To disclose or not to disclose: an ethnographic exploration of factors contributing to the (non) disclosure of Ghanaian women's breast cancer diagnosis to social networks

BACKGROUND

Although there may be theoretical support linking positive health outcomes with cancer disclosure to social networks, women from contexts such as Ghana where cancer is not openly talked about may have concerns around breast cancer disclosure. Women may not be able to share their experiences about their diagnosis, which may prevent them from receiving support. This study aimed to obtain the views of Ghanaian women diagnosed with breast cancer about factors contributing to (non) disclosure.

METHODS

This study is based on secondary findings from an ethnographic study that employed participant observation and semi-structured face to face interviews. The study was conducted at a breast clinic in a Teaching Hospital in southern Ghana. 16 women diagnosed with breast cancer (up to stage 3); five relatives nominated by these women and ten healthcare professionals (HCPs) participated in the study. Factors contributing to breast cancer (non) disclosure were explored. Data were analysed using a thematic approach.

RESULTS

The analysis indicated that most of the women and family members were very reticent about breast cancer disclosure and were secretive with distant relatives and wider social networks. Whilst remaining silent about their cancer diagnosis helped women protect their identities, prevented spiritual attack, and bad advice, the need for emotional and financial support for cancer treatment triggered disclosure to close family, friends, and pastors. Some women were discouraged from persevering with conventional treatment following disclosure to their close relatives.

CONCLUSIONS

Breast cancer stigma and fears around disclosure hindered women from disclosing to individuals in their social networks. Women disclosed to their close relatives for support, but this was not always safe. Health care professionals are well placed to explore women's concerns and facilitate disclosure within safe spaces to enhance engagement with breast cancer care services.

Green consumers' behavioral intention and loyalty to use mobile organic food delivery applications: the role of social supports, sustainability perceptions, and religious consciousness

Consumer behavior in the food industry has undergone significant changes in recent years, largely driven by growing consumer awareness of environmental, technological, religious, and social concerns. As a result, organic food has emerged as a popular alternative to conventionally produced food. Many emerging nations, including Bangladesh, promote its consumption due to its perceived health and safety benefits. Despite this growing trend, there remains a need for more understanding of consumer behavior, particularly concerning their motivations for continuous purchases toward mobile organic food delivery applications. In order to fill this knowledge gap, this study looks at how six indirect predictors (emotional support, informational support, environmental consciousness, religious consciousness, trust, and technological consciousness) affect customer loyalty through the intention to use organic food. This study employed a purposive sampling technique (i.e., judgmental sampling) and collected data from 386 respondents across three cities in Bangladesh. Data analysis was conducted using SmartPLS 3 software. The study found that all predictors, except for technological consciousness, significantly influenced behavioral intention, which, in turn, significantly influenced loyalty. Additionally, the study revealed that the five predictors, excluding technological consciousness, indirectly influenced loyalty through behavioral intention. The results of this study add to the existing literature on organic food by extending social support theory to include consumers' primary motivations, such as environmental, religious, technological, and social consciousness, as predictors of loyalty to use mobile organic food delivery applications. The study highlights the importance of sustainable food consumption in promoting environmental protection, ensuring social justice, creating economic success, and providing valuable insights for implementers looking to expand the organic food market.

Graphical abstract

The role of informational support from women's social networks on antenatal care initiation: qualitative evidence from pregnant women in Uganda

BACKGROUND

Early and appropriate use of antenatal care services is critical for reducing maternal and neonatal mortality and morbidity. Yet most women in sub-Saharan Africa, including Uganda, do not seek antenatal care until later during pregnancy. This qualitative study explored pregnant women's reliance on social ties for information about initiation of antenatal care.

METHODS

We conducted semi-structured, in-depth interviews with 30 pregnant women seeking their first antenatal care visit at Kawempe Referral Hospital in Kampala, Uganda. Recruitment was done purposively to obtain variation by parity and whether women currently had a male partner. Study recruitment occurred from August 25^th 2020 - October 26^th, 2020. We used thematic analysis following a two-stage coding process, with both deductive and inductive codes. Deductive codes followed the key domains of social network and social support theory.

RESULTS

We found that the most important source of information about antenatal care initiation was these women's mothers. Other sources included their mothers-in-law, female elders including grandmothers, and male partners. Sisters and female friends were less influential information sources about antenatal initiation. One of the primary reasons for relying on their own mothers, mothers-in-law, and elder women was due to these women's lived experience with pregnancy and childbirth. Trust in the relationship was also an important factor. Some pregnant women were less likely to rely on their sisters or female friends, either due to lack of trust or these women's lack of experience with pregnancy and childbirth. The advice that pregnant women received from their mothers and others on the ideal timing for antenatal care initiation varied significantly, including examples of misinformation about when to initiate antenatal care. Pregnant women seemed less likely to delay care when more than one social tie encouraged early antenatal care.

CONCLUSIONS

Educating women's social networks, especially their mothers, mothers-in-law, and community elders, about the importance of early antenatal care initiation is a promising avenue for encouraging pregnant women to seek care earlier in pregnancy.

Informational support for depression and quality of life improvements in older patients with cancer: a systematic review and meta-analysis

PURPOSE

To assess and summarize the effects of informational support on depression and quality of life of older patients with cancer.

METHODS

PubMed, MEDLINE, and Web of Science were searched to identify articles written in English and published until March 2021. Studies within 10 years period (2010-2021) were included. Randomized controlled trials were included if they evaluated the impact of informational support on depression and quality of life. All analyses were performed with Review Manager 5.3.

RESULTS

Twelve studies with a total of 2374 participants met the inclusion criteria. Our primary outcomes included depression and quality of life. (1) Depression: results indicated no statistically significant difference and low heterogeneity [SMD = 0.28, 95% CI (- 0.24,0.80), p = 0.45; I² = 0%], (2) Quality of life: in the subgroup analyses of EORTC QLQ-C30, results indicated a significant effect of informational support on quality of life [SMD = 2.84, 95% CI (0.63, 5.05), p = 0.03; I² = 79%]; in the subgroup analyses of FACT and SF-36, there were no significance.

CONCLUSIONS

Informational support could reduce depression and did improve the quality of life in older cancer patients with statistical significance. The findings suggested that informational support was an effective approach to improve depression and quality of life in older patients with cancer.

Informational support, risk perception, anti-pandemic motivation and behavior: a longitudinal study in China

Mobilizing the public to take anti-pandemic behavior (APB) by strengthening informational support has been recognized as an effective strategy to combat the COVID-19 pandemic. However, it remains unclear how health-related informational support from different channels affects individual factors and, thus, the adoption of different types of APB as the pandemic situation changes. To resolve this issue, we build a multiple mediation model to investigate the associations among informational support from three different channels, two individual internal factors, and two kinds of APB. A three-stage longitudinal study administered to Chinese citizens from February to October 2020 revealed that informational support from media played the most critical role in facilitating individuals’ adoption of compliance APB, while informational support from family was the most significant predictor of the adoption of participation APB. Meanwhile, these effects were mediated by risk perception and anti-pandemic motivation, and weakened to varying degrees as the pandemic situation eased. It is recommended that authorities adjust the focus of publicity strategies in light of the changing situation, and make efforts to heighten the public’s risk perception and anti-pandemic motivation. This study contributes to deepening the understanding of the dynamic efficacy of informational support from different channels on individuals’ adoption of two heterogeneous APBs, and thus to the formulation of more scientific, and situation-based publicity strategies during a public health crisis.

The effect of informational support on anxiety and satisfaction among patients' family members in the emergency room using path analysis

This study was to determine the direct and indirect effect of informational support on the levels of anxiety and satisfaction of patients' family members in the ER. A cross-sectional design was used involving 74 family members of patients in an ER. The respondents were selected by way of a purposive sampling technique. The study employed the Hamilton Anxiety Rating Scale (HARS) and a satisfaction questionnaire to collect data. Path analysis was performed on the data analysis. The study findings show that informational support has a more direct (β=0.599) than the indirect effect (β=0.084) on family satisfaction. The results also reveal that informational support has a significant effect on the anxiety score and satisfaction of a patient's family members (p<0.05). The quality and the quantity of informational support affects the levels of anxiety and satisfaction experienced by the family of a patient in the ER.

Knowledge mobilization tool to promote, protect, and support breastfeeding during COVID-19

Setting

This knowledge mobilization project was conceptualized to increase awareness among breastfeeding mothers and the general public on safe infant feeding practices during the COVID-19 pandemic by addressing myths and misconceptions associated with breastfeeding practices, guiding breastfeeding mothers to make informed decisions around child feeding practices, and offering meaningful guidance in simple language through a short online animated video.

Intervention

This project was undertaken in four phases. During phase 1, an informal discussion was held with the breastfeeding mothers, service providers, and community partner in identifying issues surrounding lactation counselling facilities during the COVID-19 pandemic. During phase 2, recommendations from 23 organizations with regard to breastfeeding during COVID-19 were reviewed and analyzed. During phase 3, using evidence from reliable sources, a 5-minute animated e-resource on breastfeeding during COVID-19 was conceptualized and developed. During phase 4, the e-resource was disseminated to the breastfeeding mothers, general public, post-secondary institutions, and organizations providing services to breastfeeding mothers in Canada.

Outcomes

This evidence-based e-resource facilitated addressing misconceptions around breastfeeding during COVID-19 and raising public awareness on safe infant feeding practices during this pandemic. Overall, the video was described as an informative, user-friendly, useful, and easily accessible resource by breastfeeding mothers who were in self-isolation with little access to healthcare services during the pandemic.

Implications

This project highlighted the importance of patient engagement and collaboration with the community partner in protecting breastfeeding during the COVID-19 pandemic. It further illustrated how informational e-resources can protect breastfeeding in situations where breastfeeding mothers’ access to healthcare services is compromised.

Profiles of instrumental, emotional, and informational support in Chinese breast cancer patients undergoing chemotherapy: a latent class analysis

Background

To date, few studies have assessed social relationships in patients with breast cancer during their chemotherapy process. This study aimed to explore profiles of instrumental, emotional, and informational support in Chinese breast cancer patients undergoing chemotherapy.

Methods

In a cross-sectional study performed between September 2018 and September 2020 in China, 638 patients with breast cancer completed demographic information questionnaires, the PROMIS-Social Relationships Short Forms, the PROMIS-Anxiety Short Form, and the PROMIS-Depression Short Form. Analysis of variance and chi-square tests were performed to examine between-group differences in demographic characteristics, anxiety, and depression outcomes across the identified latent classes. Multinomial logistic regression was performed to identify the correlation of significant variables among the identified classes.

Results

Three profiles of social relationships were identified: Class 1-low social relationships group (14.3%), Class 2-high instrumental support, medium emotional and informational support group (24.6%), and Class 3-high social relationships group (61.1%). The findings revealed the heterogeneity of instrumental, emotional, and informational support in Chinese breast cancer patients undergoing chemotherapy, which was significantly correlated with educational background, monthly family income, health insurance, and employment status. Additionally, patients with low instrumental, emotional, and informational support were more likely to report high levels of anxiety and depression.

Conclusions

When conducting interventions to promote social relationships during the chemotherapy process, healthcare providers should consider the sociodemographic characteristics, anxiety levels, and depression symptoms of patients with breast cancer and identify high-risk patients for tailored interventions.

Investigating the healthcare pathway through patients' experience and profiles: implications for breast cancer healthcare providers

Background

Healthcare systems are facing many changes. Particularly, patients are more engaged in the care process. The medical perspective of the process is insufficient to provide patients with high quality care and service personalisation. This research presents an attempt to complete this medical perspective through an experiential perspective, especially for chronic diseases such as cancer. We investigated patients’ experiences and profiles to reach a deeper understanding of their needs and expectations when they confront the disease.

The objectives of this research were to model the key stages underling the patient pathway and to identify the challenging touch points of the interactions between patients and healthcare providers. Bringing together findings of patient experience, pathway, and profiles would help all the stakeholders involved to develop better practices for the healthcare process.

Methods

A qualitative observational nethnography on a French specialized forum for breast cancer patients “les Impatientes” was conducted. A total of 967 reviews were collected over a complete year period from all over France. Thematic and lexicometric content analysis were performed according to the experience dimensions, the pathway stages and touch points, as well as the patients’ profiles.

Results

Data analysis shows that the healthcare pathway experienced by the patients is built around three stages. The discovery stage is closely related to the emotional dimension regarding the patient and physician relationship. The examination stage is characterized by a more technical and informational needs for the types of treatments. The follow-up and survivorship stage illustrates the patients’ need to assess the treatments’ effectiveness and the quality of the follow-up. Moreover, three profiles of patients were identified. The newcomers, the altruists and the autonomous are characterized by different attitudes depending on the stage of the healthcare pathway they were living.

Conclusions

Our research presents an original modelling of the patient pathway and profiles beyond the medical process. It gives practical tracks to improve the healthcare pathway. Patients expect healthcare providers to integrate and strengthen several challenging touch points in order to create satisfactory patient experiences and high quality service.

Effect of Informational Support on Anxiety in Family Caregivers of Patients with Hemiplegic Stroke

BACKGROUND

Brain stroke causes physical and mental disabilities, as well as dependence on one's family. In such cases, the families suffer from severe crisis and anxiety due to the unexpected incidence of the disease and unawareness of the associated consequences.

OBJECTIVES

The aim of the present study was to evaluate the effectiveness of informational support on the level of anxiety in family caregivers of hemiplegic stroke patients.

METHODS

This quasi-experimental study was performed on 78 family caregivers of hemiplegic stroke patients admitted to the Neurology Department of Farshchian Hospital in Hamadan, Iran, over 8 months. The subjects were selected through convenience sampling method and divided into two groups of intervention (n = 40) and control (n = 38). Intervention started from the third day of hospitalization and continued until the eleventh day. During this period, information about the ward, equipment, patient status, and care procedure at home, was provided for the intervention group individually and in groups. On the other hand, the control group only received the routine care. Anxiety level of caregivers was measured through the Spielberger scale both before and after the intervention. Data analysis was performed in SPSS software (version 16).

RESULTS

Based on the results, both groups were similar in terms of demographic variables (P > 0.05). Moreover, there was no significant difference between the two groups regarding the mean level of state and trait anxiety before the intervention (P > 0.05). However, after intervention, the mean level of state and trait anxiety of the intervention group showed a significant reduction in comparison to that of the control group (P < 0.05).

CONCLUSIONS

According to the findings, it can be concluded that informational support is effective in reducing the state and trait anxiety in family caregivers of stroke patients. Therefore, it is suggested that nurses consider informational support as an important nursing intervention during hospitalization.

Male student nurses need more support: Understanding the determinants and consequences of career adaptability in nursing college students

BACKGROUND

To better understand nursing students' high attrition rates, especially for male student nurses, it is important to understand their academic satisfaction and compare it based on gender.

OBJECTIVES

To examine the relationships between proactive personality, core self- evaluations, types of support (emotional/instrumental/informational support), career adaptability, and academic satisfaction in nursing college students using the career construction theory.

DESIGN

This study uses a cross-sectional design.

PARTICIPANTS AND METHODS

1062 students recruited from one health vocational college in northwest China completed questionnaires measuring proactive personality, core self-evaluations, emotional/instrumental/informational support, career adaptability, and academic satisfaction. Data was analyzed by structural equation modeling, and mediation and moderation analyses were performed.

RESULTS

Proactive personality (Beta = 0.24, p < 0.001), core self-evaluations (Beta = 0.31, p < 0.001) and informational support (Beta = 0.21, p < 0.001) were positively correlated with career adaptability, and career adaptability was positively (Beta = 0.43, p < 0.001) associated with academic satisfaction. Career adaptability mediates the relationships between proactive personality, core self-evaluations, informational support and academic satisfaction. For male student nurses, emotional support (Beta = 0.31, p < 0.01) has a positive association with career adaptability.

CONCLUSIONS

In nursing students, personal features (e.g., proactive personality, core self-evaluations) and supporting materials (e.g., informational support) have a positive association with career adaptability, and career adaptability has a mediating role in the relationships. Male student nurses need extra emotional support to promote their academic satisfaction. Targeted interventions may improve nursing college students' academic satisfaction.

Individual and network factors associated with HCV treatment uptake among people who inject drugs

BACKGROUND

Hepatitis C virus (HCV) treatment uptake among people who inject drugs (PWID), a population with disproportionately high rates of HCV, remains low. Peers have been shown to positively impact a broad range of health outcomes for PWID. There is, however, limited data on the impact of PWID social network members on HCV treatment.

METHODS

HCV-infected PWID enrolled in an ongoing community-based cohort were recruited as "indexes" to complete an egocentric social network survey. The survey elicited from the index PWID a list of their network members and the index's perception of network member characteristics. Logistic regression analyses were conducted to compare individual and network factors associated with HCV treatment in the index PWID.

RESULTS

Among 540 HCV-infected PWID, the mean age was 55.7 years and the majority were black (87.2%) and male (69.8%). PWID reported a mean of 4.4 (standard deviation [SD] 3.2) network members, most of whom were relatives (mean 2.2 [SD 1.5]). In multivariable analysis, increasing index age and HIV infection were positively associated with HCV treatment, while drug use and homelessness in the preceding 6 months were negatively associated with HCV treatment. From a network perspective, having at least one network member who regularly talked with the index about seeing their doctor for HIV care was associated with HCV treatment (Adjusted Odds Ratio [AOR] 2.7; 95% Confidence Interval (CI) [1.3, 5.6]). Conversely, PWID who had at least one network member who helped them understand their HCV care were less likely to have been HCV treated (AOR 0.2; CI [0.1, 0.6).

CONCLUSION

HCV treatment uptake in this group of PWID appeared to be positively influenced by discussions with network members living with HIV who were in care and negatively influenced by HCV information sharing within PWID networks. These findings underscore the influence of peers on health seeking behaviors of their network members and emphasizes the importance of well-informed peers.

Exploring the role of social support and adjuvant endocrine therapy use among breast cancer survivors

BACKGROUND

Adjuvant endocrine therapy (AET) significantly reduces recurrence and mortality in women with estrogen receptor-positive breast cancer. Adherence to AET is about 50-60% for 5 years, and while numerous studies have identified barriers to AET adherence, few have identified the role of social support as a facilitator. Therefore, the objective of this study is to explore the role of social support during the ongoing management of AET.

METHODS

We conducted semi-structured in-depth interviews with breast cancer survivors (n = 22) who filled a prescription for AET in the previous 12 months. Women were recruited from Los Angeles, California, and Houston, Texas, between 2014 and 2015. Interview questions prompted discussion about AET and how social support affects AET adherence. We analyzed interview transcripts with a grounded theory approach and grouped social support into four categories (emotional, informational, instrumental, and appraisal), then used a thematic content analysis to identify the sources and delivery of support.

RESULTS

Women described that informational support was provided by medical providers who explained the purpose, benefits, and management of AET. Emotional support in the form of reassurance, communication, and empathy was provided by family, survivorship groups, medical providers, and spirituality/religiosity. Women identified several organizations and exercises that provided them with instrumental and appraisal support in the form of physical and emotional benefits, which was also provided by family, friends, and medical providers.

CONCLUSION

We identified that social support delivered to breast cancer survivors provided women with educational, physical, and emotional benefits that may play an important role in their continuation of AET.

Support provided by midwives to women during labour in a public hospital, Limpopo Province, South Africa: a participant observation study

BACKGROUND

Physical presence during labour offer women opportunity of having positive childbirth experiences as well as childbirth outcomes. The study aimed to determine what support provided by midwives during intrapartum care at a public hospital in Limpopo Province. The study was conducted at a tertiary hospital in Limpopo Province.

METHODS

A participant observation approach was used to achieve the objectives of the study. The population comprised of all women who were admitted with labour and for delivery and midwives who were providing midwifery care in the obstetric unit of a tertiary public hospital in Limpopo Province. Non-probability, purposive and convenience sampling were used to sample 24 women and 12 midwives. Data were collected through participant observations which included unstructured conversations with the use of observational guide, field notes of all events and conversations that occurred when women interact with midwives were recorded verbatim and a Visual Analog Scale to complement the observations. Data were analysed qualitatively but were presented in the tables and bar graphs.

RESULTS

Five themes emerged as support provided by midwives during labour, namely; communication between women and midwives, informational support, emotional support activities, interpretation of the experienced labour pain and supportive care activities during labour.

CONCLUSION

The communication between woman and midwife was occurring as part of midwifery care and very limited for empowering. The information sharing focused on the assistive actions rather than on the activities that would promote mothers' participation. The emotional support activities indicated lack of respect and disregard cultural preferences and this contributed to inability to exercise choices in decision-making. The study recommended the implementation of Batho Pele principles in order to provide woman-centred care during labour.