Health literacy, health communication challenges, and cancer screening among rural Native Hawaiian and Filipino women

Background. Native Hawaiian and Filipino women are disproportionately impacted by cancer, and are less likely to participate in cancer screening than whites. Limited information exists about health literacy and cancer-related health communication challenges in these groups.

Methods. Six focus groups (n=77) of Native Hawaiian and Filipino women age 40+ in rural communities were conducted to investigate these research gaps.

Results. Health literacy varied across focus groups. Three groups had high percentages of limited health literacy (>18%) and three groups had low percentages (<10%). Across all focus groups, participants noted many health information challenges. Challenges were both practical and interpersonal and included both written and oral health communication. Practical challenges included “big” words, complexity of terms, and lack of plain English. Interpersonal issues included doctors rushing, doctors not asking them if they understood, and doctors not treating them like individuals. Women noted that they would often not ask questions even when they knew they did not understand because they did not want to be seen as stupid.

Participants had innovative and culturally-relevant ideas to improve cancer-related communication gaps in their communities. Overarching themes included: (1) the importance of family and community in health information dissemination; (2) the key role women play in interpreting health information for others; (3) the importance of personal experience and relationships to the salience of health information; and (4) the desire for local cultural relevance in health communication.

Conclusions. These focus groups provided novel insights into cancer-related communication barriers and solutions among understudied, vulnerable populations.