title: Beliefs and attitudes of Samoan women toward early detection of breast cancer and mammography utilization.
abstract: BACKGROUND
  Among Pacific Islanders in Hawaii, the breast has been the foremost cancer site. Among Samoans, it is a leading cancer site along with sites for respiratory cancers. A recent study reported that cancer has been diagnosed at relatively advanced stages in younger Samoans.
  
  
  METHODS
  An exploratory, qualitative design was used with a semi-structured, open ended, talk story interview with Samoan women aged 40 years and older who spoke English and who had no personal history of breast cancer. The coding of interviews was validated with a faculty member unrelated to the study. Interviews were stopped at 15 participants once thematic patterns were saturated. Content analysis was performed. Triangulation to validate results was performed with research assistants and one participant.
  
  
  RESULTS
  Participants ranged from 40-73 years of age, had lived in the U.S. 3-40 years, and most were married, born in Samoa or American Samoa, and had health insurance. Their education ranged from ninth grade to some college. Their health promotion activities included eating right, exercising, immunizing their children, and visiting their physician for an annual examination. Most had had positive or neutral experiences with western health care. Most reported that they would use Samoan medicine if available. Priorities reported were health, family, and education. Women considered the care and health of their families their responsibility. All had negative perceptions of cancer. Most had had mammograms. Reported major barriers to mammography were fear, not a priority, and pain. Reported major motivators were physician recommendation, prevention, and fear. Over half of the women reported concern over their breasts being touched either by themselves or by others.
  
  
  CONCLUSIONS
  The study participants had strong beliefs that cancer meant death and, therefore, no cure. Samoan women emphasized the health and education of their families and their role in family health care. Therefore, health care providers should promote health and breast screening by emphasizing that family health care also means caring for oneself. Although Samoan women reported that they used western health care, most women also were willing to use traditional Samoan medicine if it was available. Their understanding the causes of cancer included currently accepted explanations and uncommonly accepted views of causation. Correcting misinformation, teaching, addressing fears (motivators as well as barriers), using female health providers for screening, conveying respect for privacy and person, reinforcing that examination of the breast is not sexual, and gently handling breasts during examinations are important considerations for the prevention of breast cancer in Samoan women.
authors.affiliation: University of Hawaii at Manoa, School of Nursing and Dental Hygiene, Honolulu, Hawaii 96822, USA. dianne@hawaii.edu
authors.forename: D N
authors.initials: DN
authors.lastname: Ishida
authors.forename: T F
authors.initials: TF
authors.lastname: Toomata-Mayer
authors.forename: N S
authors.initials: NS
authors.lastname: Braginsky
mesh_terms: D000328:Adult; D000368:Aged; D001293:Attitude to Death; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000208:ethnology*; D003144:Communication Barriers; D003466:Cultural Characteristics; D005192:Family Health; D005239:Fear; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008519:Medicine, Traditional; D008875:Middle Aged; D009042:Motivation; D010353:Patient Education as Topic; D018947:Samoa / Q000208:ethnology; D019529:Sexuality