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Report Title:	Focus Groups with Caucasian, African American, and Latino Target Audiences to Freshen the 5 A Day for Better Health Program Message
*Abstract:*	The purpose of this research was to gain insight into new concepts for future communications materials about the 5 A Day program. Research objectives included identifying new ways to "freshen" 5 A Day program messages, exploring the appeal of new concepts, and updating NCI’s awareness of audience attitudes and behaviors about nutrition and chronic disease prevention.
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Agency:	NIH:National Cancer Institute
Date of Report:	7/1/2001

2

Report Title:	CMRI's Asian American and Pacific Islander Medicare Mammography Brochure Focus Group Report
*Abstract:*	The AAPI mammography brochures were created in response to concerns that while Asian American women were facing increasing cancer risk, there are many myths and language and cultural barriers that result in relatively fewer AAPI women from having an annual mammogram. This may be even truer among elder women over the age of 65, despite the fact that Medicare covers an annual mammogram. The focus groups conducted for the CMRI brochures were an opportunity to learn more about AAPI women’s preference in regard to mammography and learn more about the key messages that would serve as an effective “call to action” in obtaining their necessary health care. All stages of the focus groups brochure development represented a collaborative effort between the three agencies that were contracted to conduct the focus groups and assist in the development of the key messages and brochures. While the groups varied a bit in some of their preferences, the following themes emerged overall: The elder women responded to the words and images about family and community. Women wanted to have the message reflect their concerns about their families and communities. Furthermore, many groups commented that they wanted multigenerational photographs, and wanted photos of men, to either show that the issue affects families, not just individuals, and that men were at risk for breast cancer too. The elder women said the images and colors in the brochures should be bright, colorful and friendly. While a few focus group participants said the brochure should be frightening, most wanted bright colors. They liked the brochures with flowers. They also said they preferred photographs of people, with drawings illustrating how a mammogram is performed. Different colors represent different meanings. Unlike Western culture, there is no universally acceptable color to Asian cultures. While red means health, happiness and prosperity in some cultures, it represents death in other cultures. Other colors such as purple can also represent death. These issues should always be discussed and verified with a number of community representatives. The elder women wanted information on local referral networks. Nearly all the groups wanted information or a phone number where they could get information on a local provider or network to get a mammogram. The elder women wanted AAPI statistics. The elder women liked the idea of having more specific statistics on AAPI elder women's risk for breast cancer. The community partners that conducted English speaking focus groups, and the community partners whose languages were not addressed continually offered their interest in the project, and in seeing similar materials being developed and offered to the their communities in the future.
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Agency:	Centers for Medicare & Medicaid Services
Date of Report:	6/7/2000

3

Report Title:	Provider-Targeted Interventions to Increase Mammography Screening Among Older Women: Report of Literature Review Findings
*Abstract:*	Physician referral for mammography screening is one of the strongest predictors of mammography utilization among women of all ages. Although the risk for breast cancer increases with age, older women appear to be referred for regular mammography screening less often than younger women. To increase the number of women, particularly those ages 65 and older with Medicare, who are referred for regular breast cancer screening, the National Cancer Institute’s (NCI) Office of Communication and the Centers for Medicare & Medicaid Services (CMS) have partnered to develop a health care providers outreach campaign. As a first step in this endeavor, published literature from the past 10 years (found through a stringent MEDLINE search) and internal research documents (from NCI, CMS, and Prospect Associates) were reviewed to explore: 1) Why physicians are less likely to make a mammography referral to older patients 2) What tools would facilitate/encourage mammography referral 3) What are the best methods to reach providers 4) What provider-targeted strategies most effectively increase mammography use among older women The review found that while physicians hold a positive opinion about mammography screening, they perceive certain barriers to screening older women, such as the likelihood of noncompliance, increased competing comorbid conditions, and lack of efficacy trials with women over age 75 to support screening guidelines. Other barriers mentioned by physicians include lack of continuity of care with older women, difficulties with followup, and forgetfulness on the part of the provider. Older women, on the other hand, were likely to cite the lack of a physician referral as the primary barrier to obtaining a mammogram. Studies with older women demonstrate the added effectiveness of an enthusiastic physician referral. A review of methods to reach physicians showed that physicians preferred to be reached through medical journals/newsletters, educational sessions, and mass media. The review also revealed that preferred methods for educating patients on breast cancer include mass media, print materials, and teaching aids. Five intervention studies targeted at providers and aimed at increasing mammography screening among older women were reviewed. Multifaceted interventions, which include both provider (physician and/or nonphysician) and patient-targeted strategies, were most effective at increasing mammography screening. Components of these multifaceted interventions included physician education, physician and nurse reminders (such as computer-generated prompts and chart stickers), patient education (which includes the distribution of educational material), and patient reminders. This report recommends that provider-targeted interventions should include both physician and nonphysician provider reminders and education, as well as patient reminders and education. Efforts to educate providers should emphasize the importance of the mammography referral with older women and the importance of being enthusiastic when making the referral. Future research is recommended for testing the effectiveness of individual components of multifaceted interventions and for exploring the role of specialist physicians in referring older women for mammography screening.
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Agency:	NIH:National Cancer Institute
Date of Report:	8/1/2001

4

Report Title:	Knowledge, Attitudes, and Behavior of Immigrant Asian American Women Ages 40 and Older Regarding Breast Cancer and Mammography Screening
*Abstract:*	Background and Methodology The National Cancer Institute’s (NCI) Office of Cancer Communications (OCC) established the national Breast Cancer Education Program to increase awareness of the importance of regular mammography screening among women ages 40 and older. While this program has focused primarily on White, Black, and Hispanic women in the past, it is currently being expanded to other ethnic groups, including Asian women. The overall purpose of the research described in this report was to gain general background information on the attitudes, knowledge, and behaviors of Asian women regarding breast cancer and mammography screening, as well as to test some NCI materials developed for these audiences. Specific objectives were: ·To review epidemiological literature on Asian women’s risk for breast cancer; ·To determine whether Asian women are getting mammograms and to better understand their reasons for getting or not getting them; ·To learn whether and how cultural characteristics affect Asian women’s decisions to seek or not seek mammograms; ·To identify appropriate methods of disseminating messages about breast cancer and mammography screening to Asian women; and ·To assess Asian women’s reactions to draft posters and bookmarks encouraging them to have mammography screening. OCC conducted the research in three phases: 1) Literature review. A literature review of articles related to breast cancer and mammography screening among Asian women was conducted using Medline, an on-line search database covering medicine, public health, and psychology. Twenty-eight articles were identified from the search period 1989 to 1999. 2) Key informant interviews. Telephone interviews were conducted with four organizations identified by OCC as being involved in Asian-specific breast cancer education efforts: the American Cancer Society-Chinese Unit; the Korean Health Education, Information & Research Center; the National Asian Women’s Health Organization (NAWHO); and the Vietnamese Community Health Promotion Project. Each interview lasted between 30 and 45 minutes. 3) Focus groups. Eight focus groups were held with Asian women in New York City and Los Angeles, California—two groups each with women who spoke Cantonese, Mandarin, Korean, or Vietnamese. To be eligible for the groups, participants had to identify themselves as having one of these languages as their mother tongue; primarily speak the language of their native country; and be 40 to 74 years of age. All of the participants were first-generation immigrants; most had lived in the United States for at least 10 years. The focus group discussions were structured similarly to the key informant interviews, with each discussion lasting approximately two hours. All sessions were conducted in the language of women in the group. For the materials testing, OCC had developed three sets of draft posters and bookmarks intended for Asian women, encouraging them to be aware of their risk for breast cancer and to seek mammograms. Each poster and bookmark set differed by depicting a woman from a specific national group (i.e., Chinese, Korean, or Vietnamese) engaged in a different everyday activity (reading a book, arranging a vase of flowers, or pouring tea). Each set also had a different visual background and a unique set of colors. The messages printed on the materials were in either Chinese, Korean, or Vietnamese. It should be noted that the literature review conducted for this study was an attempt to get a “snapshot” of the intended audience and did not attempt to summarize all the current knowledge about breast cancer prevalence and mammography screening among Asian women. Moreover, key informant interviews and focus groups are qualitative in nature, and the findings cannot be generalized to all Asian women ages 40 and older in the United States. The usefulness of this research is in providing detailed insights into the intended audience’s knowledge, attitudes, and behaviors toward breast cancer and mammography screening among Asian women. Moreover, key informant interviews and focus groups are qualitative in nature, and the findings cannot be generalized to all Asian women ages 40 and older in the United States. The usefulness of this research is in providing detailed insights into the intended audience’s knowledge, attitudes, and behaviors toward breast cancer and mammography screening. Key Findings Rates of Breast Cancer and Mammography Screening ·Breast cancer among Asian American women is a concern. According to the 1988-1992 SEER data, rates for invasive breast cancer (per 100,000 women) are lower in Asian women than in women of other ethnicities: 112 for Whites, 95 for Blacks, 70 for Hispanics, 55 for Chinese, 38 for Vietnamese, and 29 for Korean (Miller, et al., 1996). Despite having lower rates than other ethnic groups, however, breast cancer is the most common type of cancer in Chinese and Korean women and the second most common type in Vietnamese women (Miller et al., 1996). ·Breast cancer rates increase with successive generations of Asian women living in the United States. One study of Chinese and Japanese women found that the breast cancer incidence rate of those living in the U.S. was approximately twice the rate of those living in China or Japan (Stanford et al., 1995). Another study found that the risk of Chinese, Japanese, and Filipino women born in the U.S. was 60% higher than the risk of those born in China, Japan, or the Philippines (Ziegler et al., 1993). Moreover, among the women born in the U.S., risk was 500/0 higher among those with three or four grandparents also born in the U.S., whereas risk was lower among those with all grandparents born in China, Japan, or the Philippines. ·Studies show that mammography screening rates are low among Asian women. The National Institutes of Health (1998) reports that Asian women ages 40 and older in 1991 were more likely than their Black and White counterparts to report not having had a mammogram in the past two years (54% Asian versus 52% Black and 44% White) (Hahn, 1992). Moreover, studies conducted in specific states have illustrated low mammography screening rates among Chinese, Korean, and Vietnamese women. Yu et al. (1998) found that only 57% of Chinese women ages 40 or older in Michigan had had a mammogram within the past two years. Another study (Wismer et al., 1998) surveyed Korean women ages 50 or older in California and found that only 34% had had a mammogram in the past two years. In addition, a study conducted by McPhee et al. (1997) in California demonstrated that only 30% of Vietnamese women ages 40 or older had ever had a mammogram. Interestingly, most focus group participants said they had had at least one mammogram in their lifetime, yet also expressed the belief that many other women in their community are not getting mammograms. ·Asian women may be less likely to get mammograms if they are older, have a lower socioeconomic status, lack health insurance, and have lived in the United States for a short period of time. Key informants indicated that cost can be a major barrier to mammography screening. Some focus group participants noted that older women are not getting mammograms because they think they are too old to get cancer, will be unable to do anything about it if they do get the disease, or will die soon anyway. Other focus group participants said new immigrants are less likely to get mammograms because they lack insurance, encounter language barriers, and must cope with more pressing concerns. Knowledge and Attitudes Regarding Breast Cancer and Mammography Screening ·All of the focus group participants agreed that breast cancer is an important health issue, although some said other health issues take precedence (e.g., heart disease). Participants overwhelmingly associated the word “cancer” with “fear” and “death.” During the discussion, many named family members, mends, or co-workers who had experienced breast cancer; a few of the participants had dealt with the disease themselves. In every group, participants became very quiet and attentive when listening to each other relate their breast cancer stories. ·Key informants and focus group participants also pointed out that Asian women lack a general awareness of breast cancer and the importance of mammography screening. Key informants emphasized that some Asian women require the most basic information—for example, that breast cancer is not merely due to fate and that it can be detected early. In addition, key informants indicated that many Asian women do not know how a mammogram is performed. ·Focus group participants said the greatest motivators for getting mammograms are early detection and the peace of mind that comes from knowing that one does not have cancer. Coupled with these beliefs was the notion that it is important to stay healthy for one’s family or children. ·Key informants and focus group participants said a major barrier to mammography screening for Asian women is a general lack of orientation toward physical exams and screenings. They indicated that Asian women have many non-health related concerns including caring for their families and children, watching their finances, finding jobs, speaking a new language, and adapting to a new American culture. They added that Asian women usually do not visit a Western physician until they are so sick that they are unable to attend to other, higher-priority concerns. Many focus group participants added their perception that a woman does not need to get a mammogram unless she experiences symptoms such as pain or a breast lump. Payment for Mammograms ·Asian women appear to be paying for preventive services including mammograms out of pocket (i.e., cash) and through some form of public assistance (e.g., free clinical screenings, Medicaid). Focus group participants demonstrated little awareness of Medicare coverage of mammograms. ·Key informants, as well as some focus group participants, also noted that mammograms can be costly, especially for newer immigrants. At the same time, focus group participants also indicated that if women need mammograms badly enough, they can easily find low-cost or free mammograms, which often are advertised in the Chinese/Korean/Vietnamese media. Language Issues ·Many Asian women prefer to speak the language of their native country instead of English. Almost two-thirds of Asian women speak a language other than English at home (Naisbitt, 1996). It should be pointed out that the Chinese read one language (Chinese) but speak primarily one of two dialects—Mandarin and Cantonese. Both Koreans and Vietnamese read one language and speak one dialect. ·Key informants and focus group participants confirmed existing studies documenting that Asian women prefer to visit Asian physicians (versus “American” physicians), primarily because they speak the same language. Focus group participants explained that women can better describe their health problems to Asian physicians, as well as better understand the information given back to them. Some also expressed the perception that Asian doctors understand their physiology better. In addition, participants commented that it can be inconvenient to find translators or family members to help them converse with American physicians. ·Key informants and focus group participants agreed that language is an important barrier to mammography screening. They explained that many Asian women cannot find health care providers who can talk to them in their language about such health issues as breast cancer and mammography screening. They also indicated that there are not nearly enough translators to address this problem. ·Focus group participants unanimously agreed that health information should be provided in Chinese/Korean/Vietnamese (versus English) so that they can easily understand it. Sources of Information ·Key informants and focus group participants said that Asian women would turn to family members, friends, and neighbors for information about breast cancer and mammography screening. ·Key informants and focus group participants noted that Asian women greatly trust their physicians (usually Asian) for health information. Key informants emphasized that Vietnamese women in particular trust their Vietnamese physicians. ·Key informants mentioned the lack of preventive medicine practiced by Asian physicians as a barrier and cited Asian physicians as an important secondary intended audience for breast cancer education campaigns. They explained that Asian physicians may not have received adequate training regarding preventive health in their native countries or may not have time to address prevention and wellness because they have extremely heavy patient loads (Asian physicians are in high demand by Asian women). ·Many key informants and focus group participants also noted that Chinese-, Korean-, or Vietnamese-language media play important roles in the dissemination of health information. For example, they noted that newspapers and magazines often include sections with information about health, and that radio and television have programs often featuring physicians. ·Key informants pointed to community gathering places such as markets, civic clubs, and churches/temples as other channels for disseminating and obtaining information. Korean focus group participants noted that churches are especially good sources of information for Korean women. Materials Testing: Message Content ·Regardless of language group, most focus group participants understood the main message of the bookmark and poster set they were shown. At the same time, they suggested that the mammography directive convey a greater sense of urgency. Specifically, their suggestion was to change the phrase “consider mammograms” to “get mammograms.” ·Key informants and focus group participants unanimously agreed that the materials had been translated literally, resulting in inappropriate word choice, incorrect grammar (e.g., capitalization, accent marks), and general awkwardness. They said that Asian women would not consider the materials to be professional and would throw them away. Focus group participants added that the materials appeared to have been translated by an American person who is not well-versed in medical terminology. Key informants and focus group participants stressed that all materials should be written by professional Asian translators with medical knowledge. ·Focus group participants suggested adding information about the costs of mammograms and on breast cancer statistics. In particular, some participants wanted to know where they could get free mammograms. A few wanted to know about cancer death rates, incidence rates, and survival rates. ·Key informants wanted more information about places women could consult for more information, especially those with in-language services. Among other things, they listed national and community-based organizations (including their own organizations), health centers, churches, and the media. ·Key informants and most focus group participants wanted to know whether the telephone information specialists at the 1-800-4-CANCER number speak Cantonese/Mandarin/Korean/Vietnamese or English. They emphasized that they would not call unless someone could speak in their language. ·Many participants also wondered whether a human being answers the 1-800-4-CANCER number, noting that they would prefer to speak to a person instead of an answering machine. ·In addition, some participants were not sure of the purpose of the phone line and recommended stating its purpose on the materials. They wondered whether its purpose was to sell products or provide information. They also wondered whether the topic covered was limited to breast cancer or is inclusive of other health topics. ·Many participants in each language group recommended writing out the numbers for the word “CANCER.” Korean participants added that some women may have Korean phones, which do not list letters on the dial pad. In addition, Mandarin participants said that “4” sounds like the word “death” and suggested not using that number. ·Regardless of their language group, most focus group participants said they were not aware of the National Cancer Institute but would trust this organization because it is a government agency. They said the materials should clearly state that NCI is a “government” organization (versus a for-profit or not-for-profit). Materials Testing: Creative Execution ·Cantonese, Mandarin, and Korean participants said the images of the Chinese and Korean materials were not attention-getting because they were unrelated to the topics of breast cancer and mammography screening. They strongly recommended replacing the images of the woman pouring tea (Chinese) and arranging flowers (Korean) with more relevant images. Alternatives suggested included a woman getting a mammogram, a woman with her doctor, a woman doing a breast self-examination, a mammogram machine, a mammogram picture, a breast, a woman reading about breast cancer, or a woman with her family. While the Vietnamese participants said they liked the Vietnamese picture of the woman reading the book, they suggested adding breast cancer and mammography words on the pages of the book. ·Most participants said the images of the women depicted on the materials did not accurately reflect women of their nationalities. They suggested changing the women’s hairstyles and clothing so that they would look more traditional. ·Focus group participants expressed mixed reactions regarding the age appropriateness of the women. Cantonese participants said the woman looked too young, and Vietnamese participants said the woman’s face looked old but her body looked young because “she has no breasts.” ·Cantonese and Mandarin participants recommended using traditional lettering (rather than simple lettering) when developing materials. They explained that some Chinese women are not able to read simple lettering. It should be noted that the major Chinese print media in the United States employ traditional lettering (Erlich and Jiang, no date). Conclusions and Recommendations This research provided valuable insight into the population of Asian American immigrant women ages 40 to 74 who still predominantly speak their native language. An overall conclusion coming from this research concerns the critical importance of developing culturally appropriate messages and materials using input and feedback from members of the intended audience, as well as from knowledgeable community organizations. Involving these groups and individuals is essential for developing a complete picture of the audience one is trying to reach, for creating the content and creative execution of materials for that intended audience, and for determining the most appropriate methods of materials dissemination. The following conclusions and recommendations are based on the combined findings from the literature review, key informant interviews, and focus groups: Intended Audience ·Asian women ages 40 and older are in need of breast cancer and mammography screening education. Although breast cancer rates for Asians are lower than those for other ethnic groups, breast cancer is a common type of cancer among Asian women ages 40 and older. Furthermore, Asian women ages 40 and older have lower mammography screening rates compared to other ethnic groups. Women in greatest need have been identified as those who are older, have a lower socioeconomic status, lack health insurance, are recent immigrants, and do not speak English well. Although the Asian population is currently a small segment of the overall United States population, it is growing fast and will continue to grow. ·Chinese, Korean, and Vietnamese physicians are an important secondary audience. Focus group participants identified Asian physicians as common sources of health information. Because they speak the same language, Asian women view Asian physicians as more likely than “American” physicians to be able to fully understand their health needs. Yet Asian physicians may not be adequately oriented toward wellness care or preventive medicine and thus may not be recommending regular screening. ·Culturally appropriate campaigns must be developed based on research that focuses on how to most effectively communicate with these intended audiences. Audience culture should be considered in all aspects of campaign development, particularly in research methodology, message development, and message delivery. Naisbitt (1996) concluded that Asians who are recent immigrants prefer to be addressed as a separate ethnic group with language- and culture-specific needs, while those who are born in the United States prefer to be viewed as a part of mainstream American society. The current focus group research provided indirect support for this observation, although it should be noted that participants were not asked to talk about their preference because it would have been insensitive to do so. Future research should continue to explore how messages and materials can be developed so that they both look and sound culturally appropriate. ·To be culturally appropriate, health education campaigns need to communicate messages in the respective Asian languages. One of the greatest barriers to health care is language. Older Asian women, regardless of their nationality, are likely to be first-generation immigrants who do not speak English fluently and prefer to speak their native language. Future research and program efforts should pay special attention to the specific language and dialect needs of the intended audience. For example, callers to telephone information lines should have the option to speak to an Asian language operator. Message Content ·The current research illustrates that Asian women, regardless of nationality, lack basic awareness and knowledge of breast cancer and mammography screening. Asian women must be attuned to these issues before they can begin to digest more complex information such as risk factors and mammography screening guidelines. Furthermore, this research suggests that Asian women are generally receptive to messages highlighting the importance of breast cancer awareness and mammography screening. ·It is important to convey the appropriate degree of urgency to the topics of breast cancer and mammography so that audience members will find the messages attention-getting but not frightening. Focus group participants stated that messages raising awareness about breast cancer and mammography screening are very important and that women in their community need this information. For this reason, they emphasized that messages should be direct and persuasive. ·When recommending mammography screening to Asian women, peace of mind and the value of early detection may be important screening benefits to highlight. These motivational concepts may help counteract women’s fear of talking about breast cancer and the perception that breast cancer is due to fate. ·Breast cancer and mammography messages for Asian women should be placed in a broader context that emphasizes the importance of women’s overall health. Many Asian women are aware of the importance of eating a healthy diet and getting enough exercise, and they try to practice these healthy behaviors (although their decisions to do so may not be deliberate). Messages need to frame screening tests as part of an Asian woman’s routine health care, similar to eating well, exercising, and taking vitamins or hems. ·Women who have not grown up with Western medical traditions of technology and prevention may not be easily persuaded to make mammography screening a routine practice. We know that many Asian women incorporate ideas from Western and alternative medicine systems, but it is difficult to determine whether they prefer one system over the other. If an Asian woman leans more toward alternative medicine, then she may not be interested in mammograms, which are part of the Western medical tradition. Focusing on staying healthy for one’s family members as part of an overall preventive routine may help bridge the gap between Western and alternative medicine. ·Regardless of audience literacy level, messages should be conveyed in simple, clear terms that are easy to understand. Messages should also explicitly state whether mammography screening services are covered by Medicare and Medicaid, and whether phone lines are free of charge. Low-cost and free services are important for this intended audience. Creative Execution of Materials ·Images used on materials should be relevant to breast cancer and mammography screening, not merely artistic. Focus group participants described a woman with her children, a woman reading a book about breast cancer and mammography screening, groups of women of different ages or different Asian national groups, a woman with her doctor, or a woman getting a mammogram as effective images to be used on materials. ·Given the difficulties of portraying Asian women who look like they are of the appropriate age and nationality, it may be useful to consider using photographs rather than drawings. ·Show women dressed in traditional (versus modern) clothing. In addition, make sure that the women look attractive and age-appropriate to the intended audience. ·Explore whether pictures and images that convey feelings of intimacy will be accepted by this intended audience. Research has indicated that Asian women may be sensitive toward the topic of breast cancer because it evokes feelings of body intimacy and fear. Yet focus group participants stressed that avoiding images of the breast only serves to magnify such feelings in a negative way. Furthermore, some participants suggested emphasizing women’s breasts or showing them, at least in part, in the print materials. It is difficult at this point to determine whether highlighting the breast would resonate well with Asian women; future copy testing efforts should explore this possibility. ·Examine the use of symbolism to convey the appropriate tone. For example, our focus group research revealed that animals, flowers, and certain colors and numbers may be associated with good or bad fortune. It is possible that using symbols of good fortune could help balance out the urgency of the main message that Asian women should get mammograms. ·Employ translators well-versed in appropriate conversational style, grammar, and scientific terms relating to breast cancer and mammography screening. Community organizations are ideal for providing appropriate translations or reviewing drafts of translations. A professional translation service with knowledge of medical terminology should be used in the preparation of all draft materials. ·Write out the numbers of telephone information lines that use acronyms and, when applicable, indicate that they are free of charge. Be sure to include the purpose of the service (i.e., what information it can provide), that an actual person will answer, and what language(s) is spoken. ·Clearly state that NCI is a government organization concerned about Asian women’s health. Focus group participants noted that NCI would be a trusted source because it is a government agency. Message Dissemination ·Partnerships with community organizations are key to programmatic efforts. Asian women possess a substantial amount of knowledge about what their community organizations provide, and they are likely to trust and use these organizations for information and, when possible, for mammography services. This trust may be explained by the fact that community organizations are likely to speak the same language and have well-established communication networks. Some provide mammograms, and most know where to refer women for services. For these reasons, community organizations may be able to provide culturally appropriate materials that can be distributed to the intended audience, distribute NCI’s materials to their service populations, and review NCI’s materials before they are copy tested with intended audience members to ensure they meet standards of appropriateness. ·Dissemination should start at the local level. Planners should identify and concentrate on message dissemination within local Asian communities. In general, Asians reside in discrete communities where there are established networks of family and friends; identifying their locations and directing program efforts in these locations will establish a far-reaching and powerful network for message dissemination. This holds true for both large urban areas and smaller cities. ·The areas to target for initial health education efforts and further research are Los Angeles, New York City, and San Francisco. These areas have a high concentration of Asians. Nevertheless, it is important to monitor migration patterns over the ensuing years, as Asians are slowly moving to other (albeit discrete) areas of the country. ·As key informants pointed out, family members (especially children) are another possible channel of message dissemination because these individuals often act as translators and mediators between the intended audience and the health system. ·Peers who can enhance the perception that mammography screening is the norm can be important influencers to encourage Asian women to get mammograms. In particular, peers who are touched by cancer can relate personal stories and encourage mammograms. ·In-language print media (newspapers, newsletters, journals, magazines), particularly those that are free, are effective ways to disseminate messages. Other effective sources are in-language television and radio. Older Asian women are heavy users of in-language broadcast and print media. Program planners should identify community print sources (e.g., newsletters) that disseminate health messages at little or no cost.
	Details...
Agency:	NIH:National Cancer Institute
Date of Report:	10/1/1999

5

Report Title:	Mammography and Breast Cancer Motivational Messages: A Focus Group Study of their Effectiveness across Ethnic Groups
*Abstract:*	NCI's Office of Communications conducted a series of focus groups with women of diverse ethnic backgrounds. The overall purpose of the research was to find out whether there are particular mammography and breast cancer motivational messages that resonate across ethnic groups, as opposed to having appeal only to a single group.
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Agency:	NIH:National Cancer Institute
Date of Report:	8/1/2000

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