Exploring Individual and Social Determinants of Health to Improve Access to Breast and Cervical Cancer Screening for Cambodian and Thai Women in California

Southeast Asian women, including Cambodians and Thais, experience higher rates of breast and cervical cancer incidence than any other racial/ethnic group in the U.S. Incidence of cervical cancer among Cambodian and Thai women is among the highest in the U.S. and incidence rate of breast cancer for these two groups is rapidly increasing, while rates are decreasing for other racial/ethnic groups. Cambodians and Thai women also experience higher rates of late-stage breast cancer than non-Hispanic White women, resulting in increased morbidity and mortality from the disease. Despite these staggering statistics, little is known about barriers and facilitators of screening for Cambodian and Thai women, particularly women in Southern California, which is home to the largest population of both groups. This dissertation sought to better understand breast and cervical cancer screening behavior among Cambodian and Thai women in California. Using a mixed methods approach, this study has the following aims: 1) identify individual and environmental level predictors of breast and cervical cancer screening among Cambodian and Thai women in Northern and Southern California, 2) examine the association between behavioral intention and mammogram adherence among Cambodian and Thai women in Southern California, 3) explore ethnic-specific, culturally-based norms and systems-related factors that influence the decision-making process for Cambodian and Thai women in Southern California, and 4) examine the role of community health navigators in assisting Cambodian and Thai women to overcome individual and environmental barriers to mammogram screening in Southern California. Results from this study contribute to breast and cervical cancer literature and expands the existing literature on Cambodian and Thai women. By stratifying data analysis, the quantitative portion of this study identified community-specific individual, social, and environmental level predictors of breast and cervical cancer screening. Additionally, the qualitative portion of this study found that while self-efficacy and health-care seeking behavior differ between Cambodian and Thai women in Southern California, these two groups are influenced by similar factors in the decision-making process. Lastly, using a mixed methods approach, this study found that Cambodian and Thai women are not able to act on their intentions to get screened without assistance from a Community Health Navigator. This finding supports previous research that found behavioral intention to be a poor indicator of actual behavior in more disadvantaged communities. The overall findings of this dissertation research have significant implications for how health disparities are conceptualized and addressed in diverse communities. This research recognizes that health behavior is a function of individual, social, and environmental factors and as such, a mixed methods approach is need to better contextualize and interpret breast and cervical cancer screening practices for Cambodian and Thai women in Southern California. This dissertation research underscores the need to move beyond the traditional research paradigm of using quantitative methods alone and reinforces the value of using mixed paradigms and methods to better understand health behavior in order to design more effective interventions to eliminate health disparities