Cervical cancer screening attitudes and beliefs of malaysian women who have never had a pap smear: A qualitative study

Background: Attitudes toward cervical cancer and participation in early detection and screening services are well known to be profoundly affected by cultural beliefs and norms.Purpose: This study explored the attitudes and sociocultural beliefs on cervical cancer screening among Malaysian women.Method: In this qualitative study, in-depth interviews were conducted with 20 Malaysian women, ages 21 to 56 years, who have never had a Papanicolaou (Pap) smear.Results: Respondents generally showed a lack of knowledge about cervical cancer screening using Pap smear, and the need for early detection for cervical cancer. Many believed the Pap smear was a diagnostic test for cervical cancer, and since they had no symptoms, they did not go for Pap screening. Other main reasons for not doing the screening included lack of awareness of Pap smear indications and benefits, perceived low susceptibility to cervical cancer, and embarrassment. Other reasons for not being screened were related to fear of pain, misconceptions about cervical cancer, fatalistic attitude, and undervaluation of own health needs versus those of the family.Conclusion: Women need tobe educated about the benefits of cervical cancer screening. Health education, counseling, outreach programs, and community-based interventions are needed to improve the uptake of Pap smear in Malaysia. This study was funded by the Ministry of Science, Technology and Environment Malaysia, Intensification of Research in Priority Areas (IRPA) 06-02-1032 PR0024/09-06.     

Gynecologic cancer screening and communication with health care providers in women with Lynch syndrome

We evaluated knowledge of gynecologic cancer screening recommendations, screening behaviors, and communication with providers among women with Lynch syndrome (LS). Women aged ≥25 years who were at risk for LS‐associated cancers completed a semi‐structured interview and a questionnaire. Of 74 participants (mean age 40 years), 61% knew the appropriate age to begin screening, 75–80% correctly identified the recommended screening frequency, and 84% reported no previous screening endometrial biopsy. Women initiated discussions with their providers about their LS cancer risks, but many used nonspecific terms or relied on family history. Most were not offered high‐risk screening options. While many women were aware of risk‐appropriate LS screening guidelines, adherence was suboptimal. Improving communication between women and their providers regarding LS‐related gynecologic cancer risk and screening options may help improve adherence.     

Personal factors affecting African-American men's prostate cancer screening behavior

PURPOSE: Although there are significant controversies about prostate cancer screening, it is the only method recognized to combat prostate cancer through early detection and appropriate treatment. The primary goal of this study was to identify personal factors influencing African-American men's participation in prostate cancer screening. METHODS: Two cross-sectional mail surveys were conducted over one year to test the validity of the Attitude-Social Influence-Efficacy model in predicting prostate cancer screening. Data were collected from African-American men age > or =40. The study hypotheses were tested using multiple linear regression and logistic regression analyses RESULTS: One-hundred-ninety-one African-American men participated in the first cross-sectional survey, and 65 African-American men responded to the follow-up survey a year later. The participants were mostly African-American men who were born and grew up in America, were 50-59 years of age, had some college training, were married, were urban residents, had full-time employment status and had a household income of $20,000-$39,000. The key determinants of intention to undergo prostate cancer screening were attitude, perceived behavioral control, past behavior and perceived susceptibility. Attitude was the primary determinant of screening behavior. CONCLUSION: To foster appropriate prostate cancer detection activities, the modifiable factors identified in this study should be considered.     

Exploring beliefs about prostate cancer and early detection in men and women of three ethnic groups

OBJECTIVES: Practice guidelines support informed or shared decision-making about prostate cancer screening. To compare beliefs across three racial/ethnic categories concerning prostate cancer etiology and risk, screening routines, and shared decision-making, we conducted 12 focus groups. METHODS: Participants were recruited in primary care settings and included 33 African Americans, 35 Hispanics, and 22 non-Hispanic Whites. Of the 90 participants, 53% were male. RESULTS: Groups identified heredity, age, race, sexual activity, and other lifestyle influences as risk factors. Few were aware that prostate cancer is asymptomatic in early stages. Confidence in knowledge of screening routines was high, but included misconceptions supporting initiation of screening at earlier ages and at shorter intervals than professional recommendations. Females encouraged screening of male relatives to protect their health. DISCUSSION AND CONCLUSION: While racial/ethnic groups had similar views and knowledge about screening, African Americans wanted to organize to address the threat of prostate cancer in their communities. Hispanics had awakening awareness of the health risks of prostate cancer. Non-Hispanic Whites were aware of the health threat of prostate cancer, but their approach to health protection was more individual and less community focused than that of African Americans. Participants were not aware of controversy about screening. PRACTICE IMPLICATIONS: Developers of educational materials to support informed or shared decision-making should be aware that initial views of prostate cancer screening are positive.     

What women think about their husbands' opinions might influence women's body image: an explorative study

Background : Self-perception of weight status is an important factor in food consumption and weight-loss-related behaviors. Aims : To determine women's self-perception of weight status, married women's perception of their husbands' opinions regarding women's weight status, the relationship between socio-demographic factors and under-assessment of weight status in overweight/obese women. Settings and Design : In a cross-sectional study in the year 2003 in Islamshahr, 704 adult women aged 19 to 65 years were included. Materials and Methods : Women's self-perception of weight and married women's perception of husbands' opinions regarding women's weight status were compared with actual weight group categorized according to body mass index (BMI). Statistical Analysis Used : Results were expressed as frequency and percentage. Logistic regression was used to assess the independent effects of various socio-demographic factors on under-assessment of weight status in overweight and obese women. Data were analyzed using SPSS 11.5 for Windows (SPSS, Chicago, IL). Results : Overall, 48% (338) women misclassified their weight status relative to their actual weight. Married women's perception of husbands' opinion regarding women's weight status showed about 57% (266) misclassification. Multivariate regression analysis revealed place of residence and women's perception of husbands' opinion regarding women's weight status to be independently associated with under-assessment of weight status by overweight and obese women. Conclusions : Overweight and obese women's perception of their husbands' opinion regarding women's weight status has a significant effect on assessment of weight status by women. Women of Islamshahr should be taught to more accurately assess weight status and to initiate action to prevent or correct excessive weight.     

Marriage, Intimate Support and Depression during Pregnancy: A Study of Inner-City Women

We examined the influence of stress, intimate support and marital status on postpartum depression among 189 African American and European American, inner-city women. We selected women in three common categories: (1) married, (2) cohabitating with partner, and (3) romantically involved, but not cohabitating. Women were interviewed on two occasions during pregnancy and seven to nine weeks following delivery. Women who were not married and did not live with their partner reported less intimacy with their partner and greater depression and increases in depression. Both marriage and cohabitation limited women's depression level. Married women also increased in intimacy during their pregnancy, but cohabitating women did not. Results were independent of ethnic status, age and income. The importance of the findings given the rise in single parenthood was discussed.     

Perceptions of barriers and facilitators of cancer early detection among low-income minority women in community health centers

African-American and Hispanic women receive fewer indicated cancer early detection services than do majority women. Low rates of cancer screening may, in part, explain the disproportionately higher rates of cancer deaths in this population. The aim of this qualitative study was to explore through individual interviews the perceptions of barriers and facilitators of colorectal, cervical and breast cancer screening among 187 low-income, primarily minority women in four New-York-City-based community/migrant health centers. We identified various barriers and facilitators within each of these categories. Clinician recommendation was the most commonly cited encouragement to cancer screening. Other facilitators of cancer screening identified by patients included personal medical history, such as the presence of a symptom. The perception of screening as routine was cited as a facilitator far more commonly for mammography and Pap tests than for either of the colorectal screenings. Less commonly cited facilitators were insurance coverage and information from the media. The most common barriers were a lack of cancer screening knowledge, patients' perception of good health or absence of symptoms attributable to ill health, fear of pain from the cancer test and a lack of a clinician recommendation. Using standard qualitative techniques, patients' responses were analyzed and grouped into a taxonomy of three major categories reflecting: (1) patients' attitudes and beliefs, (2) their social network experience and (3) accessibility of services. This taxonomy may serve as a useful framework for primary care providers to educate and counsel their patients about cancer screening behaviors.     

Uncovering myths and transforming realities among low-SES African-American men: implications for reducing prostate cancer disparities

PURPOSE: Prostate cancer provides the most dramatic evidence of cancer disparities based on race and ethnicity among U.S. men. African-American men still hold a commanding lead in both prostate cancer incidence and mortality, particularly among those of low socioeconomic status (SES) and the medically underserved. Therefore, the need for early intervention persists. The purpose of this exploratory pilot study was to: a) assess the knowledge of a cohort of low-SES African-American men regarding prostate health/prostate cancer, and b) uncover myths/misinformation as barriers to prostate health decisions and behaviors. PROCEDURES: Asymptomatic African-American men participated in focus groups to candidly discuss: a) health concerns, b) prostate health, c) prostate cancer screening, diagnosis and treatment, and d) factors influencing prostate health decisions/behaviors. FINDINGS: Participants revealed sociocultural and psychological barriers: myths and lack of accurate/adequate knowledge about prostate health and cancer, fear, denial and apathy. CONCLUSIONS: These findings suggest factors that may explain the reluctance and limited participation in prostate health and prostate cancer services among medically underserved, socioeconomically disadvantaged, African-American men. Lack of knowledge, which affects all barriers to care, is amenable to change. Therefore, improvements in prostate cancer outcomes are achievable through culturally and linguistically appropriate health education tailored to their specific needs.     

How making a risk estimate can change the feel of that risk: shifting attitudes toward breast cancer risk in a general public survey

Counseling women about breast cancer risks has been found to decrease screening compliance. We investigated whether women's reactions to risk information are an artifact of requiring women to estimate the risk of breast cancer prior to receiving risk information. Three hundred and fifty-six women were randomized to either make or not make a risk estimate prior to receiving risk information. Outcome measures were participants' estimates of the average woman's breast cancer risk and their emotional response to the risk information. Women overestimated the lifetime risk of breast cancer (M = 46%). Women who made risk estimates felt more relieved about the risk and perceived the risk as being lower than women who did not make estimates (p's < 0.001). Asking people to estimate risks influenced their subsequent perceptions of the risk of breast cancer.     

Factors affecting women''s response to an invitation to attend for a second breast cancer screening examination.

A survey was conducted to study the impact of women's previous experiences of breast cancer screening on their subsequent readiness to reattend. Women aged 45-64 years from three general practices were invited to attend for a second breast cancer screening test at a mobile clinic. Of the 1582 women who were invited, 1408 (89.0%) reattended. A questionnaire about their experience of the previous screening test was completed by 641 women who attended and 124 who did not attend the second test. Twenty six per cent of the women had found the previous test painful, and a minority also reported embarrassment (7%) or distress (6%). Women who did not reattend were significantly more likely than those who did to report the previous screening test as embarrassing or distressing and were significantly less likely to have found the clinic staff helpful or attendance for screening worthwhile or reassuring. No significant difference was found in the reattendance rate of women who had experienced a false positive result at the previous screening test compared with the remaining women. These results show that there may be substantial scope for reducing non-attendance by improving the way the service is provided, thereby enhancing the overall impact of breast cancer screening.     

Health locus of control and perceived risk for breast cancer in healthy women

Although early detection is closely linked to survival of breast cancer, many women do not adhere to recommended screening guidelines. One of the most studied factors that contribute to women's screening behavior is their perceived risk of developing breast cancer. In this study, the authors examined contributions of general health locus of control and breast cancer-specific control to understanding perceived risk. Sixty-six healthy women with and without family histories of breast cancer participated in the study. The following were the central findings: (1) internal locus of control and breast cancer-specific control predicted perceived risk, as measured by the certainty of remaining free of breast cancer, and (2) breast cancer-specific control mediated the relationship between internal locus of control and perceived risk. Findings suggest that significant relations between health locus of control and perceived risk variables may be overlooked in the absence of situation-specific measures.     

Family history of breast cancer and screening behavior: An inverted U-shaped curve?

There are conflicting reports regarding the association between breast cancer risk factors, especially family history, and early detection/screening behavior. While some studies have reported that women at higher risk for breast cancer engage in more screening behavior than those at lower risk, others have found no relationship between the two variables, and still other studies have found the opposite effect-less screening in high risk women as compared to lower risk women. It is suggested that these conflicting results might be explained by including anxiety or fear as a mediating factor in the relationship between risk status and screening behavior. Specifically, it is hypothesized that anxiety or fear associated with family history of breast cancer operates in a manner similar to that observed in other behavioral tasks. That is, an optimal amount of anxiety or fear facilitates performance, but too much inhibits it. Previous studies are examined in the context of this hypothesis.     

Patient–provider communication and cancer screening among unmarried women

Objectives

Unmarried women are less likely than married women to receive recommended cancer screenings. Patient–provider communication is a consistent predictor of cancer screening among women. The purpose of this study was to investigate the relationship between patient and provider communication, barriers to cancer screening, and on-schedule breast and cervical cancer screening (BCCS) among unmarried women.

Methods

Data were from the Cancer Screening Project for Women, a 2003–2005 survey examining cancer screening practices. We computed polytomous logistic regression models to examine the relationship between communication (communication about tests, communication about sexual and intimate relationships), barriers to screening, and on-schedule BCCS among unmarried women.

Results

A total of 630 women were enrolled, and 605 women completed the baseline questionnaire. Overall, more than 60% reported on-schedule BCCS. More than half reported that their providers communicated about BCCS most or all of the time. Fewer than half communicated about sexual history and intimate relationships. Women who reported that their providers communicated about screening tests and their sexual and intimate relationships were more likely to be on-schedule for BCCS.

Conclusion

Patient–provider communication about multiple topics may encourage women to remain on-schedule for their recommended cancer screenings. Longitudinal research should be conducted to examine whether communication predicts BCCS, and to examine how patient and provider characteristics may influence communication in order to promote adherence to screening guidelines for unmarried women.

Practice implications

Comprehensive communication that goes beyond information about screening tests may impact adherence to cancer screening guidelines.     

Reasons and risk: factors underlying women's perceptions of susceptibility to osteoporosis

OBJECTIVES: To assess women's perceptions of risk for osteoporosis and to identify factors that shape those perceptions. METHODS: A community sample of 358 women (aged 40-86) rated their perceived risk of osteoporosis and provided detailed information about factors underlying their risk perceptions. Their open-ended responses were content analysed. RESULTS: On average, participants believed they were less likely to develop osteoporosis than other women their age. In all, 63% perceived their risk as lower than other women their age; only 16% as higher. In explaining their risk, women mentioned more risk-decreasing factors than risk-increasing factors. Women who rated their risk as low attributed their risk primarily to their own preventive behaviors (e.g. taking calcium, exercising), whereas women who rated their risk as high attributed their risk primarily to their family history. Risk-increasing and risk-decreasing personal actions, hereditary factors, and physiological factors accounted for 53% of the variance in perceived risk for osteoporosis. Only one-half and one-third of all women, however, mentioned calcium consumption and exercise, respectively, as protective factors employed to reduce osteoporosis risk. Women also held misconceptions about osteoporosis risk and protective factors. CONCLUSIONS: The current findings yield a detailed portrait of women's risk perceptions for osteoporosis. Increasing awareness of osteoporosis should be a priority for future osteoporosis prevention campaigns. Interventions should address misconceptions women may hold about their risk for the disease and promote specific behavioral strategies for osteoporosis prevention.     

Partner violence, partner notification, and women's decisions to have an HIV test

OBJECTIVES: Reports of partner violence against HIV-positive women after they have disclosed their serostatus have led some to reassess partner notification strategies and to speculate that fear of partner violence following partner notification may influence women's HIV testing decisions. We studied whether associations exist between women's declining to have an HIV test and history of partner violence, fear of partner violence, previous experience with partner notification, or beliefs about partner notification. METHODS: In this cross-sectional study, we interviewed women seen at Newark and Miami sexually transmitted disease clinics. The women were at least 18 years old, not known to be HIV positive, not tested for HIV in the previous 3 months, and offered HIV testing during the clinic visit. Women who declined testing were compared with women who accepted. RESULTS: Of 490 participants (89% of eligible women), 16% reported partner violence in the past year, and 28% declined HIV testing. Declining the test was not significantly (p >.05) associated with history or fear of partner violence, previous experience with partner notification, or beliefs about partner notification. When specifically asked, only 2 women responded that their declining the test was related to fear that their partner or partners might harm them if the women tested positive. CONCLUSIONS: Among women seen at these clinics, we did not find evidence that declining the HIV test was strongly influenced by partner violence, previous experience with partner notification, or beliefs about partner notification. However, many women reported partner violence. Therefore, providers should assess the potential for partner violence and be prepared to make appropriate referrals.     

The short-term impact of tailored mammography decision-making interventions

BACKGROUND: We assessed the short-term impact of decision-making interventions on knowledge about mammography, accuracy of women's breast cancer risk perceptions, attitudes toward mammography, satisfaction with decisions, and mammography use since the intervention. METHODS: The study was conducted among women who were members of Blue Cross Blue Shield of North Carolina and were in their 40s or 50s at the time the study began in 1997. Women were randomly assigned to usual care (UC), tailored print booklets (TP) alone, or TP plus telephone counseling (TP+TC ). RESULTS: 12-month interviews were completed by 1127 women to assess short-term intervention effects. Generally, women who received TP+TC were significantly more knowledgeable about mammography and breast cancer risk and were more accurate in their breast cancer risk perceptions than women in the TP and UC groups. They also were more likely to have had a mammogram since the baseline interview. In multivariable analyses, we found significant benefits of the combination of TP+TC compared to TP and to UC for knowledge, accuracy of risk perceptions, and mammography use. DISCUSSION: For complex decision-making tasks, such as women's decisions about mammography in the face of controversy, the combination of TP and TC may be more effective than TP alone, and certainly more effective than UC. It is critical that investigators determine the topics for which TP is appropriate and the situations that require additional supportive interventions.     

The impact of family history of breast cancer and cancer death on women's mammography practices and beliefs

PurposeTo summarize the impact of a family history of breast cancer on mammography practices and beliefs.MethodSurvey data concerning breast health practices and beliefs were utilized for a cross-sectional analysis. Participants were 899 racially diverse nonpregnant women 40 years and older without breast cancer. The impact of various aspects of cancer family history on mammography, perceived barriers to and benefits of screening, and perceived breast cancer risk was assessed.ResultsMore women with a first-degree relative with breast cancer reported a mammogram within the past year and rated their breast cancer risk higher. Death of a first-degree relative impacted the belief that breast cancer can be cured with early detection. Degree of relatedness of affected relative impacted mammography practice and risk perceptions.ConclusionFamily history of breast cancer impacted mammography adherence, beliefs about outcomes with early detection, and risk perceptions. Breast cancer death in a family may be a better predictor of beliefs about breast cancer detection and cure than family history of cancer alone. These findings have implications for how screening recommendations and risk information are communicated to patients with different familial cancer experiences.     

Effect of husbands' education on fatness of wives

The aim of the study was to examine the relationship between social position of females achieved by marriage and level of fatness and relative fat distribution. The data of 588 healthy, occupationally active, married women, age 21–62 years, with 12 years of education (completed secondary school) were used. The body mass index (BMI, kg/m² ), triceps and subscapular skinfold thicknesses, and summed skinfold thicknesses were used as indicators of fatness. The waist–hip ratio, the waist–thigh ratio, and waist, hip, and thigh circumferences were used as indicators of fat distribution. According to the educational level of husbands, women were grouped as 1) moving up the social scale (spouse with complete university education), 2) stable (equal level of education), and 3) moving down the social scale (spouse who never passed beyond the level of basic vocational school, i.e., skilled and unskilled manual workers). The two opposite groups were analyzed, i.e., moving up and moving down. Women with secondary schooling who married up were consistently leaner than women who married down. A similar pattern was observed for fat distribution. Women marrying down had more abdominal body fat compared to women marrying up. Am. J. Hum. Biol. 15:1–7, 2003. © 2002 Wiley‐Liss, Inc.