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Colorectal Cancer Screening among Chamoru on Guahan: Barriers and Access to Care.

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Title:Colorectal Cancer Screening among Chamoru on Guahan: Barriers and Access to Care.
Authors:Diaz, Tressa P.
Contributors:Social Welfare (department)
Date Issued:Aug 2017
Publisher:University of Hawaiʻi at Mānoa
Abstract:Colorectal cancer (CRC) is the second most common cause of cancer death on Guahan (Guam).
Chamoru, the Indigenous peoples of Guahan, have the highest mortality rates in CRC on island,
which implicates the need for earlier detection. Limited research has been conducted on CRC
screening behavior among Chamoru. To address the gap, this study seeks to understand, explore,
and predict factors associated with CRC screening among Chamoru, and to address the research
questions: (1) How does access to care impact colorectal cancer screening among Chamoru on
Guam; and (2) What are barriers to colorectal cancer screening among Chamoru on Guam?
Guided by Andersen’s Behavioral Model of Health Service Utilization, individual predictors
were categorized as predisposing, enabling, and need factors that facilitate or hinder CRC
screening. A mixed quantitative and qualitative methods approach was utilized. First, screening
data from the 2010 Guam Behavioral Risk Factor Surveillance System were used to model the
association between CRC screening and predisposing, enabling, and need factors. Second, semistructured
in-depth interviews with Chamoru men and women were conducted on why they
opted for or against CRC screening. Purposive and snowball sampling was implemented to
recruit participants due to the potentially sensitive and stigmatizing subject of colon/rectum
screening processes. Binary logistic regression was used in quantitative analysis to determine
significant predictors of CRC screening utilization. Qualitative analysis implemented Grounded
Theory to determine relevant themes and key findings. Quantitative results show that having an
annual check-up and educational attainment of high school or greater significantly predicted
CRC screening. Qualitative analysis points to five themes in CRC screening decision-making:
(1) being proactive in one’s healthcare; (2) intergenerational consciousness of cancer diagnosis
and related screening behaviors; (3) social stigma associated with colonoscopies; (4) “If I’m
gonna die, I’m gonna die”; and (5) negative perceptions of the medical system. Findings provide
insight toward cultural and health beliefs as facilitators and barriers to CRC screening with
broader implications for political status as a determinant of health. Further research toward
culturally tailored screening interventions is recommended to address cancer disparities in the
context of healthcare access and health equity for Chamoru.
Description:Ph.D. Thesis. University of Hawaiʻi at Mānoa 2017.
Rights:All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
Appears in Collections: Ph.D. - Social Welfare

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