Cultural considerations in development church-based programs to reduce cancer health disparities among Samoans

Abstract

We examined receptivity to developing church-based cancer programs with Samoans. Cancer is a leading cause of death for Samoans, and investigators who have found spiritually linked beliefs about health and illness in this population have suggested the Samoan church as a good venue for health-related interventions. We interviewed 12 pastors and their wives, held focus groups with 66 Samoan church members, and engaged a panel of pastors to interpret data. All data collection was conducted in culturally appropriate ways. For example, interviews and meetings started and ended with prayer, recitation of ancestry, and apology for using words usually not spoken in group setting (like words for body parts), and focus groups were scheduled to last 5 hours, conferring value to the topic and allowing time to ensure that cancer concepts were understood (increasing validity of data collected). We found unfamiliarity with the benefits of timely cancer screening, but an eagerness to learn more. Church-based programs were welcome, if they incorporated fa'aSamoa (the Samoan way of life )-including a strong belief in the spiritual, a hierarchical group orientation, the importance of relationships and obligations, and traditional Samoan lifestyle. This included training pastors to present cancer as a palagi (white man) illness vs. a Samoan (spiritual) illness about which nothing can be done, supporting respected laity to serve as role models for screening and witnesses to cancer survivorship, incorporating health messages into sermons, and sponsoring group education and screening events. Our findings inform programming, and our consumer-oriented process serves as a model for others working with minority churches to reduce cancer health disparities.