Korean Immigrants & Mammography—Culture-Specific Health Intervention (KIM-CHI)
In this two-group cluster randomized, longitudinal, controlled design, the KIM-CHI and
control activities were delivered immediately after baseline data collection at 50 KA
religious organizations. Participants in the attention control group followed the same study
procedures as participants in the KIM-CHI group, except for the content of the educational
films. The baseline and longitudinal data were collected from August 2008 to September 2010
in Cook County, Illinois.
The KIM-CHI group slogan was "Healthy Family, Healthy Wife," and the control group slogan
was "Healthy Family, Healthy Diet," emphasizing the importance of the husband's support in
promoting family health by improving breast cancer screening or diet in the KIM-CHI and
attention control groups, respectively.
The KIM-CHI program consisted of (1) showing a project team-designed 30-minute Korean
language film (in DVD format) on breast cancer screening to change health beliefs; (2)
holding a brief group discussion session immediately after the film showing; and (3)
requiring each couple to complete a discussion activity together at home to enhance spousal
support for the women.
A total of 516 women were assessed for eligibility for this study from August 2008 to June
2009. 428 KA women were recruited at baseline. The response rates for returning homework
activity in intervention and control groups were 98.1% (207/211) and 98.6% (214/217),
All the variables reported are from KA women, but socio-demographic variables are from both
KA women and their husbands. Mammography uptake was measured by self-report at 6- months and
15-months post-baseline, based on the ACS guideline recommending that women 40 and older
receive a mammogram every year. Predictor variables measured were age, education,
employment, and level of acculturation. Level of acculturation was measured by the
Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA). The SL-ASIA was modified
slightly by deleting one item about generation because it was not relevant for
first-generation KAs. The words "Asian" and "Oriental" in the original instrument were also
changed to "Korean." Scoring for the revised SL-ASIA was the same as the original SL-ASIA,
using a 5-point Likert scale with a final score ranging from 1.00 (low acculturation) to
5.00 (high acculturation). Questions on health care resources and utilization, health
insurance status, usual source of care (a regular place or doctor to visit), and physical
examinations in the past 2 years without sickness or for health problems were measured.
Family history of breast cancer and history of mammography (when the last mammogram was, if
they ever had one) were also measured.
After Human Subjects Review Approval was obtained, invitation letters were mailed to all 210
religious organizations listed in the Korean language Chicago Korean Business Directory
2006. One hundred KA organizations were contacted to request participation in the study and
110 KA religious organizations were treated as "unable to reach." Of those 100 contacted
organizations, 32 were ineligible (e.g., they were younger KAs, students, multi-ethnics, or
disabled persons). Eighteen of the remaining 68 eligible organizations (26.5%) refused to
participate. The 50 organizations were randomly assigned to either the KIM-CHI or attention
control group. After random assignment, the characteristics of religious organizations
(location and size) were not statistically significantly different between the two groups.
A total of 428 couples participated in this study at baseline; 211 wife-husband dyads from
26 KIM-CHI organizations and 217 wife-husband dyads from 24 attention control organizations.
KA women and their husbands who were interested in participating in our study signed two
copies of an informed consent form. Next, each completed a self-administered baseline
questionnaire which took 30-45 minutes. Then they received the KIM-CHI or control education.
Six- and 15-month post-baseline data were collected via phone by telephone surveyors who
were blind to the study group assignment. At 6-months, 414 women participated in the
telephone survey in Korean, with 3.3% lost to follow-up. At 15-months post-baseline, 395
women participated in the telephone survey, with 7.7% lost to follow-up, for the entire
study period. The reasons for lost to follow-up were death, refused to participate, or
unable to contract. KA women included at the 15 months' data collection (n = 395) and those
who dropped out (n = 33) did not differ in demographic or other major variables in this
Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Screening
Change from baseline in mammography uptake at 15 months
Non of the participants at baseline had a mammogram within the previous 1 year. The primary outcome was measured by self-report about how many times and when (month and year) mammograms were obtained by women in the study, with follow-up validation by the mammography facility for each woman who reports having had a mammogram in the past 15 months at Time 3. The number of mammograms (o, 1, or 2) and length of time to mammogram were calculated.
6- and 15-months post-baseline
Eunice E Lee, PhD
UCLA School of Nursing
United States: Institutional Review Board