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pdfOMB #0925-0046
Exp. Date: 10/31/2006
National Cancer Institute and the Vietnamese American Medical Association
Pap Test Barriers Survey for Health Care Providers
The National Cancer Institute (NCI) has received permission from the Vietnamese American Medical
Association (VAMA) to survey its members and other supporters to learn more about barriers to cervical
cancer screening among Vietnamese women. Your answers to these questions will help guide the
development of educational materials, written in Vietnamese, to help motivate women to receive routine
Pap tests. This survey should take about 5 minutes to complete.
Your participation in this survey is completely voluntary. Your responses will be kept confidential and
will not be disclosed to anyone except the people conducting the survey, or as otherwise required by
law. Data will be provided to the NCI in aggregate form only, with any potentially identifying
information removed. You may skip any questions that you prefer not to answer.
Please return this survey in the postage paid envelope provided by Wednesday, August 18, 2004.
Thank you in advance for your time and comments.
QUESTIONS ABOUT CERVICAL CANCER
1.
2.
How important would you say routine Pap tests are in the early detection of cervical
cancer in Vietnamese women living in the United States?
Very important
Not at all important
Somewhat important
Don’t know
Please rate on a scale of “1” to “5” how much of an influence each of the following
factors are in explaining why Vietnamese women may not seek a Pap test, with “1” being
very influential and “5” being not very influential.
1
Cost of Pap test is too high
Fear about cancer
Lack of knowledge about the importance of
Pap tests
No access to screening services
Language barriers
Cultural or religious beliefs
Other (please specify)
_____________________________
_____________________________
1
2
3
4
5
Don’t
know
3.
In your opinion, are there any reasons why Vietnamese providers may not recommend
Pap tests for specific Vietnamese patients? If so, please explain.
4.
In your opinion, what should be done to encourage more Vietnamese women to get Pap
tests?
QUESTIONS ABOUT PATIENT EDUCATION MATERIALS
5.
What types of patient education materials are needed to help to motivate Vietnamese
women who have rarely or never received a Pap test? (please check as many as you want)
Printed booklet with detailed information
One-page fact sheet with basic, introductory information
Poster with motivational message
Print materials that include both English and Vietnamese translations in the same
publication
Other (please specify) _______________________________________________
Don’t know
6.
Would it be helpful to have materials that include an English and Vietnamese translation
within the same publication?
Yes
No
Don’t know
2
Two years ago the National Cancer Institute and the Vietnamese American Medical
Association collaborated on this brochure about cervical cancer screening.
7a
Have you ever seen this brochure?
Yes
No Æ SKIP to Question #8
Don’t know
7b.
Have you ever used it with patients?
Yes
No Æ SKIP to Question #8
7c.
How would you rate the effectiveness of
this brochure in educating women about Pap
tests?
Very effective
Somewhat effective
Ineffective
Don’t know
7d.
What, if anything, would you change about this brochure to make it better?
Go to next page
3
QUESTIONS ON BACKGROUND
8a.
Which of the following health care provider categories describes you?
Obstetrician/Gynecologist Æ SKIP TO Question #9
Family Practitioner
Nurse Practitioner
Other (please specify) _____________________________________
8b.
Are most of your patients female?
Yes
9.
No
Where did you receive your training to administer Pap tests?
Vietnam
United States
Other (please specify): _______________________________________________
I am not trained to administer Pap tests.
10.
Which of the following settings best describes where you work?
Private practice
Community clinic or local health center
Hospital or medical center
HMO
Other (please specify)
___________________________________________________
Please return this survey in the postage paid envelope provided by August 18, 2004.
Thank you for taking time to complete this survey. Your responses will assist the NCI and
VAMA in developing educational materials to help motivate women to receive routine Pap tests.
4
| File Type | application/pdf |
| File Title | Vietnamese Medical Association |
| Author | Harry Kwon |
| File Modified | 2005-01-25 |
| File Created | 2004-07-12 |