Breast cancer knowledge, attitudes and screening behaviors among Indian-Australian women

The relationships among breast cancer-related prevention behavior, attitude, knowledge and fatalism in Chinese women with benign breast tumors

PURPOSE

This study aimed to explore the relationships between breast cancer prevention behavior, attitude, knowledge, and fatalism, and to examine the chain mediating effect of breast cancer-related fatalism (mediating variable 1, M1) and attitude (mediating variable 2, M2) on the relationship between breast cancer-related knowledge (X) and prevention behavior in Chinese women with benign breast tumors.

METHODS

A cross-sectional design was used in this study, and 201 women with benign breast tumors were evaluated in terms of breast cancer-related fatalism, prevention knowledge, attitude and behavior by using the Multidimensional Fatalism Scale (MFS) and the Knowledge - attitude-behavior Questionnaire for Breast Cancer Prevention. Regression analysis was adopted to test and explain the relationships between breast cancer prevention behavior, attitude, knowledge, and fatalism, and the chain mediating effect of breast cancer-related fatalism (mediating variable 1, M1) and attitude (mediating variable 2, M2) on the relationship between breast cancer-related knowledge (X) and prevention behavior (Y) in women with benign breast tumors.

RESULTS

Knowledge had significant direct predictive effects on fatalism, attitude and behavior (βknowledge→fatalism = -0.24, p = 0.002; βknowledge→attitude = 0.30, P < 0.001; βknowledge→behavior = 0.14, p = 0.019), attitude has a significant direct predictive effect on behavior (βattitude→behavior = 0.19, P < 0.001). In addition, there were two significant mediating paths: ① knowledge - attitude-behavior (β = 0.06, P < 0.05); and ② knowledge - fatalism - attitude-behavior (β = 0.01, P < 0.05).

CONCLUSION

Our findings indicate that helping women with benign breast tumors increase their knowledge, reduce fatalism, and promote positive attitude toward breast cancer prevention is conducive to enhancing their preventive behavior. In addition, improving the knowledge of women with benign breast tumors can also enhance their prevention behavior by affecting their fatalism and attitude.

Status and influencing factors of knowledge, attitudes and practices relating to screening for breast and cervical cancer among rural women aged 40-65 years in China: a cross-sectional study

OBJECTIVES

The objectives are to investigate the status of knowledge, attitudes and practices (KAP) and to identify factors related to KAP towards breast and cervical cancer screening among rural Chinese women aged 40-65 years.

DESIGN AND SETTING

This cross-sectional study was conducted from July to September 2020 in rural areas of eastern China.

PARTICIPANTS

This study involved 301 rural women aged 40-65 years.

VARIABLES AND OUTCOMES

The questionnaire included demographic information and the KAP related to breast and cervical cancer screening. Multivariate linear regression analysis was used for the multifactor analysis.

RESULTS

A total of 301 rural women aged 40-65 years participated in the survey. The overall score of KAP was (62.41±11.24), and the scores of each KAP domain relating to screening for breast and cervical cancer among participants in rural areas were (1.82±0.97), (44.52±7.20) and (16.06±4.56), respectively. The following factors were significantly associated with the total KAP Score relating to breast and cervical cancer screening among rural women aged 40-65 years, explaining 35% of the variance (p<0.001): aged 50-54 (β=-0.160, 95% CI -7.403 to -0.794), aged 55-59 (β=-0.266, 95% CI -10.763 to -3.757), aged 60-65 (β=-0.243, 95% CI -12.504 to -4.331), junior high school (β=0.186, 95% CI 1.287 to 7.064), housewife (β=0.172, 95% CI 0.849 to 6.868), other work (β=0.171, 95% CI 3.818 to 15.044), annual household income ranging from 50 000 to 79 999 (β=0.281, 95% CI 3.887 to 10.458) and annual household income≥80 000 (β=0.330, 95% CI 4.735 to 11.554).

CONCLUSIONS

The status of KAP related to breast and cervical cancer screening still requires improvement. Measures to enhance the participation of the two-cancer screening should be provided to rural women aged between 50 and 65 years with lower education level and lower annual household income, especially women who are farmers.

Quality of life of Jordanian menopausal working and retired women and its associated factors: a cross-sectional study

OBJECTIVE

Life expectancy of Jordanian women has increased, indicating that the number of women entering menopause age, during the prime of their working life, will also increase. Therefore, assessments of the quality of life (QoL) of working and retired women and factors associated with overall wellbeing, are essential for the provision of quality services and care.

METHOD

A cross-sectional study was conducted with 200 Jordanian women between the ages of 45 to 60 years old. The Utian QOL tool was used to assess the quality of life among menopausal women. Multiple regressions were used to determine predictors for QoL for the whole sample and for each group of working and retired women.

RESULTS

The study shows that the total QoL for women was 77.5 ±14.4, with a significant difference (p=.023) in total QoL and the occupational domain (p=.003) between working and retired women. Employed women with fewer chronic diseases and using frequent preventive measures had a higher QoL compared to others.

CONCLUSION

Working itself might be an important indicator for better a quality of life among menopausal women. Better working conditions and more attention from the health care providers for the menopausal changes and the preventive measures could enhance women's perceived QoL in addition to increasing their productivity.

Quality of life of Jordanian menopausal working and retired women and its associated factors: a cross-sectional study

Objective

Life expectancy of Jordanian women has increased, indicating that the number of women entering menopause age, during the prime of their working life, will also increase. Therefore, assessments of the quality of life (QoL) of working and retired women and factors associated with overall wellbeing, are essential for the provision of quality services and care.

Method

A cross-sectional study was conducted with 200 Jordanian women between the ages of 45 to 60 years old. The Utian QOL tool was used to assess the quality of life among menopausal women. Multiple regressions were used to determine predictors for QoL for the whole sample and for each group of working and retired women.

Results

The study shows that the total QoL for women was 77.5 ±14.4, with a significant difference (p=.023) in total QoL and the occupational domain (p=.003) between working and retired women. Employed women with fewer chronic diseases and using frequent preventive measures had a higher QoL compared to others.

Conclusion

Working itself might be an important indicator for better a quality of life among menopausal women. Better working conditions and more attention from the health care providers for the menopausal changes and the preventive measures could enhance women's perceived QoL in addition to increasing their productivity.

The acceptability of, and informational needs related to, self-collection cervical screening among women of Indian descent living in Victoria, Australia: A qualitative study

BACKGROUND

In July 2022, self-collection became universally available as part of Australia's National Cervical Screening Program. This change aims to address screening inequities experienced among underscreened populations, including women of Indian descent. This study explored experiences of cervical screening, alongside the acceptability of self-collection, among women of Indian descent living in Victoria, Australia. We also aimed to articulate the informational needs to promote self-collection among this population.

METHODS

Five focus group discussions with 39 women living in Victoria were conducted in English (n = 3) and Punjabi (n = 2). Transcripts were thematically analysed, as informed by the Theoretical Framework of Acceptability.

RESULTS

Women were motivated by the choice to self-collect, perceiving the ability to maintain modesty and greater autonomy as key enablers. Healthcare practitioners were seen as central in supporting patient-centred models of care. Perceived barriers to self-collection included concerns around its accuracy and women's confidence in collecting their own sample. Widespread dissemination of culturally tailored promotion strategies communicating concepts such as 'privacy' and 'accuracy' were suggested by women to promote self-collection.

CONCLUSION

Self-collection was highly acceptable among women of Indian descent, particularly when assured of its accuracy, and sociocultural norms and previous screening experiences are considered. This study highlights the huge potential that self-collection can play in increasing equity in Australia's cervical screening programme.

PATIENT OR PUBLIC CONTRIBUTION

Members of the public were involved in focus group discussions. Findings were summarised and disseminated via a poster. A bicultural worker was involved in all stages of the research.

The contribution of prognostic factors to socio-demographic inequalities in breast cancer survival in Victoria, Australia

BACKGROUND

Breast cancer survival in Australia varies according to socio-economic status (SES) and between rural and urban places of residence. Part of this disparity may be due to differences in prognostic factors at the time of diagnosis.

METHODS

Women with invasive breast cancer diagnosed from 2008 until 2012 (n = 14,165) were identified from the Victorian Cancer Registry and followed up for 5 years, with death from breast cancer or other causes recorded. A prognostic score, based on stage at diagnosis, cancer grade, whether the cancer was detected via screening, reported comorbidities and age at diagnosis, was constructed for use in a mediation analysis.

RESULTS

Five-year breast cancer mortality for women with breast cancer who were in the lowest quintile of SES (10.3%) was almost double that of those in the highest quintile (5.7%). There was a small survival advantage (1.7% on average, within each socio-economic quintile) of living in inner-regional areas compared with major cities. About half of the socio-economic disparity was mediated by prognostic factors, particularly stage at diagnosis and the presence of comorbidities. The inner-regional survival advantage was not due to differences in prognostic factors.

CONCLUSIONS

Part of the socio-economic disparity in breast cancer survival could be addressed by earlier detection in, and improved general health for, more disadvantaged women. Further research is required to identify additional causes of socio-economic disparities as well as the observed inner-regional survival advantage.

The impact of exposure to HPV related information and injunctive norms on young women's intentions to receive the HPV vaccine in China: A structural equation model based on KAP theory

Background

The HPV vaccination is a crucial line of defensing against cervical cancer. As a result of government support and positive publicity from the majority of media, a craze for HPV vaccination has occurred in China. Besides, the intentions to get the HPV vaccine among women of appropriate age is also influenced by families' and friends' attitudes and perceptions toward HPV vaccine. Therefore, the purpose of this study was to investigate how HPV related information exposure and injunctive norms affect young Chinese women's intentions to receive the HPV vaccine.

Methods

A structural equation model was developed based on KAP theory, and 567 effective questionnaires were collected through an online survey. We used SPSS 26.0 for the reliability and validity analysis and the differential testing of demographic characteristics, and Amos 26.0 for the goodness-of-fit analysis and paths testing of the model.

Results

Our findings showed that (1) intention to receive HPV vaccine differed significantly in age (P = 0.046), educational background (P = 0.001), and occupation (P = 0.004). (2) Exposure to HPV related information positively affected knowledge about HPV (β = 0.316, P < 0.001) and intention to receive HPV vaccine (β = 0.141, P < 0.001). (3) Knowledge about HPV positively affected attitude toward HPV vaccine (β=0.341, P < 0.001), but negatively affected intention to receive HPV vaccine (β = -0.148, P < 0.05), and attitude toward HPV vaccine positively affected intention to receive HPV vaccine (β = 0.594, P < 0.001). (4) Injunctive norms positively affected attitude toward HPV vaccine (β = 0.362, P < 0.001) and intention to receive HPV vaccine (β = 0.420, P < 0.001).

Conclusions

Exposure to HPV related information influenced young Chinese women's intentions to receive the HPV vaccine and related knowledge, that is, the more frequently they were exposed to HPV related information, the stronger their intentions to receive the vaccine and the higher their HPV knowledge. Also, the perception and support of HPV vaccination by people around them will further influence their attitudes and intentions to receive the HPV vaccine.

Socio-economic and ethnocultural influences on geographical disparities in breast cancer screening participation in Victoria, Australia

OBJECTIVE

To examine the socio-economic and ethnocultural characteristics of geographical areas that may influence variation in breast cancer screening participation.

METHODS

In a cross-sectional analysis breast cancer screening participation for statistical areas in Victoria, Australia (2015-2017) was linked with data from the 2016 Australian Census. We selected four commonly used area-level measures of socio-economic status from the Australian Census (i) income (ii) educational level (iii) occupational status and (iv) employment profile. To assess the ethnocultural characteristics of statistical areas we used the Census measures (i) country of birth (ii) language spoken at home (iii) fluency in English (iv) religion and (v) the proportion of immigrants in an area, together with their recency of migration.

RESULTS

All the selected measures were related to screening participation. There was a high degree of association both within and between socio-economic and ethnocultural characteristics of areas as they relate to screening. Ethnocultural characteristics alone accounted for most of the explained geographical disparity in screening participation.

CONCLUSIONS

Geographical disparities in breast cancer screening participation may be due to ethnocultural factors that are confounded with socio-economic factors.

Breast self-examination as a route to early detection in a lower-middle-income country: assessing psychosocial determinants among women in Surabaya, Indonesia

Background

Breast cancer has become a public health concern in Indonesia. Regular breast self-examination (BSE) is considered an important first step for its early detection, especially in countries with limited healthcare access, as it is the case in Indonesia. This study aimed to confirm and assess the psychosocial determinants of intention to perform BSE and BSE performance.

Methods

The cross-sectional study was conducted on 204 women aged 18–65 years in Surabaya, Indonesia. A 64-item survey was conducted, included variables from the Reasoned Action Approach, and the Health Belief Model, presented questions about demographics, breast cancer knowledge, and behavior related to BSE.

Results

Most women (72.5%) expressed intention to perform BSE; however, only 7.8% and 2.9% performed BSE per week and per month, respectively, in the past year. Breast cancer knowledge and attitudes towards BSE were uniquely associated with BSE performance. Perceived behavioral control (PBC) and BSE attitudes were unique correlates of intention. Perceived benefits and barriers and subjective norms were significantly associated with intention and BSE behavior in bivariate analyses.

Conclusions

Breast screening education should incorporate strategies for improving attitudes towards BSE, PBC, and breast cancer knowledge with perceived benefits and barriers and subjective norms as relevant targets.

The Role of Education in Breast Cancer Beliefs and Screening Practices Among Korean Women - A quantitative study

INTRODUCTION

Cultural beliefs are influential factors that affect breast cancer screening practices among Korean women. The aim of this study was to examine the role of educational levels and compare the cultural beliefs associated with breast cancer screening practices among immigrant Korean women in Australia with those of their counterparts in Korea.

METHODS

A secondary analysis based on data from convenience samples of 245 and 249 Korean women living in Australia and Korea, respectively. Data were collected by the Korean version of Breast Cancer Screening Beliefs Questionnaire.

RESULTS

Educational level has a significant association with Korean women's cultural beliefs about breast cancer and breast cancer screening practices regardless of country of residence.

DISCUSSION

Nurses working in multicultural societies should take cultural beliefs and the role of education into account while designing strategies to promote breast cancer screening practices among immigrant Korean women.

The Role of Vaccination and Screening in Limiting the Worldwide Disease Burden of Preventable Female Cancers: A Review

Cancer represents one of the most common causes of death worldwide. Among women, breast cancer is the most diagnosed cancer and the principal cause of death due to malignant disease, while cervical cancer ranks fourth for both incidence and mortality. The present review aims to analyze the epidemiology of cervical and breast cancer (incidence, mortality, survival rates, and trends). Moreover, the most important primary and secondary preventive strategies (reduction of risk factors, exposure, vaccination, cancer screening) intended to reduce the future burden of cervical and breast cancer, that should be adopted actively and free of charge, were discussed in accordance to more recent and evidence-based findings.

Breast cancer knowledge and awareness among females in Al-Qassim Region, Saudi Arabia in 2018

Aim:

This study aimed to measure breast cancer (BC) awareness among women in Al-Qassim and to compare the results to previous studies in Saudi Arabia and international studies.

Method:

This is a cross-sectional study conducted in Al-Qassim region, Saudi Arabia. All women above 18 years of age were included and those who could not complete the questionnaire for any reason were excluded. The data were collected by using a valid pretested structured questionnaire taken from previous studies. Descriptive statistics were presented using frequency and proportion for all categorical variables and mean ± standard deviation for continuous variable. The relationship between dependent variable versus independent variables had been conducted using Chi-square test. P value of ≤0.05 was considered as statistically significant.

Results:

Nearly all participants were highly aware of BC (95.4%) and half of them correctly identified that not only females are affected by BC. With regards to personal breast assessment, more than a half of them have done breast self-examination; however, only one out of four females had done clinical breast examination and mammography test. The most common risk factor of BC was family history and the commonest signs and symptoms were the size and shape changes of the breast. The prevalence of poor knowledge was 202 (38.9%) while good knowledge was 317 (61.1%). Age group in years and use of oral contraceptives were the independent significant factors of poor knowledge.

Conclusion:

The overall knowledge of women about BC in this study was inadequate. While half of the women performed breast self-examination on the contrary, the actual clinical breast examination found to be low. The most common risk factor being identified was family history of BC and smoking. Size and shape changes of breast as well as breast lump were the most common signs and symptoms. Age group in years and the use of contraceptives pills were being identified as the significant factors of knowledge toward BC.

Factors associated with insufficient awareness of breast cancer among women in Northern and Eastern China: a case-control study

OBJECTIVES

To investigate the awareness and knowledge level of breast cancer among Chinese participants.

DESIGN

Case-control study.

SETTINGS

This study was based on the database of the minister-affiliated hospital key project of the Ministry of Health of the People's Republic of China that included 21 Chinese hospitals between April 2012 and April 2013.

PARTICIPANTS

Matched study was designed among 2978 participants with Han ethnicity aged between 25 and 70.

PRIMARY AND SECONDARY OUTCOME MEASURES

Student's t-test, Pearson's χ² test, reliability analysis, exploratory factor analysis, and univariate and multivariate logistic regression analyses were performed to know the level of breast cancer knowledge and find the breast cancer awareness-associated factors.

RESULTS

80.0% (2383/2978) of the participants had poor awareness level of breast cancer. In-depth knowledge of breast cancer such as early symptoms and risk factors was poorly found among them. Television broadcast and relatives or friends with breast cancers were the main sources of information about breast cancer. Of all participants, 72.8% (2167/2978) had heard about breast cancer as a frequent cancer affecting women, and 63.3% (1884/2978) knew that family history of breast cancer was a risk factor for breast cancer. Over half of them were aware that a breast lump could be a symptom of breast cancer. Multivariate analysis identified the following variables that predicted awareness of breast cancer: young age (OR=0.843, 95% CI 0.740 to 0.961), occupation (agricultural worker) (OR=12.831, 95% CI 6.998 to 23.523), high household social status (OR=0.644, 95% CI 0.531 to 0.780), breast hyperplasia history (OR=1.684, 95% CI 1.273 to 2.228), high behavioural prevention score (OR=4.407, 95% CI 3.433 to 5.657).

CONCLUSION

Most women were aware of breast cancer as a disease, but their in-depth knowledge of it was poor. More publicity and education programmes to increase breast cancer awareness are necessary and urgent, especially for the ageing women and agricultural workers.

Breast cancer screening practices of African migrant women in Australia: a descriptive cross-sectional study

BACKGROUND

Breast cancer is the most diagnosed cancer among women and a leading cause of mortality and morbidity, globally. Breast cancer mortality can be improved through routine cancer screening, yet migrant populations have lower participation rates. While African migrants are among the fastest growing migrant population in Australia, their breast cancer screening behaviour is under-studied. The aims of this study were to report breast cancer screening status of African migrant women and factors associated with their breast cancer screening behaviour in Australia.

METHODS

A descriptive, cross-sectional approach was utilised for this study. Two hundred and sixty four African migrant women aged 18-69 years and recruited from a number of organisations responded to a self-reported African version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ). Main research variables are breast cancer screening practices and demographic characteristics and total scores on each of the BCSBQ subscales. Multivariable logistic regression analyses were performed to investigate the impact of the demographic variables on the likelihood of women in the target age range 50-74 years having screening practices as recommended.

RESULTS

While most of the participants heard of breast awareness (76.1%) and mammogram (85.2%), only 11.4% practised monthly breast awareness, whereas 65.9% had ever had a mammogram as frequently as recommended. Age and employment were determining factors for participating in mammogram. Significant different scores were found in the "Practical barriers" between women at the target age who had and had not performed breast awareness (80.4 versus 77.5, p-value = 0.002) and mammogram (77.1 versus 70.3, p-value = 0.009) regularly as recommended. Moreover, attitudes towards general health check-ups subscale scores were significantly higher in women who had performed clinical breast examination as frequently as recommended than those who had not.

CONCLUSIONS

The research reveals that practical barriers and attitudes towards general health check-ups are important factors to take into account in determining African migrant women's participation in breast cancer screening. Progress in reducing breast cancer deaths through early detection needs to focus on attitudinal change among African migrants.

Conducting Cancer Research among Culturally and Linguistically Diverse Groups in Australia: A Reflection on Challenges and Strategies

Background

While effort has been made to include minority groups in cancer studies in Western countries, overseas experience indicates that recruiting immigrant members to participate in cancer research is challenging. The aim of the paper is to set out the challenges and strategies needed to ensure the success of cancer research among culturally and linguistically diverse (CALD) groups in Australia.

Discussion

Author suggested that partnership with ethnic community organization, research team, research setting and data collection methods, access to national data in cancer register, the informed consent process, and resources management are important elements to ensure the success of cancer research among CALD groups.

Summary

The paper provides health care professionals with insight into methodological and practical issues needed to plan and conduct cancer research among CALD populations not only in Australia but also other Western countries, where numbers of minority groups are increasing significantly.

Validation of the Breast Cancer Screening Beliefs Questionnaire among African Australian women

Background

The Breast Cancer Screening Beliefs Questionnaire (BCSBQ) has been designed as a culturally appropriate instrument for assessing women’s beliefs, knowledge and attitudes to breast cancer and breast cancer screening practices. While it has proved to be a reliable instrument when applied to women of Chinese, Arabic and Korean origin living in Australia, its psychometric properties among women from African backgrounds have not been tested. The aim of this study is to examine the psychometric properties of the BCSBQ among African Australian women.

Methods

The BCSBQ was administered to 284 African Australian women who were recruited from a number of African community organizations and churches. Factor analysis was conducted to study the factor structure. Construct validity was examined using Cuzick’s non-parametric test while Cronbach alpha was used to assess internal consistency reliability.

Results

Exploratory factor analysis results demonstrated that the African-Australian BCSBQ can be conceptualized as a 4-factor model. The third factor, viz. “barriers to mammography”, was split into two separate factors namely, “psychological” and “practical” barriers. The results indicated that the African-Australian BCSBQ had both satisfactory validity and internal consistency. The Cronbach’s alpha of the three subscales ranged between 0.84-0.92. The frequency of breast cancer screening practices (breast awareness, clinical breast-examination and mammography) were significantly associated with attitudes towards general health check-ups and perceived barriers to mammographic screening.

Conclusions

Our study provided evidence to support the psychometric properties of the BCSBQ.in African Australian women. The study moreover demonstrated that the use of the instrument can help health professionals to understand the beliefs, knowledge and attitudes to breast cancer among African Australian women and also the factors that impact on their breast cancer screening practices.