The Vietnamese American women in this study were willing to learn, discuss, and share information about breast cancer with their family and friends. Consistent with earlier studies, breast cancer screening adherence rates were low. The breast cancer screening rates among Vietnamese American women reported by McPhee, Bird, and Davis, for example, showed that 57% of women aged 40 and older had never had a clinical breast examination, and 51% of women 50 and older had never had a mammogram. Screening rates for study participants improved following the grocery store-based educational intervention, suggesting that the simultaneous access to knowledge and screening along with the reduction of language and cultural barriers may have been sufficiently synergistic facilitators to prompt some women to schedule appointments. This hypothesis warrants further evaluation. The women's low rates of adherence to the American Cancer Society's annual screening guidelines, their perceived need for more information, and their receptivity to receiving health information underscore the importance of raising breast cancer awareness within this cohort. The frequent reporting of lack of time to pursue health education in this and other studies underscores the value of creating education programs women can easily access. The Asian Grocery Store-Based Cancer Education Program reduced the time barrier by (1) becoming a part of the women's routine social patterning, (2) providing a concise transfer of the key information points in verbal and written format, and (3) giving phone numbers for nearby free and low-cost screening services. Because the educational intervention was offered repeatedly at the participating Asian grocery stores, women had the opportunity to return for additional information. Some also brought loved ones with them. These were opportunities to offer additional screening reminders. Even when the exhibit was not present, women passed by the location where the community health educators had previously greeted them on one or more occasions, possibly offering subliminal cueing. The finding that only 20.7% of the participants reported language as a barrier to breast cancer knowledge and screening was unexpected, given that 98% of the women reported Vietnamese as their primary language and the region's dearth of Vietnamese-proficient physicians. Studies have reported that between 41 and 48% of Vietnamese Americans have limited English proficiency. It is possible that because the program was available in Vietnamese, women were reporting that language was not a barrier in this program. On the other hand, it may be that although Vietnamese was the women's preferred and most proficient language, they had sufficient English proficiency that language was not a barrier to health care. Beyond the barriers reported in this study, there are other possible contributors to the low frequency of breast cancer screening in these Vietnamese American women. For example in traditional Vietnamese medicine, there is a focus on treating symptoms rather than preventing disease, and a focus on herbal remedies rather than taking pills and aggressive interventions. Having clinical breast exams or mammograms to find cancer early so that treatment can be initiated promptly is a less familiar paradigm to recently immigrated Vietnamese women and may contribute to a lower acceptance of preventive health care. Culture, cultural bias, and misinformation may also prevent women from receiving regular breast examination and mammography. One of these beliefs, for example, is that only sexually active women are prone to breast cancer. Some Vietnamese American women in the present study also expressed the belief that women get breast cancer because men fondle the breasts too hard.
