Asian-Islamic women and breast cancer screening: a socio-cultural analysis

Breast Cancer Screening among African Immigrants in the United States: An Integrative Review of Barriers, Facilitators, and Interventions

The purpose of this review was to synthesize the available literature on breast cancer-screening barriers, facilitators, and interventions among U.S. African immigrants. Following the integrative review framework and PRISMA guidelines for reporting systemic reviews, five electronic databases were searched: PubMed, CINAHL, PsycINFO, Medline, and Google Scholar. Studies were included if they were published in English language journals after 1 January 2000 and reported data on breast cancer-screening barriers, facilitators, or interventions among U.S. African immigrants. Barriers and facilitators reported by studies were descriptively examined and synthesized by two authors and classified as aligning with one of the three levels of influences based on the social-ecological model (intrapersonal, interpersonal, and community). Interventions promoting breast cancer screening were narratively summarized. Search procedures retrieved 1011 articles, with 12 meeting the criteria for inclusion in the review (6 qualitative and 6 quantitative). Intrapersonal barriers included limited awareness, fear of pain, language barriers, health concerns, transportation issues, costs, and negative past experiences. Interpersonal barriers involved modesty, spiritual beliefs, and lack of support, while community-level barriers included provider and healthcare-system challenges. Regarding facilitators, past screening experiences and health insurance were the most commonly reported intrapersonal facilitators. The only interpersonal facilitator identified was observing other women experience a breast cancer diagnosis and undergo treatment. Community-level facilitators included appointment reminders, scheduling assistance, culturally congruent interpreters, transportation to screening facilities, and patient navigators. Three articles reported outcomes of breast cancer-screening interventions. All three were pilot studies and reported increased knowledge and attitudes regarding breast cancer screening following the respective interventions. One study examined the uptake of breast cancer screening following the intervention, with results indicating an increase in screening. Findings provide a comprehensive synthesis of factors influencing breast cancer screening among African immigrants and highlight the need for future research on the topic. This review was registered with Prospero (CRD42024502826) before the initiation of search procedures.

Navigating Living Kidney Donation and Transplantation Among South Asian Canadians: The ACTION Project

RATIONALE & OBJECTIVE

South Asian (SA) Canadians with kidney failure have a 50%-77% lower likelihood of kidney transplant and are less likely to identify potential living donors (LDs). This study aimed to identify health system-, patient-, and community-level barriers and facilitators for accessing LD kidney transplantation in the SA community to inform the development of health system- and community-level interventions to address barriers.

STUDY DESIGN

Qualitative study.

SETTING & PARTICIPANTS

20 SA recipients of an LD or deceased-donor kidney transplant, 10 SA LDs, and 41 general SA community members.

ANALYTICAL APPROACH

In-depth multilingual interviews were conducted with recipients and LDs. Gender-, language-, and age-stratified focus groups were conducted with general SA community members. Summative content analysis was used to analyze the data.

RESULTS

Hesitancy in approaching potential donors, fear about the health of potential LDs, information gaps, language barriers, and challenges evaluating out-of-country donors were highlighted as significant barriers by recipients, and financial concerns and information gaps were identified by donors. Cultural barriers in the SA community were highlighted by donors, recipients, and community members as critical factors when considering donation and transplant; women and elderly SA Canadians highlighted nuanced challenges. Participants reported generally a favorable perception of their health care teams, citing SA representation in the teams as important to providing culturally and linguistically sensitive care.

LIMITATIONS

Limited geographic, race, and cultural representation and reliance on virtual data collection.

CONCLUSIONS

This study highlights several culturally relevant barriers to donation and transplant that are potentially modifiable through patient-, health system-, and community-focused engagement and education.

Breast cancer screening among immigrant Muslim arab women in the United States: Analyzing relationships between beliefs, knowledge, spousal support and mammogram utilization

BACKGROUND

Regular mammogram screenings contribute to a decreased breast cancer (BC) mortality rate. Women from ethnic minorities in the United States, however, often underutilize mammogram screenings; in particular, immigrant Muslim Arab (IMAW) women have low mammogram screening rates.

OBJECTIVE

To explore the associations between mammogram utilization and (a) health and religious beliefs, (b) level of knowledge about mammograms, (c) health care provider (HCP) recommendations, and (d) spousal support.

METHODS

A cross-sectional study employed online data collection. An Arabic or English survey was completed by women who were 45 or older and married, had immigrated from Arab countries, and had no history of breast cancer. Logistic regression was conducted for data analyses.

RESULTS

Of the 184 Immigrant Muslim Arab survey participants, 86.6% reported having had at least one mammogram in their lifetime, and 32.6% adhered to mammograms. Ever having obtained a mammogram and adherence to mammograms were negatively associated with perceived mammogram barriers and positively associated with (a) spousal support, (b) level of mammogram knowledge, and (c) perceived self-confidence. Receiving (HCP) recommendation increased the likelihood of ever having obtained a mammogram. Finally, participants who reported higher levels of perceived mammogram benefits were more likely to have obtained a mammogram within the last 2 years compared to their counterparts.

CONCLUSIONS

IMAW have demonstrated low mammogram adherence rate.

IMPLICATIONS

Nursing clinicians and scholars must play a role in designing and implementing interventions to promote women adherence to mammograms. Involving husbands in these interventions may improve immigrant Muslim Arab women's mammogram adherence rates.

Overcoming challenges to breast cancer screening among Muslim women: addressing barriers to early detection and treatment: A correspondence

Breast cancer is the second leading cause of cancer-related deaths and is the most common type of cancer diagnosed in women. In an attempt to decrease its mortality, screening guidelines recommend mammograms, breast self-examinations, and breast clinical examinations for women above the age of 40. Compliance to these guidelines have been found to be significantly low in Muslim women which has been linked to their perceptions of religious guidelines regarding modesty and fatalism. In order to overcome these barriers and increase screening rates among Muslim women, faith-based intervention has been proven to be effective as it incorporates the use of religious leaders and allows the concerns of women to be addressed directly.

Patient-centered care in the Middle East and North African region: a systematic literature review

BACKGROUND

The need for patient centered care (PCC) and its subsequent implementation has gained policy maker attention worldwide. Despite the evidence showing the benefits and the challenges associated with practicing PCC in western countries there has been no comprehensive review of the literature on PCC practice in the Middle East and North African (MENA) region, yet there is good reason to think that the practices of PCC in these regions would be different.

OBJECTIVES

This paper summarizes the existing research on the practice of PCC in the MENA region and uses this analysis to consider the key elements of a PCC definition based on MENA cultural contexts.

METHODS

Five electronic databases were searched (EMBASE, Cochrane, Medline, CINAHL and Scopus) using the search terms: patient OR person OR client OR consumer AND centered OR centred AND care. The MENA countries included were Bahrain, Iran, Iraq, Jordan, Kuwait, Lebanon, Oman, Palestine, Israel, Qatar, Saudi Arabia, Syria, United Arab Emirates, Yemen, Algeria, Egypt, Libya, Morocco, Tunisia, Djibouti, Pakistan, Sudan, and Turkey. Identified papers were imported to Covidence where they were independently reviewed against the inclusion criteria by two authors. The following data were extracted for each paper: author, year, location (i.e., country), objectives, methodology, study population, and results as they related to patient centred care.

RESULT

The electronic search identified 3582 potentially relevant studies. Fifty articles met the inclusion criteria. Across all papers five themes were identified: 1) patient centered care principles; 2) patient and physician perceptions of PCC; 3) facilitators of PCC; 4) implementation and impact of PCC; and 5) barriers to PCC.

CONCLUSION

The preliminary findings suggest that the concept of PCC is practiced and supported to a limited extent in the MENA region, and that the implementation of PCC might be impacted by the cultural contexts of the region. Our review therefore highlights the importance of establishing patient-centered care definitions that clearly incorporate cultural practices in the MENA region. The elements and impact of culture in the MENA region should be investigated in future research.

Associations between Spiritual Health Locus of Control, Perceived Discrimination and Breast and Cervical Cancer Screening for Muslim American Women in New York City

BACKGROUND

We sought to understand the impacts of religion-related factors, namely perceived discrimination and spiritual health locus of control, on breast and cervical cancer screening for Muslim American women.

METHODS

A total of 421 Muslim American women were surveyed at baseline of a breast and cervical cancer screening intervention, measuring discrimination through the Perceived Ethnic Discrimination Questionnaire (PED-Q), a 17-item scale measuring perceived interpersonal racial/ethnic discrimination; and spiritual beliefs through the Spiritual Health Locus of Control Scale, a 13-item scale measuring the link between control over one's health with a connection to religious beliefs. Multivariable logistic regression models were used to determine factors associated with an up-to-date mammogram and Pap test.

RESULTS

Most women preferred to receive medical care from a healthcare provider of their same gender (75.2%) and same race, ethnicity or religion (62.1%). The middle age group (50-59) and a lower God's Grace Spiritual Health Locus of Control subscale were associated with up-to-date mammogram. Younger age, lower education, higher Exclusion/Rejection subscale, and lower Spiritual Life/Faith Subscale were associated with an up-to-date Pap test.

CONCLUSION

The spiritual beliefs of Muslim American women impact their likelihood of obtaining breast and cervical cancer screenings. Therefore, these services need to be better tailored to match these needs, for example, by ensuring that Muslim American women have access to healthcare providers of their same gender, race, ethnicity or religion.

Beliefs and perceptions about breast cancer among the people living in rural and less privileged areas in Sindh, Pakistan

Purpose

Globally, women suffer from a lack of knowledge about breast cancer (BC), its symptoms and treatment. The purpose of this paper is to examine how people living in rural and less developed areas in Pakistan perceive BC. The study investigates the level of knowledge about BC in rural communities and analyses how the prevalent perceptions and beliefs impact women's lives and delay the diagnosis.

Design/methodology/approach

This study is based on 42 in-depth interviews with the women who have undergone BC treatment during the past five years. The participants were interviewed were the residents of the northern Sindh, southern Pakistan.

Findings

Findings show that BC was perceived as a contagious disease transmitted through touching or being physically close to the patient. Some women were abandoned by their husbands because of this perception. Faith in fatalism and the perception that BC is an incurable disease were common in communities with low socio-economic status. This is likely to affect the prevention and early detection of BC.

Originality/value

The study shows a strong co-relation of awareness with the prevalent perceptions regarding BC. Therefore, we recommend promoting health literacy and introducing culturally specific interventions in remote communities to enhance their understanding of the available treatment and help remove misconceptions about BC.

Determinants of early breast cancer presentation: a qualitative exploration among female survivors in Indonesia

OBJECTIVE

Early presentation with breast cancer symptoms is crucial to the effectiveness of treatment and the affected women's long-term survival. However, in Indonesia, 60-70% of breast cancer patients first present themselves to the hospital in an advanced stage. Knowledge about the determinants of breast cancer early presentation could inform efforts to promote healthcare seeking at earlier symptomatic stages. In the current study, we explored the psychosocial determinants of early presentation among female breast cancer survivors.

METHODS

Face-to-face semi-structured interviews were conducted with 23 female breast cancer survivors in Surabaya, Indonesia (mean age = 49.8 years). Directed content analysis approach was used to analyse the data.

RESULTS

Half of the respondents underwent breast cancer screening prior to onset of symptoms. Nine determinants of breast cancer early presentation were reflected in the women's responses: (lack of) knowledge, perceived behavioural control, previous health related experiences and risk perceptions, attitudes and beliefs, norms, competing priorities, financial issues, instrumental factors, and health provider factors.

CONCLUSION

Health promotion efforts should focus on both internal and external psychosocial determinants related to the breast cancer early presentation, and on involving women's social environment as target for education. Additionally, providing accessible and affordable healthcare is important for early presentation.

'Our culture prohibits some things': qualitative inquiry into how sociocultural context influences the scale-up of community-based injectable contraceptives in Nigeria

OBJECTIVES

To explore how sociocultural factors may support or impede the adoption of community-based distribution of injectable contraceptives in Nigeria.

DESIGN

A qualitative study based on inductive thematic analysis was conducted through in-depth interviews and focus group discussions.

SETTING

Most participants lived in Gombe State, North-East Nigeria. Other participants were from Ibadan (South-West) and Abuja (Federal Capital Territory).

PARTICIPANTS

Through seven key informant interviews, 15 in-depth interviews and 10 focus group discussions, 102 participants were involved in the study.

METHODS

This study conducted in 2016 was part of a larger study on scale-up of community-based distribution of injectable contraceptives. Qualitative data were collected from traditional and religious leaders, health workers and community members. The data were audio recorded, transcribed and analysed using a thematic framework method.

RESULTS

Sociocultural challenges to scale-up included patriarchy and men's fear of losing control over their spouses, traditional and religious beliefs about fertility, and myths about contraceptives and family planning. As a result of deep-rooted beliefs that children are 'divine blessings' and that procreation should not be regulated, participants described a subtle resistance to uptake of injectable contraceptives. Since Gombe is largely a patriarchal society, male involvement emerged as important to the success of meaningful innovation uptake. Community leaders largely described their participation in the scale-up process as active, although they also identified the scope for further involvement and recognition.

CONCLUSION

Scale-up is more than setting up health sector implementing structures, training health workers and getting innovation supplies, but also requires preparedness which includes paying attention to complex contextual issues. Policy implementers should also see scale-up as a learning process and be willing to move at the speed of the community.

Barriers and Facilitators to Breast and Cervical Cancer Screening Among Immigrants in the United States

To summarize the literature on barriers and facilitators to breast and cervical cancer screening among immigrants to the US. A literature review was conducted for studies on breast and cervical cancer screening among immigrant populations. A thematic analysis of 180 studies identified a variety of barriers and facilitators to screening at the personal and system levels. Personal barriers included lack of knowledge and insurance coverage, high cost of care, and immigration status. System barriers included poor access to services, lack of interpreter services, and insensitivity to patient needs. Facilitators to screening included knowledge of disease, access to information sources, physician recommendation, and social networks. Cultural norms and resource availability at the individual and system levels influence screening among immigrants. Health insurance coverage was found to be an important predictor of preventative screening use. Future research should seek to identify the best way to address this and other barriers to cancer screening among immigrants groups.

To the point: gender differences in the obstetrics and gynecology clerkship

Gender differences in performance on the obstetrics and gynecology clerkship have been reported, with female students outperforming male students. Male students report that their gender negatively affects their experience during the clerkship. Additionally, there are fewer male students applying for obstetric/gynecology residency. This "To The Point" article by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee will describe the gender differences that have been found, examine factors that could be contributing to these issues, and propose measures to correct these disparities.

Breast Cancer Characteristics in Middle Eastern Women Immigrants Compared With Non-Hispanic White Women in California

Background

Emerging evidence has indicated that Middle Eastern (ME) immigrants might be more likely to be diagnosed with breast cancer at advanced stage, yet have better overall survival than nonimmigrant non-Hispanic whites (NHW). This study aims to analyze the association between ME immigration status and breast cancer stage at diagnosis and survival.

Methods

Using the California Cancer Registry, a total of 343 876 women diagnosed with primary in situ or invasive breast cancers were identified during 1988–2013. Multinomial logistic regression models were fitted to evaluate the risk of in situ and nonlocalized breast cancer stage in comparison with localized breast cancer among first-generation ME immigrants, second- or subsequent-generation ME immigrants, and NHW. Cox proportional hazard models were applied to calculate hazard ratios (HRs) with their 95% confidence intervals (CIs) for breast cancer mortality among the three population groups with invasive primary breast cancer.

Results

First-generation ME immigrants had higher odds of being diagnosed with a nonlocalized stage (vs localized) than NHW (odds ratio [OR] = 1.17, 95% CI = 1.09 to 1.26). Second- or subsequent-generation ME immigrants also had higher odds of being diagnosed with a nonlocalized stage (vs localized) than NHW (OR = 1.31, 95% CI = 1.20 to 1.43). First-generation ME immigrants were 11% less likely to die from breast cancer than NHW (HR = 0.89, 95% CI = 0.82 to 0.97).

Conclusions

First-generation ME immigrants had higher breast cancer survival despite being diagnosed at a nonlocalized breast cancer stage at diagnosis when compared with NHW. Screening interventions tailored to this ME immigrant group need to be implemented.

Reducing Muslim Mammography Disparities: Outcomes From a Religiously Tailored Mosque-Based Intervention

OBJECTIVE

To describe the design of, and participant-level outcomes related to, a religiously tailored, peer-led group education program aimed at enhancing Muslim women's mammography intention.

METHOD

Using a community-engaged approach and mixed methods, we identified and addressed barrier beliefs impeding mammography screening among Muslim American women. Our religiously tailored, mosque-based, peer-led intervention involved facilitated discussions and expert-led didactics conveying health-related religious teachings, and information about the benefits and process of mammography. Barrier beliefs were addressed through reframing, reprioritizing, or reforming such beliefs. Participant surveys were collected preintervention, postintervention, 6 months postintervention, and 1 year postintervention. These measured changes in mammography intention, likelihood, confidence, and resonance with barrier and facilitator beliefs.

RESULTS

A total of 58 Muslim women (mean age = 50 years) that had not had a mammogram in the past 2 years participated in the two-session program. Self-reported likelihood of obtaining a mammogram increased significantly ( p = .01) and coincided with a positive trend in confidence ( p = .08). Individuals with higher agreement with barrier beliefs preintervention had lower odds for positive change in likelihood (odds ratio = 0.80, p = .03), while those who were married had higher odds for positive change in likelihood (odds ratio = 37.69, p = .02). At 1-year follow-up, 22 participants had obtained a mammogram.

CONCLUSION

Our pilot mosque-based intervention demonstrated efficacy in improving Muslim women's self-reported likelihood of obtaining mammograms, and increased their mammography utilization, with nearly 40% obtaining a mammogram within 12 months of the intervention.

IMPACT

Our conceptual model for religiously tailoring messages, along with its implementation curriculum, proved effective in enhancing the likelihood and receipt of mammograms among Muslim American women. Accordingly, our work advances both the theory and practice of faith-based interventions and provides a model for addressing Muslim women's cancer screening disparities.

Developing religiously-tailored health messages for behavioral change: Introducing the reframe, reprioritize, and reform ("3R") model

RATIONALE

As community health interventions advance from being faith-placed to authentically faith-based, greater discussion is needed about the theory, practice, and ethics of delivering health messages embedded within a religious worldview. While there is much potential to leverage religion to promote health behaviors and improve health outcomes, there is also a risk of co-opting religious teachings for strictly biomedical ends.

OBJECTIVE

To describe the development, implementation, and ethical dimensions of a conceptual model for religiously-tailoring health messages.

METHOD

We used data from 6 focus groups and 19 interviews with women aged 40 and older sampled from diverse Muslim community organizations to map out how religious beliefs and values impact mammography-related behavioral, normative and control beliefs. These beliefs were further grouped into those that enhance mammography intention (facilitators) and those that impede intention (barriers). In concert with a multi-disciplinary advisory board, and by drawing upon leading theories of health behavior change, we developed the "3R" model for crafting religiously-tailored health messages.

RESULTS

The 3R model addresses barrier beliefs, which are beliefs that negatively impact adopting a health behavior, by (i) reframing the belief within a relevant religious worldview, (ii) reprioritizing the belief by introducing another religious belief that has greater resonance with participants, and (iii) reforming the belief by uncovering logical flaws and/or theological misinterpretations. These approaches were used to create messages for a peer-led, mosque-based, educational intervention designed to improve mammography intention among Muslim women.

CONCLUSIONS

There are benefits and potential ethical challenges to using religiously tailored messages to promote health behaviors. Our theoretically driven 3R model aids interventionists in crafting messages that address beliefs that hinder healthy behaviors. It is particularly useful in the context of faith-based interventions for it highlights the ethical choices that must be made when incorporating religious values and beliefs in tailored messages.

Barriers to Cervical Cancer and Breast Cancer Screening Uptake in Low-Income and Middle-Income Countries: A Systematic Review

Background:

Cervical cancer (CCa) and breast cancer (BCa) are the two leading cancers in women worldwide. Early detection and education to promote early diagnosis and screening of CCa and BCa greatly increases the chances for successful treatment and survival. Screening uptake for CCa and BCa in low and middle - income countries (LMICs) is low, and is consequently failing to prevent these diseases. We conducted a systematic review to identify the key barriers to CCa and BCa screening in women in LMICs.

Methods:

We performed a systematic literature search using Ovid MEDLINE, EMBASE, PsycINFO, SCOPUS, CINHAL Plus, and Google scholar to retrieve all English language studies from inception to 2015. This review was done in accordance with the PRISMA-P guidelines.

Results:

53 eligible studies, 31 CCa screening studies and 22 BCa screening studies, provided information on 81,210 participants. We found fewer studies in low-income and lower - middle - income countries than in upper - middle - income countries. Lack of knowledge about CCa and BCa, and understanding of the role of screening were the key barriers to CCa and BCa screening in LMICs. Factors that are opportunities for knowledge acquisition, such as level of education, urban living, employment outside the home, facilitated CCa and BCa screening uptake in women in LMICs.

Conclusions:

Improvements to CCa and BCa screening uptake in LMICs must be accompanied by educational interventions which aim to improve knowledge and understanding of CCa and BCa and screening to asymptomatic women. It is imperative for governments and health policy makers in LMICs to implement screening programmes, including educational interventions, to ensure the prevention and early detection of women with CCa and BCa. These programmes and policies will be an integral part of a comprehensive population-based CCa and BCa control framework in LMICs.

Evaluation of Breast Cancer Knowledge and Awareness Among Hospital Staff in a Women Heath Hospital in Turkey

The purpose of this study was to examine breast cancer prevention knowledge, beliefs, and information sources among people which are employed in healthcare system including nurses and hospital staff. A cross-sectional survey was conducted among hospital staff of the largest women health hospital in Turkey. Self-administered questionnaires were delivered to participants. A total of 200 hospital staff participated to the study with a response rate of 80.5 %. One-way ANOVA with post-hoc Tukey test was used for multiple comparisons. The results showed that the overall knowledge of hospital staff about breast cancer is inadequate. The mean total knowledge score of the participants was approximately 60 %. The overall mean score of the survey for all participants was 16.69 (SD, 3.12) out of 27. Significant difference was detected in mean total score among educational levels. Education and increasing awareness about the disease can be identified as the major determinants for improving the percentages of early diagnosis and decreasing the mortality rates. Hospital staff education should be the key target for increasing the awareness of whole population especially for developing countries.

Breast and Cervical Cancer Screening among US and non US Born African American Muslim Women in New York City

PURPOSE

Health disparities related to breast and cervical cancer among African American and African-born Muslim women in the United States have been identified in previous literature. Our study aimed at exploring the breast and cervical screening rates and factors that influence this population's disposition to adhere to cancer screening exams.

METHODS

Mixed methods were used to collect data with African American and African-born Muslim women in New York City. Data were collected from a total of 140 women; among them, 40 participated in four focus groups.

FINDINGS

Focus groups revealed nine themes: healthcare practices; lack of knowledge/misconceptions; negative perceptions and fear; time; modesty; role of religion; role of men; role of community; stigma and shame. Among 130 women who reported their cancer screening status, 72.3% of those age 21 and over were adherent to cervical cancer screening; 20.0% never had a Pap test. Among women age 40 and over, 80.2% reported adherence to recommended mammogram; 12.8% never had one. Among women under age 40, 52.2% had their last clinical breast exam (CBE) less than three years ago. Among women age 40 and over, 75.0% were adherent to yearly CBE.

CONCLUSIONS

While rates of screenings were above the national average and higher than expected, specific barriers and facilitators related to religious and health beliefs and attitudes that influence the decision to adhere to screening were revealed. These factors should be further explored and addressed to inform future research and strategies for promoting regular breast and cervical cancer screenings.

Breast cancer genetic counseling among Dutch patients from Turkish and Moroccan descent: participation determinants and perspectives of patients and healthcare professionals

Lower participation rates in cancer genetic counseling are observed among different ethnic minorities. The goal of our study is to gain insight into determinants of Turkish and Moroccan patients’ participation in breast cancer genetic counseling and DNA testing, from the point of view of healthcare professionals and patients. Questionnaire-based telephone interviews about awareness, perceptions, and reasons for (non-) participation in cancer genetic counseling were conducted with 78 Dutch breast cancer patients from Turkish and Moroccan descent. The interviews were held in Arabic, Berber, Turkish, or Dutch by bilingual research assistants. Additionally, 14 breast cancer patients participated in one of two focus group meetings, and two focus groups were held with 11 healthcare professionals. SPSS and QSR Nvivo were used to examine the quantitative and qualitative data, respectively. Half of the total group of patients (N = 78) and 79% of patients eligible for genetic counseling and testing (N = 33) were aware of the possibility of genetic counseling. The most important determinants for nonparticipation in genetic counseling were experienced difficulties in patient-doctor communication, cultural factors (e.g., social norms), limited health literacy, limited knowledge of the family cancer history, and anxiety about cancer. Religious beliefs and knowing personal and family members’ breast cancer risks were motives to obtain genetic counseling. Despite the fact that our study showed that Moroccan and Turkish women reported several personal motives to obtain genetic counseling and testing (GCT), patients and healthcare professionals experience significant language and health literacy difficulties, which make it harder to fully access health care such as genetic counseling and testing.

Religious beliefs and mammography intention: findings from a qualitative study of a diverse group of American Muslim women

OBJECTIVE

Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors, scant research has examined how religion-related beliefs inform Muslim women's intention for mammography. Our study identifies and examines such beliefs.

METHODS

Muslim women aged 40 years and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the theory of planned behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention.

RESULTS

Fifty women participated in 6 focus groups and 19 in semistructured interviews, with near-equal numbers of African American, South Asian, and Arab Muslims. Forty-two percent of participants had not had a mammogram within the past 2 years. Across differences in race/ethnicity and mammography status, women voiced four religion-related salient beliefs that inform mammography intention: (1) the perceived duty to care for one's health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant health care.

CONCLUSIONS

Religious beliefs influence decisions to pursue mammography across the ethnic/racial diversity of Muslim women. Notions about duty to God and the stewardship of one's body appear to enhance mammography intention. Theocentric notions of cure and illness and varied views regarding personal agency also inform decisional frames that impact mammography intention. Given the salience of religion among our participants, religiously tailored messages in interventions have the potential to enhance cancer screening.

Predictors of Delayed Healthcare Seeking Among American Muslim Women

BACKGROUND

Delayed care seeking is associated with adverse health outcomes. For Muslim women, delayed care seeking might include religion-related motivations, such as a preference for female clinicians, concerns about preserving modesty, and fatalistic beliefs. Our study assesses associations between religion-related factors and delayed care seeking due to a perceived lack of female clinicians.

MATERIALS AND METHODS

Surveys were distributed to Muslim women attending mosque and community events in Chicago. Survey items included measures of religiosity, religious fatalism, discrimination, modesty, and alternative medicine utilization and worship practices. The outcome measure asked for levels of agreement to the statement "I have delayed seeking medical care when no woman doctor is available to see me."

RESULTS

Two hundred fifty-four women completed the survey with nearly equal numbers of African Americans (26%), Arab Americans (33%), and South Asians (33%). Fifty-three percent reported delays in care seeking due to a perceived lack of female clinicians. In multivariate analysis adjusting for sociodemographic factors, higher religiosity (odds ratio [OR] = 5.2, p < 0.01) and modesty levels (OR = 1.4, p < 0.001) were positively associated with delayed care seeking. Having lived in the United States for >20 years (OR = 0.22, p < 0.05) was negatively associated with delayed care seeking.

CONCLUSION

Many American Muslim women reported delays in care seeking due to a perceived lack of female clinicians. Women with higher levels of modesty and self-rated religiosity had higher odds of delaying care. Women who had lived in the United States for longer durations had lower odds of delaying care. Our research highlights the need for gender-concordant providers and culturally sensitive care for American Muslims.

Ramadan Fasting and Patients with Cancer: State-of-the-Art and Future Prospects

Ramadan fasting represents one of the five pillars of the Islam creed. Even though some subjects (among which patients) are exempted from observing this religious duty, they may be eager to share this particular moment of the year with their family and peers. However, there are no guidelines or standardized protocols that can help physicians to properly address the issue of patients with cancer fasting in Ramadan and correctly advising them. Moreover, in a more interconnected and globalized society, in which more and more Muslim patients live in the Western countries, this topic is of high interest also for the general practitioner. For this purpose, we carried out a systematic review on the subject. Our main findings are that (1) very few studies have been carried out, addressing this issue, (2) evidence concerning quality of life and compliance to treatment is contrasting and scarce, and (3) generally speaking, few patients ask their physicians whether they can safely fast or not. For these reasons, further research should be performed, given the relevance and importance of this topic.

Patient delay factors in women presenting with breast cancer in a low income country

Background

In low income countries, many patients with breast cancer present with advanced disease which is majorly attributed to late presentation and this is associated with poor survival rates. The aim of this study was to determine the magnitude of patient delay and the factors that influence, delay in seeking health care in female breast cancer patients.

Methods

A cross-sectional study was done between January and April 2014 at a tertiary breast unit. Female patients with breast cancer above the age of 18 years were interviewed. Ethical approval was obtained.

Results

In total 162 patients were recruited, the mean patient delay in months was 22.6 (SD = 26.4), median delay was 13 months and range was 1–127 months. 139 (89 %) patients delayed by more than 3 months after noticing symptoms of breast anomaly. Patients with no social support from spouses and family were more likely to delay (OR = 7.1, 95 % CI 2.4–21.5, p = 0.001), those who perceived the symptoms as very serious were less likely to delay (OR = 0.2, 95 % CI 0.1–0.6, p = 0.007). There was a significant association between delayed presentation and advanced stage at presentation (p = 0.006).

Conclusion

Most women (89 %) with breast cancer delayed by more than 3 months to seek the first medical consultation after noticing symptoms. Patients who had no social support from their families were more likely to delay.

Associations between religion-related factors and breast cancer screening among American Muslims

American Muslims have low rates of mammography utilization, and research suggests that religious values influence their health-seeking behaviors. We assessed associations between religion-related factors and breast cancer screening in this population. A diverse group of Muslim women were recruited from mosques and Muslim organization sites in Greater Chicago to self-administer a survey incorporating measures of fatalism, religiosity, discrimination, and Islamic modesty. 254 surveys were collected of which 240 met age inclusion criteria (40 years of age or older). Of the 240, 72 respondents were Arab, 71 South Asian, 59 African American, and 38 identified with another ethnicity. 77% of respondents had at least one mammogram in their lifetime, yet 37% had not obtained mammography within the past 2 years. In multivariate models, positive religious coping, and perceived religious discrimination in healthcare were negatively associated with having a mammogram in the past 2 years, while having a PCP was positively associated. Ever having a mammogram was positively associated with increasing age and years of US residency, and knowing someone with breast cancer. Promoting biennial mammography among American Muslims may require addressing ideas about religious coping and combating perceived religious discrimination through tailored interventions.

Birth preferences by nulliparous women and their partners in Turkey

OBJECTIVE

The aim of this study was to examine the preferences of nulliparous women and their partners in giving birth and the reasons for these preferences.

METHODS

The sample in this cross-sectional study consisted of 162 pregnant women in the last trimester of pregnancy and their partners. Data collection was accomplished using a questionnaire.

RESULTS

It was found that most women (90.8%) and their partners (92%) preferred a vaginal birth. The couples' birth preferences were generally similar to one another. The main reasons for the choice of a vaginal birth were that it was natural and healthier for the mother and child and that recovery and discharge from the hospital were quicker. The main reasons for the choice of cesarean section were fear of childbirth and not putting the baby at risk.

CONCLUSIONS

Antenatal education may help to reduce the number of elective cesarean sections by changing the negative perceptions of vaginal birth and reducing the fear of childbirth.

Culturally informed views on cancer screening: a qualitative research study of the differences between older and younger Somali immigrant women

BACKGROUND

Somali women are infrequently screened for breast or cervical cancer, and there is a paucity of evidence-based interventions to increase cancer screening in this community. In order to create a culturally relevant intervention for Somali women living in Minnesota, we sought to understand what Somali immigrant women know about breast and cervical cancer, what are the attitudes toward screening and what cultural barriers are there to screen as well as cultural factors that would facilitate screening.

METHODS

In partnership with a community-based organization, New American Community Services (NACS), focus groups were conducted to explore the issues described above. Two focus groups were held with younger women age 20 to 35 and two were held with women age 36 to 65.

RESULTS

Twenty-nine women participated in the four focus groups. The women identified 1) differences in health care seeking behavior in Somalia verses the United States; 2) cultural understanding of cancer and disease; 3) barriers to mammogram or Pap screening; 4) facilitators to seeking preventive cancer screening; and 5) risk factors for developing cancer.

CONCLUSIONS

Cultural misperceptions and attitudes need to be addressed in developing culturally-appropriate interventions to improve screening uptake for Somali women. A nuanced response is required to address barriers specific to younger and older groups. Culturally informed beliefs can be integrated into intervention development, preventive care and screening promotion.

Associations between religion-related factors and cervical cancer screening among Muslims in greater chicago

OBJECTIVE

This study aimed to assess rates of Papanicolaou (Pap) testing and associations between religion-related factors and these rates among a racially and ethnically diverse sample of American Muslim women.

MATERIALS AND METHODS

A community-based participatory research design was used in partnering with the Council of Islamic Organizations of Greater Chicago to recruit Muslim women attending mosque and community events. These participants self-administered surveys incorporating measures of fatalism, religiosity, perceived discrimination, Islamic modesty, and a marker of Pap test use.

RESULTS

A total of 254 survey respondents were collected with nearly equal numbers of Arabs, South Asians, and African American respondents. Of these respondents, 84% had obtained a Pap test in their lifetime, with individuals who interpret disease as a manifestation of God's punishment having a lower odds of having had Pap testing after controlling for sociodemographic factors (odds ratio [OR]=0.87, 95% CI=0.77-1.0). In multivariate models, living in the United States for more than 20 years (OR=4.7, 95% CI=1.4-16) and having a primary care physician (OR=7.7, 95% CI=2.5-23.4) were positive predictors of having had a Pap test. Ethnicity, fatalistic beliefs, perceived discrimination, and modesty levels were not significantly associated with Pap testing rates.

CONCLUSIONS

To our knowledge, this is the first study to assess Pap testing behaviors among a diverse sample of American Muslim women and to observe that negative religious coping (e.g., viewing health problems as a punishment from God) is associated with a lower odds of obtaining a Pap test. The relationship between religious coping and cancer screening behaviors deserves further study so that religious values can be appropriately addressed through cancer screening programs.

A community-based intervention to promote breast cancer awareness and screening among Asian American women

Cancer is the leading cause of death for Asian Americans, and breast cancer is the leading cancer diagnosed among Asian American women. Despite the alarming facts, Asian American women have low breast cancer screening rates. This study examined the effects of a culturally appropriate community-based breast intervention program on participants' knowledge about breast cancer and intention for screening among Southeast Asian and South Asian women in Michigan. Data were collected from 166 women. At baseline, participants had limited knowledge of breast cancer screening guidelines and misconceptions about the risk factors of breast cancer. After the educational intervention, participants reported significantly higher knowledge scores related to breast cancer and screening recommendations and intentions to obtain follow-up CBE and mammograms. This culturally appropriate intervention provides strategies to overcome personal instructional barriers to meet the needs of this group for early detection and cancer control.

Breast cancer screening practices among first-generation immigrant muslim women

BACKGROUND

The purpose of this study was to identify beliefs about breast cancer, screening practices, and factors associated with mammography use among first-generation immigrant Muslim women in Chicago, IL.

METHODS

A convenience sample of 207 first-generation immigrant Muslim women (Middle Eastern 51%; South Asian 49%) completed a culturally adapted questionnaire developed from established instruments. The questionnaire was administered in Urdu, Hindi, Arabic, or English, based on participant preference. Internal-consistency reliability was demonstrated for all scales (alpha coefficients ranged from 0.64 to 0.91). Associations between enabling, predisposing, and need variables and the primary outcome of mammography use were explored by fitting logistic regression models.

RESULTS

Although 70% of the women reported having had a mammogram at least once, only 52% had had one within the past 2 years. Four factors were significant predictors of ever having had a mammogram: years in the United States, self-efficacy, perceived importance of mammography, and intent to be screened. Five factors were significant predictors of adherence (having had a mammogram in the past 2 years): years in the United States, having a primary care provider, perceived importance of mammography, barriers, and intent to be screened.

CONCLUSIONS

This article sheds light on current screening practices and identifies theory-based constructs that facilitate and hinder Muslim women's participation in mammography screening. Our findings provide insights for reaching out particularly to new immigrants, developing patient education programs grounded in culturally appropriate approaches to address perceived barriers and building women's self-efficacy, as well as systems-level considerations for ensuring access to primary care providers.

Developing a measure of cultural-, maturity-, or esteem-driven modesty among Jewish women

Understanding modesty and how it relates to religiosity among Jewish women was relatively unexplained, and as part of a larger study, a measure was needed. The purpose of this article is to report on three studies which represent the three stages of instrument development of a measure of modesty among Jewish women, "Your Views of Modesty": (a) content/concept definition; (b) instrument development; and (c) evaluation of the psychometric properties of the instrument: reliability and validity. In Study I, Q methodology was used to define the domain and results suggesting that modesty has multidimensions. In Study II, an instrument was developed based on distinctive perspectives from each group or what was important and not so important. This formed a 25-item Likert scale. In Study III, a survey of 300 Jewish women revealed internal consistency estimates with Cronbach's alpha 0.92, indicating high degree of internal consistency reliability for "Your Views of Modesty." For construct validity, four factors were found explaining 55% of the variance of modesty: (a) religion-driven, (b) maturity-driven, (c) esteem-driven, and (d) public-based modesty was identified. "Your Views of Modesty" shows good evidence for reliability and validity in this Jewish population.

Gender barriers to health promotion in middle-aged Iranian women

This study explores the perceived socio-cultural factors that might be barriers to health-promoting behaviour in middle-aged women in the city of Yazd in Iran. The aim of this qualitative study was to explore the barriers to a healthy lifestyle in middle-aged women. Interviews with women aged 40-60 were audio-taped, transcribed and analysed using content analysis. The interviews focused on socio-cultural factors and five main themes emerged: (a) giving higher priority to non-health-related needs; (b) the dominance of the husband's will in the family; (c) preference of children's needs to own needs; (d) having to fulfil multiple responsibilities; and (e) low access to community resources for health promotion. The multiple responsibilities of family and work, patriarchal societal attitudes and lack of exercise facilities are barriers to health in middle-aged Iranian women.

American Muslim perceptions of healing: key agents in healing, and their roles

American Muslims represent a growing and diverse community. Efforts at promoting cultural competence, enhancing cross-cultural communication skills, and improving community health must account for the religio-cultural frame through which American Muslims view healing. Using a community-based participatory research model, we conducted 13 focus groups at area mosques in southeast Michigan to explore American Muslim views on healing and to identify the primary agents, and their roles, within the healing process. Participants shared a God-centric view of healing. Healing was accessed through direct means such as supplication and recitation of the Qur'an, or indirectly through human agents including imams, health care practitioners, family, friends, and community. Human agents served integral roles, influencing spiritual, psychological, and physical health. Additional research into how religiosity, health care systems, and community factors influence health-care-seeking behaviors is warranted.

Public and professional educational needs for downstaging breast cancer in Egypt

We conducted focus groups with women from urban and rural areas in the Nile Delta region to investigate their attitudes regarding breast cancer diagnosis, treatment, and screening. Six 60-min focus groups, each group comprised of 6-10 women with ages between 20-69 years, were conducted. Discussions included breast health, breast cancer diagnosis, treatment, early detection and screening, and communication for breast health. Almost all urban and rural women reported that women do not see physicians until they are seriously ill or have advanced cancer. They reported that oncologists or gynecologists were important to be seen first if a woman suspected breast cancer and primary care physician are not the primary line of cancer diagnosis. Other deterring factors besides distrust in primary care physicians included attitude that breast cancer equals death and lack of knowledge of early detection and screening techniques. Women felt that public education campaigns must be implemented to improve early detection and screening methods for breast cancer. The majority of beliefs regarding breast cancer and screening were common among urban and rural women. Culture-specific and tailored professional and public education programs in developing countries are essential for achieving downstaging cancer.

Why breast cancer patients seek traditional healers

Traditional healing is a common practice in low and middle income countries such as Malaysia. Eighty percent of Malaysians consult traditional healers or "bomoh" at some time in their life for health-related issues. The purpose of our study was to explore why breast cancer patients visit traditional healers. This is a qualitative study utilizing in-depth interviews with 11 cancer survivors who sought both traditional and Western medicine. The findings revealed the following reasons for which patients seek traditional healers: (1) recommendation from family and friends, (2) sanction from family, (3) perceived benefit and compatibility, (4) healer credibility, and (5) reservation with Western medicine and system delay. These factors work together and are strongly influenced by the Malaysian cultural context. The issue with the Western health system is common in a developing country with limited health facilities.

The role of imams in American Muslim health: perspectives of Muslim community leaders in Southeast Michigan

American Muslims are a diverse and growing population, numbering nearly 200,000 in Southeast Michigan. Little empirical work exists on the influence of Islam upon the healthcare behaviors of American Muslims, and there is to date limited research on the roles that imams, Muslim religious leaders, play in the health of this community. Utilizing a community-based participatory research (CBPR) model through collaboration with four key community organizations, we conducted semi-structured interviews with 12 community leaders and explored their perceptions about the roles imams play in community health. Respondents identified four central roles for imams in healthcare: (1) encouraging healthy behaviors through scripture-based messages in sermons; (2) performing religious rituals around life events and illnesses; (3) advocating for Muslim patients and delivering cultural sensitivity training in hospitals; and (4) assisting in healthcare decisions for Muslims. Our analysis also suggests several challenges for imams stemming from medical uncertainty and ethical conflicts. Imams play key roles in framing concepts of health and disease and encouraging healthy lifestyles outside of the healthcare system, as well as advocating for Muslim patient needs and aiding in healthcare decisions within the hospital. Healthcare partnerships with these religious leaders and their institutions may be an important means to enhance the health of American Muslims.

Utilization of breast cancer screening methods in a developing nation: results from a nationally representative sample of Malaysian households

As is the case in many developing nations, previous studies of breast cancer screening behavior in Malaysia have used relatively small samples that are not nationally representative, thereby limiting the generalizability of results. Therefore, this study uses nationally representative data from the Malaysia Non-Communicable Disease Surveillance-1 to investigate the role of socio-economic status on breast cancer screening behavior in Malaysia, particularly differences in screening behaviour between ethnic groups. The decisions of 816 women above age 40 in Malaysia to screen for breast cancer using mammography, clinical breast exams (CBE), and breast self-exams (BSE) are modeled using logistic regression. Results indicate that after adjusting for differences in age, education, household income, marital status, and residential location, Malay women are less likely than Chinese and Indian women to utilize mammography, but more likely to perform BSE. Education level and urban residence are positively associated with utilization of each method, but these relationships vary across ethnicity. Higher education levels are strongly related to using each screening method among Chinese women, but have no statistically significant relationship to screening among Malays.

Equity of colorectal cancer screening: which groups have inequitable participation and what can we do about it?

The National Bowel Cancer Screening Program (NBCSP) offers population-based screening for colorectal cancer (CRC) across Australia. The aims of this paper were to highlight the inequities in CRC screening in South Australia (SA) and the system-related barriers and enablers to CRC screening from the perspective of participants identified as having inequitable participation. First, de-identified data for the SA population of the NBCSP were statistically analysed and then mapped. Second, 117 in-depth interviews were conducted with culturally and linguistically diverse (CALD) groups, Indigenous and Anglo-Saxon Australians. Participation rates in the NBCSP were geographically and statistically significantly different (P < 0.0001) on the basis of gender (higher for women), age (higher for older people) and socioeconomic status (higher for more affluent people). The main system-related barriers were the lack of awareness of CRC or CRC screening within these groups, the problems with language due to most of the information being in English and the lack of recommendation by a doctor. This study revealed that inequity exists in the NBCSP participation in SA, and we identified both barriers and facilitators to CRC screening that require action at the level of both policy and practice. There is a large role in primary health care of both recommending CRC screening and facilitating equitable participation.

Traditional-Westernizing continuum of change in screening behaviors: comparison between Arab women in Israel and the West Bank

Health perceptions are changing, but the pace of change varies across societies, exercising different effects on women's screening behaviors. Our aim is to assess the rate of mammography and clinical breast examination (CBE) attendance in younger and older Arab women in Israel and in the West Bank, and the effect of health beliefs on the screening behaviors. A random sample of 697 Arab women, 300 from Israel and 397 from the West Bank, aged 30-65 years, answered questionnaires on screening behaviors, the Arab culture-specific barriers, fatalism, worry, and health beliefs. The participation rate was 93.5% in Israel and 98.3% in the West Bank. Higher fatalistic perceptions, traditional beliefs, barriers to bodily exposure, and social, environmental, and personal barriers to screening were reported by women from the West Bank compared to Arab women in Israel and by older women compared to the younger women. Adjusted lower likelihood of attending screening was predicted by group (AOR 3.55, 95% CI 1.25-10.11 for mammography and AOR 2.36, 95% CI 1.19-3.65 for CBE), higher fatalism (AOR 0.52, 95% CI 0.30-76 for mammography and AOR 0.68, 95% CI 0.54-92 for CBE), more traditional beliefs (AOR 0.61, 95% CI 0.48-0.80 for mammography and AOR 0.51, 95% CI 0.39-0.68 for CBE), and higher barriers to self-exposure (AOR 0.69, 95% CI 0.48-0.83 for mammography and AOR 0.76, 95% CI 0.62-0.95 for CBE), higher perceived personal barriers (AOR 0.36, 95% CI 0.12-1.08 for mammography and AOR 0.77, 95% CI 0.60-0.98 for CBE), and lower perceived benefits (AOR 1.98, 95% CI 1.17-3.34 for mammography and AOR 1.39, 95% CI 1.06-1.81 for CBE). Also, adjusted lower likelihood of CBE attendance was predicted by younger age, higher religiosity, and higher social barriers. Differences in screening behaviors of younger and older Arab women from the West Bank and from Israel represent a traditional-westernizing continuum of change, but are also related to the social and situational context.

Patient-centered care for Muslim women: provider and patient perspectives

OBJECTIVE

The purpose of this study was twofold: (1) to address the gap in existing literature regarding provider perspectives about provision of high-quality, culturally appropriate, patient-centered care to Muslim women in the United States and (2) to explore congruence between provider and patient perceptions regarding barriers to and recommendations for providing such care.

METHODS

Using a cross-sectional study design, a written survey was administered to a convenience sample of healthcare providers (n = 80) and Muslim women (n = 27).

RESULTS

There was considerable congruence among patients and providers regarding healthcare needs of Muslim women. A majority (83.3%) of responding providers reported encountering challenges while providing care to Muslim women. A majority (93.8%) of responding patients reported that their healthcare provider did not understand their religious or cultural needs. Providers and patients outlined similar barriers/challenges and recommendations. Key challenges included lack of providers' understanding of patients' religious and cultural beliefs; language-related patient-provider communication barriers; patients' modesty needs; patients' lack of understanding of disease processes and the healthcare system; patients' lack of trust and suspicion about the healthcare system, including providers; and system-related barriers. Key recommendations included provider education about basic religious and cultural beliefs of Muslim patients, provider training regarding facilitation of a collaborative patient-provider relationship, addressing language-related communication barriers, and patient education about disease processes and preventive healthcare.

CONCLUSIONS

Both providers and patients identify significant barriers to the provision of culturally appropriate care to Muslim women. Improving care would require a flexible and collaborative care model that respects and accommodates the needs of patients, provides opportunities for training providers and educating patients, and makes necessary adjustments in the healthcare system. The findings of this study can guide future research aimed at ensuring high-quality, culturally appropriate, patient-centered healthcare for Muslim women in the United States and other western countries.

Comparison of Arab breast cancer survivors and healthy controls for spousal relationship, body image, and emotional distress

BACKGROUND

Cultural perceptions and norms affect individuals' psychological reactions to cancer and quality of life, but very few studies have assessed reactions to breast cancer in specific cultural groups. Such assessments are especially rare for Arab women with breast cancer.

AIMS

To assess the effect of spousal support, sharing household tasks, and body image in relation to emotional distress in Arab breast cancer survivors compared with matched healthy controls.

METHOD

Fifty-six Israeli Arab breast cancer survivors (stages I-III), and 66 age- and education-matched women answered Brief Symptoms Inventory-18, Perceived Body Image, Perceived Spousal Support and Division of Household Labor scale questionnaires.

RESULTS

Breast cancer patients experienced higher psychological distress, especially anxiety and somatization. They reported receiving more support from their spouses and higher sharing of household tasks than did matched healthy controls, but were not different regarding body image. Twenty-eight percent of the variance of psychological distress was explained, with group, perceived support, and group × body image interaction. Thus, higher psychological distress was more likely to occur in participants receiving lower support and in breast cancer survivors with lower body image.

CONCLUSIONS

The study described the effects of breast cancer on Arab women compared to healthy women. It highlights the need for culture-sensitive care for Arab breast cancer patients, as well as other patients from minority groups residing in other Western countries.

Barriers to cancer screening in Hmong Americans: the influence of health care accessibility, culture, and cancer literacy

Hmong Americans face high cancer mortality rates even in comparison to their Asian American counterparts, and report low utilization of cancer screenings. To date, no study has been conducted on the cultural barriers this population faces in undergoing cancer screenings. A systematic review of the literature was conducted to examine the existing knowledge regarding the barriers to cancer screening for Hmong Americans. Potential barriers were identified from this examination to include: health access factors (type of health insurance, ethnicity of provider, low English proficiency, and years spent in the U.S.); cultural factors (belief in the spiritual etiology of diseases, patriarchal values, modesty, and mistrust of the western medical system); and cancer literacy factors (cancer and prevention illiteracy). Based on this review, potential cultural and ethnic group-specific prevention strategies and cancer health policies are discussed to address these barriers and enhance screening behavior among the Hmong.

Development of a breast and cervical cancer screening intervention for Vietnamese American women: a community-based participatory approach

Community-based participatory research (CBPR) is a collaborative partnership approach to research that combines the efforts of researchers and stakeholders. CBPR can effectively be used to target local community populations in increasing knowledge and improving behaviors in cancer prevention as participants have a voice and active role in the research process. This article describes how CBPR was used in the development, implementation, and evaluation of a pilot intervention for breast and cervical cancer screening among a Vietnamese female population. The authors outline the use of CBPR in three phases: (a) the identification of preventive health topics important in the local Vietnamese community, (b) the development and administration of a survey to gain a deeper understanding of barriers to breast and cancer screening among Vietnamese women, and (c) the development of a culturally appropriate pilot intervention to promote cancer screening behavior among a local Vietnamese population. In Study 1, it was found that Vietnamese women experienced disparities in breast and cervical cancer screening. In Study 2, it was found that having health insurance and a regular physician were predictive of breast and cervical cancer screening. It was also found that participants had low levels of acculturation and lacked cancer screening knowledge. In Study 3, it was found that the culturally relevant intervention used in this study improved cancer screening-related outcomes in knowledge, self-efficacy, intention, and behavior.

How equitable are colorectal cancer screening programs which include FOBTs? A review of qualitative and quantitative studies

OBJECTIVE

To review published literature on the equity of participation in colorectal cancer screening amongst different population subgroups, in addition to identifying factors identified as barriers and facilitators to equitable screening. Studies were included in the review if they included FOBT as at least one of the screening tests.

METHOD

Relevant published articles were identified through systematic electronic searches of selected databases and the examination of the bibliographies of retrieved articles. Studies of the association with colorectal cancer screening test participation, barriers to equitable participation in screening, and studies examining interventional actions to facilitate screening test participation were included. Data extraction and analysis was undertaken using an approach to the synthesis of qualitative and quantitative studies called Realist Review.

RESULTS

Sixty-three articles were identified that met the inclusion criteria. SES status, ethnicity, age and gender have been found as predictors of colorectal cancer screening test participation. This review also found that the potential for equitable cancer screening test participation may be hindered by access barriers which vary amongst population sub-groups.

CONCLUSION

This review provides evidence of horizontal inequity in colorectal cancer screening test participation, but limited understanding of the mechanism by which it is sustained, and few evidence-based solutions.

Evaluation of breast cancer awareness among female university students in Malaysia

Breast cancer is the most common cancer and the leading cause of cancer death among women of all ethnic and age groups in Malaysia.

Muslim women and medical students in the clinical encounter

CONTEXT

Increasingly, male medical students report being refused by female patients, particularly in obstetrics and gynaecology, which is impacting on recruitment into the discipline. However, little has been documented in terms of Muslim patients and medical students in the clinical consultation.

METHODS

Female Emirati nationals (n = 218) attending out-patient clinics at a public hospital in Al Ain, United Arab Emirates (UAE), were interviewed by medical students. Participants were provided with four hypothetical clinical scenarios (three personal, one concerning a pre-pubertal child) and asked whether they would allow male and female students to be present at a consultation, take a history or perform an examination. They were also canvassed about their past experiences with medical students and their social responsibility to contribute towards the training of Emirati doctors.

RESULTS

Significant differences were recorded in terms of female versus male student involvement for all activities (P < 0.05-0.0005). For gynaecological and abdominal problems, patients would generally refuse male students. More than 50% of interviewees would not allow a male student to examine their face. Students of either gender could, however, examine their 8-year-old child. Although 47% of the women had had previous clinical encounters with students, in only 58% of consultations had the attending doctor asked their permission. Despite this, the women had generally felt comfortable, although satisfaction decreased with increasing age (P = 0.088). Almost 90% of the women believed that Emiratis had a social responsibility to contribute towards the training of Emirati doctors, but this decreased with increasing income (P = 0.004).

CONCLUSIONS

As many medical students will encounter Muslim patients during their training, they need to be sensitive to religious and cultural issues, particularly for personal examinations. In contexts where most patients are Muslim, alternative options (e.g. manikins, international rotations) may be required for male students. In the UAE, patient education may improve history-taking opportunities but will probably not transcend religious and cultural beliefs without intervention from religious leaders.

Developing and testing an instrument for identifying culture-specific barriers to breast cancer screening in Israeli Arab women

AIMS

To develop and assess an instrument for studying culture-specific barriers to performing examinations for early detection of breast cancer.

METHODS

A three-step design: (a) content analysis of five focus groups (n=51); (b) constructing and initial testing of the Arab culture-specific barriers (ACSB) instrument in a pilot study (n=79); (c) testing for validity and reliability of the revised ACSB instrument (n=300, of these 200 Muslim and 100 Christian, mean age 48). Construct validity was examined using factor analysis. Performance of screenings (mammography and clinical and self breast examination) was used to test criterion validity by logistic regression and receiver operating characteristic (ROC) curve; convergent validity was tested by the barriers subscale of the health beliefs questionnaire. Internal consistency reliability was tested by Cronbach's alpha coefficients.

RESULTS

Factor analysis revealed five subscales: social barriers, exposure barriers, environmental barriers, uneasiness with own body, and traditional beliefs concerning cancer. The factors accounted for 54.6% of cumulative variance. Twelve items not meeting item-scale criteria were removed, resulting in a 21-item instrument. Convergent validity was confirmed for all subscales except traditional beliefs. ACSB mean score explained between 0.79 (95% CI .72-.86) and 0.85 (95% CI .79-.94) of the area under the ROC curve of the screening procedures. Internal consistency of the subscales ranged from 0.76 to 0.90.

CONCLUSIONS

The study showed initial satisfactory reliability of the ACSB. Validity was approved for social barriers, exposure barriers, environmental barriers and uneasiness with own body subscales, and only partially for traditional beliefs. Further examination of the instrument with different populations of Arab women is needed.