Using narrative intervention for HPV vaccine behavior change among Khmer mothers and daughters: A pilot RCT to examine feasibility, acceptability, and preliminary effectiveness.

PURPOSE: To develop a theory-guided culturally grounded narrative intervention to promote HPV vaccination behavior and examine the feasibility, acceptability, and preliminary effectiveness of the intervention among dyads of Cambodian American mothers and daughters. METHOD: The principles of community-based participatory research guided the development and evaluation and involved two phases: Phase 1: Development of storytelling narrative intervention videos which focused on a series of HPV vaccination-related messages and which integrated the narrative theory with the revised network episode model (rNEM); Phase 2: conducting the pilot RCT with 19 dyads of Khmer mothers and daughters aged from 14 to 17years to examine the feasibility and acceptability of the study. FINDINGS: Recruitment was completed in 7months with an overall retention of 84%. The acceptability of the intervention was high, as reflected by the number of positive comments on the narrative video. Preliminary data indicate that vaccine uptake at one-month follow-up was the same (2 vs. 2) between intervention and control groups. However, daughters in the narrative intervention group reported higher intention to receive HPV vaccination within one month compared to the control group (4 vs. 1). CONCLUSION: All the procedures to inform a full RCT were examined, including identification of eligible participants, recruitment, randomization, intervention adherence, and short-term follow-up. The positive preliminary outcomes and feedback support the feasibility and potential effectiveness of the theory-guided narrative intervention.

Factors Associated with HPV Vaccination among Cambodian American Teenagers.

OBJECTIVES: Parents have general influence over their children's health and health behavior. However, given the dearth of specific literature regarding knowledge level and social and cultural factors influencing HPV vaccination behaviors among Cambodian American (CA) parent, it is difficult to develop an effective, evidence-based public health HPV vaccination program. Therefore, the objectives of this study were to determine the HPV vaccine uptakes among CA teenagers and to examine factors influencing HPV vaccine uptakes. DESIGN AND SAMPLE: A descriptive, cross-sectional survey design and a combination of network and targeted sampling methods were used. RESULTS: CA mothers (n = 130) completed a health survey through face-to-face interviews in either English or Khmer language. Girls vaccination rates were 29% while that of boys was 16%. Awareness and knowledge of HPV among CA mothers was very low, and many believed that their daughters, who speak English and were educated in the U.S., had more knowledge about health than they did. Logistic regression analysis showed that CA girls had significantly higher odds of vaccination when their mothers possessed a higher level of English reading ability and had greater awareness and knowledge of HPV. CONCLUSIONS: The strikingly low rates of HPV vaccination among CA girls and boys underscore the need to improve vaccination outreach, education, and uptake. The findings can be used to develop targeted public health HPV vaccination programs for CAs, which will reduce cervical cancer disparities.

Khmer American Mothers' Knowledge about HPV and HBV Infection and Their Perceptions of Parenting: My English Speaking Daughter Knows More.

PURPOSE: The purpose of this study is to explore and describe Khmer mothers' understanding of HBV and HPV prevention as well as their perception of parenting on health and health education of their daughters in the US. METHODS: The qualitative pilot study guided by the revised Network Episode Model and informed by ethnographic analysis and community-based purposive sampling method were used. Face-to-face audiotaped interviews with eight Khmer mothers were conducted by bilingual female middle-aged community health leaders who spoke Khmer. RESULTS: The findings revealed that Khmer mothers clearly lacked knowledge about HBV and HPV infection prevention and had difficulty understanding and educating their daughters about health behavior, especially on sex-related topics. The findings showed that histo-sociocultural factors are integrated with the individual factor, and these factors influenced the HBV and HPV knowledge and perspective of Khmer mothers' parenting. CONCLUSIONS: The study suggests that situation-specific conceptual and methodological approaches that take into account the uniqueness of the sociocultural context of CAs is a novel method for identifying factors that are significant in shaping the perception of Khmer mothers' health education related to HBV and HPV prevention among their daughters. The communication between mother and daughter about sex and the risk involved in contracting HBV and HPV has been limited, partly because it is seen as a "taboo subject" and partly because mothers think that schools educate their children regarding sexuality and health.

Using qualitative methods to develop a contextually tailored instrument: Lessons learned.

OBJECTIVE: To develop a population-specific instrument to inform hepatitis B virus (HBV) and human papilloma virus (HPV) prevention education and intervention based on data and evidence obtained from the targeted population of Khmer mothers reflecting their socio-cultural and health behaviors. METHODS: The principles of community-based participatory research (CBPR) guided the development of a standardized survey interview. Four stages of development and testing of the survey instrument took place in order to inform the quantitative health survey used to collect data in stage five of the project. This article reports only on Stages 1-4. RESULTS: This process created a new quantitative measure of HBV and HPV prevention behavior based on the revised Network Episode Model and informed by the targeted population. The CBPR method facilitated the application and translation of abstract theoretical ideas of HBV and HPV prevention behavior into culturally-relevant words and expressions of Cambodian Americans (CAs). CONCLUSIONS: The design of an instrument development process that accounts for distinctive socio-cultural backgrounds of CA refugee/immigrant women provides a model for use in developing future health surveys that are intended to aid minority-serving health care professionals and researchers as well as targeted minority populations.

HBV-related health behaviors in a socio-cultural context: perspectives from Khmers and Koreans.

PURPOSE: The aim of this study is to explore factors influencing health and health care within the sociocultural context of Cambodian Americans (CAs or Khmers) and Korean Americans (KA) and to examine intergroup similarities and differences between CAs and KAs, focusing on hepatitis B virus (HBV) and liver cancer prevention behaviors. METHODS: The study used a qualitative design guided by the revised Network Episode Model (NEM) and informed by ethnographic analysis. Focus group interviews with key informants among CA community health leaders (CHLs, n=14) and individual interviews with key informants of KA CHLs (n=9) were audiotaped and transcribed. RESULTS: Three categories that influenced HBV and liver cancer prevention emerged from both CAs and KAs: the socio-cultural, individual, and behavioral. Four additional subcategories (sub-themes) of sociocultural were identified as socio-history, socio-medicine, socio-linguistic, and socio-health resources. Both CAs and KAs, however, have low levels of knowledge and significant misunderstandings about HBV infection. CONCLUSIONS: The study identifies and compares the social-cultural determinant for HBV and liver cancer and highlights the factors of education, intercultural communication, and interactions within socio-cultural contexts of CA and KA subgroups. In general, conceptual overlaps are apparent between Khmers (from now on, the terms, CA and Khmer, will be used interchangeably) and Koreans except for the sub-theme of socio-history. However, differences in concept-specific attributes point to the need to account for differing conceptualizations and implications of specific ethnic groups' sociocultural contexts, and to design contextually-relevant outreach and educational interventions for targeted AAPI subgroups.

Normal grief and complicated bereavement among traumatized Cambodian refugees: cultural context and the central role of dreams of the dead.

This article profiles bereavement among traumatized Cambodian refugees and explores the validity of a model of how grief and post-traumatic stress disorder (PTSD) interact in this group to form a unique bereavement ontology, a model in which dreams of the dead play a crucial role. Several studies were conducted at a psychiatric clinic treating Cambodian refugees who survived the Pol Pot genocide. Key findings included that Pol Pot deaths were made even more deeply disturbing owing to cultural ideas about "bad death" and the consequences of not performing mortuary rites; that pained recall of the dead in the last month was common (76 % of patients) and usually caused great emotional and somatic distress; that severity of pained recall of the dead was strongly associated with PTSD severity (r = .62); that pained recall was very often triggered by dreaming about the dead, usually of someone who died in the Pol Pot period; and that Cambodians have a complex system of interpretation of dreams of the deceased that frequently causes those dreams to give rise to great distress. Cases are provided that further illustrate the centrality of dreams of the dead in the Cambodian experiencing of grief and PTSD. The article shows that not assessing dreams and concerns about the spiritual status of the deceased in the evaluation of bereavement results in "category truncation," i.e., a lack of content validity, a form of category fallacy.

Loving-kindness in the treatment of traumatized refugees and minority groups: a typology of mindfulness and the nodal network model of affect and affect regulation.

This article discusses how loving-kindness can be used to treat traumatized refugees and minority groups, focusing on examples from our treatment, culturally adapted cognitive-behavioral therapy (CA-CBT). To show how we integrate loving-kindness with other mindfulness interventions and why loving-kindness should be an effective therapeutic technique, we present a typology of mindfulness states and the Nodal Network Model (NNM) of Affect and Affect Regulation. We argue that mindfulness techniques such as loving-kindness are therapeutic for refugees and minority populations because of their potential for increasing emotional flexibility, decreasing rumination, serving as emotional regulation techniques, and forming part of a new adaptive processing mode centered on psychological flexibility. We present a case to illustrate the clinical use of loving-kindness within the context of CA-CBT.

Long-term development of a "whole community" best practice model to address health disparities in the Cambodian refugee and immigrant community of Lowell, Massachusetts.

Cambodians in Lowell, Massachusetts, experience significant health disparities. Understanding the trauma they have experienced in Cambodia and as refugees has been the starting point for Lowell Community Health Center's whole community approach to developing community-based interventions. This approach places physical-psychosocial-spiritual needs at the center of focus and is attentive to individual and institutional barriers to care. Interventions are multilevel. The effect of the overall program comes from the results of each smaller program, the collaborations and coordination with the Cambodian community and community-based organizations, and the range and levels of services available through the health center.