The influence of socio-cultural factors on breast cancer screening behaviors in Lagos,Nigeria

Culture has been shown to influence health beliefs and health-related behaviors by influencing the type of health information to which women have been exposed and shapes health and illness perceptions and practices. To increase screening rates, cultural influences should be considered as important correlates of screening behaviors for breast cancer. This study used semi-structured interviews of women attending a cancer screening facility in Lagos, Nigeria guided by the PEN-3 model to describe culturally relevant factors that shape attitudes toward breast cancer and breast cancer screening. Religion was the most prominent theme and was shown to have positive, negative and existential effect on breast cancer perceptions. Other major themes observed were related to family and traditional beliefs. The results from this study could be used to develop and implement culturally relevant cancer prevention interventions, strategies, and recommendations to overcome screening barriers in an effort to increase breast cancer participation and awareness among Nigerian women.     

Voices of South Asian women: immigration and mental health

PURPOSE: This qualitative research aimed to elicit experiences and beliefs of recent South Asian immigrant women about their major health concerns after immigration. METHODS: Four focus groups were conducted with 24 Hindi-speaking women who had lived less than five years in Canada. The audiotaped data were transcribed, translated, and analyzed by identification of themes and subcategories. RESULTS: Mental health (MH) emerged as an overarching health concern with three major themes i.e. appraisal of the mental burden (extent and general susceptibility), stress-inducing factors, and coping strategies. Many participants agreed that MH did not become a concern to them until after immigration. Women discussed their compromised MH using verbal and symptomatic expressions. The stress-inducing factors identified by participants included loss of social support, economic uncertainties, downward social mobility, mechanistic lifestyle, barriers in accessing health services, and climatic and food changes. Women's major coping strategies included increased efforts to socialize, use of preventative health practices and self-awareness. CONCLUSION: Although participant women discussed a number of ways to deal with post-immigration stressors, the women's perceived compromised mental health reflects the inadequacy of their coping strategies and the available resources. Despite access to healthcare providers, women failed to identify healthcare encounters as opportunities to seek help and discuss their mental health concerns. Health and social care programs need to actively address the compromised mental health perceived by the studied group.     

Breast cancer health promotion model for older Puerto Rican women: results of a pilot programme

This article focuses on the development of a health promotion model programme for elderly Puerto Rican women intended to minimize barriers for early detection of breast cancer and to increase women's compliance with recommended guidelines. The programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non-compliance. It involves the combination of educational and environmental support for actions and conditions conducive to health behaviour and consists of the following components: (i) a culture- and cohort-sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client-physician relationship; (ii) training for primary-care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico; and (iii) coordination of necessary support services to facilitate access to clinical breast exams and mammograms. Programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long-term impact of the programme. Results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p < 0.05) in beliefs after the health education sessions. Interventions in breast cancer early detection practices showed significant changes (p < 0.05) for mammogram and clinical breast examination. Different strategies must be combined to increase older women's compliance with breast cancer screening. Health system and access barriers to preventive care must be addressed.     

Knowledge and beliefs about health promotion and preventive health care among somali women in the United States

We explored conceptualizations of health promotion and experiences with preventive health services among African refugee women. We asked 34 resettled Somali refugee women about their beliefs and experiences regarding health promotion and common preventive health care services in the United States. Interviews were audiotaped, transcribed, and analyzed using a grounded theory approach. Key themes were the importance of good hygiene, an adequate source of food and water, access to a regular source of health care, spirituality, traditional practices, and functioning well at home. All participants were familiar with the process and rationale for immunizations and routine medical examinations; few understood cancer screening services.     

An examination of cancer risk beliefs among adults from Toronto's Somali, Chinese, Russian and Spanish-speaking communities

BACKGROUND: Canada's growing ethnocultural diversity challenges health professionals to develop culturally sensitive cancer prevention strategies. Little is known about the ethnocultural specificity of cancer risk beliefs. This qualitative pilot study examined cancer risk beliefs, focusing on diet, among adults from Toronto's Somali, Chinese, Russian, and Spanish-speaking communities. METHOD: Group interviews (n = 4) were conducted with convenience samples of adults (total n = 45) from four ethnocultural communities (total 45 participants). RESULTS: The constant comparison method of data analysis identified three common themes: knowledge of cancer risk factors, concern about the food supply, and the roles of spiritual and emotional well-being. Two areas of contrasting belief concerning specific mediators of cancer risk were identified. INTERPRETATION: Findings support the investigation of cultural-specific health promotion strategies emphasizing both the maintenance of traditional cancer protective eating practices and the adoption of additional healthy eating practices among new Canadians. More research is needed to enhance our understanding of ethnoculturally specific cancer risk beliefs and practices to ensure the cultural relevance of programming.     

Knowledge and Beliefs About Health Promotion and Preventive Health Care Among Somali Women in the United States

We explored conceptualizations of health promotion and experiences with preventive health services among African refugee women. We asked 34 resettled Somali refugee women about their beliefs and experiences regarding health promotion and common preventive health care services in the United States. Interviews were audiotaped, transcribed, and analyzed using a grounded theory approach. Key themes were the importance of good hygiene, an adequate source of food and water, access to a regular source of health care, spirituality, traditional practices, and functioning well at home. All participants were familiar with the process and rationale for immunizations and routine medical examinations; few understood cancer screening services.     

Integrating cervical cancer prevention initiatives with HIV care in resource-constrained settings: A formative study in Durban,South Africa

Cervical cancer screening rates remain suboptimal among women in South Africa (SA), where cervical cancer prevalence is high. The rollout of HIV-related services across SA may provide a means to deliver cervical cancer screening to populations with limited access to health care systems. In this mixed methods study, psychosocial factors influencing cervical cancer prevention and perceptions of the provision of Pap smears in HIV care settings were examined. Structured interviews were conducted with women (n = 67) from a municipal housing estate in Durban, SA. Key informants (n = 12) also participated in semi-structured interviews. Findings revealed that participants had low cervical cancer knowledge, but desired more information. Relevant themes included the normalisation of HIV and beliefs that cervical cancer might be worse than HIV. A comprehensive community clinic was desired by most, even if HIV-positive patients were treated there. This study provides important insight into integrating cervical cancer screening with HIV clinics, which may increase cancer screening among South African women.     

Views of Mammography Screening Among U.S. Black and Hispanic Immigrant Women and Their Providers

Views of ethnic immigrant women's experiences about mammography screening are important to determine barriers to cancer screening. We explored perceptions and barriers about mammography screening and breast health services among Haitian, Hispanic, Portuguese, and Somali women (n = 51) using semistructured interviews. Providers (n = 19) offered insight into health system barriers. Content analysis was conducted using qualitative data from the 2011 Komen Massachusetts needs assessment. Grounded theory was employed to explore themes and patterns in narratives. Six themes represented knowledge, health care, culture, spirituality, survivorship, and health systems improvement. Results may inform breast health policies that impact ethnic immigrant women in Massachusetts.     

A socio-anthropological study of birth in Morocco

BACKGROUND: To understand the role of beliefs, notions of risk and local practices in explaining the low utilization of maternal health services in Morocco. METHODS: Ethnographic research in three sites in Morocco, including interviews with 126 women and observation of medical encounters at health facilities. RESULTS: Local practices are not incompatible a priori with the use of health services, and women manifest a relatively pragmatic and flexible attitude towards the decisions they make regarding birth. The different factors that influence women's choices are analyzed, in particular those related to obstacles of accessibility and quality of services. CONCLUSION: The pluralism and eclecticism that characterize beliefs and behaviors related to birth in Morocco suggest that an improvement in the quality of care would encourage more women to seek care from health facilities.     

Health Care Practices of the Foreign Born Asian Indians in the United States. A Community Based Survey

Although successful utilization of medical and preventive care by members of the non-US born communities is an important public health concern, our knowledge regarding health practices of different ethnic subgroups is limited. In the present study, participants of the health fairs organized during South Asian cultural and religions events were asked anonymously to complete the South Asian Total Health Initiative (SATHI) health survey questionnaire to evaluate their health-related practices, self-health perception, and satisfaction with medical care. Among 1,250 surveyed, 1,016 foreign born Asian Indians adults that represented the fastest growing subgroups of the South Asian born nationals in the US were included in the analysis. We found that the majority reported healthy behavior (exercise activities and abstinence from alcohol or tobacco), high self-health perception, satisfaction with medical care, and compliance with annual routine medical examinations that was directly associated with the annual house income. Approximately 40% of women complied with breast and cervical cancer screenings and less than 20% of men complied with prostate cancer screening guidelines. Presence of chronic conditions (mostly cardiovascular pathology and/or diabetes) that were reported by approximately half of the participants negatively impacted their self-health perception. In conclusion, positive self-reported health perception and compliance with routine health examinations of the surveyed foreign born Asian Indians was reported along with an increased rate of chronic morbidity and underutilization of specific preventive services. Observed discrepancy between self-health perception and health status highlights the need to enhance utilization of preventive services among the non-US born Asian Indian community.     

Cultural feasibility assessment of tuberculosis prevention among persons of Haitian origin in South Florida

A cultural feasibility study was conducted among persons of Haitian origin in South Florida to identify factors which might influence utilization of screening and treatment services for latent tuberculosis infection in this population. Five focus group interviews conducted among men and women explored cultural beliefs and practices related to TB, barriers and incentives to screening, and approaches to increasing treatment adherence. Key findings include the influence of social stigma and fears related to confidentiality of medical status as disincentives to screening. Cultural sensitivity to being labeled as a high risk group for these infections also emerged as a critical variable. Community-based approaches to health education for this population are described. Study recommendations include the planning of programs based on a service delivery model that stresses respect and personal attention to clients, improved interpersonal skills of health center staff, and coordination of services between private doctors and public health agencies.     

Knowledge of cancer risk reduction practices in rural towns of New South Wales

Abstract: The Australian Cancer Society has published guidelines for recommended risk reduction strategies for breast, cervical, smoking-related and skin cancer. While knowledge may not be sufficient for change, it is argued to be necessary for change to occur. A measure of the level of health knowledge in the community can be useful for health promotion practitioners, identifying where health messages are not reaching their proposed targets. Our aims were to examine the level of knowledge about risk reduction practices for breast, cervical, smoking-related and skin cancers, for a rural New South Wales sample, and to examine sex and age effects on knowledge levels. A survey of 2846 women and 1732 men from rural New South Wales, which used an unprompted recall strategy, revealed some notable deficits in recall of cancer risk reduction practices: only 26 per cent of women identified mammograms as a risk reduction strategy for breast cancer; only 5 per cent of women knew at which ages mammograms should start and stop; only 6 per cent of women could identify when Pap tests should be discontinued; less than half of the sample could identify common solar protection strategies; and less than one-third of people identified passive smoking as a lung cancer risk.     

Health literacy in relation to cancer: addressing the silence about and absence of cancer discussion among Aboriginal people,communities and health services

Cancer outcomes for Aboriginal Australians are poorer when compared with cancer outcomes for non‐Aboriginal Australians despite overall improvements in cancer outcomes. One concept used to examine inequities in health outcomes between groups is health literacy. Recent research and advocacy have pointed to the importance of increasing health literacy as it relates to cancer among Aboriginal people. This study examined individual, social and cultural aspects of health literacy relevant to cancer among Aboriginal patients, carers and their health workers in New South Wales. Qualitative interviews were conducted with 22 Aboriginal people who had been diagnosed with cancer, 18 people who were carers of Aboriginal people with cancer and 16 healthcare workers (eight Aboriginal and eight non‐Aboriginal health workers). Awareness, knowledge and experience of cancer were largely absent from people's lives and experiences until they were diagnosed, illustrating the need for cancer awareness raising among Aboriginal people, communities and services. Some beliefs about cancer (particularly equating cancer to death) differed from mainstream Western biomedical views of the body and cancer and this served to silence discussion on cancer. As such, these beliefs can be used to inform communication and help illuminate how beliefs can shape responses to cancer. Participants proposed some practical strategies that could work to fill absences in knowledge and build on beliefs about cancer. These results were characterised by a silence about cancer, an absence of discussions of cancer and an acknowledgement of an already full health agenda for Aboriginal communities. To promote health literacy in relation to cancer would require a multi‐layered programme of work involving grass‐roots community education, workers and Board members of Aboriginal community‐controlled health organisations and speciality cancer services, with a particular focus on programmes to bridge community‐based primary care and tertiary level cancer services.     

Cultural stereotypes of women from South Asian communities: mental health care professionals' explanations for patterns of suicide and depression

Low rates of treated depression and high rates of suicide in women from some South Asian communities are evident in epidemiological studies in the UK. It is argued here that explanations for these apparent differences are likely to be located in stereotypes of repressive South Asian cultures. This small scale study, utilising focus groups and individual interviews, sought to explore the construction of cultural stereotypes within mental health discourse with specific reference to stereotypes of women from South Asian communities. Mental health carers from a UK inner city area of relatively high social deprivation were targeted. Focus groups were conducted with a range of mental health care professionals who worked in both inpatient and outpatient mental health care services. In addition, individual interviews were conducted with consultant psychiatrists and General Practitioners. Extensive reference is made in this paper to the content of focus groups and interviews and how health carer's knowledge about and experience of South Asian cultures and caring for women from these communities was contextualised. Mental health care professionals constructed cultural difference in terms of fixed and immutable categories which operated to inferiorise Britain's South Asian communities. It is argued that their knowledge is constructed upon stereotypes of western culture as superior to a construction of eastern cultures as repressive, patriarchal and inferior to a western cultural ideal. Ultimately, it is argued that these stereotypes become incorporated as 'fact' and have the potential to misdirect diagnosis and therefore, also misdirect treatment pathways.