title: Pathways of Breast Cancer Screening Among Chinese American Women.
abstract: OBJECTIVE
  The purpose of this community-based study was to develop a structural equation model for factors contributing to breast cancer screening among Chinese American women.
  
  
  METHODS
  A cross-sectional design included a sample of 440 Chinese American women aged 40 years and older. The initial step involved use of confirmatory factor analysis, which included the following variables: access/satisfaction with health care, enabling, predisposing, and cultural and health belief factors. Structural equation model analyses were conducted to evaluate factors related to breast cancer screening in Chinese American women.
  
  
  RESULTS
  Initial univariate analyses indicated that women without health insurance were significantly more likely to report being never-screened compared to women with health insurance. Structural equation modeling techniques were used to evaluate the utility of the Sociocultural Health Behavior model in understanding breast cancer screening among Chinese American women. Results indicated that enabling and predisposing factors were significantly and positively related to breast cancer screening. Cultural factors were significantly associated with enabling factors and satisfaction with healthcare. Overall, the proposed model explained 34% of the variance in breast cancer screening among Chinese American women.
  
  
  CONCLUSIONS
  The model highlights the significance of enabling and predisposing factors in understanding breast cancer screening behaviors among Chinese American women. In addition, cultural factors were associated with enabling factors, reinforcing the importance of providing translation assistance to Chinese women with poor English fluency and increasing awareness of the critical role of breast cancer screening. Partnering with community organizations may help to facilitate and enhance the screening rates.
authors.affiliation: Professor of Public Health, Department of Public Health, Director of Center for Asian Health, College of Health Professions, Temple University, Philadelphia, USA.
authors.forename: Grace X
authors.initials: GX
authors.lastname: Ma
authors.forename: Carolyn
authors.initials: C
authors.lastname: Fang
authors.forename: Min Qi
authors.initials: MQ
authors.lastname: Wang
authors.forename: Steven E
authors.initials: SE
authors.lastname: Shive
authors.forename: Xiang S
authors.initials: XS
authors.lastname: Ma
keywords: Breast cancer screening; Chinese women; Mammograms