Breast cancer and screening information needs and preferred communication medium among Iranian immigrant women in Toronto

Few studies have investigated what information women from minority immigrant groups need about breast cancer and screening. Nor has much research been conducted about how such women would prefer to receive this information. Mere translation of breast cancer and screening information from generic materials, without considering and respecting women's unique historical, political, and cultural experiences, is insufficient. This study explored breast cancer and screening information needs and preferred methods of communication among Iranian immigrant women. A convenience sample of 50 women was recruited and interviewed over a 4-month period (June-September 2008); all resided in Toronto Canada, and had no history of breast cancer. Tape-recorded interviews were transcribed and analysed using a thematic analysis technique. While generic breast health communication focusing on physiological risk information meets some of the needs of Iranian immigrant women, results showed that the needs of this group go beyond this basic information. This group is influenced by historical, sociopolitical, and cultural experiences pre- and post-immigration. Their experiences with chemical war, unsafe physical environment (air and water pollution), and their sociopolitical situation appear to have limited their access to accurate and reliable breast cancer and screening information in their homeland. Moreover, the behavioural and psychosocial changes they face after immigration appear to have a strong influence on their breast cancer and screening information needs. Considering their limited time due to their multiple demands post-migration, multi-media methods were highly preferred as a communication means by this group. The results of this study can be used to guide the design and implementation of culturally sensitive breast health information. For instance, video presentations conducted by a trusted Iranian healthcare professional focusing on socioculturally relevant breast cancer risk factors, symptoms, and screening methods, as well as a list of available breast health resources, could improve Iranian women's knowledge and uptake of breast health practices.     

Physical activity programs for refugee Somali women: working out in a new country

Islamic refugee women from non-westernized countries face a number of challenges in adapting to their new country, especially when that new country is westernized and is not Islamic. Refugees are primarily women and children, so it is important that women be in their best health because they usually bear the responsibility of caring for each other and children, often in very difficult situations. Maintaining or obtaining good levels of physical activity contributes to good health: mentally, physically and socially. At the request of women in the local Somali community, a number of initiatives were taken to increase their opportunities for physical activity. Through interviews, observations and conversations we explored barriers to fitness and exercise, the social, physical, and cultural effects of physical activity, and solutions to facilitate Somali women's access to fitness and exercise opportunities. Physical activity interventions included exercise classes in a community center used by the Somali community, trial memberships at a local women-only fitness center, and walking and sports groups. We discuss the procedural issues relating to setting-up these physical activity opportunities, the results of interviews with 37 of the women about their health and perceptions and issues relating to the physical activity options, and our recommendations for setting up similar classes with other Somali or Islamic communities.     

The role of natural environments within women’s everyday health and wellbeing in Copenhagen,Denmark

Urbanisation has been linked with sedentary lifestyles and poor mental health outcomes amongst women. The potential for natural environments to enhance physical activity and mental wellbeing in urban areas is now well recognised. However, little is known about the ways that women use natural spaces for health and wellbeing within the context of their everyday lives. This paper draws on ideas developed in the therapeutic landscapes literature to examine how experiences in different types of green and blue space provide important health and wellbeing benefits for women in Copenhagen, Denmark. As well as facilitating physical exercise, such spaces were found to enable a range of more subtle benefits that helped to restore mental wellbeing through stress and anxiety alleviation, the facilitation of emotional perspective, clarity and reassurance, and through the maintenance of positive family dynamics. However, amongst some women who were overweight, the socio-political associations they made with natural environments deterred use of such spaces. Such findings challenge dominant planning and policy assumptions that equate open public access to natural spaces with universal benefit.     

Exploring breast cancer screening barriers among Barbadian women: a focus group study of mammography in a resource-constrained setting

Breast cancer affects women worldwide. Early detection strategies, notably mammography, aim to reduce mortality from breast cancer. However, mammography is a costly screening tool, generates controversy in terms of its impact and adverse effects, and its uptake remains low among some populations. This qualitative study (12 focus groups with 110 participants) explored experiences with mammography among Barbadian women by investigating how barriers are negotiated in a setting of resource-constrained health care provision without a national screening programme. The study findings indicate that, firstly, Barbadian women have to actively seek understanding of both breast cancer and the mammography process. Women described how, with little public awareness and knowledge, they borrow from available public health information on diabetes and HIV/AIDS to give meaning to mammographic screening. Secondly, many women expressed their fear about mammography and its potential consequences, such as experiencing social stigma and losing a romantic relationship after diagnosis. Thirdly, the cost of screening for women who opted for the more reliable private facilities was discussed, along with the potential cost of health care following a diagnosis and the emotional cost of enduring the societal taboo of breast cancer. If breast cancer screening is to be acceptable for this or similar populations, there should be provision of additional services to ensure better access to free screening or alternative strategies, as well as post-diagnostic social and financial support. The policies to develop these services must also address women’s concerns about screening and breast cancer, and provide comprehensive information to allow informed decisions about screening.     

Arranging Appropriate Activities Immigrant Women's Ideas of Enabling Exercise

OBJECTIVE: Several studies have reported low levels of physical activity among immigrant women. However, few studies have attempted to explore possible causes underlying this phenomenon. This study intended to explore immigrant women's attitudes and experiences of physical activity and exercise. The ultimate goal was to find methods that can increase levels of physical activity among immigrant women. METHODS: A qualitative exploratory study was undertaken in Stockholm County, Sweden, involving 63 immigrant women from Chile, Iraq, and Turkey. Data were collected through interviews in 10 focus groups. The analysis was based on grounded theory approaches. Constant comparative analysis and theoretical sampling were employed to construct categories. MAIN FINDINGS: The model that emerged illustrated the core process, that is, enabling exercise. The model also described the women's attitudes and experiences and their ideas of how exercise can be made possible. The women agreed that the local community should recognize the problem and arrange exercise in familiar places. In addition, they called for activities that felt appropriate. If appropriate exercise was arranged, the women sometimes decided to participate. Otherwise, they hesitated or waited. CONCLUSION: If appropriate activities are arranged, levels of physical activity and exercise might increase among immigrant women. Future studies could explore specific activities that can facilitate immigrant women's opportunities to exercise.     

Physical activity and cancer risk

Evidence is accumulating that high levels of physical activity are associated with a reduced risk of some cancers. This evidence is most consistent for colon cancer, which is reduced by 40-50% among the most active individuals, compared with the least active. The effect is evident in men and women, and appears to be independent of important confounding factors. However, there may be important interactions with body fatness; a high BMI has been reported to be associated with an increased risk of colon cancer in sedentary men but not in physically-active men. Whilst the evidence on breast cancer is less consistent, case-control studies typically suggest a reduction of 25-30% among the most active women, although several studies have found no effect. Potential mechanisms include systemic influences and others relevant only to site-specific cancers. One unifying hypothesis is that physical inactivity reduces insulin sensitivity, leading to a growth-promotional environment which may facilitate neoplasia. The non-specific immune system may be improved by physical activity, possibly through the summative effects of repeated exercise bouts. Regular exercise, even at a recreational level, probably reduces exposure to oestrogen and thus decreases the risk of breast cancer. Increased colonic peristalsis, and thus reduced bowel transit time, might partly explain the lower risk of colon cancer in active people. Physical activity emerges as one of the few modifiable risk factors for some cancers and, as such, justifies further study.     

Physical activity and the prevention of breast cancer

Epidemiologists have identified several risk factors for breast cancer, yet clinical advice to women to change these risk factors has been uncommon. Physical activity promises to be one modifiable risk factor through which women can reduce their risk for breast cancer. Clinicians can now advise women that reducing risk for breast cancer may be one additional reason to adopt an active lifestyle. There are still questions about the type and amount of exercise needed, the ages at which exercise should be done, and the interactions with other risk factors such as reproductive and menstrual history, diet, body mass, alcohol intake, genetics, and hormone therapy. Finding answers to these questions will require a research agenda focused on the biology of exercise and breast cancer.     

Influence of exercise activity on quality of life in long-term breast cancer survivors

Background: Behavioral and lifestyle factors may influence quality of life (QOL) outcomes in breast cancer survivors. Methods: Information on QOL (Short Form-36, SF-36), lifestyle and survivorship was collected during telephone interviews with 374 breast cancer patients, diagnosed between 1983 and 1988 at ages 40 years or younger and interviewed, on average 13.2 years following diagnosis. These women previously participated in a case-control study soon after their diagnoses, providing information on breast cancer risk factors including exercise activity. We examined the impact of changes in exercise activity (comparing pre- to post-diagnosis levels) on the SF-36 mental and physical health summary scales using regression analyses. Results: A positive change in exercise activity was associated with a higher score on the SF-36 physical health summary scale at follow-up (p= 0.005). Change in exercise activity was not associated with the SF-36 mental health summary scale score. Patients who increased their activity levels did not differ from those who did not in terms of medical or demographic characteristics. Conclusion: This study provides one of the longest follow-up periods of breast cancer survivors to date among studies that focus on QOL and is unique in its focus on women diagnosed at a young age. Our results confirm high levels of functioning and well-being among long-term survivors and indicate that women whose exercise activity increased following diagnosis score higher on the SF-36 physical health summary scale. These findings suggest a potential role for exercise activity in maintaining well-being after a cancer diagnosis.     

Breast cancer attitudes, knowledge, and screening behavior in women with and without a family history of breast cancer

Women volunteers with or without a first-degree relative with breast cancer (FDR) were compared on several measures. Relative to the comparison group, women in the FDR group had more negative attitudes about breast cancer (including more anxiety about breast cancer), viewed their risk for getting breast cancer as greater (although they underestimated the actual risk), and were more likely to engage in appropriate screening behavior. A high percentage of women in both groups stated that they would want to have a genetic test for breast cancer if it were generally available.     

Experiences of women with breast cancer: exchanging social support over the CHESS computer network

Using an existential-phenomenological approach, this paper describes how women with breast cancer experience the giving and receiving of social support in a computer-mediated context. Women viewed their experiences with the computer-mediated support group as an additional and unique source of support in facing their illness. Anonymity within the support group fostered equalized participation and allowed women to communicate in ways that would have been more difficult in a face-to-face context. The asynchronous communication was a frustration to some participants, but some indicated that the format allowed for more thoughtful interaction. Motivations for seeking social support appeared to be a dynamic process, with a consistent progression from a position of receiving support to that of giving support. The primary benefits women received from participation in the group were communicating with other people who shared similar problems and helping others, which allowed them to change their focus from a preoccupation with their own sickness to thinking of others. Consistent with past research is the finding that women in this study expressed that social support is a multidimensional phenomenon and that their computer-mediated support group provided abundant emotional support, encouragement, and informational support. Excerpts from the phenomenological interviews are used to review and highlight key theoretical concepts from the research literatures on computer-mediated communication, social support, and the psychosocial needs of women with breast cancer.     

Changes in coping,autonomous motivation,and beliefs about exercise among women in early recovery from alcohol participating in a lifestyle physical activity intervention

Women are particularly likely to drink alcohol for the purpose of coping with or alleviating negative affect. Engaging in physical activity has been posited as a potentially effective alternate coping strategy during early recovery for managing mood and cravings. Utilizing exercise to cope may be associated with more adaptive coping strategies in general. Additionally, an intrinsic (autonomous) motivational style and positive beliefs about exercise are associated with long-term adherence to physical activity. The current study evaluates changes in coping strategies, autonomous motivation, and beliefs about exercise among women engaged in a physical activity intervention during early recovery (N = 20; mean age = 39.53). General coping strategies, motivational style, and beliefs about exercise were examined before and after engaging in the 12-week intervention which aimed to help women utilize physical activity as a means to cope with negative affect and alcohol craving. We found that, by the end of the intervention, participants significantly increased utilization of adaptive coping strategies such as the use of emotional support from others. Additionally, participants increased autonomous motivation over time. There were no significant changes in beliefs about exercise. Changes in beliefs about benefits of exercise, autonomous motivation, and adaptive coping were related to use of exercise to cope. However, even though these changes were associated with how women in the intervention used exercise, they were not associated with exercising more. Results from this open pilot suggest that women in early recovery from alcohol who increase physical activity – specifically as a means to cope with negative affect and craving – also demonstrate other wider coping strategies, more positive beliefs, and autonomous motivation.     

Pre-exercise screening and health coaching in CHD secondary prevention: a qualitative study of the patient experience

Secondary prevention programmes can be effective in reducing morbidity and mortality from coronary heart disease (CHD). In particular, UK guidelines, including those from the Department of Health, emphasize physical activity. However, the effects of secondary prevention programmes with an exercise component are moderate and uptake is highly variable. In order to explore patients' experiences of a pre-exercise screening and health coaching programme (involving one-to-one consultations to support exercise behaviour change), semi-structured telephone interviews were undertaken with 84 CHD patients recruited from primary care. The interviews focused on patients' experiences of the intervention including referral and any recommendations for improvement. A thematic analysis of transcribed interviews showed that the majority of patients were positive about referral. However, patients also identified a number of barriers to attending and completing the programme, including a belief they were sufficiently active already, the existence of other health problems, feeling unsupported in community-based exercise classes and competing demands. Our findings highlight important issues around the choice of an appropriate point of intervention for programmes of this kind as well as the importance of appropriate patient selection, suggesting that the effectiveness of health coaching may be under-reported as a result of including patients who are not yet ready to change their behaviours.     

Physical activity among older Filipino-American women

Filipino women (N = 530, mean age 63 years, predominantly low income) were recruited through various community based organizations and churches in Los Angeles County. All women were randomly invited to attend a single group session with a Filipino health educator to discuss breast and cervical cancer screening or the health benefits of exercise. At 3 months after the group session, the exercise assessment tool used in the National Health and Nutrition Examination Survey III was completed by 487 women (92 percent retention rate). This paper describes the pattern of physical activity among older Filipino-American women and a physical activity intervention specifically designed for this group.     

Mammography: a critical evaluation of its role in breast cancer screening, especially in developing countries

Screening for breast cancer using mammography alone, or mammography plus physical examination of the breasts, reduces mortality from breast cancer in women age 50-69. The evidence for effectiveness in older women is less clear. If effective in younger women, benefit is delayed compared to that seen in women age 50 or more. The increasing incidence of breast cancer in developing countries, and the late stage at diagnosis of most disease, supports efforts to introduce screening for breast cancer. However, the requirements of mammography in terms of technology and skilled personnel make it difficult to apply in most developing countries at present. There is a need to evaluate simpler screening tests, such as physical examination of the breasts and breast self-examination, as they can be applied by existing health personnel, and more readily integrated into medical care.     

The perceived influence of an exercise class intervention on the process and outcomes of post-traumatic growth

Post-traumatic growth (PTG) is the phenomenon of positive change through the experience of trauma and has been linked recently to the participation in group based therapies. The aim of this study was the explorative documentation of the experience of PTG among breast cancer patients and the role, if any, that a group based physical activity intervention had in the attainment of growth. Ten female breast cancer survivors, from an already existing study, participated in an individual, open-ended interview. Employing interpretive phenomenological analysis (IPA), interviews were transcribed verbatim and analysed for themes that reflected the women's experience of growing from adversity. The women attributed much of their process and outcomes of PTG to the experience of participating in an exercise intervention programme during rehabilitation. The programme's success in facilitating PTG could be viewed as superior in some ways to other group based therapies in offering the women a safe environment, positive support system, opportunity to transfer new skills and heightened health awareness/behaviours. Future research should acknowledge and conduct further investigations into the role of physical activity interventions as facilitators of the PTG process.     

Breast cancer: women's knowledge and attitudes and the difficulties of influencing them

Summary Women's knowledge about breast cancer and their attitudes towards the disease were surveyed before and after a public health education campaign which encouraged the early reporting of breast symptoms. There was a lack of knowledge about incidence, mortality and predisposing factors of breast cancer with some differences between age groups. The public campaign had no significant effect on the level of knowledge, even amongst a group of women who had received a letter containing factual information. Prior to the campaign the vast majority of women already agreed that new breast symptoms should be reported straight away, so a marked change in attitude could not be expected as a result of the campaign. However, the campaign did have some effect; there were significant increases in the proportion of women who disagreed that it was pointles to think about breast cancer and who had heard about breast self-examination from a pamphlet or their family doctor.     

Using qualitative methods to elicit recall of a critical time period

The period during and after puberty seems to be important for breast cancer initiation. Because experiences during that time are likely to be influenced by a woman's cultural background, we conducted a pilot study among Hispanic and Caucasian women to elicit their memories of early life events. These data were used to design culture-specific questionnaire modules for the retrospective assessment of peripubertal breast cancer risk factors, using specific strategies to trigger accurate recall. Study subjects were volunteer breast cancer survivors or relatives of survivors. In carrying out this work, we took methods from the social sciences and applied them to a research question in chronic disease epidemiology. We found both qualitative and quantitative differences in recall of peripubertal exposures and experiences between Hispanic and Caucasian subjects. Our preliminary data indicate that in contrast to Caucasian women, Hispanic women consider the church rather than school a touchstone for recalling past events. Under the domain "body development," Hispanic women are more likely to mention menstruation than Caucasian women but less likely to recall changes in body hair and breast development. Caucasian women cited team sports as an important physical activity during the peripubertal period, whereas Hispanic women listed more sedentary games and housework as the main activities. Results of our pilot study support the view that to enhance the validity of retrospective data on peripubertal breast cancer risk factors, it is important to take account of cultural differences. Our experience using qualitative methods to elicit data of this kind in the context of a larger epidemiologic research effort suggests that such innovative approaches are valuable.     

BREAST CANCER ATTITUDES,KNOWLEDGE, AND SCREENING BEHAVIOR IN WOMEN WITH AND WITHOUT A FAMILY HISTORY OF BREAST CANCER

Women volunteers with or without a first-degree relative with breast cancer (FDR) were compared on several measures. Relative to the comparison group, women in the FDR group had more negative attitudes about breast cancer (including more anxiety about breast cancer), viewed their risk for getting breast cancer as greater (although they underestimated the actual risk), and were more likely to engage in appropriate screening behavior. A high percentage of women in both groups stated that they would want to have a genetic test for breast cancer if it were generally available.