cross cultural communication

1. Culturally Appropriate
Communication for the
Asian Americans, Native Hawaiians
and Pacific Islanders
Presented by: Mavis Nitta, MPH, CHES
1
Advisory Committee on Breast Cancer in Young Women Meeting
September 21-23, 2011

2. 2
AAs and NHPIs in the U.S.
are Diverse Populations
• ~30 distinct Asian ethnic and
cultural groups1
• 60% of Asians in U.S. foreign
born in 20092
1U.S. Census: The Native Hawaiian and Other Pacific Islander Population: 2000, Census 2000 Brief, issued December 2001; Asian & Pacific Islander
American Health Forum, 2000. 2U.S. Census 2009 Estimates. 3Boeree CG: The Language Families of the World,
http://webspace.ship.edu/cgboer/languagefamilies.html. 4AAPCHO: Asian Americans, Native Hawaiians and other Pacific Islanders (AA and NHOPIs),
http://www.aapcho.org/site/aapcho/section.php?id=10950.
• ~50 distinct Native Hawaiian
and Pacific Islander ethnic
and cultural groups1
• 12% of NHPIs in U.S. foreign
born in 20092
• >2,000 distinct Asian and Pacific languages and dialects3
• >100 Asian or Pacific Island languages/dialects
commonly spoken in the U.S.4

3. 3
Who are
Asian Americans
and how do they differ?

4. 4
Graphic Maps, 2005, http://worldatlas.com/webimage/countrys/as.htm
SOUTH ASIA
Map of ASIA

5. 5
ASIANS
Persons “having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian subcontinent”.1
FAR EAST
(“ASIA”)
SOUTHEAST ASIA INDIAN SUBCONTINENT
(“South Asians”)
Iwo-Jiman
Japanese
Korean
Chinese
Mongolia
Taiwanese
Tibetan2,3
Burmese2 Malayan
Bornean Mien
Cambodian Mongolian
Hmong Nepali2
Indochinese Filipino / Pilipino
Indonesian Singaporean
Javanese Thai
Laotian Vietnamese
Asian Indian
Bangladeshi
Bhutanese
Maldives
Nepali2
Pakistani
Sri Lankan
Afghanistani2
Burmese/Myanmar2
Tibetan2,3
1U.S. Census definition. 2These groups are sometimes included in a broader definition of South Asian or South-east Asian;
although they are not always identified as being of “Asian origin”. 3Although the People’s Republic of China claims sovereignty
over the Tibetan people, Tibet maintains its independence as a government-in-exile. Officially, the U.S. government considers
Tibet to be part of China. However, Tibet’s exiled spiritual leader, the Dalai Lama, has many supporters in the U.S. and the
Congress, and Tibet’s political status remains controversial in the U.S.
Asian American Network for Cancer Awareness, Research & Education, 2000, http://aancart.org/whoareasianamericans.html; Leadership Education for
Asian Pacifics, Inc. (LEAP), 2000; South Asian Public Health Association (SAPHA), 2002; U.S. Census, 2000 and 2004; U.S. Department of State:
Background Notes: Taiwan, U.S. Relations, Oct 2009, http://www.state.gov/r/pa/ei/bgn/35855.htm#relations.

6. 6
Who are
Native Hawaiians and
Pacific Islanders
and how do they differ?

7. 7
WorldAtlas.com (http://worldatlas.com/aatlas/infopage/oceans/pacificocean.htm);
Pacific Resources for Education and Learning (http://www.prel.org/pacserv/pacserv_top.asp)
THE PACIFIC

8. 8
NATIVE HAWAIIANS and
PACIFIC ISLANDERS
Persons “having origins in any of the original peoples of Hawai`i, Guam, Samoa, or other
Pacific Islands”
POLYNESIAN MICRONESIAN MELANESIAN
Cook Islander
French Polynesian
Maori
Native Hawaiian
Niuean
Samoan
Tongan
Tahitian
Tokelauan
Bikini Islander Marshall Islander
Carolinian Marshallese
Chamorro/Guamanian Palauan
Chuukese/Trukese Pohnpeian /
Enewetak Islander (Ponapean)
I-Kiribati Saipanese
Kosraean Tinian Islander
Kwajalein Islander Yapese
Northern Mariana Islander
Fijian
Nauruan
New Caledonian
Ni-Vanuatu /
Vanuatu Islander
Papuan
Papua New Guinean
Solomon Islander
Tuvaluan
U.S. Census: The Native Hawaiian and Other Pacific Islander Population: 2000, Census 2000 Brief, issued December
2001; Asian & Pacific Islander American Health Forum, 2000

9. 9
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
US Total Non-Hispanic
White
Latino /
Hispanic
African Am/
Black
Asian
American
American
Indian/ Alaska
Native
Native
Hawaiian/
Pacific
Islander
281,421.9
216,931.0
35,305.8
36,419.4
11,898.8
4,119.3
874.4
308,745.5
231,040.4
50,477.6
42,020.7
17,320.9
5,220.6
1,225.2
2000 2010
U.S. Census by Race/Ethnicity Inclusive
Population in Thousands, 2000 and 2010
U.S. Census 2000 and 2010
PopulationinThousands
46%
 40%

10. 10
Im/migrant Populations
are more likely to:
• Be socially isolated
– Holding on to their native cultures
– Often exacerbated by language isolation
• Experience significant language barriers
– Non-English speaking
– Limited English Proficient (LEP)
• Be socioeconomically disadvantaged
– High poverty rates
– Medically uninsured
• Despite being employed full-time (often working 2 or more
full-time and/or part-time jobs)

11. Impact of AA and NHPI Culture
• Causes of physical
illness:
– Sins of past life
– Physical ailment is
caused by the
“supernatural”
• Home and folk remedies
(CAM):
– Herbal and plant
medicines common
– Use of massage
• Faith:
– Look to religion for
assistance
– Praying as a cure
– Medicine healers to
treat illness
• Stigma of cancer
• Fatalism
• Fear of knowing
• Social & cultural
obligations (i.e. funerals)
11

12. Structural Challenges Faced by AAs
and NHPIs
• Lack of health insurance
• Undocumented status
• Low socioeconomic
status
• Distorted conclusions
from being categorized
with API
– Data
– Cultural beliefs
• Lack of Asian and Pacific
Islander interpreters
• Need for health
navigation
• Lack of culturally
competent health care
providers
12

13. Culturally and Linguistically
Appropriate Messages
• Use positive pictures and messages
– Connection with family
– Pictures of their people, relatable
– Cancer survivor’s story to put a face to the issue
– Eye catching photos
– Respectful tone
• Positive feeling, happy message, nothing scary
or not directing blame at individual
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14. Culturally and Linguistically
Appropriate Messages
• Message affirms belief that mammograms can
be lifesaving
• Encourages responsibility to take care of self
in order to care for family
– Consider using this message with a family photo
• Clear message on when you should get
mammograms
• Messages need to be direct, but not too
detailed
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15. Language issues
• Chinese:
– Mandarin vs Cantonese
– Simplified vs Traditional
• Filipinos:
– Tagalog vs English vs
Ilocano
• Terminology:
– Layman’s terms vs
medical terminology
– Word for cancer may not
exist in Asian or Pacific
Islander language
– Mammogram is difficult
to translate in various
Asian or Pacific Islander
languages (description is
needed)
15

16. Examples of Educational Materials
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17. Examples of Educational Materials
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18. Breast Cancer Awareness for Tongans
Project
3 media messages were used for project:
1. Life is a gift, Take good care of it, Get a
mammogram
2. A woman’s good health is her most precious gift
to her family. Remember your annual
mammogram.
3. Educate & motivate. Screening saves lives.
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19. Filipino Breast Cancer Project
5 print media messages using family, individual
Filipina, health provider images and messages:
1. Do it for yourself, Do it for your family.
2. Taking care of yourself is showing love to your
family
3. Take care of your health now, so you can be
there for your family later.
4. Mammograms…Not just once, but for a lifetime
5. Ate, Get your mammogram. It could save your
life.
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20. Work with Community to Outreach
and Maintain Communication
• Use ethnic and
mainstream
newspapers, radio, and
television
• Use community lay
health workers
• Work with church
leaders
20

21. Chinese Radio Station
Photonovella in Bengali
Print ad in Vietnamese
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22. Messenger
• Trusted member of the community
– Physician vs nurse vs public health navigator/lay
health worker
– Minister vs minister’s wife
• Male vs Female
• Women they can relate to
– Age/generation
– Color of skin
– Cancer survivors
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23. Take Home Messages
• One size doesn’t fit all approach
• Get feedback from community
• Tailor and adapt
• Evaluate effectiveness of the message
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