Breast Health Behaviors of Immigrant Afghan Women

Institution: Afghan Coalition
Investigator(s): Aida  Shirazi ,  - Joan  Bloom , Ph.D. -
Award Cycle: 2007 (Cycle 13) Grant #: 13AB-1301 Award: $99,255
Award Type: CRC Pilot Award
Research Priorities
Disparities>Disparities: eliminating the unequal burden of breast cancer

This is a collaboration with: 13AB-1300 -

Initial Award Abstract (2007)
Early detection and treatment of breast cancer can save lives. Despite evidence that early detection leads to decreased breast cancer mortality, it continues to be underused by minority women, especially new immigrants. Research shows that Muslim immigrant women are less likely to use breast care health services and are more likely to die from breast cancer. Due to the on going war crisis in Afghanistan, there has been an increase in the number of immigrants to the United States from this country. It is estimated that there are more than 60,000 Afghans in the United States. The Bay Area is home to the largest Afghan community in the US with an estimate of more than 30,000. Research conducted outside of United States indicates that Afghan immigrant women, diagnosed with breast cancer, are ten years younger compared to western women. In addition, they are usually diagnosed with breast cancer at a more advanced stage. This places Afghan women at very high risk of death from breast cancer. To our knowledge no one yet has studied Afghan immigrant women’s understanding of breast health. We plan to examine, the beliefs, knowledge, attitudes, needs and barriers of this underserved population in Northern California about breast health care and early detection.

The question(s) or central hypotheses of the research in non-technical terms:
The central question in this proposal is to understand how Afghan women in Northern California view their breast health. In this pilot study, we hope to:
  1. Learn more about what the Afghan community members believe to be their greatest concerns and barriers to receiving breast health care.

  2. Learn more about Afghan women’s knowledge and attitudes about breast health care and their opinions about their sources of health information.

  3. Identify the specific cultural/religious characteristics needed to adapt an existing “successful” community breast health education and promotion program to the needs of the Afghan Women.

The information that we will learn from this study not only has the potential to increase breast health awareness among Afghan women, but may also help increase breast cancer awareness and the likelihood of early detection among other Muslim women in California and the US.

In this qualitative project we will conduct face- to face- interviews with 50 first generation immigrant Afghan women, 40 years of age and older with limited English proficiency and no personal history of breast cancer who live in Northern California. The participants will be recruited through the Afghan Community. Trained bilingual community members will conduct the interviews in the women’s native language (Farsi). Qualitative methods and software will be used to analyze the interviews and develop new knowledge regarding the knowledge, attitudes, and barriers to receiving breast health care.

By conducting in-depth interviews with Afghan women we can learn more about the existing barriers in access and utilization of breast health care services from the women’s personal point of view. Not only does this group of women face cultural barriers as other groups do, but also religious barriers (taboos) that may preclude them from learning about their breast health and using existing services. Afghan culture/religious values are utilized in all phases of the research.

The proposed pilot project is a collaboration between the Afghan Coalition located in Southern Alameda County and the School of Public Health at UC Berkeley. We have already established a dynamic and interactive Community Advisory Board. People from the Afghan Coalition and Afghan community will participate in all aspects of the project, both as members of the Advisory Board and as project partners. The Advisory Board meetings have been very successful in the preliminary planning of the research project to develop a partnership where there is equity of control and participation by the community and research partners. Both the community and research team have certain roles in all phases of the project. Community PI and the Scientific PI will work together to direct the project. The members of the Afghan Coalition will continue to participate in all aspects of the design and implementation of the project from the development of the instruments, to the data collection, data analysis and interpretation, and writing of reports and manuscripts. The community will be directly involved in recruiting the study participants, conducting interviews, and transcribing and translating the interviews and providing feedback. The lay community members (grass roots) will have an active role in recruiting community members and will participate during the entire duration of the research to share their insights and experiences with the group.


Progress Report 1 (2008)
Despite evidence that early detection leads to reductions in breast cancer mortality, early detection methods continue to be underused by minority women, especially immigrants. For instance, research shows that the incidence of breast cancer among ethnic minority women is lower than the Euro-American population in the US, but early detection and survival rates are also lower. Afghan refugees are part of the largest refugee population in the world. The ongoing humanitarian crisis in Afghanistan has caused a sharp increase in the number of Afghan immigrants in the US and Afghan women are among those at the highest risk for health problems due to lack of access to health services, lack of education, language barriers, men's gate keeping, social isolation, and cultural and religious barriers. Our focus is to determine whether cultural and social impediments prevent immigrant Afghan women from receiving breast health care.

The aims of this qualitative study are:
  1. To identify what Afghan community members believe to be their greatest concerns and barriers to receiving breast health care.
  2. To identify the women's knowledge, attitudes and sources of information regarding breast health care.
  3. To identify specific religious/social elements need to adapt and linguistically tailore an evidence-based education program for Muslim immigrant Afghan women.

We are still interviewing subjects for the study. The major barriers in the project to date include: 1) getting an H1B Visa for Mehra Shirazi, PhD who is to be the post-doctoral fellow--this has precluded hiring her as a post-doctoral employee. We will need her help in analyzing the data we are collecting; 2) getting the money for the project that caused us to delay interviewing of the women, the money was finally received by the Afghan Coalition in December, 2007: 3) transcribing the interview consists of two processes--transcription and translation of digitalized tapes of the interviews. It has taken some time to work out the process of interviewing to facilitate the transcription.

The major accomplishments to date include: a) working with our Community Advisory Committee in designing the open-ended interview protocol; b) training five community members to do qualitative interviewing; c) completing 42 interviews to date; d) transcribing 12 interviews to date.

We expect to complete interviews, transcriptions and data analysis, so that and we can identify an evidence based education program to be linguistically and culturally adapted for immigrant Afghan women.