Improving the validity and generalizability of studies with underserved US populations expanding the research paradigm

The gap in cancer incidence and mortality between ethnic minority groups and European Americans in the U.S. is significant and growing. Compared with a drop in incidence and mortality rates in the U.S. since 1992, the rates for ethnic minority groups have increased or stayed the same. A major transformation in the predominantly deductive social and behavioral research paradigm in cancer is required to reduce these disparities in cancer outcomes and improve the quality of life fur ethnic minority populations with cancer. This article highlights the fundamental changes that are required to transform the prevalent paradigm for social and behavioral research in cancer care from a monocultural, Eurocentric framework to a multicultural one. Use of the expanded framework would enhance the scientific rigor, validity, generalizability, applicability, anal acceptability of multicultural behavioral research. The strategies developed from such research would have a greater likelihood of success in providing optimal cancer care for underserved populations and reduce the disparities in cancer outcomes between U.S, ethnic minority populations and the white population Examples from the cancer literature are used to illustrate each of the seven steps of the expanded paradigm. (C) 2000 Elsevier Science Inc. All rights reserved.