health care), and location of CRC screening utilization (Korea,
the US, or both Korea and US) were measured and analyzed using descriptive statistics and multinominal logistic
regression. Results: Out of 133 KA participants who had had lifetime CRC screening (i.e., had ever had FOBT, flexible
sigmoidoscopy, or colonoscopy), 19% had visited Korea and undergone CRC screening in their lifetimes. Among
socio-demographic factors and access to health care factors, having a usual source of health care in the US (OR=8.45)
was significantly associated with having undergone lifetime CRC screening in the US. Having health insurance in the
US and having had lifetime CRC screening in the US were marginally significant (OR=2.54). Conclusion: Access to
health care in the US is important for KAs to have CRC screening in the US. As medical tourism has been increasing
globally, the location of CRC screening utilization must be considered in research on cancer screening to determine
correlates of CRC screening.
Keywords: Colorectal cancer- screening- Korean Americans- medical tourism
Asian Pac J Cancer Prev, 19 (5), 1387-1395
Introduction
Korean Americans (KAs) constitute one of the
fastest-growing Asian groups in the U.S. The KA
population increased from 799,000 to 1,700,000 between
1990 and 2010 (U.S. Census Bureau, 2001; US Census
Bureau, 2012). Among Asian American/Pacific Islander
groups, KAs represent 9.9% of the total Asian American
population (US Census Bureau, 2012). Colorectal cancer
(CRC) was the second most commonly diagnosed cancer
for both KA men and women (Gomez et al., 2013).
Compared to other racial and ethnic groups in the US,
KAs have higher incidence rates than non-Hispanic
whites and Asian Americans. Because CRC incidence
can be decreased through CRC screening for the early
detection of precancerous polyps and cancers, the US
Preventive Services Task Force (2017) has recommended
that individuals aged 50 to 75 years at average risk for
developing CRC have an annual fecal occult blood test
(FOBT), a flexible sigmoidoscopy every 5 years, or
a colonoscopy every 10 years. However, KAs consistently
had lower rates of CRC screening utilization than whites,
African Americans, Latinos, and other Asian subgroups,
including Chinese, Filipino, Japanese, and Vietnamese in
the US (Homayoon et al., 2013; Lee et al., 2011; Maxwell
and Crespi, 2009).
Although previous studies have examined CRC
screening behavior among KAs (Jo et al., 2008; Jo et
al., 2017; Juon et al., 2003; Kim et al., 1998; Lu et al.,
2016; Maxwell et al., 2000; Oh et al., 2013), researchers
have not considered where KAs undergo their CRC
screening. Approximately 750,000 US residents travel
abroad for health care each year, according to the Centers
for Disease Control and Prevention (Deloitte, 2008). A
large number of medical tourists are immigrants in the
US returning to their home country for care (Deloitte,
2008). In fact, many KAs in the US leave the country,
primarily to travel to Korea, to obtain health-screening
packages at a lower price than in the US (Ko et al., 2016;
Oh et al., 2014). Despite the large number of KAs having
Department of Nursing, Chosun University 309 Pilmun-daero, Dong-gu, Gwangju, 501-759 Republic of Korea. *For
Correspondence: shinyoung0114@gmail.com
Asian Pacific Journal of Cancer Prevention, Vol 19
1387
Shin-Young Lee
health check-ups in Korean health care services in Korea,
previous cancer screening studies (Jo et al., 2008; Jo et
al., 2017; Juon et al., 2003; Kim et al., 1998; Lu et al.,
2016; Maxwell et al., 2000; Oh et al., 2013) have asked the
question, “Have you had CRC screening?” and have used
this as an outcome variable, without asking the participants
about where they had the CRC screening. Studies that
have reported CRC screening might have included both
KA medical tourists who traveled to Korea for CRC
screening as well as those who had CRC screening in
the US. But the characteristics of KAs screened in Korea
could be different from the characteristics of those who
have had CRC screening in the US. For example, not
having a usual source of health care and health insurance
in the US (defined as access to health care) could force
persons to travel to Korea for CRC screening. In fact,
studies on medical tourism report that medical tourists
often do not have access to health care (Gan and Frederick,
2013; Karuppan and Karuppan, 2010). In this situation,
KA medical tourists who were asked the question,
“Have you had CRC screening?” would say “yes” if
they had undergone CRC screening in Korea. However,
they would more likely answer “no” to the question
about whether they have health insurance, which would
make it difficult to identify associations between having
the access to health care in the US and CRC screening
utilization. Because of these limitations, research needs
to be conducted with KAs to examine CRC screening test
options by location of screening, such as in Korea or the
US. To date, CRC screening rates and factors associated
with CRC screening for KAs by location of screening
have not been investigated, although this information is
essential to accurately determine factors associated with
CRC screening behaviors to improve low CRC screening
rates for this group. The purpose of this study was (a) to
assess CRC screening rates, including FOBT, flexible
sigmoidoscopy, and colonoscopy by location of CRC
screening including Korea, US, or both countries, and
(b) to explore factors related to these tests among KAs by
location of CRC screening. This will help us identify the
relationship between medical tourism and CRC screening
behaviors among KAs. This is the first study to investigate
CRC screening for KAs by location of screening, and
knowledge gained from this study can make an important
contribution to better understanding and predicting the
international care accessed by immigrant populations
including KAs.
Materials and Methods
Study design
A descriptive and correlational research design with
a cross-sectional survey was used to assess CRC screening
rates and to explore factors related to CRC screening tests
among KAs by location of CRC screening.
Participants
The sample for this study included KAs who were:
born in Korea, immigrants to the US, fluent in spoken
Korean, aged 50 and older, and at average risk of
CRC (such as who had no history of Crohn’s disease,
ulcerative colitis, CRC, or first-degree relative with
1388
Asian Pacific Journal of Cancer Prevention, Vol 19
CRC) according to ACS guidelines (American Cancer
Society, 2017). A total of 210 KAs living in the Chicago
metropolitan area, which has one of the largest KA
populations in the US, participated in this study.
Ethical considerations
After the Institutional Review Board at the University
approved the research protocol, the survey was conducted
in the Chicago metropolitan area. Written consent forms
that included the purpose and procedures of the study,
possible benefits to and risks of participation in the study,
and a statement about the protection of privacy and
confidentiality were given to participants. Participants
were informed that they could withdraw from the study
at any time without any consequences of any kind.
Participant ID numbers, rather than personal identifiers
such as names, were used for participants in the survey.
Measures
Socio-demographics (age, gender, years in the
US, marital status, education, employment, household
income, and level of spoken English); access to health
care (health insurance and usual source of health care);
and CRC screening utilization by location (Korea, the
US, or both Korea and the US) were measured. All the
socio-demographic measures except level of spoken
English and access to health care measures were adapted
from previous studies (Lee et al., 2016; Menon et al.,
2007). Among the socio-demographic variables, we
measured years in the US (length of time in the US) as a
continuous variable and then categorized it as more than
or less than 20 years because we wanted to compare our
results with those of previous studies. Household income
was measured as a categorical variable because income
questions are sensitive to ask and studies have shown that
the item nonresponse to income questions is 20% – 40%
(Tourangeau and Yan, 2007). Having health insurance,
such as commercial insurance, Medicare, or Medicaid,
and usual source of care (i.e., a regular doctor or a regular
place to go for health care) was measured as a proxy of
access to health care. FOBT, flexible sigmoidoscopy, and
colonoscopy utilization were measured as the outcome
variables of this study. Participants were asked for the
time and place of each CRC screening test. We first
asked participants whether they had undergone each
CRC screening test in their lifetime. If they answered
‘yes’, we asked them if they had it either in Korea, the
US, or both Korea and the US. Lifetime CRC screening
(had undergone either FOBT, flexible sigmoidoscopy,
or colonoscopy) and up-to-date (had undergone either
FOBT in the previous year, flexible sigmoidoscopy in the
previous 5 years, or colonoscopy in the previous 10 years)
were calculated according to the ACS guidelines on CRC
screening (American Cancer Society, 2017). This study
was conducted with a Korean language questionnaire
after the English version of the scales was translated into
Korean by three bilingual translators using a committee
translation method.
DOI:10.22034/APJCP.2018.19.5.1387
Location of Colorectal Cancer Screening Utilization
Data collection
The PI recruited a convenience sample of participants
from a Korean church and two community centers
in the Chicago metropolitan area. The PI explained
the project and asked KAs to participate in the survey.
If they were eligible and agreed to participate, the PI
gave them a survey package including a self-administered
questionnaire, a consent form, and a stamped return
envelope. The participants returned the consent form
and the survey questionnaire to the PI in person or by
mail depending on the participant’s preference. Out of
a total of 285 distributed, 210 surveys were completed
and returned (response rate = 72.9%). Ninety-seven
completed surveys (46.2%) were received in person, and
113 (53.8%) were received by mail. Comparing the data
collected in person or by mail, no differences were found
in socio-demographics, access to health care, or CRC
screening rates between the two groups. Participants did
not report having any difficulties with the survey. Each
participant received a $20 grocery store gift certificate
in person or by mail after the PI received the completed
questionnaire.
Data analysis
Data were entered and all analyses were conducted
using SPSS Version 23 (Statistical Package for Social
Sciences Inc, 2016). Descriptive statistics were calculated
for participants’ characteristics and use of CRC screening.
Regarding socio-demographic variables, access to health
care variables, and CRC screening utilization by locations,
means, standard deviations, and ranges were reported for
interval or ratio variables, and numbers and percentages
were reported for categorical variables. To determine
the associations between socio-demographic variables
and access to health care with CRC screening utilization
by location of tests, multinomial logistic regression was
conducted.
Results
Sample Characteristics
Socio-demographic and health-related characteristics
are shown in Table 1. A total of 210 KAs aged 50 and
older living in the Chicago metropolitan area were
surveyed. The mean age was 62.54, ranging from 50-84.
Both women (61%) and men (39%) participated in
this study. The majority of participants were married
(81.9%), reported an annual household income of more
than $50,000 (74.8%) and had lived in the US for more
than 20 years (74.8%). More than half of the participants
spoke some English (67.6%) and their usual source of
health care was in the US (61.4%). More than half of
the participants (57.9%) had health insurance such as
commercial insurance, Medicare, or Medicaid, and 15.2%
had two or three kinds of health insurance.
Prevalence of CRC Screening
Overall, 133 (63.3%) of the participants had had CRC
screening during their lifetime, and 119 (56.7%) had had
up-to-date CRC screening (Table 2). When the screening
data were examined by location, a total of 40 (19.0%) KAs
had visited Korea to undergo CRC screening, including
those who had had the lifetime CRC screening only in
Korea (N = 28, 13.3%) as well as in both Korea and the US
(N = 12, 5.7%) while 93 (44.3%) had had the lifetime CRC
screening only in the US (Table 2).
Table 3 summarizes the results of screening rates
for FOBT, flexible sigmoidoscopy, and colonoscopy,
along with the locations of each lifetime screening
test. Among the 210 participants, 48 (22.9%) had had
lifetime FOBT, 8 (3.8%) had had FOBT in the previous
year, 49 (23.3%) had had lifetime sigmoidoscopy,
42 (20.0%) had had sigmoidoscopy in the preceding
5 years, 122 (58.1%) had had lifetime colonoscopy, and
115 (54.8%) had had colonoscopy in the previous 10 years.
Regarding the locations of lifetime CRC screening,
of the 210 KAs, a total of 15 (7.1%) visited Korea for
FOBT, including KAs who had had FOBT in Korea only
(N = 12, 5.7%) and in both Korea and the US (N = 3, 1.4%),
whereas 33 (15.7%) had had FOBT in the US only. A total
of 9 (4.3%) KAs visited Korea for flexible sigmoidoscopy,
including those who had had it in Korea only (N = 6, 2.9%)
and in both Korea and the US (N = 3, 1.4%), whereas 40
(19.0%) had had it in the US only. A total of 32 (15.2%)
KAs visited Korea for colonoscopy, including KAs who
had had it in Korea only (N = 30, 14.3%) only and in both
Korea and the US (N = 2, 1.0%), whereas 90 (42.9%) had
had it in the US only (Table 3).
Factors Associated with KA CRC Screening Utilization
by Location
To determine relationships among socio-demographic
factors, access to health care, and lifetime CRC screening
utilization by location, multinomial logistic regression
using SPSS was conducted. KA participants who had
lifetime CRC screening in both Korea and the US were
rare (n=12), which could affect statistical test results.
Therefore, three groups of KA participants who had had
lifetime CRC screening in Korea, in the US, and had not
had lifetime CRC screening were included in multinomial
logistic regression. All variables were entered into the
multinomial logistic regression model. Table 4 shows
the results of the multinomial logistic regression analysis.
Based on the multinomial logistic regression,
the variable “usual source of health care in the US” were
significantly associated with higher odds of having had
lifetime CRC screening in the US when the reference
category was KAs who had not had CRC screening
(P<0.05) (Table 4). The variable “health insurance in the US” and having had lifetime CRC screening were marginally significant. After controlling for other variables, KAs who had a usual source of care in the US had more than 8 times greater odds of having had CRC screening in the US (OR=8.45, 95% CI 3.39, 21.10) compared to KAs who did not have a usual source of health care in the US. Additionally, KAs who had health insurance in the US had marginally higher odds of having had lifetime CRC screening in the US (OR = 2.54, 95% CI 0.98, 6.59) than those who did not have health insurance in the US. Asian Pacific Journal of Cancer Prevention, Vol 19 1389 Shin-Young Lee Table 1. Socio-Demographic and Health-Related Characteristics of KAs (n = 210) Variable n (%) M ± SD Range 50-64 130 (61.9) 62.54 ± 8.75 50–84 ≥65 80 (38.1) 25.18 ± 10.13 1-52 Age (year) Gender Male 82 (39.0) Female 128 (61.0) Years in the US <20 53 (25.2) ≥20 157 (74.8) Marital Status Currently married 172 (81.9) Not married 38 (18.1) Education ≤High school graduate 85 (40.5) >High school graduate
125 (59.5)
Employment
Unemployed
131 (62.4)
Employed
79 (37.6)
Usual source of health care in the US
Yes
129 (61.4)
No
81 (38.6)
Health insurance in the US
Yes
1 …
Purchase answer to see full
attachment

error: Content is protected !!