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Padilla CD, Abadingo ME, Maceda EBG, Alcausin MMLB. Integrating Genetic Services in the Philippine Public Health Delivery System: The Value of Networks. Genes (Basel) 2024; 15:780. [PMID: 38927716 PMCID: PMC11202899 DOI: 10.3390/genes15060780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
The delivery of genetic services in developing countries is faced with significant challenges, despite medical and technological advances globally. The Philippines, being an archipelago, faces even more challenges, with significant disparities in access to healthcare, and tertiary medical centers and specialists being concentrated in the major cities. The utilization of different networks for the integration of genetic services in the existing public health delivery system has been valuable. Using the well-established network of the national newborn screening program, genetic services have been successfully integrated into the delivery of healthcare, even at the grassroot level. Equitable access to healthcare, including genetic services, was highlighted and supported by the enactment of the Rare Disease Law in 2016. The support of the academe to assure the sustainability of services was evident in the establishment of a genetic counseling program to augment the work of a handful of clinical geneticists. Professional societies and support groups have been instrumental in identifying genetic conditions to be prioritized and lobbying for increased public awareness, leading to national programs and policies. This paper primarily discusses the value of networks in the delivery of genetic services, specifically newborn screening, programs for rare diseases, birth defects, and genetic counseling.
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Affiliation(s)
- Carmencita D. Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines; (M.E.A.); (E.B.G.M.); (M.M.L.B.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
| | - Michelle E. Abadingo
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines; (M.E.A.); (E.B.G.M.); (M.M.L.B.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
| | - Ebner Bon G. Maceda
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines; (M.E.A.); (E.B.G.M.); (M.M.L.B.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
| | - Maria Melanie Liberty B. Alcausin
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines; (M.E.A.); (E.B.G.M.); (M.M.L.B.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
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Turnbull M, Yu C, Tay D. "We Need to Go Back Home (to) the Philippines Healthy": An Interpretive Phenomenological Analysis of Migrant Domestic Workers' Experiences of Having Breast Cancer in Hong Kong. QUALITATIVE HEALTH RESEARCH 2024:10497323241228789. [PMID: 38311814 DOI: 10.1177/10497323241228789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Diagnoses of breast cancer are continuing to increase in the Philippines, but little is known about incidence rates among the significant number of Filipino women working abroad as migrant domestic workers (MDWs). These women are often the main income providers for their families, and their ability to work depends upon their physical health and strength. In this article, we use interpretive phenomenological analysis to explore the experiences of 10 MDWs from the Philippines who were diagnosed with breast cancer during a period of employment in Hong Kong. Analysis of these narratives revealed numerous points at which their status as temporary, transnational migrant workers intersected with their experiences of breast cancer detection, diagnosis, and treatment. We argue that these women's experiences of breast cancer were shaped by the structures of migration that link the Philippines with host destinations like Hong Kong. These structures create a unique context in which these women had to constantly renegotiate their identities as migrants, financial providers, and breast cancer patients.
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Affiliation(s)
- Margo Turnbull
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong, China
| | - Carol Yu
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong, China
| | - Dennis Tay
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong, China
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Lim DW, Li WW, Giannakeas V, Cil TD, Narod SA. Survival of Filipino women with breast cancer in the United States. Cancer Med 2023; 12:19921-19934. [PMID: 37755311 PMCID: PMC10587940 DOI: 10.1002/cam4.6403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The survival of women with early-stage breast cancer varies by racial group. Filipino women with breast cancer are an understudied group and are often combined with other Asian groups. We compared clinical presentations and survival rates for Filipino and White women with breast cancer diagnosed in the United States. METHODS We conducted a retrospective cohort study of women with breast cancer diagnosed between 2004 and 2015 in the SEER18 registries database. We compared crude survival between Filipino and White women. We then calculated adjusted hazard ratios (HR) in a propensity-matched design using the Cox proportional hazards model. RESULTS There were 10,834 Filipino (2.5%) and 414,618 White women (97.5%) with Stage I-IV breast cancer in the SEER database. The mean age at diagnosis was 57.5 years for Filipino women and 60.8 years for White women (p < 0.0001). Filipino women had more high-grade and larger tumors than White women and were more likely to have node-positive disease. Among women with Stage I-IIIC breast cancer, the crude 10-year breast cancer-specific survival rate was 91.0% for Filipino and 88.9% for White women (HR 0.81, 95% CI 0.74-0.88, p < 0.01). In a propensity-matched analysis, the HR was 0.73 (95% CI 0.66-0.81). The survival advantage for Filipino women was present in subgroups defined by age of diagnosis, nodal status, estrogen receptor status, and HER2 receptor status. CONCLUSION In the United States, Filipino women often present with more advanced breast cancers than White women, but experience better breast cancer-specific survival.
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Affiliation(s)
- David W. Lim
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Women's College Research Institute, Women's College HospitalTorontoOntarioCanada
- Department of SurgeryWomen's College HospitalTorontoOntarioCanada
- Division of General Surgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Winston W. Li
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Vasily Giannakeas
- Women's College Research Institute, Women's College HospitalTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Tulin D. Cil
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Department of SurgeryWomen's College HospitalTorontoOntarioCanada
- Division of General Surgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
- Division of General SurgeryUniversity Health Network (Princess Margaret Cancer Centre)TorontoOntarioCanada
| | - Steven A. Narod
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Women's College Research Institute, Women's College HospitalTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Institute of Medical Science, University of TorontoTorontoOntarioCanada
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Akoto EJ, Allsop MJ. Factors Influencing the Experience of Breast and Cervical Cancer Screening Among Women in Low- and Middle-Income Countries: A Systematic Review. JCO Glob Oncol 2023; 9:e2200359. [PMID: 37141559 DOI: 10.1200/go.22.00359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE The persistent high morbidity and mortality from breast and cervical cancer in low- and middle-income countries (LMICs) may be influenced by global disparities in the uptake of screening services. This review sought to synthesize existing evidence to determine factors that influence the experience of women relating to breast and cervical screening in LMICs. METHODS A qualitative systematic review of the literature identified through Global Health, Embase, PsycInfo, and MEDLINE. Eligible studies included those outlining primary qualitative research or mixed-method studies with reporting of qualitative findings, detailing women's experiences of involvement with programs for breast or cervical cancer screening. Framework synthesis was used to explore and organize findings from primary qualitative studies and the Critical Appraisal Skills Programme checklist used for quality assessment. RESULTS Database searches yielded 7,264 studies for title and abstract screening and 90 full-text articles for screening, with qualitative data from 17 studies and a total of 722 participants included in this review. Four stages influencing experiences of women were generated across both breast and cervical cancer screening approaches, with individual (eg, knowledge of cancer), social (eg, religion, cultural beliefs), and health system (eg, accessibility) factors identified that influence women's initial and subsequent engagement. CONCLUSION This study synthesizes existing evidence of factors that influence engagement with breast and cervical cancer screening in LMICs. Evidence-informed recommendations are proposed that may improve the experience of cancer screening in LMICs, with further research necessary to explore their operationalization and impact on cancer care delivery.
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Affiliation(s)
- Edem J Akoto
- Lekma Hospital, Accra, Ghana
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Valencia KMB, Cagasan EG. Lived experiences of risk among pregnant women in Baybay City, Leyte during the COVID-19 pandemic: A phenomenological study. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2023; 89:103624. [PMID: 36945251 PMCID: PMC10015824 DOI: 10.1016/j.ijdrr.2023.103624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Giving birth is risky by nature, and this makes pregnant women one of the most vulnerable individuals during the COVID-19 pandemic. For pregnant women in Baybay City, Leyte, conceiving a child during a COVID-19 pandemic means: living with constant anxiety and worry, living with the fear of the unknown, and being the most vulnerable people in a medical emergency. These fears and worries revolved around hospital settings, financial difficulties, isolation, labor, and delivery while their feeling of vulnerability meant contracting the virus easily and having to undergo stricter protocols. Meanwhile, they had varied perceptions of COVID-19 risk. These were classified as positive or negative. Informants with positive perceptions were those that viewed COVID-19 as not personally risky but rather showed a hopeful view of its risk. They view its risk as something not too dangerous because of the vaccines available and that its symptoms are simple to cure. On the other hand, informants with negative perceptions view COVID-19 risks as something that will have a bad effect on them. They link pregnancy to susceptibility to COVID-19 and foresee premature birth, negative effects on the fetus development, and child-related death as negative results of COVID-19. Pregnant women also perceived COVID-19 risk deliberatively, affectively, and experientially. This indicates that they take the most deliberate approach to managing COVID-19 risk. Informants demonstrated affective reactions like worry and fear as they estimate the risks COVID-19 may pose to them. These factors together form their experiential risk perception of COVID-19 as an encounter with danger.
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Afaya A, Ramazanu S, Bolarinwa OA, Yakong VN, Afaya RA, Aboagye RG, Daniels-Donkor SS, Yahaya AR, Shin J, Dzomeku VM, Ayanore MA, Alhassan RK. Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review. BMC Health Serv Res 2022; 22:1601. [PMID: 36587198 PMCID: PMC9805268 DOI: 10.1186/s12913-022-08927-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/05/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. METHODS We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. CONCLUSION This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.
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Affiliation(s)
- Agani Afaya
- grid.15444.300000 0004 0470 5454Mo-Im Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea ,grid.449729.50000 0004 7707 5975Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Sheena Ramazanu
- grid.4280.e0000 0001 2180 6431Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Obasanjo Afolabi Bolarinwa
- grid.127050.10000 0001 0249 951XDepartment of Global Public Health, Canterbury Christ Church University, Canterbury, UK
| | - Vida Nyagre Yakong
- grid.442305.40000 0004 0441 5393Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Adongo Afaya
- grid.442305.40000 0004 0441 5393Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Gyan Aboagye
- grid.449729.50000 0004 7707 5975Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Silas Selorm Daniels-Donkor
- grid.8241.f0000 0004 0397 2876Department of Nursing, School of Health Sciences, University of Dundee, Scotland Dundee, UK
| | - Ahmed-Rufai Yahaya
- Hariri School of Nursing, American University of Beruit, Beirut, Lebanon ,grid.460777.50000 0004 0374 4427Department of Internal Medicine, Tamale Teaching Hospital, Tamale, Ghana
| | - Jinhee Shin
- grid.412965.d0000 0000 9153 9511Woosuk University, College of Nursing, Wanju, Republic of Korea
| | - Veronica Millicent Dzomeku
- grid.9829.a0000000109466120Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Martin Amogre Ayanore
- grid.449729.50000 0004 7707 5975Department of Health Policy Planning and Management, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- grid.449729.50000 0004 7707 5975Centre for Health Policy and Implementation Research. Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Kumar K, Mohammadnezhad M. "Once you get cancer you die. There is no way to get saved from cancer." A qualitative exploration of patients' perceptions towards cancer in Fiji. PLoS One 2022; 17:e0277970. [PMID: 36525441 PMCID: PMC9757585 DOI: 10.1371/journal.pone.0277970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Understanding patients' perspective to get an insight into cancer, and how best the public health systems can battle with this disease is the way forward in this current world. This study aimed to explore patients' knowledge about common cancers, barriers to assessing cancer information and cancer preventative approaches in Fiji. METHODS The study used a qualitative method approach that was conducted among patients who attended Special Outpatients (SOPD) at the four selected health centres in Lautoka Subdivision, Fiji from 1st March to 30th April 2021. A semi-structured open-ended questionnaire was used to guide in-depth interviews. These audio recordings were transcribed and analysed using thematic analysis. All interview transcripts were read and similar words and phrases were assigned numbers which were grouped together to identify themes and sub themes. RESULTS Twenty-eight patients took part in the in-depth interview and the responses were grouped into four themes including; cancer knowledge, diagnosis of cancer in a close friend/family, barriers of communication and optimizing cancer awareness. Patients' awareness about common cancers and cancer risk factors was low. Many barriers for cancer screening were highlighted including stigmatization, fear, worry, death, lack of information, herbal medicine use, lack of resources and delay in diagnosis. Awareness strategies highlighted by participants included community outreach programs, house to house visits, opportunistic screening, engagement of community health care workers and the concept of a cancer hub centre. CONCLUSION It is evident that there is a range of views from patients towards cancer and it is important to understand these perceptions to better guide public health interventions concerning cancer. This puts more focus on the need to invest more in information, education, and communication material for public campaigns that target a variety of people for a wider reach.
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Affiliation(s)
- Kaushal Kumar
- Fiji Ministry of Health and Medical Services, Lautoka Hospital, Lautoka, Fiji Islands
| | - Masoud Mohammadnezhad
- School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Nakhon Pathom, Thailand
- * E-mail:
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Sabado-Liwag MD, Zamora M, Esmundo S, Sumibcay JR, Kwan PP. Preliminary Observations from The FILLED Project (FILipino Lived Experiences during COVID-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12303. [PMID: 36231606 PMCID: PMC9566375 DOI: 10.3390/ijerph191912303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Health outcomes for Asian American subgroups are often aggregated, masking unique experiences and disparities exacerbated by the COVID-19 pandemic, specifically among Filipino Americans (FilAms). The FILLED (Filipino Lived Experiences during COVID-19) Project launched a cross-sectional online survey between April-August 2021 among FilAm adults in Southern California to document community issues and outcomes during the pandemic. Among 223 participants, 47.5% were immigrants, 50.9% identified as essential workers, and 40.6% had a pre-existing health condition before the pandemic. Despite high rates of health insurance (93.3%), 24.4% of the sample did not have a regular health care provider. During the pandemic, 32.7% needed mental health help but did not get it and 44.2% did not know where to get such services. Most respondents felt that the COVID-19 vaccination was a personal responsibility to others (76.9%) and the majority had received at least one dose of a COVID-19 vaccine (82.4%). Regarding COVID-19 impact, participants reported moderate-severe changes in their daily routines (73.5%), access to extended social support (38.9%), housing issues (15.4%), and access to medical care (11.6%). To our knowledge, this study is the first community-driven effort highlighting FilAm community experiences in Southern California, where the highest proportion of FilAms in the United States reside, specifically after the COVID-19 vaccine was made widely available. The observational findings may help community leaders, policy makers, and public health researchers in the design, development, and implementation of post-pandemic intervention strategies used by community-partnered projects that address FilAm and sub-Asian group health disparities at grassroots to societal levels.
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Affiliation(s)
| | - Mayra Zamora
- Department of Public Health, California State University, Los Angeles, CA 90032, USA
| | - Shenazar Esmundo
- Department of Health Sciences, California State University, Northridge, CA 91330, USA
| | - Jake Ryann Sumibcay
- Department of Public Health, California State University, Los Angeles, CA 90032, USA
| | - Patchareeya P. Kwan
- Department of Health Sciences, California State University, Northridge, CA 91330, USA
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Ho FDV, Arevalo MVPN, de Claro PTS, Jacomina LE, Germar MJV, Dee EC, Eala MAB. Breast and Cervical Cancer Screening in the Philippines: Challenges and Steps Forward. Prev Med Rep 2022; 29:101936. [PMID: 35959499 PMCID: PMC9361315 DOI: 10.1016/j.pmedr.2022.101936] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | - Luisa E. Jacomina
- Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Maria Julieta V. Germar
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Philippine General Hospital, Manila, Philippines
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Ann B. Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Corresponding author at: College of Medicine, University of the Philippines, 547 Pedro Gil Street, Manila 1000, Philippines.
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Luu K, Brubacher LJ, Lau LL, Liu JA, Dodd W. Exploring the Role of Social Networks in Facilitating Health Service Access Among Low-Income Women in the Philippines: A Qualitative Study. Health Serv Insights 2022; 15:11786329211068916. [PMID: 35095277 PMCID: PMC8793367 DOI: 10.1177/11786329211068916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Despite efforts to implement universal health care coverage (UHC) in the Philippines, income poor households continue to face barriers to health care access and use. In light of recent UHC legislation, the aim of this study was to explore how gender and social networks shape health care access and use among women experiencing poverty in Negros Occidental, Philippines. Semi-structured interviews were conducted with women (n = 35) and health care providers (n = 15). Descriptive statistical analyses were performed to report demographic information. Interview data were analyzed thematically using a hybrid deductive-inductive approach and guided by the Patient-Centred Access to Health Care framework. Women’s decisions regarding health care access were influenced by their perceptions of illness severity, their trust in health care facilities, and their available financial resources. Experiences of health care use were shaped by interactions with health professionals, resource availability at facilities, health care costs, and health insurance acquisition. Women drew upon social networks throughout their lifespan for social and financial support to facilitate healthcare access and use. These findings indicate that social networks may be an important complement to formal supports (eg, UHC) in improving access to health care for women experiencing poverty in the Philippines.
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Affiliation(s)
- Kathy Luu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Lincoln L Lau
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- International Care Ministries, Manila, Philippines
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jennifer A Liu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Anthropology, University of Waterloo, Waterloo, ON, Canada
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Grandi G, Del Savio MC, Boggio Sola V, Monari F, Melotti C, Facchinetti F. Attitudes of women towards products containing hormones (hormonal contraceptives or hormone therapy): what changes from pre to postmenopause? Ann Med 2021; 53:908-915. [PMID: 34124968 PMCID: PMC8205098 DOI: 10.1080/07853890.2021.1938662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION To evaluate the actual perceptions of hormonal contraceptives (HC) in women of reproductive age in comparison with similar concerns of postmenopausal women in relation to hormone therapy (HT). MATERIALS AND METHODS A questionnaire-based study was conducted in a population of 370 women, 198 (53.5%) premenopausal and 172 (46.5%) postmenopausal. Perceptions were evaluated using specific questions and Likert scales (-5 to +5).Multivariate regression analyses were adjusted for categories of HC/HT use (never, past and current). RESULTS The most reported adverse effect associated with hormonal treatments was venous thrombosis (1.4 ± 0.1), especially for HC use in premenopausal women (p < .0001). According to responses, hormonal treatments can increase the risk of developing venous thrombosis (OR 0.79; 95% CI 0.67-0.96, p = .004) and depression (OR 0.80; 95% CI 0.69-0.92, p = .002) more in pre-menopause, while they can increase the risk of weight gain more in post-menopause (OR 1.24: 95% CI 1.07-1.42, p = .003).The greatest oncological concern throughout life was about breast cancer (0.9 ± 0.1). There was the perception that hormonal treatments can increase the risk of developing ovarian cancer more in post-menopause (OR 1.44; 95% CI 1.19-1.75, p = .0002), while they can increase the risk of uterine cervix cancer more in pre-menopause (OR 0.74; 95% CI 0.52-0.97, p = .03). CONCLUSIONS Our data suggest that our patients are primarily concerned about the effects of hormonal treatments on venous thrombosis, mood, breast cancer and cervical cancer risk, and, later in life, about their impact on weight gain, breast and ovarian cancer risk.KEY MESSAGESYoung patients are primarily concerned about the effects of hormonal treatments on venous thrombosis, mood, breast cancer and cervical cancer risk.Older patients are primarily concerned about the effects of hormonal treatments on weight gain, breast and ovarian cancer risk.The greatest oncological concern throughout life was about breast cancer.
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Affiliation(s)
- Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Chiara Del Savio
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Boggio Sola
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Monari
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Melotti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
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