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Wahidie D, Yilmaz-Aslan Y, Brzoska P. A Comparative Analysis of Mammography Uptake between Migrant and Non-Migrant Women in Austria-Results of the Austrian Health Interview Survey. Healthcare (Basel) 2024; 12:1468. [PMID: 39120172 PMCID: PMC11311779 DOI: 10.3390/healthcare12151468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 08/10/2024] Open
Abstract
Mammography can reduce breast cancer incidence and mortality. Studies on the utilization of mammography among migrant and non-migrant women are inconsistent. Many of these studies do not take the heterogeneity of migrants in terms of ethnicity and country of origin into account. The aim of the present study was to examine disparities in the use of mammography between non-migrant women and the five largest migrant groups in Austria. The study used data from a nationwide population-based survey of 5118 women aged 45 years and older and analyzed the participation in mammography as a dependent variable. Multivariable logistic regression was used to compare mammography uptake between the aforementioned groups of women, while adjusting for socioeconomic and health variables. The study shows that all migrant groups involved tended to use mammography less frequently than non-migrant women; statistically significant differences, however, were only observed for Hungarian migrant women (adjusted OR = 0.36; 95%-CI: 0.13, 0.95; p = 0.038) and women from a Yugoslavian successor state (adjusted OR = 0.55; 95%-CI: 0.31, 0.99; p = 0.044). These findings are consistent with other studies in Europe and beyond, highlighting the heterogeneity of migrant populations and emphasizing the need for a diversity-sensitive approach to health care.
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Affiliation(s)
- Diana Wahidie
- Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany; (Y.Y.-A.); (P.B.)
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Di Girolamo C, Cammarata G, Giordano L, Zengarini N, Ferracin E, Vergini V, Ferrante G, Ricceri F. Contextual and individual inequalities in breast cancer screening participation and outcomes in Turin (North-West Italy). NPJ Breast Cancer 2024; 10:51. [PMID: 38937476 PMCID: PMC11211318 DOI: 10.1038/s41523-024-00660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
Breast cancer incidence and screening participation exhibit an unequal distribution in the population. This study aims to investigate the impact of socioeconomic position (SEP) on three breast screening indicators (participation, recall, and cancer detection rates) among women aged 50-69 in the city of Turin between 2010 and 2019. The study also aims to determine whether contextual factors (deprivation index) or individual factors (educational level) have a greater influence. The data used in this study are sourced from the Turin Breast Screening Program (TBSP) and the Turin Longitudinal Study (TLS). To test the hypothesis and account for the hierarchical structure of the data, multilevel models were used. Both contextual and individual SEP were found to be associated with screening participation. Participation increased with higher levels of deprivation (odds ratio for most deprived: 1.13; 95% CI 1.11-1.16) and decreased with higher educational levels (OR for low educated: 1.37; 95% CI 1.34-1.40). Contextual SEP did not show any association with recall or cancer detection rates, but individual SEP had an impact. Women with lower educational levels had a statistically significant 19% lower odds of being recalled and a statistically significant 20% lower odds of being diagnosed with cancer. Additionally, immigrant women were less likely to participate in screening, be recalled, or receive a cancer diagnosis. Educational level consistently influenced the analyzed screening indicators, while contextual deprivation appeared to have less importance. It is likely that women living in less deprived areas and with higher education have greater access to opportunistic screening.
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Affiliation(s)
- Chiara Di Girolamo
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH) - Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | | | - Livia Giordano
- SSD Epidemiologia Screening - CRPT, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Nicolás Zengarini
- Epidemiology Department, Local Health Unit TO3, Via Sabaudia, 164, 10095, Grugliasco, Italy
| | - Elisa Ferracin
- Epidemiology Department, Local Health Unit TO3, Via Sabaudia, 164, 10095, Grugliasco, Italy
| | - Viviana Vergini
- SSD Epidemiologia Screening - CRPT, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy
| | - Gianluigi Ferrante
- SSD Epidemiologia Screening - CRPT, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Turin, Italy.
| | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH) - Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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Naseri N, Taleghani F, Hashemi MS, Najimi A. Designing a virtual breast cancer prevention program for Iranian women: A study protocol. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:93. [PMID: 38726097 PMCID: PMC11081432 DOI: 10.4103/jehp.jehp_263_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/30/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND The growing number of breast cancer patients in Iran, following the lower referrals of women to screening centers after the outbreak of the COVID-19, suggests the need for designing virtual educational interventions to teach self-care methods to women. The aim of this study is to design a virtual training program for the prevention of breast cancer in women based on the steps of the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) educational design model. MATERIALS AND METHODS This developmental study will be conducted based on the steps of the ADDIE model. In the first step (analysis), a qualitative study, literature review, and a panel of experts will be conducted to analyze the situation (learners, content, platforms, and media for the electronic presentation of the program). In the design step, the learning objectives, educational strategies, and the way of program's implementation and evaluation will be specified. In the third step, not only are the content, storyboard, and educational program developed, but the pilot study is also conducted and formative assessment is performed. In the fourth step, the program will be provided to the audience and will be implemented as a preliminary program. In the final step, the final virtual education program for the prevention of breast cancer in women will be presented based on the results of the evaluation. CONCLUSIONS Using a comprehensive and systematic educational design model can be a step toward making changes and encouraging innovations in breast cancer prevention education programs in women based on virtual education. Given the existing needs and conditions, this program can promote cancer preventive behaviors as much as possible, reduce the costs imposed on the family and healthcare systems, and lower the complications and mortality rate caused by the delayed diagnosis of the disease.
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Affiliation(s)
- Nayereh Naseri
- Ph.D. Student of Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Nursing, Nursing and Midwifery Sciences Development Research Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Fariba Taleghani
- Professor of Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Sadat Hashemi
- Assistant Professor of Nursing, Nursing and Midwifery Care Research Center, Department of Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Najimi
- Associate Professor of Health Education and Promotion, Department of Medical Education, Medical Education Research Center, Education Development Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Portero de la Cruz S, Béjar LM, Cebrino J. Temporal Evolution and Associated Factors of Adherence to Mammography Screening among Women in Spain: Results from Two National Health Surveys (2017-2020). Healthcare (Basel) 2023; 11:2934. [PMID: 37998426 PMCID: PMC10671473 DOI: 10.3390/healthcare11222934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Ensuring equity in cancer screening is recommended by the European Commission. Despite the fact that breast cancer screening is a free population-based program in Spain, there remains considerable variation in the adherence to screening rate among population groups. This study was designed to describe the adherence of breast cancer screening in women in Spain, to evaluate the evolution in the period from 2017 to 2020, and to determine the variables that influence choosing to undergo breast cancer screening. A nationwide cross-sectional study with 7220 females aged 50-69 years from the 2017 Spanish National Health Survey and the 2020 European Health Survey for Spain was performed. We investigated mammography uptake rates, with socio-demographic factors, lifestyle habits, and health-related characteristics as independent variables. Multivariable logistic regression was used to identify the associated factors of mammography adherence. Of the women, 78% had undergone mammography in the previous two years, and there was a significant decrease in the uptake rate for breast cancer screening from 2017 (81.23%) to 2020 (74.68%) (p < 0.001). Educational level, marital status, residential location, nationality, smoking status, alcohol consumption, and leisure-time physical activity were all associated factors of mammography uptake.
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Affiliation(s)
- Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Avda. Menéndez Pidal, S/N, 14071 Córdoba, Spain
- Research Group GE10 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, 14071 Córdoba, Spain
| | - Luis M. Béjar
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain; (L.M.B.); (J.C.)
| | - Jesús Cebrino
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain; (L.M.B.); (J.C.)
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Hofvind S, Iqbal N, Thy JE, Mangerud G, Bhargava S, Zackrisson S, Berstad P. Effect of invitation letter in language of origin on screening attendance: randomised controlled trial in BreastScreen Norway. BMJ 2023; 382:e075465. [PMID: 37726122 PMCID: PMC10507477 DOI: 10.1136/bmj-2023-075465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To explore attendance at organised mammographic screening among immigrant groups that received an invitation letter and information leaflet (invitation) in their language of origin and Norwegian compared with Norwegian only. DESIGN Randomised controlled trial. SETTING Population based screening programme for breast cancer in Norway (BreastScreen Norway), which invites women aged 50-69 to two-view mammographic screening biennially. PARTICIPANTS All women invited to BreastScreen Norway in the study period April 2021 to June 2022 whose language of origin was Arabic (women born in Algeria, Egypt, Lebanon, Iraq, Palestine, Sudan, Syria, Tunisia, or Morocco), English (women born in the Philippines), Polish (women born in Poland), Somali (women born in Somalia), or Urdu (women born in Pakistan) (n=11 347). INTERVENTION The study group received an invitation to screening in their language of origin and in Norwegian, whereas the control group received an invitation in Norwegian only during the study period. MAIN OUTCOME MEASURE Attendance at BreastScreen Norway during the study period. RESULTS Overall attendance was 46.5% (2642/5683) in the study group and 47.4% (2682/5664) in the control group. No statistical differences in attendance were observed after stratification by language of invitation, age at invitation, or years since immigration. CONCLUSIONS No difference in attendance was observed between immigrant women invited to BreastScreen Norway in their language of origin and in Norwegian compared with Norwegian only. Several barriers to cancer screening may exist among immigrants, and translating the invitation is probably only a part of a complex explanation. TRIAL REGISTRATION NCT04672265. CLINICALTRIALS gov NCT04672265.
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Affiliation(s)
- Solveig Hofvind
- The Cancer Registry of Norway, Oslo, Norway
- Department of Health and Care Sciences, The Arctic University of Norway - the University of Tromsø, Tromsø, Norway
| | - Nadia Iqbal
- The Cancer Registry of Norway, Oslo, Norway
- Cancer Registry of Norway and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | - Sameer Bhargava
- The Cancer Registry of Norway, Oslo, Norway
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Sophia Zackrisson
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
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Cao DJ, Alabousi M, Farshait N, Patlas MN. Barriers to Screening At-risk Populations in Canada. Can Assoc Radiol J 2023; 74:508-513. [PMID: 36573884 DOI: 10.1177/08465371221147307] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cancer screening is invaluable for early detection of disease, including for breast and lung cancer. Through early detection, cancer treatment can be commenced prior to the development of advanced stage disease, significantly reducing morbidity and mortality. However, eligible patients may face barriers when accessing screening services, and some groups may be more disproportionately affected than others. This review aims to describe some of the most prominent barriers that at-risk populations may face when accessing image-based cancer screening services in Canada. Characterizing these barriers would be helpful in determining the best strategies to increase uptake to these screening services and, consequently, improve health equity.
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Affiliation(s)
- Daniel J Cao
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Nataly Farshait
- Healthcare Insurance Reciprocal of Canada, Toronto, ON, Canada
| | - Michael N Patlas
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
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Asante AO, Korsah KA, Amoako C. Does the gender of nurses matter to patients? A qualitative analysis of gender preferences of patients. SAGE Open Med 2023; 11:20503121231182514. [PMID: 37456084 PMCID: PMC10338727 DOI: 10.1177/20503121231182514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Background This study argues that the gender of a nurse could give patients the emotional and psychological support they need in their healing process. Nonetheless, in many developing countries, these intricate preferences of patients are usually ignored due to poor staffing and logistical capacities of health facilities. As a contribution to this professional and operation gap, this paper explores patients' preference for nurses' gender in health care at the Komfo Anokye Teaching Hospital in Ghana. The paper further explores the importance of these preferences to the delivery of patient-centred care in Ghana and across Africa. Objective The paper has two specific objectives: (a) to explore patients' preferences for the gender of nurses who attend to them while on admission; and (b) to find out the range of factors that inform these preferences. Methods Qualitative exploratory descriptive design was used to select adult patients who were not seriously ill and nursed by male and female nurses at the medical and surgical wards of the Komfo Anokye Teaching Hospital in Ghana for at least 5 days from January to March 2017 and before their discharge. Participants were recruited using purposive sampling technique. A semi-structured interview guide was used to elicit information from 14 participants after seeking their written informed consent. The data were analysed using content analysis. Results Two major themes emerged. These were: the Preferred Gender of a Nurse in Nursing Care and the Reasons for the Preference or no Preference for Nurses' Gender in Nursing Care. Under each of these themes, the associated aspects were also discussed. Patients had varying preference for a particular nurse during care but gender was not particularly significant in patients' preference for nurses. Majority of the participants emphasized their preference for nurses with professional expertise and good virtues to determine a preferred nurse and both genders of nurses can possess these qualities. However, nurses of the same gender as the patient were preferred for intimate procedures to ensure privacy and satisfaction. Conclusion The gender of a nurse is not on top of the preferences list of patients in the study context. This may be attributed to the long-term practice that the participants have not had the chance to be choosing a preferred nurse's gender, so most patients are tolerant and familiar with both male and female nurses. Instead, patients' preferences are determined by the performance and quality of service provided by nurses. Age, maturity and social connections were also found to influence patients' preferences.
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Affiliation(s)
| | | | - Clifford Amoako
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Bakarman M, Kalthoum D, Wahby Salem I, Alshuaibi RO, Almohammadi TA, Beser RA, Almuwallad RH, Alotaibi LA. Barriers to Using Breast Cancer Screening Methods Among Adult Females in Jeddah, Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e41739. [PMID: 37575760 PMCID: PMC10415231 DOI: 10.7759/cureus.41739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Breast cancer (BC) is one of the most common cancers worldwide and it considerably increases morbidity and mortality globally. Screening methods, such as self-examination, clinical examination, and mammography, can help in early detection and treatment, which will help in improving survival rates and reducing mortality. While regular screening of the breast is essential to detect the earliest stages of breast cancer, not all women adhere to regular breast screening. Methods A cross-sectional study was conducted in Jeddah, Saudi Arabia, between December 2021 to July 2022. using an online self-administered questionnaire. The total number of responses (n = 328), Data was analyzed using SPSS 25. Results In this study, out of the 328 respondents, 18.9% reported undergoing regular mammography, 14.3% reported having regular clinical breast examinations, and 38.1% reported practicing regular breast self-examinations.. In addition, the participants' most known warning signs of BC were a lump under their armpit (69.1%). the most perceived barrier to breast self-examination (BSE) was Doing a breast examination will make her worry about what is wrong with her breast (47%). whereas the most barrier to clinical breast examination (CBE) was embarrassment (45.9%). On the other hand, the main barriers that prevented women from having mammograms were embarrassment (36%) and pain (32.6%). Conclusion The most perceived barrier to BSE was women's concern, while embarrassment and painful procedures were significant barriers to performing mammography and CBE. Therefore, adult females in Jeddah need educational programs to improve their knowledge and increase public awareness of breast cancer screening for early detection.
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Affiliation(s)
- Marwan Bakarman
- Medicine, King Abdulaziz University Faculty of Medicine, Rabigh, SAU
| | - Duha Kalthoum
- Community and Family Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Iman Wahby Salem
- Community Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | | | | | - Rana A Beser
- Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Leena A Alotaibi
- Otolaryngology - Head and Neck Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Tsai PL, Ghahari S. Immigrants' Experience of Health Care Access in Canada: A Recent Scoping Review. J Immigr Minor Health 2023; 25:712-727. [PMID: 36870008 DOI: 10.1007/s10903-023-01461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/05/2023]
Abstract
Existing literature has reported inequities in access to Canadian health care services among immigrants. The aim of this scoping review was (a) to explore research regarding Canadian immigrants' unique experiences in accessing healthcare, and (b) to provide suggestions for future research and programming considering the identified immigrant-specific service gaps in health care. We searched MEDLINE, CINAHL, EMBASE, and Google Scholar, following the Arksey and O'Malley (2005) framework. The review's findings suggest unmet health care access needs specific to immigrants in Canada, with the most common access barriers including communication, socioeconomic, and cultural barriers. The scoping review expands on the immigrant health care experiences and accessibility factors through a thematic analysis. Findings suggest that developing community-based programming, improving training for health care providers in culturally competent care, and policies that address the social determinants of health can improve health care accessibility among immigrants.
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Affiliation(s)
- Pei-Ling Tsai
- Faculty of Arts and Sciences, Queen's University, 94 University Ave, Kingston, ON, Canada
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, 31 George St, Kingston, ON, K7L 3N6, Canada.
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Puli AV, Lussiez A, MacEachern M, Hayward L, Dualeh S, Richburg CE, Capellari E, Kwakye G. Barriers to Colorectal Cancer Screening in US Immigrants: A Scoping Review. J Surg Res 2023; 282:53-64. [PMID: 36257164 PMCID: PMC10369365 DOI: 10.1016/j.jss.2022.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/26/2022] [Accepted: 08/19/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Timely colorectal cancer (CRC) screening has been shown to improve CRC-related morbidity and mortality rates. However, even with this preventative care tool, CRC screening rates remain below 70% among eligible United States (US) adults, with even lower rates among US immigrants. The aim of this scoping review is to describe the barriers to CRC screening faced by this unique and growing immigrant population and discuss possible interventions to improve screening. METHODS Four electronic databases were systematically searched for all original research articles related to CRC screening in US immigrants published after 2010. Following a full-text review of articles for inclusion in the final analysis, data extraction was conducted while coding descriptive themes. Thematic analysis led to the organization of this data into five themes. RESULTS Of the 4637 articles initially identified, 55 met inclusion criteria. Thematic analysis of the barriers to CRC screening identified five unique themes: access, knowledge, culture, trust, health perception, and beliefs. The most cited barriers were in access (financial burden and limited primary care access) and knowledge (CRC/screening knowledge). CONCLUSIONS US immigrants face several barriers to the receipt of CRC screening. When designing interventions to increase screening uptake among immigrants, gaps in physician and screening education, access to care, and trust need to be addressed through culturally sensitive supports. These interventions should be tailored to the specific immigrant group, since a one-size-fits approach fails to consider the heterogeneity within this population.
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Affiliation(s)
| | - Alisha Lussiez
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Laura Hayward
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Shukri Dualeh
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Emily Capellari
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Gifty Kwakye
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Sun Y, Ma Y, Cao M, Hu Z, Lin W, Chen M, He Y. Breast and cervical cancer screening adherence in Jiangsu, China: An ecological perspective. Front Public Health 2022; 10:967495. [PMID: 36033808 PMCID: PMC9403787 DOI: 10.3389/fpubh.2022.967495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023] Open
Abstract
Background High screening coverage can effectively reduce the mortality in breast and cervical cancer. Further research on extending the coverage of breast and cervical cancer screening in China is required. This study explored factors influencing women's "two-cancer" screening service utilization using an ecological approach. Methods Data were obtained from the National Health Services Survey (NHSS) conducted in 2018 in Jiangsu, China. A total of 3,500 women aged 18-64 years were included in the analysis. Chi-squared test, hierarchical multiple logistic regression analysis, and binary logistic regression analysis were performed. Results In total, 44.1% of the women had been screened for breast cancer (BC) and 40.9% for cervical cancer (CC). Breast cancer screening (BCS) and cervical cancer screening (CCS) differed significantly in the following common categories: age, gestational experiences, chronic disease status, body mass index (BMI), exercise, health checkup, marital status, number of children, employment, education, family doctors, and health records. In the results of hierarchical multiple logistic regression analysis, the explanatory power of the final model was 37.5% and the area under the receiver operating characteristic curve was 0.812. The results showed that being in the age group of 35-64 years, having gestational experiences, having chronic diseases, exercising, having a health checkup, being married, having children, and being employed were statistically significant positive predictors of "two-cancer" screening adherence. The household size was a barrier. For BCS, obesity was also a negative factor, and a higher overall self-related health status was a positive factor. Being married and living in households of three or more families were not predictors. For CCS, having health records was also positively significant, while having chronic disease did not influence adherence. Conclusion The findings provide an ecological explanation for women's BCS and CCS service utilization. Both proximal and distal factors should be considered to achieve a high coverage rate.
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Affiliation(s)
- Yanjun Sun
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Yuhao Ma
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Menghan Cao
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Zhiqing Hu
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Wei Lin
- Department of Students Affairs, Nanjing Medical University, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yuan He
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
- Research Center for Social Risk Management of Major Public Health Events (Key Research Base of Philosophy and Social Sciences of Universities in Jiangsu), Nanjing Medical University, Nanjing, China
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Understanding the Influence of Ghanaian Women’s Migration Patterns on Access to Health Care. WOMEN 2022. [DOI: 10.3390/women2010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Increased migration rates demonstrate a rise in women seeking relocation as a means to access employment or academic opportunities; this is referred to as the feminization of migration. Migration stimulates female empowerment, increases access to financial opportunities, and promotes cultural diversity, all while simultaneously exposing women to detrimental conditions that impose risks to their physical and psychological well-being. Health is a fundamental human right that female migrants often are deprived of due to various social, cultural, political, and economic factors. A secondary analysis design was implemented to explore the impact of social determinants of health, specifically socioeconomic status, culture, and education, on health outcomes and health care access of Ghanaian internal and external female migrants. Interviews collected from two primary studies were analyzed using thematic analysis and an intersectionality approach. Ghanaian female migrants experienced cultural, financial, social, and health accessibility related barriers in accessing health care services. Our findings will serve as a foundation for improving health outcomes for female migrant populations and support health care professionals’ practice of cultural competence.
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Kwok C, Lee MJ, Lee CF. The Role of Education in Breast Cancer Beliefs and Screening Practices Among Korean Women - A quantitative study. J Transcult Nurs 2022; 33:287-296. [PMID: 35000508 DOI: 10.1177/10436596211066812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Cultural beliefs are influential factors that affect breast cancer screening practices among Korean women. The aim of this study was to examine the role of educational levels and compare the cultural beliefs associated with breast cancer screening practices among immigrant Korean women in Australia with those of their counterparts in Korea. METHODS A secondary analysis based on data from convenience samples of 245 and 249 Korean women living in Australia and Korea, respectively. Data were collected by the Korean version of Breast Cancer Screening Beliefs Questionnaire. RESULTS Educational level has a significant association with Korean women's cultural beliefs about breast cancer and breast cancer screening practices regardless of country of residence. DISCUSSION Nurses working in multicultural societies should take cultural beliefs and the role of education into account while designing strategies to promote breast cancer screening practices among immigrant Korean women.
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Affiliation(s)
- Cannas Kwok
- Western Sydney University, Penrith South, NSW, Australia
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Low ESL, Apostolov R, Wong D, Lin S, Kutaiba N, Grace JA, Sinclair M. Hepatocellular carcinoma surveillance and quantile regression for determinants of underutilisation in at-risk Australian patients. World J Gastrointest Oncol 2021; 13:2149-2160. [PMID: 35070048 PMCID: PMC8713329 DOI: 10.4251/wjgo.v13.i12.2149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/13/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While clinical guidelines recommend hepatocellular carcinoma (HCC) surveillance for at-risk individuals, reported surveillance rates in the United States and Europe remain disappointingly low.
AIM To quantify HCC surveillance in an Australian cohort, and assess for factors associated with surveillance underutilisation.
METHODS All patients undergoing HCC surveillance liver ultrasounds between January 1, 2018 to June 30, 2018 at a tertiary hospital in Melbourne, Australia, were followed until July 31, 2020, or when surveillance was no longer required. The primary outcome was the percentage of time up-to-date with HCC surveillance (PTUDS). Quantile regression was performed to determine the impact of factors associated with HCC surveillance underutilisation.
RESULTS Among 775 at-risk patients followed up for a median of 27.5 months, the median PTUDS was 84.2% (IQR: 66.3%-96.3%). 85.0% of patients were followed up by specialist gastroenterologists. Amongst those receiving specialist care, quantile regression demonstrated differential associations at various quantile levels of PTUDS for several factors. Older age at the 25th quantile (estimate 0.002 per percent, P = 0.03), and cirrhotic status at the 75th quantile (estimate 0.021, P = 0.017), were significantly associated with greater percentage of time up-to-date. African ethnicity (estimate -0.089, P = 0.048) and a culturally and linguistically diverse (CALD) background (estimate -0.063, P = 0.01) were significantly associated with lower PTUDS at the 50th quantile, and again for CALD at the 75th quantile (estimate -0.026, P = 0.045).
CONCLUSION While median PTUDS in this Australian cohort study was 84.2%, awareness of the impact of specific factors across PTUDS quantiles can aid targeted interventions towards improved HCC surveillance.
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Affiliation(s)
- Elizabeth SL Low
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Ross Apostolov
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne 3000, Victoria, Australia
| | - Darren Wong
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Sandra Lin
- Department of Radiology, Monash Health, Clayton 3168, Victoria, Australia
| | - Numan Kutaiba
- Department of Radiology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Josephine A Grace
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne 3000, Victoria, Australia
| | - Marie Sinclair
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne 3000, Victoria, Australia
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Kwok C, Lee CF. Assessment of the validity and reliability of the Vietnamese version of the Breast Cancer Screening Beliefs Questionnaire. Asia Pac J Oncol Nurs 2021; 9:69-74. [PMID: 35528800 PMCID: PMC9072186 DOI: 10.1016/j.apjon.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to evaluate the cultural adaptability and psychometric properties of the Vietnamese version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ). Methods A total of 253 women aged 18 years and older with no history of breast cancer was included in the analysis. Results Confirmatory factor analysis showed an adequate fit for the hypothesized three-factor structure of the original version of the BCSBQ. The results indicated that the frequency of women’s breast cancer screening practices and their educational levels were significantly associated with “Attitudes towards general check-ups”. Demonstrating the Cronbach’s α of the three subscales ranged between 0.79 and 0.85 while the corrected item-total correlations for the hypothesized subscales ranged from 0.38 to 0.74, constituted a result which indicated that the Vietnamese version of the BCSBQ had satisfactory validity and internal consistency. Conclusions The Vietnamese version of the BCSBQ is a culturally appropriate, valid, and reliable instrument for examining the beliefs, knowledge, and attitudes about breast cancer and breast cancer screening practices among Vietnamese women living in Australia.
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Chowdhury N, Naidu J, Chowdhury MZI, Vaska M, Rumana N, Lasker MAA, Turin TC. Knowledge translation in health and wellness research focusing on immigrants in Canada. J Prim Health Care 2021; 13:139-156. [PMID: 34620296 DOI: 10.1071/hc20072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Knowledge translation (KT) is a relatively new concept referring to transfers of knowledge into practice in collaboration with multiple sectors that work for the health and wellness of society. Knowledge translation is crucial to identifying and addressing the health needs of immigrants. AIM To scope the evidence on KT research engaging immigrants in the host country regarding the health and wellness of immigrants. METHODS This study followed a scoping review approach suggested by Arksey O'Malley. We identified relevant studies from both academic and grey literature using structured criteria, charted the data from the selected studies, collated, summarised and report the results. RESULTS Analysis of the eligible studies found two types of KT research: integrated KT and end-of-grant KT. Meeting or discussion with community-level knowledge-users were common KT activities among immigrants, but they were involved in the entire research process only if they were hired as members of research teams. Most KT research among immigrants explored cancer screening and used a community-based participatory action research approach. Barriers and enablers usually came from researchers rather than from the community. There was little practice of evaluation and defined frameworks to conduct KT research among immigrants in Canada. CONCLUSION This study can help the researchers and other stakeholders of health and wellness of the immigrant population to identify appropriate KT research activities for immigrants and where KT research is required to facilitate the transfer of research knowledge into action.
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Affiliation(s)
- Nashit Chowdhury
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Naidu
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mohammad Z I Chowdhury
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marcus Vaska
- Knowledge Resource Service, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Nahid Rumana
- Sleep Center, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | | | - Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; and Corresponding author.
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Brar J, Ferdous M, Abedin T, Turin TC. Online Information for Colorectal Cancer Screening: A Content Analysis of YouTube Videos. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:826-831. [PMID: 32072485 DOI: 10.1007/s13187-020-01710-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Preventive care is a form of healthcare that aims to prevent diseases or detect diseases in an eary stage, especially for diseases like colorectal cancer. YouTube is a platform with great reach and opportunity to educate the public through preventive healthcare-related resources. However, understanding on current YouTube resources, specifically related to colorectal cancer screening, are inadequate in terms of informational quality. In this study, videos related to colorectal cancer and colorectal cancer screening were identified and analyzed by two reviewers. Very useful (4.5%), moderately useful (18.5%), somewhat useful (38.9%), and not useful (38.2%) videos were categorized based on a usefulness scale compiled by medical professionals. Less useful videos are paralleled with more views and public engagement in comparison with more useful videos which had been released by more credible sources. There is a significant association between video length and level of usefulness as well between video source and usefulness. This study illustrates the need for better educational healthcare resources and/or filtration on widely accessible platforms such as YouTube.
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Affiliation(s)
- Jasleen Brar
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mahzabin Ferdous
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tasnima Abedin
- Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada
| | - Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Satoh M, Sato N. Relationship of attitudes toward uncertainty and preventive health behaviors with breast cancer screening participation. BMC WOMENS HEALTH 2021; 21:171. [PMID: 33882923 PMCID: PMC8061057 DOI: 10.1186/s12905-021-01317-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Abstract
Backgroundcxs Early detection of breast cancer is effective for prolonging survival, but the participation rate in breast cancer screening among target Japanese women remains low. This study examined the relationships between tendencies in decision-making under conditions of uncertainty, health behaviors, demographics, and breast cancer screening participation in Japanese women. Methods Secondary analysis was performed using data from the 2017 Keio Household Panel Survey (KHPS). The study population consisted of 2945 households. Data were obtained from the KHPS for women aged 40 years or older. Breast cancer screening participation in the past year, risk aversion, time preference, health behaviors (e.g., smoking, alcohol consumption, and medical treatment received in the past year), and demographic variables were analyzed. Results Data from 708 women were analyzed. Among the respondents, 28.8% had attended breast cancer screening in the past year. Factors found to significantly contribute to breast cancer screening participation included higher risk aversion (odds ratio [OR], 2.34; 95% confidence interval [CI] = 1.03–5.32; p = 0.043), medical treatment received in the past year (OR, 1.56; 95% CI = 1.06–2.30; p = 0.026), higher self-rated health (OR, 1.47; 95% CI = 1.18–1.83; p = 0.001), living above the poverty line (OR, 2.31; 95% CI = 1.13–4.72; p = 0.022), and having children (OR, 1.57; 95% CI = 1.02–2.42; p = 0.042). Factors significantly associated with non-participation in breast cancer screening were smoking (OR, 0.20; 95% CI = 0.10–0.42; p < 0.000), alcohol consumption (OR, 0.56; 95% CI = 0.37–0.86; p = 0.007), being self-employed (OR, 0.22; 95% CI = 0.10–0.46; p < 0.000), and being unemployed (OR, 0.48; 95% CI = 0.26–0.90; p = 0.022). No significant relationship was observed between time preference and screening participation. Conclusions The results indicate that women who recognize the actual risk of developing breast cancer or have high awareness of breast cancer prevention tend to participate in breast cancer screening. Barriers to screening participation are not working for an organization that encourages screening and low income.
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Affiliation(s)
- Miho Satoh
- Department of Fundamental Nursing, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Naoko Sato
- Department of Clinical Nursing, Fukushima Medical University, Fukushima, Fukushima, Japan
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Access to health care among racialised immigrants to Canada in later life: a theoretical and empirical synthesis. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x20001841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Evidence that immigrants tend to be underserved by the health-care system in the hosting country is well documented. While the impacts of im/migration on health-care utilisation patterns have been addressed to some extent in the existing literature, the conventional approach tends to homogenise the experience of racialised and White immigrants, and the intersecting power axes of racialisation, immigration and old age have been largely overlooked. This paper aims to consolidate three macro theories of health/behaviours, including Bronfenbrenner's ecological theory, the World Health Organization's paradigm of social determinants of health and Andersen's Behavioral Model of Health Service Use, to develop and validate an integrated multilevel framework of health-care access tailored for racialised older immigrants. Guided by this framework, a narrative review of 35 Canadian studies was conducted. Findings reveal that racial minority immigrants’ vulnerability in accessing health services are intrinsically linked to a complex interplay between racial-nativity status with numerous markers of power differences. These multilevel parameters range from socio-economic challenges, cross-cultural differences, labour and capital adequacy in the health sector, organisational accessibility and sensitivity, inter-sectoral policies, to societal values and ideology as forms of oppression. This review suggests that, counteracting a prevailing discourse of personal and cultural barriers to care, the multilevel framework is useful to inform upstream structural solutions to address power imbalances and to empower racialised immigrants in later life.
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Zhang X, Li P, Zhang C, Guo P, Wang J, Liu N, Yang S, Yu L, Zhang W. Breast Cancer Screening Practices and Satisfaction With Healthcare Providers in Chinese Women: A Cross-sectional Study. Cancer Nurs 2021; 45:E573-E581. [PMID: 33813526 DOI: 10.1097/ncc.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Chinese government has proposed cancer screening guidelines and launched 2 cancer screening programs to improve screening practices. However, the screening participation rates of Chinese women remain low. Exploring the factors affecting breast cancer screening to promote cancer screening is necessary. OBJECTIVE The aim of this study was to investigate women's satisfaction with healthcare providers and screening practices. METHODS A cross-sectional survey was conducted from November 2019 to April 2020 in Changchun, Jilin Province, China. The Medical Care Satisfaction Scale and SERVQUAL were used to quantify women's satisfaction with doctors and nurses, respectively. RESULTS Women's satisfaction with doctors (68.81 ± 11.08; range, 20-100) and with nurses (87.64 ± 16.17; range, 22-110) was moderate. Compared with women who had not participated in screening within the past 2 years, screened women reported higher satisfaction with doctors (P = .026) and nurses (P = .012). Older age (P = .004) was an independent predictor of women's satisfaction with doctors. Similarly, women's education level (P = .049), chronic disease history (P = .029), and physical examination history (P = .039) were 3 independent predictors of women's satisfaction with nurses. CONCLUSIONS Future intervention strategies can not only increase the screening rates by providing existing intervention methods but also improve women's satisfaction with healthcare providers to promote screening practices. IMPLICATIONS FOR PRACTICE This article provides a theoretical basis for healthcare providers to increase female screening practices. It also provides references for improving existing intervention methods.
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Affiliation(s)
- Xuehui Zhang
- Author Affiliations: Nursing School, Jilin University (Mss X Zhang, Guo, Wang, Liu, Yang, and Yu, and Dr W Zhang); and the Second Hospital of Jilin University (Dr Li and Ms C Zhang), Changchun, China
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Turin TC, Rashid R, Ferdous M, Naeem I, Rumana N, Rahman A, Rahman N, Lasker M. Perceived barriers and primary care access experiences among immigrant Bangladeshi men in Canada. Fam Med Community Health 2020; 8:e000453. [PMID: 32994217 PMCID: PMC7526305 DOI: 10.1136/fmch-2020-000453] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The study aimed to explore the experience of male members of a rapidly grown community of Bangladeshi immigrants while accessing primary healthcare (PHC) services in Canada. DESIGN A qualitative research was conducted among a sample of Bangladeshi immigrant men through a community-based participatory research approach. Focus group discussions were conducted to collect the qualitative data where thematic analysis was applied. SETTING The focus group discussions were held in various community centres such as individual meeting rooms at public libraries, community halls and so on arranged in collaboration with community organisations while ensuring complete privacy. PARTICIPANT Thirty-eight adults, Bangladeshi immigrant men, living in Calgary were selected for this study and participated in six different focus groups. The sample represents mostly married, educated, Muslim, Bangla speaking, aged over 25 years, full-time or self-employed and living in an urban centre in Canada >5 years. RESULT The focus groups have highlighted long wait time as an important barrier. Long wait at the emergency room, difficulties to get access to general physicians when feeling sick, slow referral process and long wait at the clinic even after making an appointment impact their daily chores, work and access to care. Language is another important barrier that impedes effective communication between physicians and immigrant patients, thus the quality of care. Unfamiliarity with the healthcare system and lack of resources were also voiced that hinder access to healthcare for immigrant Bangladeshi men in Canada. However, no gender-specific barriers unique to men have been identified in this study. CONCLUSION The barriers to accessing PHC services for Bangladeshi immigrant men are similar to that of other visible minority immigrants. It is important to recognise the extent of barriers across various immigrant groups to effectively shape public policy and improve access to PHC.
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Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruksana Rashid
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mahzabin Ferdous
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Iffat Naeem
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nahid Rumana
- Sleep Center, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Afsana Rahman
- Community Based Citizen Researcher, Calgary, Alberta, Canada
| | - Nafiza Rahman
- Community Based Citizen Researcher, Calgary, Alberta, Canada
| | - Mohammad Lasker
- Community Based Citizen Researcher, Calgary, Alberta, Canada
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