Addressing Cancer Disparities Through Community Engagement: Improving Breast Health Among Haitian Women

Cathy D. Meade

Janelle Menard

Claudine Thervil

Marlene A. Rivera

cultural aspects, breast cancer care
ONF 2009, 36(6), 716-722. DOI: 10.1188/09.ONF.716-722

Purpose/Objectives: To describe processes for fostering community engagement among Haitian women to facilitate breast health education and outreach that are consonant with Haitians' cultural values, literacy, and linguistic skills.

Data Sources: Existing breast cancer education and outreach efforts for Haitian immigrant communities were reviewed. Local community partners were the primary source of information and guided efforts to create a series of health-promoting activities. The resultant partnership continues to be linked to a larger communitywide effort to reduce cancer disparities led by the Tampa Bay Community Cancer Network.

Data Synthesis: A systematic framework known as the CLEAN (Culture, Literacy, Education, Assessment, and Networking) Look Checklist guided efforts for improved communications.

Conclusions: Community engagement forms the foundation for the development and adaptation of sustainable breast education and outreach. Understanding and considering aspects of Haitian culture are important to the provision of competent and meaningful care.

Implications for Nursing: Nurses should expand their skills, knowledge, and competencies to better address the changing demographics of their communities. Nurses also can play a critical role in the development of outreach programs that are relevant to the culture and literacy of Haitian women by forming mutually beneficial partnerships that can decrease health disparities in communities.

Jump to a section


    Albano, J.D., Ward, E., Jemal, A., Anderson, R., Cokkinides, V.E., Murray, T., et al. (2007). Cancer mortality in the United States by education level and race. Journal of the National Cancer Institute, 99(18), 1384-1394.
    Andrulis, D.P., & Brach, C. (2007). Integrating literacy, culture, and language to improve health care quality for diverse populations. American Journal of Health Behavior, 31(1, Suppl.), S122-S133.
    Braveman, P., & Gruskin, S. (2003). Defining equity in health. Journal of Epidemiology and Community Health, 57(4), 254-258.
    Brodwin, P.E. (1996). Medicine and morality in Haiti: The contest for healing power. Cambridge, NY: Cambridge University Press.
    Brookfield, K.F., Cheung, M.C., Lucci, J., Fleming, L.E., & Koniaris, L.G. (2009). Disparities in survival among women with invasive cervical cancer: A problem of access to care. Cancer, 115(1), 166-178.
    Brown, W.M., Consedine, N.S., & Magai, C. (2006). Time spent in the United States and breast cancer screening behaviors among ethnically diverse immigrant women: Evidence for acculturation? Journal of Immigrant and Minority Health, 8(4), 347-358.
    Chu, K.C., Miller, B.A., & Springfield, S.A. (2007). Measures of racial/ethnic health disparities in cancer mortality rates and the influence of socioeconomic status. Journal of the National Medical Association, 99(10), 1092-1100, 1102-1104.
    Consedine, N.S., Magai, C., & Neugut, A.I. (2004). The contribution of emotional characteristics to breast cancer screening among women from six ethnic groups. Preventive Medicine, 38(1), 64-77.
    Consedine, N.S., Magai, C., Spiller, R., Neugut, A.I., & Conway, F. (2004). Breast cancer knowledge and beliefs in subpopulations of African American and Caribbean women. American Journal of Health Behavior, 28(3), 260-271.
    David, M. (2001). Communication, cultural models of breast cancer beliefs, and screening mammography: An assessment of attitudes among Haitian immigrant women in eastern Massachusetts (Rep. No. A226683). Boston: Boston Medical Center.
    David, M.M., Ko, L., Prudent, N., Green, E.H., Posner, M.A., & Freund, K.M. (2005). Mammography use. Journal of the National Medical Association, 97(2), 253-261.
    De Alba, I., Hubbell, F.A., McMullin, J.M., Sweningson, J.M., & Saitz, R. (2005). Impact of U.S. citizenship status on cancer screening among immigrant women. Journal of General Internal Medicine, 20(3), 290-296.
    Desrosiers, A., & St. Fleurose, S. (2002). Treating Haitian patients: Key cultural aspects. American Journal of Psychotherapy, 56(4), 508-521.
    Echeverria, S.E., & Carrasquillo, O. (2006). The roles of citizenship status, acculturation, and health insurance in breast and cervical cancer screening among immigrant women. Medical Care, 44(8), 788-792.
    Engebretson, J., Mahoney, J., & Carlson, E.D. (2008). Cultural competence in the era of evidence-based practice. Journal of Professional Nursing, 24(3), 172-178.
    Erwin, D.O., Spatz, T.S., & Turturro, C.L. (1992). Development of an African American role model intervention to increase breast self-examination and mammography. Journal of Cancer Education, 7(4), 311-319.
    Foster, G.M. (1993). Hippocrates' Latin American legacy: Humoral medicine in the New World. New York: Gordon and Breach.
    Francois, F., Elysée, G., Shah, S., & Gany, F. (2008). Colon cancer knowledge and attitudes in an immigrant Haitian community. Journal of Immigrant and Minority Health, 11(4), 319-325.
    Freeman, H. (2004). Poverty, culture, and social injustice: Determinants of cancer disparities. CA: A Cancer Journal for Clinicians, 54(2), 72-77.
    Goel, M.S., Wee, C.C., McCarthy, E.P., Davis, R.B., Ngo-Metzger, Q., & Phillips, R.S. (2003). Racial and ethnic disparities in cancer screening: The importance of foreign birth as a barrier to care. Journal of General Internal Medicine, 18(12), 1028-1035.
    Kramer, E.J., Ivey, S.L., & Ying, Y. (1999). Immigrant women's health: Problems and solutions. San Francisco: Jossey-Bass.
    Laguerre, M.S. (1981). Haitian Americans. In A. Harwood (Ed.), Ethnicity and medical care (pp. 172-210). Cambridge, MA: Harvard University Press.
    Laguerre, M.S. (1984). American odyssey: Haitians in New York City. Ithaca, NY: Cornell University Press.
    Laguerre, M.S. (1987). Afro-Caribbean folk medicine. South Hadley, MA: Bergin and Garvey.
    Lewis, M.J. (2004). A situational analysis of cervical cancer in Latin America and the Caribbean. Washington, DC: Pan American Health Organization.
    McMullin, J.M., De Alba, I., Chavez, L.R., & Hubbell, F.A. (2005). Influence of beliefs about cervical cancer etiology on Pap smear use among Latino immigrants. Ethnicity and Health, 10(1), 3-18.
    Meade, C.D., & Calvo, A. (2001). Developing community-academic partnerships to enhance breast health among rural and Hispanic migrant and seasonal farm worker women. Oncology Nursing Forum, 28(10), 1577-1584.
    Meade, C.D., Menard, J.M., Martinez, D., & Calvo, A. (2007). Impacting health disparities through community outreach: Utilizing the CLEAN look (culture, literacy, education, assessment, and networking). Cancer Control, 14(1), 70-77.
    Miller, N.L. (2000). Haitian ethnomedical systems and biomedical practitioners: Directions for clinicians. Journal of Transcultural Nursing, 11(3), 204-211.
    Minkler, M. (2000). Using participatory action research to build healthy communities. Public Health Reports, 115(2-3), 191-197.
    Ramirez, A.G. (2003). Consumer-provider communication research with special populations. Patient Education and Counseling, 50(1), 51-54.
    Seeff, L.C., & McKenna, M.T. (2003). Cervical cancer mortality among foreign-born women living in the United States, 1985-1996. Cancer Detection and Prevention, 27(3), 203-208.
    Simon, C.E. (2006). Breast cancer screening: Cultural beliefs and diverse populations. Health and Social Work, 31(1), 36-43.
    Singh, G.K., Miller, B.A., Hankey, B.F., & Edwards, B.K. (2003). Area socioeconomic variations in U.S. cancer incidence, mortality, stage, treatment, and survival, 1975-1999. Retrieved September 22, 2009, from
    Smedley, B.D., Stith, A.Y., & Nelson, A.R. (Eds). (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.
    Suh, E.E. (2008). The sociocultural context of breast cancer screening among Korean immigrant women. Cancer Nursing, 31(4), E1-E10.
    Tammemagi, C.M. (2007). Racial/ethnic disparities in breast and gynecologic cancer treatment and outcomes. Current Opinions in Obstetrics and Gynecology, 19(1), 31-36.
    U.S. Central Intelligence Agency. (2007). CIA world factbook: Haiti. Retrieved March 18, 2007, from
    U.S. Department of Health and Human Services. (2006). Healthy People 2010. Retrieved December 9, 2006, from
    Wallerstein, N., & Bernstein, E. (1994). Introduction to community empowerment, participatory education, and health. Health Education Quarterly, 21(2), 141-148.
    Zanchetta, M.S., & Poureslami, I.M. (2006). Health literacy within the reality of immigrants' culture and language. Canadian Journal of Public Health, 97(2, Suppl.), S26-S30.
    Zéphir, F. (1997). The social value of French for bilingual Haitian immigrants. French Review, 70(3), 395-406.