JMIR Publications

ABSTRACT

Background:

Prostate cancer (PCa) is the most commonly diagnosed non-skin cancer for Canadian males and has one of the highest five-year survival rates, straining systems to provide care. Virtual care can be one way to relieve this strain, but survivors’ care needs and technology use are influenced by intersecting social and cultural structures. Cultural adaptation has been posited as an effective method to tailor existing interventions to better serve racialized communities, including Chinese men. However, cultural adaptations may inadvertently draw attention away from addressing structural inequities.

Objective:

This study used qualitative methods to (1) explore the perceptions and experiences of Chinese Canadian PCa survivors with follow-up and virtual care, and (2) identify implications for the cultural adaptation of a PCa follow-up care application: the Ned Clinic.

Methods:

A relational paradigm and an axiology of relational accountability underpinned our phenomenologically-informed exploratory-descriptive qualitative study design. A community-based participatory approach was used, informed by cultural safety and user-centred design principles, to invite Chinese Canadian PCa survivors and their caregivers to share their stories. Data were inductively analysed to explore their unmet needs, common experiences, and levels of digital literacy.

Results:

Unmet needs and technology preferences were similar to broader trends within the wider PCa survivor community. However, participants indicated that they felt uncomfortable, unable to, or ignored when expressing their needs. Responses spoke to a sense of isolation and reflected a reliance on culturally-informed coping mechanisms, such as “eating bitterness,” and familial assistance to overcome systemic barriers and gaps in care. Moreover, virtual care was viewed as “better than nothing;” it did not change a perceived lack of focus on improving quality of life or care continuity in survivorship care. Systemic changes were identified as likely to be more effective in improving care delivery and wellbeing rather than the cultural adaptation of Ned for Chinese Canadians. Participants’ desires for care reflected accessibility issues that were not culturally specific to Chinese Canadians.

Conclusions:

Chinese Canadian survivors are seeking to strengthen their connections in a healthcare system that provides privacy and accessibility, protects relationality, and promotes transparency, accountability, and responsibility. Designing “trickle-up” adaptations that address structural inequities and emphasize accessibility, relationality, and privacy may be more effective and efficient at improving care than creating cultural adaptations of interventions.