A health literacy-focused intervention to improve breast and cervical cancer control among Korean American women

Background/Significance: Recent immigrants, including Korean Americans (KA), face an unequal cancer burden related to the significant language and cultural barriers they face in attempting to navigate the US healthcare system. Limited health literacy, closely associated with limited English language proficiency, strongly predicts inadequate utilization of healthcare resources among immigrants.

Objective/Purpose: Based on a strong partnership built over the past ten years, this academic-community collaborative team developed and tested a health literacy-focused intervention in non-adherent KA women (N=560).

Methods: Using a cluster-randomized study design, the intervention was delivered to 278 KA women by trained community health workers (n=13) from 11 ethnic churches in the Baltimore-Washington metropolitan area. The intervention consisted of computerized health messages tailored to the level of health literacy and individual risk factors, health literacy skills training, and navigation assistance. The comparison group (n=282 from 13 churches) received publicly available educational brochures.

Results: 57% of those in the intervention group received cancer screening compared to 10% in the comparison group at 6 months (p< 0.01 for both cancers). Between-group differences in improvements in health literacy scores were also significant (p< 0.001). Preliminary analysis showed that participating in the intervention significantly improved psychological outcomes such as cancer knowledge, decisional balance, and self-efficacy in the expected directions.

Conclusion: While previous interventions have primarily focused on accommodating women's needs rather than developing their skills, our findings support the use of health literacy as part of an intervention approach in improving cancer screening behaviors among women with limited English skills.