Social Cultural Influences on Breast Cancer Views and Breast Health Practices Among Chinese Women in the United Kingdom

The role of social support among caregivers of people with cancer from Chinese and Arabic communities: a qualitative study

PURPOSE

Cancer caregivers from culturally and linguistically diverse (CALD) communities have reported significant unmet emotional support needs. This study aimed explore the role of social support to manage emotional wellbeing among cancer caregivers from Arabic and Chinese communities in Australia.

METHODS

Semi-structured interviews were conducted with Chinese (n = 12) and Arabic (n = 12) speaking cancer caregivers. Participants' mean age was 40.6 years; majority were female (83%) and providing care to a parent (41.67%).

RESULTS

Using thematic analysis to analyse interview data, five overarching themes emerged describing caregivers' perspectives on social support. Themes were related to the following: (1) receiving emotional support from social networks, (2) barriers to accessing emotional support from social networks, (3) isolation and loss of connection following the cancer diagnosis, (4) faith as a source of support, and (5) utility of support groups and caregiver advocates. Several caregivers relied on social networks for emotional support; however, caregivers identified key cultural and generational barriers to seeking support from their social networks which prevented caregivers from disclosing their emotions and caregiving situation. Caregivers also reported being isolated from their support system.

CONCLUSION

Empirical testing of culturally appropriate strategies that improve social support seeking among caregivers from CALD communities is recommended.

The effect of expressive writing on Chinese cancer patients: A systematic review and meta-analysis of randomized control trails

Cancer patients in China encounter distinctive challenges stemming from cultural disparities and variations in the healthcare systems. This meta-analysis aimed to provide a synthesis of the expressive writing (EW) interventions delivered to Chinese cancer patients and assess the pooled effect of EW on their well-being. The review adheres to the latest PRISMA 2020 guidelines to ensure transparency and rigour. Randomized control trials (RCTs) published before 1 April 2023, and meeting the inclusion criteria were included. Keywords searching was performed in both English and Chinese electronic databases. Ten RCTs were identified and included in the analysis. The results showed that EW usually encompassed four to six writing sessions; the most common writing themes were 'emotional expression', 'cognitive appraisal', 'benefit finding', 'coping strategies' and 'looking to the future'. The meta-analysis suggested that EW had a substantial impact on reducing anxiety levels (Hedges' g = -1.22, 95% CI [-1.54, -0.90], I2 = 0.00%). It is worth noting that although the results of these studies could not be statistically synthesized, their individual findings suggest that EW may be beneficial in reducing anxiety, self-perceived burden and depressive symptoms, as well as increasing self-efficacy in Chinese cancer patients. In conclusion, this review highlights the importance and effectiveness of Ewin alleviating anxiety among Chinese cancer patients and underscores the potential benefits of incorporating EW into comprehensive care programmes for cancer patients in China. More RCTs are needed to explore the broader impact of EW in China.

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

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.

Predicting Rural Women's Breast Cancer Screening Intention in China: A PLS-SEM Approach Based on the Theory of Planned Behavior

Background

It was reported that the incidence of breast cancer (BC) was the highest among cancers worldwide. The breast cancer screening (BCS) program is regarded as an effective preventive measure. However, rural women's willingness to participate in the BCS program is relatively low. To provide measures to prevent BC, it is necessary for the government to identify the influencing factors of rural women's BCS intention.

Methods

A cross-sectional study was conducted among 3,011 rural women by a convenience sampling method through face-to-face interviews on a self-designed questionnaire based on the theory of planned behavior (TPB). The partial least square structural equation model (PLS-SEM) was conducted to determine the predictors of BCS intention, and a multi-group analysis (MGA) of age was performed to identify if there were differences in all hypotheses between different age groups.

Results

There were still rural women who have not been screened for BC in five years (41.7%). The research model of rural women's intention to accept this prevention against BC was rational. All of the hypotheses are supported. Especially, subjective norm (SN) (β = 0.345, p < 0.001) is found to be the strongest predictor followed by the perceived behavioral control 1 (PBC 1) (personal factors, including distance, transportation, busyness, etc.) (β = 0.165, p < 0.001), attitude (β = 0.152, p < 0.001), past behavior (PB) (β = 0.150, p < 0.001), knowledge (β = 0.121, p < 0.001), and perceived behavioral control 2 (PBC 2) (pain and cultural-social factors including embarrassment from a physician, etc.) (β = 0.042, p < 0.05). The advocacy and education (A&E), medical level and service attitude (ML&SA) of township health centers and village clinics can affect behavior intention (BI) via attitude, SN, and PBC. The results of MGA of age indicate that there are significant differences among rural women of different ages regarding the relationship between A&E and PBC 2 (p < 0.01) and the effect of PB on BI (p < 0.001).

Conclusion

The TPB with the addition of PB, knowledge, ML&SA, and A&E can provide the theoretical basis for the policy intervention that aims to enhance the rural women's BCS willingness. MGA of age is conducive to promoting the implementation of the BCS policy. The findings are of great significance to improve rural women's health levels.

Dilemma: Disclosure Experience Among Young Female Breast Cancer Survivors in China

Purpose: Culture influences whether cancer patients disclose their disease diagnosis to others. Understanding Chinese young female breast cancer survivors (BCSs)' experiences and perspectives on disclosure could play a vital role in clinical nursing. This study explores the experiences of Chinese young female BCSs with disease disclosure and describes the reasons for their choices. Methods: Using the tenets of phenomenological research and a purpose sampling method, semistructured interviews were conducted with 31 BCSs from February to April 2021. Colaizzi's analysis method was performed with NVivo software to develop common themes from the data. Results: From the analysis of the interviews of the 31 participants, three main themes were identified: (1) disclosure-to whom, including core family members, close friends, roommates, and employers; (2) disclosure to achieve positive outcomes, including: to gain social support, tell others to take precautions, obtain relevant information, and get permission to work flexibly, and (3) nondisclosure to avoid negative outcomes, including fear of discrimination and stigmatization, strengthen the role of the patient, bring excessive burden, and fear of excessive compassion. Conclusions: For young women diagnosed with breast cancer in China, it is a very complicated matter whether they choose to disclose their diagnosis to others. While disclosure can bring many benefits, it is important to look at the reasons why these women are concealing their diagnosis.

Determinants of Intention to Participate in Breast Cancer Screening among Urban Chinese Women: An Application of the Protection Motivation Theory

Despite the significance of early detection of breast cancer through screening, the screening uptake in China remains relatively low. Protection motivation theory (PMT) suggested by Rogers is one of the theories concerning threat appeal. This study aimed to apply the protection motivation theory (PMT) in predicting breast cancer screening intention. In this cross-sectional study, a sample of Chinese urban women was recruited using the convenient sampling method from five communities in Wuhan. Data were collected using a self-report questionnaire that included demographic variables, knowledge about breast cancer, six PMT subconstructs, and screening intention. We used the structural equation modeling (SEM) to identify the predictor factors associated with screening intention. Of the total sample (n = 412), 86.65% had intention to participate in screening. Our data fit the hypothesized SEM model well (Goodness of fit index (GFI) = 0.91, adjusted GFI (AGFI) = 0.89, comparative fit index (CFI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, standardized root mean residual (SRMR) = 0.06, and Chi-square/df = 2.01). Three PMT subconstructs (perceived severity, response cost, and self-efficacy) were significantly associated with screening intention. Knowledge, social status, and medical history had significantly indirect associations with screening intention through the mediating effect of PMT subconstructs. Considering the utility of PMT, intervention programs might be more effective based on the subconstructs of PMT, especially to improve self-efficacy, perceived severity, and knowledge, reduce response cost, as well as targeting specific demographic groups.

Qualitative study of Stroke Survivors' Perceptions of Secondary Prevention

AIMS

To understand how survivors of stroke perceive secondary prevention and explore their perceived barriers and facilitators using the Theoretical Domains Framework.

DESIGN

A qualitative descriptive study.

METHODS

Nineteen survivors of stroke from three hospitals were recruited and interviewed from April 2019 to April 2020. The data were analysed deductively and inductively by content analysis strategies.

RESULTS

Three main themes of perception of secondary prevention were identified, these being active treatment-seeking, attention to taking medications and negative attitude towards lifestyle changes. Using deductive analysis, eight domains of the Theoretical Domains Framework were reported to be relevant in the secondary prevention behaviour of survivors of stroke that mapped to five 'barrier' domains (i.e. knowledge, physical skills, beliefs about capability, beliefs about consequences and optimism) as well as six 'facilitator' domains (i.e. knowledge, interpersonal skills, beliefs about capability, intention, emotion and social influences). Using inductive analysis we identified two additional important factors not falling in the domains of the Theoretical Domains Framework. These comprised female spouses' support and patients' economic autonomy, both of which could be classified as a facilitator or barrier.

CONCLUSION

Survivors of stroke perceive seeking treatment and using preventive medication as more important than modifying lifestyle behaviours. Knowledge and insight into the barriers and facilitators of secondary prevention in this specific context provides a theoretical and practical basis for the design of future secondary prevention interventions.

IMPACT

Stroke survivors' perceptions of secondary prevention, barriers and facilitators were explored in the context of a developing country. These findings highlight the need to better communicate the importance of improving lifestyle modification and medication adherence, and provide evidence for designing relevant interventions for stroke management in the community.

Understanding patient factors to increase uptake of cancer screening: a review

Early detection of cancer through organized screening is a central component of population-level strategies to reduce cancer mortality. For screening programs to be effective, it is important that those invited to screening participate. However, uptake rates are suboptimal in many populations and vary between screening programs, indicating a complex combination of patient factors that require elucidation to develop evidence-based strategies to increase participation. In this review, the authors summarize individual-level (sociodemographic and psychosocial) factors associated with cancer screening uptake and evidence for the effectiveness of behavioral interventions to increase uptake. The authors reflect on current trends and future directions for behavioral cancer screening research to overcome challenges and address unmet needs in reducing cancer mortality.

The effect of fear of progression on quality of life among breast cancer patients: the mediating role of social support

Background

Women with breast cancer are prone to have mental stress and be stimulated by the fear of progression (FOP), then giving rise to a lower quality of life (QOL). The study aimed to examine the relationships between FOP, social support and QOL, and further explore whether social support mediates the association between FOP and QOL among Chinese patients with breast cancer.

Methods

The cross-sectional study was conducted from October 2019 to May 2020 at Anshan Cancer Hospital in Liaoning, China. 244 female breast cancer patients completed questionnaires including the Functional Assessment of Cancer Therapy for Breast (FACT-B), Multi-Dimensional Scale of Perceived Social Support (MSPSS), and Fear of Progression (FOP). Hierarchical multiple regression analysis was performed to assess the associations between FOP, social support and QOL. Asymptotic and resampling strategies were used to explore the mediating role of social support.

Results

The mean QOL score was 90.6 ± 17.0 among the patients with breast cancer. FOP was negatively correlated with QOL, while social support was positively related to QOL. Social support partly mediated the association between FOP and QOL, and the proportion of the mediating effect accounted for by social support was 25%.

Conclusions

Chinese breast cancer patients expressed low QOL. Social support could mediate the association between FOP and QOL. Medical staffs and cancer caregivers should alleviate patients’ FOP to improve their QOL by facilitating social support.

Global Perceptions of Women on Breast Cancer and Barriers to Screening

PURPOSE OF REVIEW

Breast cancer (BC) is a public health dilemma across the globe and a leading cause of mortality for women. Approximately 2.1 million newly diagnosed female BC cases occurred in 2018, comprising nearly 1 in 4 cancer cases among women. When BC is recognized in its early stages, successful treatment results can be achieved. Therefore, screening for BC is of paramount significance and routine screening mammography has been shown to be effective in reducing mortality from BC. Despite being considered a global health issue, national screening programmes are offered only in developed countries and BC is still often diagnosed in advanced stages.

RECENT FINDINGS

Disparities in screening exist not only between different countries but also between local and immigrant populations within a particular country. Low screening is attributed to low public awareness as well as numerous social, psychological, and geographical barriers to screening. This review addresses (a) the differences in BC awareness and screening across the globe, (b) the most important barriers and facilitators to screening, and (c) the potential role of health education programmes to increase BC awareness and promote BC screening programmes with the ultimate goal to achieve earlier stage diagnosis of BC.

Culturally Tailored Intervention to Promote Mammography Screening Practice Among Chinese American Women: a Systematic Review

Our review aimed to assess the effectiveness of culturally tailored intervention in mammography practice for Chinese American women. We searched the entire paper published by the Cochrane Library, PubMed, and Web of Science from inception to 17 October 2019. Moreover, we manually checked reference lists of included studies to find other potentially eligible studies. It included clinical trials published in English that evaluated the effects of culturally tailored intervention on mammography practice for Chinese American women. Finally, we involved eight studies in our review. After the intervention, the mammography intention and breast cancer-related knowledge were significantly improved. However, there was no significant impact on mammography completion rate, perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, and Eastern cultural views of Chinese American women. The culturally tailored interventions could serve as promising approaches to improve mammography screening practice for Chinese American women, but further improvements are needed.

Psychosocial predictors of mammography history among Chinese American women without a recent mammogram

Chinese American women have lower rates of mammography screening compared with non-Hispanic White women. Although the extent of perceived barriers, as conceptualized by the Health Belief Model, have been shown to distinguish between currently non-adherent Chinese American women who have ever and never had a mammogram, it is less clear which types of perceived barriers differentiate them. One hundred twenty-eight Chinese American women in the New York metropolitan area who had not had a mammogram in the past year completed baseline assessments for a mammography framing intervention study. Demographics, medical access variables, and perceived barriers to mammography (lack of access, lack of need for screening, and modesty) were used to predict mammography history (ever versus never screened). Fifty-five women (43%) reported having been screened at least once. A sequential logistic regression showed that English speaking ability and having health insurance significantly predicted mammography history. However, these control variables became non-significant when the three barrier factors were included in the final model. Women who reported a greater lack of access (OR = 0.36, p < .05) and greater lack of need (OR = 0.27, p < .01) were less likely to be ever screeners. Unexpectedly, women who reported greater modesty were more likely to be ever screeners (OR = 4.78, p < .001). The results suggest that interventions for Chinese American women should identify and target specific perceived barriers with consideration of previous adherence.

Cultural beliefs about breast cancer in Vietnamese women

Background

This study examined factors influencing cultural beliefs associated with later-stage detection of breast cancer and determined what factors influence those cultural beliefs in Vietnamese women residing in a rural Vietnamese community.

Methods

A cross-sectional survey was conducted with 289 women aged 20–64 years from 12 villages using a self-administered structured questionnaire. Cultural beliefs were measured with a 13-item cultural beliefs scale consisting of four domains—characteristics of breast lumps, self-help techniques, faith-based beliefs, and futility of treatment. Data were collected in February 2017 and analyzed using chi-square tests, nonparametric tests, Fisher’s exact tests, and multiple linear regression analyses with SPSS/WIN 24.0 statistical software.

Results

Although the total score was relatively low (3.4 out of 13), cultural beliefs that could contribute to later-stage breast cancer were identified. Younger women (β = .15, p = .016) and women with a lower income (β = .21, p < .001) held more erroneous cultural beliefs as compared to their counterparts. Most women believed they would not get breast cancer if they took care of themselves. More than one-third held cultural beliefs about breast lumps, thinking they would need to be painful and/or actively growing to be breast cancer.

Conclusions

The results support the urgent need for education concerning breast cancer health promotion, including breast cancer assessment as well as guidance on evidence-based and up-to-date detection measures to change rural Vietnamese women’s cultural beliefs.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0777-3) contains supplementary material, which is available to authorized users.

Breast cancer screening behaviors among Chinese women in Mainland China

In the present study, we reported on the current breast cancer screening rates among Chinese women in China and examined whether demographic factors and cultural beliefs were associated with their screening behavior. A cross-sectional survey was conducted with a convenience sample of 494 Chinese women who completed the modified Breast Cancer Screening Beliefs Questionnaire (BCSBQ). Two-sample t-tests and multivariable logistic regression were employed to analyze the data. The results indicated that participation in screening practices ranged from 27.5% for breast self-examination (BSE), 36.4% for clinical breast examination, 23.5% for mammography, and 40% for ultrasonography. Women who had previously engaged in one of the four screening practices had significantly higher scores on the three subscales of the modified BCSBQ. Being older and having a friend who had been diagnosed with breast cancer were shown to be predictors for BSE and participation in either mammography or ultrasonography, respectively. Education levels were also shown to be positively associated with the four screening measures. We suggest that cultural beliefs about breast cancer and screening practices play a significant role in Chinese women's screening behavior.

Evaluation of a Culturally Tailored Education to Promote Breast and Cervical Cancer Screening Among Chinese-Australian Women

This paper aims to evaluate the impact of the culturally sensitive and linguistically appropriate education program on the following: (i) awareness of screening practices (breast awareness, mammogram, and Pap smear test); (ii) screening intention within the next six months; and (iii) knowledge about breast and cervical cancer among Chinese-Australian women. Titled "Happy and Healthy Life in Sydney," this was a quasi-experimental study with both pre- and post-test design. A convenience sample of 288 Chinese women was recruited through Chinese organizations such as churches and community centers. Participants completed the questionnaires before and after the educational program. The results show that the program was effective in promoting awareness of breast and cervical cancer screening and resulted in increased participative intentions in both mammogram and Pap smear testing within the next 6 months. Results also indicate that knowledge and belief scores were significantly increased.

CONCLUSION

Our study supports that educational programs which use culturally sensitive and linguistically appropriate strategies are effective in improving both knowledge of breast and cervical cancer and awareness of their early detection practices among Chinese-Australian women.

Validation of the Breast Cancer Screening Beliefs Questionnaire among African Australian women

Background

The Breast Cancer Screening Beliefs Questionnaire (BCSBQ) has been designed as a culturally appropriate instrument for assessing women’s beliefs, knowledge and attitudes to breast cancer and breast cancer screening practices. While it has proved to be a reliable instrument when applied to women of Chinese, Arabic and Korean origin living in Australia, its psychometric properties among women from African backgrounds have not been tested. The aim of this study is to examine the psychometric properties of the BCSBQ among African Australian women.

Methods

The BCSBQ was administered to 284 African Australian women who were recruited from a number of African community organizations and churches. Factor analysis was conducted to study the factor structure. Construct validity was examined using Cuzick’s non-parametric test while Cronbach alpha was used to assess internal consistency reliability.

Results

Exploratory factor analysis results demonstrated that the African-Australian BCSBQ can be conceptualized as a 4-factor model. The third factor, viz. “barriers to mammography”, was split into two separate factors namely, “psychological” and “practical” barriers. The results indicated that the African-Australian BCSBQ had both satisfactory validity and internal consistency. The Cronbach’s alpha of the three subscales ranged between 0.84-0.92. The frequency of breast cancer screening practices (breast awareness, clinical breast-examination and mammography) were significantly associated with attitudes towards general health check-ups and perceived barriers to mammographic screening.

Conclusions

Our study provided evidence to support the psychometric properties of the BCSBQ.in African Australian women. The study moreover demonstrated that the use of the instrument can help health professionals to understand the beliefs, knowledge and attitudes to breast cancer among African Australian women and also the factors that impact on their breast cancer screening practices.