标题：A Qualitative Assessment of Community-Based Breast Health Navigation Services for Southeast Asian Women in Southern California: Recommendations for Developing a Navigator Training Curriculum
摘要：Objectives. We identified key elements required for a training curriculum for Southeast Asian community-based health navigators (CBHNs), who help low-income, immigrant Cambodian, Laotian, Thai, and Vietnamese women negotiate cultural and systemic barriers to breast cancer screening and care in the United States. Methods. We gathered the perspectives of 3 groups: CBHNs, community members, and their providers. We conducted 16 focus groups with 110 women representing different stages of the cancer care continuum and in-depth interviews with 15 providers and 10 navigators to identify the essential roles, skills, and interpersonal qualities that characterize successful CBHNs. Results. The most important areas identified for training CBHNs were information (e.g., knowing pertinent medical information and how to navigate resources), logistics (transportation, interpretation), and affective interpersonal skills (understanding the language and cultural beliefs of patients, communicating with providers, establishing trust). Conclusions. CBHNs serve a crucial role in building trust and making screening practices culturally meaningful, accessible, usable, and acceptable. Future research should focus on developing training curricula, policies, resources, and funding to better maximize the expertise and services that CBHNs provide and to expand our findings to other underserved communities. Women of Southeast Asian (Cambodian, Laotian, Thai, and Vietnamese) backgrounds have some of the highest rates of breast cancer incidence and mortality in the United States, 1 yet they have the lowest rates of breast cancer screening among all ethnic groups in the country. 2 , 3 These women encounter enormous barriers to breast cancer screening and treatment services because of limited English proficiency, lack of transportation, high rates of poverty, and jobs that require long hours and leave little time for preventive health care. 4 In recent years, the importance of community-based health navigators (CBHNs)—outreach workers who improve access to and utilization of breast health services among underserved communities 5 – 17 —has increasingly been recognized. Cancer health navigation can be defined broadly as services assisting individuals to overcome obstacles to timely cancer care, from screening to treatment and survivorship. 16 Many breast cancer studies describe hospital- or clinic-based health navigator programs. 18 – 21 Fewer studies have identified the skills and traits needed by health navigators in community settings, particularly among Southeast Asian communities in the United States. 22 – 27 No nationally recognized curricula or certification or degree programs yet exist for training CBHNs. This gap prompted us to identify essential elements of community-based breast health navigation in 4 Southeast Asian communities in Southern California from the perspectives of multiple stakeholders. Our objective was to identify how CBHNs address cultural differences and systemic barriers to help low-income Southeast Asian women in Los Angeles County and Orange County, California (home to the nation's largest populations of Southeast Asian immigrants) 28 to navigate breast health services across the cancer care continuum. 29 Identifying core navigation elements is the first step toward developing a training curriculum that can be disseminated and replicated in other communities. Three research questions guided our study: (1) What are the important individual, interpersonal, and community factors a breast health navigation program should address? (2) What types of culturally tailored strategies do CBHNs provide to support and enable Southeast Asian American women to obtain necessary services, from initial breast cancer screening exams through diagnostic, treatment, and rehabilitation–survivorship services or end-of-life care? (3) What specific training elements are needed in a community-based navigation program curriculum to prepare CBHNs to be effective in their role in promoting breast health? We interviewed CBHNs, community members, and providers to assess the core elements of monthly CBHN training workshops conducted from 2000 to 2005 and to develop recommendations for a curriculum that could be culturally tailored and tested to increase CBHN effectiveness in diverse communities.
