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Zheng S, Liu S, Yang Q, Chan S, Huang W, Jiang X, Zhu J. The effectiveness of interventions to reduce cancer-related stigma: An integrative review. J Clin Nurs 2024; 33:2438-2455. [PMID: 38345136 DOI: 10.1111/jocn.17014] [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: 07/06/2023] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 06/14/2024]
Abstract
AIMS The clinical significance of cancer-related stigma on patients' well-being has been widely established. Stigma can be perceived and internalised by cancer patients or implemented by the general population and healthcare workers. Various interventions have been carried out to reduce cancer-related stigma, but their effectiveness is not well-understood. This review aims to synthesise evidence on the effectiveness of interventions to reduce cancer-related stigma. DESIGN An integrative review. METHODS This integrative review combined both qualitative and quantitative studies and followed five steps to identify problems, search for the literature, appraise the literature quality, analyse data, and present data. Mixed Methods Appraisal Tool (version 2018) was applied to evaluate the quality of the included studies. DATA SOURCES Databases included Web of Science, MEDLINE, SpringerLink, Wiley Online Journals, Cochrane Library, ScienceDirect, OVID, and China National Knowledge Infrastructure (from the inception of each database to 30 April 2021). RESULTS Eighteen quantitative, six qualitative, and five mixed-methods studies were included in this review. Cultural factors should be considered when conducting interventions to reduce cancer-related stigma. For cancer patients, multi-component interventions have demonstrated a positive effect on their perceived stigma. For general population, interactive interventions show promise to reduce their implemented stigma towards cancer patients. For healthcare workers, there is a paucity of studies to reduce their implemented stigma. Existing studies reported inconclusive evidence, partially due to the lack of a robust study design with an adequate sample size. CONCLUSIONS Multi-component and interactive interventions show promise to relieve cancer-related stigma. More methodologically robust studies should be conducted in different cultures to elucidate the most appropriate interventions for different populations to reduce cancer-related stigma. IMPLICATION FOR THE PROFESSION AND PATIENT CARE These findings will facilitate healthcare workers to design and implement interventions to reduce cancer-related stigma, thus improving the quality of life for cancer patients. PATIENT AND PUBLIC CONTRIBUTION No patient and public contribution.
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Affiliation(s)
- Shuang Zheng
- School of Medicine, Xiamen University, Xiamen, China
| | - Shengjie Liu
- School of Medicine, Xiamen University, Xiamen, China
- Department of Thyroid and Breast Surgery, Weifang People's Hospital, Shandong Second Medical University, Weifang, China
| | - Qingmo Yang
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Sally Chan
- President Office, Tung Wah College, Hong Kong, China
| | - Wenhe Huang
- Cancer Center, Department of Breast and Thyroid Surgery, Xiang'an Hospital, Xiamen University, Xiamen, China
| | - Xiaoying Jiang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jiemin Zhu
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
- Cancer Care Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Koech MJ, Mwangi J, Kithaka B, Kimaru S, Kusu N, Munyi L, Chahonyo S, Makokha F. Effects of stigma on quality of life of cancer survivors: Preliminary evidence from a survivorship programme in Kenya. Heliyon 2024; 10:e30165. [PMID: 38720711 PMCID: PMC11076907 DOI: 10.1016/j.heliyon.2024.e30165] [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: 10/26/2023] [Revised: 03/22/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
Globally, cancer is a major public health problem. There is a paucity of information regarding stigma and how it affects the cancer survivors' quality of life (QoL) in Kenya. In a recent report by Globocan, 42,116 new cases and 27,072 fatalities related to cancer were documented in Kenya in 2020. Cancer survivors are more likely to suffer physical and psychological disorders as a result of their poor QoL. The purpose of this study was to evaluate the knowledge, attitudes, and beliefs regarding the stigma associated with the disease as well as how it affects their QoL among a cohort of cancer survivors supported by the KILELE Health Association. Methods This research used a cross-sectional design with both quantitative and qualitative methods. The study enrolled 45 cancer survivors from a cohort participating in the KILELE Health Association (KHA) survivors' program. The quantitative data were coded and analyzed using the 26th version of the Statistical Package for Social Sciences (SPSS). Utilizing content analysis, qualitative data was thematically evaluated. In accordance with the study's goals and key measures, the generated transcripts were organized into themes and sub-themes. Results Participants' mean age was 44.55 ± 9.89 years. Forty-two of the participants completed the survey and were thus included in the analysis. Cancer survivors reported experiencing low levels of stigma across the following dimensions: awkwardness (2.51 ± 0.75), severity (3.22 ± 1.29), financial discrimination (2.77 ± 1.17), personal responsibility (1.9 ± 1.38), avoidance (1.38 ± 0.68), and policy level stigmatization (5.09 ± 1.70). Awareness raising (97.62%), using communication channels (95.24%), advocacy, and lobbying (92.86%) were the most commonly stated strategies to change people's attitudes in terms of interventions to reduce stigma and improve QoL. Conclusion Respondents in this study showed low levels of stigma, which may be due to the support they receive from the KILELE Health Association. Strategic steps in advocacy, publicity, and education are required to end stigmatization to promote awareness and pique people's interest in cancer survivorship. Further research with a larger sample size of cancer survivors from various settings is warranted.
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Watt MH, Suneja G, Zimba C, Westmoreland KD, Bula A, Cutler L, Khatri A, Painschab MS, Kimani S. Cancer-Related Stigma in Malawi: Narratives of Cancer Survivors. JCO Glob Oncol 2023; 9:e2200307. [PMID: 36795989 PMCID: PMC10166375 DOI: 10.1200/go.22.00307] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/08/2022] [Accepted: 01/19/2023] [Indexed: 02/18/2023] Open
Abstract
PURPOSE Stigma is an impediment across the cancer care continuum, leading to delayed presentation to care, elevated morbidity and mortality, and reduced quality of life. The goal of this study was to qualitatively examine the drivers, manifestations, and impacts of cancer-related stigma among individuals who received cancer treatment in Malawi, and to identify opportunities to address stigma. METHODS Individuals who had completed treatment for lymphoma (n = 20) or breast cancer (n = 9) were recruited from observational cancer cohorts in Lilongwe, Malawi. Interviews explored the individual's cancer journey, from first symptoms through diagnosis, treatment, and recovery. Interviews were audio-recorded and translated from Chichewa to English. Data were coded for content related to stigma, and thematically analyzed to describe the drivers, manifestations, and impacts of stigma along the cancer journey. RESULTS Drivers of cancer stigma included beliefs of cancer origin (cancer as infectious; cancer as a marker of HIV; cancer due to bewitchment), perceived changes in the individual with cancer (loss of social/economic role; physical changes), and expectations about the individual's future (cancer as death sentence). Cancer stigma manifested through gossip, isolation, and courtesy stigma toward family members. The impacts of cancer stigma included mental health distress, impediments to care engagement, lack of cancer disclosure, and self-isolation. Participants suggested the following programmatic needs: community education about cancer; counseling in health facilities; and peer support from cancer survivors. CONCLUSION The results highlight multifactorial drivers, manifestations, and impacts of cancer-related stigma in Malawi, which may affect success of cancer screening and treatment programs. There is a clear need for multilevel interventions to improve community attitudes toward people with cancer, and to support individuals along the continuum of cancer care.
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Affiliation(s)
- Melissa H. Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | | | - Katherine D. Westmoreland
- Department of Pediatric Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Lux Cutler
- Honors College, University of Utah, Salt Lake City, UT
| | - Abhilasha Khatri
- School of Biological Sciences and Honors College, University of Utah, Salt Lake City, UT
| | - Matthew S. Painschab
- Department of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen Kimani
- Department of Medicine, Division of Medical Oncology, University of Utah, Salt Lake City, UT
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Romli R, Abd Rahman R, Chew KT, Mohd Hashim S, Mohamad EMW, Mohammed Nawi A. Empirical investigation of e-health intervention in cervical cancer screening: A systematic literature review. PLoS One 2022; 17:e0273375. [PMID: 35984812 PMCID: PMC9390916 DOI: 10.1371/journal.pone.0273375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022] Open
Abstract
Cervical cancer (CC) screening can detect the cancer early but is underutilized, especially among the developing countries and low- to middle-income countries. Electronic health (e-health) has the potential for disseminating health education and is widely used in the developed countries. This systematic literature review investigates the effectiveness of e-health intervention for improving knowledge of CC and the intention or uptake for CC screening. We followed the PRISMA 2020 guideline and registered with PROSPERO (registration ID CRD42021276036). We searched the Web of Science, Scopus and EBSCO Medline Complete databases for eligible studies. Studies that conveyed informational material through e-health intervention were selected. The results were analyzed using narrative synthesis, and the pooled estimates were calculated using meta-analysis. A total of six studies involving 1886 women were included in this review. The use of e-health aids alone led to increased knowledge. The meta-analysis demonstrated that the mixed-education method of e-health movies and video education with didactic sessions increased CC screening uptake. A random-effects model revealed that CC screening uptake following e-health interventions were almost double of that of their comparison (odds ratio = 2.29, 95% confidence interval: 1.28–4.10, p < 0.05). Various areas of study demonstrated e-health intervention effectiveness (minority communities, urban areas, rural areas). Health education through e-health intervention has huge potential for promoting CC screening in the community. Nevertheless, the use of appropriate frameworks, user engagement and culturally tailored e-health need to be prioritized.
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Affiliation(s)
- Rodziah Romli
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- Institut Latihan Kementerian Kesihatan Malaysia Alor Setar, Ministry of Health, Putrajaya, Malaysia
| | - Rahana Abd Rahman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Kah Teik Chew
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Syahnaz Mohd Hashim
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Emma Mirza Wati Mohamad
- Centre for Research in Media and Communication (MENTION), Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- * E-mail:
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Marfil-Carmona R, Ortega-Caballero M, Zurita-Ortega F, Ubago-Jiménez JL, González-Valero G, Puertas-Molero P. Impact of the Mass Media on Adherence to the Mediterranean Diet, Psychological Well-Being and Physical Activity. Structural Equation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3746. [PMID: 33916699 PMCID: PMC8038341 DOI: 10.3390/ijerph18073746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The influence of mass media on emotions, subjective well-being and behaviours in society should be clearly understood. Physical-health education has an important role to play as a preventive tool. The aim of this study was to develop an explanatory model regarding the relationships between mass media, psychological well-being, physical activity, Mediterranean diet and age and to compare the model with multi-group analysis according to gender. METHODS A descriptive, non-experimental, cross-sectional design was used, with 634 participants between 18 and 66 years old (M = 35.18 ± 9.68). RESULTS Structural equation modeling was found to be satisfactory for all parameters. Results show that mass media have a significant direct influence on well-being, with negative effects on physical activity and adherence to a Mediterranean diet. The model fitted better for males in terms of gender differences, showing a better fit of psychological well-being being associated with higher levels of physical activity and better adherence to the Mediterranean diet. Among women, no relationships were found between mass media pressure and psychological well-being and healthy physical habits, but higher personal satisfaction was associated with better physical activity and better dietary patterns. CONCLUSIONS Thus, the study approaches society to a perspective influenced by mass media and physical-health education, reporting and emphasizing the importance of healthy lifestyles.
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Affiliation(s)
- Rafael Marfil-Carmona
- Faculty of Education Sciences of Granada, University of Granada, 18011 Granada, Spain; (R.M.-C.); (F.Z.-O.); (J.L.U.-J.); (P.P.-M.)
| | - Manuel Ortega-Caballero
- Faculty of Education and Sport Sciences of Melilla, University of Granada, 52005 Melila, Spain;
| | - Félix Zurita-Ortega
- Faculty of Education Sciences of Granada, University of Granada, 18011 Granada, Spain; (R.M.-C.); (F.Z.-O.); (J.L.U.-J.); (P.P.-M.)
| | - José Luis Ubago-Jiménez
- Faculty of Education Sciences of Granada, University of Granada, 18011 Granada, Spain; (R.M.-C.); (F.Z.-O.); (J.L.U.-J.); (P.P.-M.)
| | - Gabriel González-Valero
- Faculty of Education and Sport Sciences of Melilla, University of Granada, 52005 Melila, Spain;
| | - Pilar Puertas-Molero
- Faculty of Education Sciences of Granada, University of Granada, 18011 Granada, Spain; (R.M.-C.); (F.Z.-O.); (J.L.U.-J.); (P.P.-M.)
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