A Qualitative Study of Cancer Information Seeking Among English-as-a-Second-Language Older Chinese Immigrant Women to Canada: Sources, Barriers, and Strategies

Little is known about the cancer information seeking experiences of Chinese immigrants despite reported disparities in cancer burden and use of cancer screening. This research used semi-structured interviews to the explore cancer information seeking preferences and experiences of 50 English-as-a-second-language older Chinese immigrant women to Canada with different levels of health literacy. Directed content analysis was used to identify three main themes: sources of cancer information, barriers to cancer information seeking, and strategies used during information seeking. Health literacy did not distinguish the women on any of the major themes. The women expressed strong preferences for interpersonal and interactive cancer information from their physician and trusted others, such as friends and family. Barriers to cancer information seeking included language difficulties and limited time with physicians. The results emphasize the need for cancer information that reinforces cultural norms, language familiarity, and other values specific to cultural identities, such as interpersonally oriented values.     

Breast Cancer Screening Knowledge and Perceived Health Beliefs among Immigrant Women in Korea

Purpose

Recently, through international marriage, immigrant women have rapidly increased throughout Korea. This study was performed to identify health beliefs and practices related to breast cancer screening in immigrant women in Korea.

Methods

A cross-sectional survey was carried out between March and July 2012, and study population included immigrant females from six other Asian countries (Cambodia, China, Japan, Mongolia, Vietnam, and the Philippines). We surveyed 197 women and categorized them into four groups according to home countries. The questionnaire consisted of 55 items, including demographic and socioeconomic factors, breast cancer-related knowledge regarding risk factors and symptoms, beliefs and attitudes towards health and breast cancer, perceived susceptibility, barriers, and benefits of screening.

Results

Japanese participants were significantly older and had resided in Korea for more years than other country-of-origin groups (all p<0.001), and showed higher screening rates without statistical significance (p=0.392). In multivariate analysis, country of origin showed a significant correlation with knowledge (p=0.001), positive beliefs (p=0.002), and perceived benefits (p=0.025) of breast cancer screening. The group with the lowest household income showed a significantly lower score of perceived benefits (p=0.022). Through analysis to identify factors affecting participation in screening mammography, we found that education level (p=0.009), occupation status (p=0.006), and Korean language fluency (p=0.002) were independent predictors for screening behavior.

Conclusion

This study identified conditions related to breast cancer screening knowledge, perception, and behavior of immigrant women in Korea. The results reflect the need for increased social aids to remove barriers to medical services and more educational programs to facilitate higher rates of screening.     

兰州市妇女乳腺癌知识知晓率调查及健康教育对策分析

[目的]了解兰州市妇女对乳腺癌的认知情况,为进行乳腺癌健康教育提供依据.[方法]抽取兰州市城区35～69岁的当地妇女5810人以问卷调查的方式进行乳腺癌相关知识的调查,应答率99.3％.[结果]在调查5771人中,15.37％的调查对象对乳腺癌完全不了解,82.27％知道一点,仅有2.36％的调查对象对乳腺癌很了解;对乳腺癌的认知途径主要是广播电视及社会教育;对乳腺癌的危险因素认识不够清楚.[结论]兰州市妇女对乳腺癌的相关知识认识不足,应通过健康教育加强妇女对健康知识的了解,提高妇女乳腺癌相关知识水平和参与乳腺自我检查的积极性.     

Explaining Perceived Priorities in Women with Breast Cancer: A Qualitative Study

Objective: Cancer is a stressful event in life, and the dreadful impact and problems created for patients and families by cancer negatively affect their quality of life. Therefore, regarding the increasing number of cancer patients and the nature of this disease, the need to recognize and understand the priorities and problems of patients after the diagnosis of cancer is of high importance. This study was designed and implemented with the aim of identifying the perceived priorities of women with breast cancer. Methods: This study is a qualitative research of content analysis type. To collect data, purposeful sampling and deep semi-structured individual interviews were used. The subjects were women with breast cancer who visited the Breast Disease Research Center of Shahid Motahari Clinic in Shiraz, and the data were saturated after 15 interviews. The four criteria presented by Lincken and Guba were used to evaluate the validity and reliability. To analyze the qualitative data, conventional qualitative data analysis and MAXQDA10 software were used. Two themes were obtained in the assessment of interviews and analysis of data: 1) Supportive relief; 2) Therapeutic support. Results: Some of the participants highlighted the role of social and family support in coping with the disease, and considered social communication and continued support in the form of empathic relationship as a turning point in their lives. The absence of a fertility specialist in the cancer treatment system was the main complaint of most participants. The results showed that receiving support from family and the healthcare system is the most important perceived priorities in breast cancer patients. Conclusion: The results of this study show the importance of social support as a perceived priority in breast cancer patients to improve their quality of life. Development and reinforcement of the supportive network seem to be essential to provide the best possible help to these patients.     

Oncologist Perspectives on Breast Cancer Screening in India- Results from a Qualitative Study in Andhra Pradesh

Background: It is important to understand the perceptions of oncologists to understand the comprehensivepicture of clinical presentation of breast cancer. In the absence of clear evidence, clinical practice involvingpatients of breast cancer in India should provide insights into stages of breast cancer with which women presentto their clinics and mode of screening of breast cancer prevalent in Andhra Pradesh. Materials and Methods:A qualitative study was conducted to understand the perceptions of oncologists regarding clinical presentationof breast cancer, stages at which women present to clinics, and mode of screening of breast cancer prevalent inAndhra Pradesh. In-depth interviews (IDI) were conducted with ten practising oncologists from various publicand private cancer hospitals in Hyderabad city to understand their perspectives on breast cancer and screening.The data were triangulated to draw inferences suitable for the current public Health scenario. Results: Latepresentation was indicated as the most important cause of decreased survival among women. Most women presentat Stage 3 and 4 when there is no opportunity for surgical intervention. The results indicate that there is a hugegap in awareness about breast cancer, especially in rural areas and among poor socioeconomic groups. Evendespite knowledge, most women delay in reporting due to reasons like fear, embarrassment, cost, ignorance,negligence, and easy going attitude. Conclusions: It is important to improve awareness about breast cancer andscreening methods for promoting early screening. The study inferred that it would be beneficial to establishcancer registries in rural areas. Also, the policymakers need to make key decisions which among three methods(breast self examination (BSE), clinical breast examination and mammography) can best be used as a screeningtool and how to successfully implement population wide screening program to prevent mortality and morbidityfrom breast cancer in India.     

Breast Cancer Information Behaviours and Needs among Singapore Women: A Qualitative Study

Background: There is growing evidence on cancer communication and its impact on cancer-related health outcomes; however, little is known about how women gain access to and use breast cancer information in the multi-ethnic Asian context. This paper aimed to explore the breast cancer information acquisition behaviours and needs among Singapore women who attended a community-based health organisation for mammography screening. Methods, design and setting: Qualitative data were collected through semi-structured interviews with 37 racially diverse, aged 50 and above women, who have received mammography screening within the past two years. The interviews were conducted at either the Singapore Cancer Society Clinic or participant’s home. Results: Although cancer information scanning was more prevalent than information seeking (91.9% vs. 62.2%), those who purposively seek information exhibited a higher knowledge level of breast cancer. The most commonly cited sources for information scanning were friends, television and family, and for information seeking were the Internet, pamphlets from a healthcare organisation/ public authority, and healthcare providers. Singapore women were well-informed about the benefits of mammogram; however, specific knowledge, such as modifiable risk factors, reasons for different screening options and the trade-off between harm and benefit, was still lacking which led to confusion about screening. Conclusion: Breast cancer health educational materials should provide clear and balanced information to give women a more accurate or realistic expectation about mammography screening. Study findings provide important implications for breast cancer education and programs to move beyond simply raising awareness and craft specific informative messages addressing the needs of the target group.     

Delayed Presentation of Self-discovered Breast Cancer Symptoms in Iranian Women: A Qualitative Study

Background: Delayed presentation of symptomatic breast cancer is a public health issue in Iran, making amajor contribution to low survival. Despite the importance of this problem, current knowledge is insufficient toinform interventions to shorten patient delay. The aim of this study was to explore factors influencing patient delayin Iranian women with self-discovered breast cancer symptom. Materials and Methods: This qualitative studywas conducted during 2012-2013. Purposeful sampling was used to recruit 20 Iranian women with self-discoveredsymptoms of breast cancer who attended the Cancer Institute of Tehran University of Medical Sciences, Tehran,Iran. Data were collected through semi-structured in-depth audiotaped interviews, which were transcribed andanalyzed using conventional content analysis with MAXqda software version 10. Findings: Content analysis of thedata revealed four main themes related to the delay in seeking medical help including: 1) attributing symptomsto the benign conditions; 2) conditional health behavior; 3) inhibiting emotional expression; and 4) barriers toaccess to health care systems. Conclusions: These results suggest that patient delay is influenced by complexand multiple factors. Effective intervention to reduce patient delay for breast cancer should be developed byfocusing on improvement of women’s medical knowledge, managing patients’ emotional expression and reformof the referral system.     

Motivational Factors for Breast Cancer Screening Behaviors in Iranian Women: A Qualitative Study

Background: Early diagnosis of breast cancer increases the chance of recovery and life expectancy. Screening is the primary tool for early diagnosis and timely treatment of breast cancer in early stages. This qualitative study aimed to explain the motivational factors for breast cancer screening in Iranian women. Methods: This qualitative study was conducted using content analysis. The 45 women were selected through purposive sampling. Focus group were used for data collection and the data were analyzed using the Lundman and Graneheim thematic content analysis approach.Results: Data analysis identified 9 themes: knowledge acquisition, presence of happy-hopeful spirit, positive attitude and self-worth, maternal role, intellectual and financial independence, religious beliefs, motivational fears, and supportive family. Conclusion: According to the results of this study, it seems that health systems need to change the attitudes and beliefs of people to enhance health culture by identifying women’s motivations for breast cancer screening in different groups and increase social knowledge about screening methods by supporting and training.     

Physical and Emotional Experiences of Chemotherapy: a Qualitative Study among Women with Breast Cancer in Southern Thailand

Background: Chemotherapy treatment can increase survival rates among women with breast cancer elsewhere.However, it also has negative impact on women’s general appearance, body image and psychological functioning.This study aimed to describe the experiences of chemotherapy treatment among Thai women with breast cancerin rural communities, sounthern Thailand. Methods: Qualitative approach was employed to gain insights aboutthe experiences of the women. In-depth interviewing and drawing methods were conducted with 20 Thai womenwho had been diagnosed with breast cancer. Thematic method was used to analyse the data. Results: Three themesemerged from the findings: I feel so weak: Lack of physical energy; experiencing physical and emotional burdens andmanaging health and life. Women were traumatized by effects of chemotherapy and suffered severe physical side effects.Most received inadequate professional support from health care providers and had to rely on their own judgment anduse local resources to deal with the effects of their treatment and to improve their health and well-being. Conclusions:Chemotherapy brought about traumatic experiences to Thai women with breast cancer. Continual support is needed forthe women to reduce the difficulties they might encounter. Support groups should be established for these women whenreceiving and completing chemotherapy treatment. Our finding suggested that social support programs that meet theirneed are salient means that could reduce the sufferings of these women. Nurses and other health care professionals inthe local community should play their important role to establish such group and make it accessible for all.     

Determinants of Breast Self-Examination Performance Among Iranian Women: An Application of the Health Belief Model

Breast cancer is one of the most common cancers among women. Screening behavior rates are low in the world. Therefore, the purpose of the current study was to investigate breast self-examination (BSE) rate and the relationships of Health Belief Model (HBM) constructs for predicting BSE. Path analysis was used to examine both one-way direct and indirect effects of HBM factors on BSE in this population (N = 382). Data were collected by a part of Champion’s HBM Scale (CHBMS) and a self-administered questionnaire. The results showed that 7.6% of the participants reported performing BSE regularly. The final model provided a good fit to the data, with 13 variables explaining 62% of the variance in BSE. Perceived self-efficacy was intermediate construct between modifying factors and HBM constructs. Also, perceived self-efficacy and perceived benefits were the most highly related to BSE. The results suggest that HBM is a useful framework for identifying factors influencing the use of BSE in Iranian women.     

Promoting Breast Cancer Screening Among Asian American Women: the Asian Grocery Store-Based Cancer Education Program

Asian American women's historically low breast cancer mortality rate has remained constant as rates decreased for all other races. From 2000 to 2004, a randomized controlled trial explored the Asian grocery store-based breast cancer education program's impact on Chinese, Filipino, Korean, and Vietnamese women (n?=?1,540). Women aged 40 and older and non-adherent for annual screening mammograms were more likely to schedule a mammogram after receiving the breast cancer education program than women randomized to the prostate cancer program (X ²?=?3.85, p?=?0.05). With the right program ingredients, late adopters of breast cancer screening can be prompted to change.     

Identifying the Social Determinants of Breast Health Behavior: a Qualitative Content Analysis

Background: Prevention, early diagnosis and reduction of mortality caused by breast cancer are the priorities ofthe world health systems. The aim of this study was to identify the social factors that affect the women’s breast healthbehavior based on the social determinants model of the World Health Organization (WHO). Materials and Method:This qualitative study was conducted and analyzed using content analysis approach. The data were collected from32 participants by semi-structured interviews and focused group discussion. The participants comprised of breastsurgeons, radiologists, health care providers and women over 35 years of age in Tehran who were selected throughpurposeful sampling. The interviews continued until data saturation was reached. Results: Based on the experiences ofthe participants, three themes were obtained from the data that shaped the women’s breast health behavior, including1) the context of health policy, 2) socioeconomic status, and 3) cultural, psychological, and behavioral factors.Conclusion: A better understanding of social determinants related to breast health behavior can be effective in designingand applying of appropriate theories and models of education and intervention, so that, by early diagnosis of breastcancer and timely treatment of patients, the disease complications and mortality would be reduced.     

Social Perceptions of Breast Cancer by Women Still Undergoing or Having Completed Therapy: a Qualitative Study

Background: Diagnosis and treatment of breast cancer is a crisis situation which effects women’s lives physically, socially and spiritually. Investigating women’s perceptions of this disease is crucially important for treatment decisions. We therefore determined social perceptions and interpretations of women diagnosed with breast cancer during therapy and in the post-treatment period. Materials and Methods: In the study, focus group and in-depth interviews were made with women still undergoing or having completed breast cancer treatment. Some 25 women were included in the research. Content analysis was used in the analysis of the qualitative data obtained after the focus group and in-depth interviews. Results: Some of the women demonstrated positive perceptions towards accepting the disease, whereas others had emotions such as rebellion and anger. The loss of a breast is important with different interpretations. Conclusions: Women’s acceptance or rebellion against the disease varies within their social interpretations after the treatment, as at the stage of diagnosis/treatment. All stages of breast cancer negatively affect the social life of the affected individual as much as her body. Nurses assume crucial roles in coping with these negative effects. Thus, it is necessary to know, and sociologically interpret, what is indicated by the information on what the negative effects concerning the disease are and how they are interpreted.     

High Risk Breast Cancer Screening is a Double Edged Sword: A Qualitative Study of Patient Perspectives on the Ontario High Risk Breast Cancer Screening Program

BackgroundMRI-based breast cancer screening for high-risk women has been associated with false positives. This study explored the benefits and drawbacks of MRI-based screening using in-depth patient interviews.MethodsThis was a qualitative study of interviews with women participating in the High Risk Ontario Breast Screening Program. Women enrolled at two centers who had completed at least one round of screening were invited to participate. Recruitment was suspended when thematic saturation was reached. Semi-structured telephone interviews were conducted and transcribed verbatim. Emergent themes were identified and a coding framework established.Results21 women (median age 41 years) participated in telephone interviews. Women had been in the program a median of 4 years (IQR 1-5), and 71% had experienced at least one abnormal screen. Eight participants (38%) had undergone biopsies. Six women (29%) were BRCA mutation carriers. MRIs were described as intimidating, uncomfortable, and claustrophobic. Participants were concerned about long-term exposure to gadolinium contrast. Compared to MRI, mammography alone was viewed as painful, less sensitive, and a “useless…waste of time.” MRI provided a “psychological safety net” that outweighed the distress associated with abnormal screens. Many women accepted this trade-off as a “two-edged sword” that was “worth it” and provided a sense of control. Suggestions for improvement included more information regarding the risks of MRI, and access to counselling.ConclusionsWomen participating in MRI-based screening strongly value reassurance from a highly sensitive screening test. This outweighed the distress of abnormal screens. There are areas for improvement around patient communication and psychosocial support.     

Self-Care Education Programs Based on a Trans-Theoretical Model in Women Referring to Health Centers: Breast Self-Examination Behavior in Iran

Background: Breast cancer is one of the most common cancers and a major public health problem in developing countries. However, early detection and treatment may be achieved by breast self-examination (BSE). Despite the importance of BSE in reducing the incidence of breast cancer and esultant deaths, the disease continues to be the most common cause of cancer death among women in Iran.This study aimed to determine the effects of self-care education on performance of BSE among women referring to health centers in our country. Materials and Methods: This quasi-experimental interventional study with pretest/posttest control group design was conducted on 168 women referred to health centers. The data were collected using a validated researcher-made questionnaire including demographic variables and trans-theoretical model constructs as well as a checklist assessing BSE behavior. The instruments were administered to groups with and without self-care education before, a week after, and 10 weeks after the intervention. Then, the data were entered into the SPSS statistical software (version 19) and analyzed using independent sample t-tests, paired sample t-test, repeated measures ANOVA, Chi-square, and Friedman tests (p<0.05). Results: The results showed an increase in the intervention group’s mean scores of trans-theoretical model constructs (stages of change, self-efficacy, decisional balance, and processes of change) and BSE behavior compared to the control group (p<0.001). Conclusion: The study confirmed the effectiveness of aneducational intervention based ona trans-theoretical model in performing BSE. Therefore, designing educational interventions based on this model is recommended to improve women’s health and reduce deaths due to breast cancer.     

Breast Cancer Education for Navajo Women: a Pilot Study Evaluating a Culturally Relevant Video

This pilot study evaluated a culturally specific video designed to teach Navajo women about breast cancer treatment options. Fourteen Navajo women diagnosed with breast cancer and 26 healthcare providers participated in a mixed-method evaluation that documented their perceptions immediately and 6 months after viewing the video. After initial viewing, women reported reduced anxiety about treatment and interest in support groups. Six months later, women said the video prompted them to seek more information from printed sources and their provider. Younger Navajo women who were 44 to 51 years old were more likely to attend support groups than women who were 55–67 years. Providers corroborated the positive effects of the video. The providers believed the video encouraged patients to seek information about breast cancer and to ask questions about treatment plans and side effects. A culturally relevant video for Navajo women can be an effective teaching tool and can enhance patient–provider communication.