Cultural Determinants of Cancer Fatalism and Cancer Prevention Behaviors among Asians in Singapore

Examining the Role of Information Behavior in Linking Cancer Risk Perception and Cancer Worry to Cancer Fatalism in China: Cross-Sectional Survey Study

BACKGROUND

Reducing cancer fatalism is essential because of its detrimental impact on cancer-related preventive behaviors. However, little is known about factors influencing individuals' cancer fatalism in China.

OBJECTIVE

With a general basis of the extended parallel process model, this study aims to examine how distinct cancer-related mental conditions (risk perception and worry) and different information behaviors (information seeking vs avoidance) become associated with cancer fatalism, with an additional assessment of the moderating effect of information usefulness.

METHODS

Data were drawn from the Health Information National Trends Survey in China, which was conducted in 2017 (N=2358). Structural equation modeling and bootstrapping methods were performed to test a moderated mediation model and hypothesized relationships.

RESULTS

The results showed that cancer risk perception and cancer worry were positively associated with online health information seeking. In addition, cancer worry was positively related to cancer information avoidance. Moreover, online health information seeking was found to reduce cancer fatalism, while cancer information avoidance was positively associated with cancer fatalism. The results also indicated that the perceived usefulness of cancer information moderated this dual-mediation pathway.

CONCLUSIONS

The national survey data indicate that cancer mental conditions should not be treated as homogeneous entities, given their varying functions and effects. Apart from disseminating useful cancer information to encourage individuals to adaptively cope with cancer threats, we advocate for health communication programs to reduce cancer information avoidance to alleviate fatalistic beliefs about cancer prevention.

Moderating influences on parents' fatalistic beliefs about cancer and their association with sun safety behaviors among children of melanoma survivors: Implications for treatment

The purpose of this study is to examine the association between parents' fatalism about melanoma and their children's sun protection, and the potential moderating role of parent-child communication. In this observational study of N = 69 melanoma-surviving parents of children ages 8-17, parents reported on their own melanoma fatalism, as well as their children's sun safety behaviors and parent-child discussion about sun safety. Parent gender, family history of melanoma, and frequency of parent-child discussions moderated the relationship between parents' fatalism and children's sun safety behaviors. Among mothers and parents with a family history of melanoma, high fatalism was associated with lower child sunscreen use, especially when discussions were less frequent. Melanoma surviving parents' fatalistic beliefs about cancer indirectly influence their children's health behavior and are a risk factor for unsafe sun behavior. Attending to parent gender, family history, and their communications about protective behaviors as co-factors of this risk could inform future intervention targeting.

A Bibliometric Analysis of the 36-Year History of Cancer Nursing (1987-2023)

BACKGROUND

Bibliometric analysis is an effective method for evaluating the publication characteristics and development of a journal. To our knowledge, this study is the first such analysis of the publications in Cancer Nursing.

OBJECTIVE

This study aimed to analyze the publication characteristics and evolution of Cancer Nursing over a period of 36 years since its inception.

METHODS

Bibliometric analysis was carried out on 3095 publications. Data were collected from the Web of Science Core Collection database on September 15, 2023. Data analysis was conducted with Web of Science Core Collection, VOSviewer, and Bibliometrix package in R software.

RESULTS

The results showed a steady increase in the citation and publication structure of Cancer Nursing. "Quality of life" was at the center of the studies, and "quality of life," "women," and "breast cancer" were identified as trend topics. The United States was both at the center of the cooperation network and was the country that contributed the most publications to the journal.

CONCLUSION

Cancer Nursing has had an increasing contribution to and impact on cancer nursing in terms of the quality and citations of published articles. It was noted that the journal's network of collaboration has expanded globally and that its thematic diversity is high. Although quality of life, women, and breast cancer have been reported extensively, more studies addressing the concepts of "children," "support," and "needs" are needed in the journal.

IMPLICATIONS FOR PRACTICE

This study not only enriches global readers in the field of cancer nursing but may also be beneficial in providing input to guide future research.

Fatalism tendency and health beliefs about medication use in older adults: A predictive correlational design

OBJECTIVE

This study was performed to investigate fatalism tendency and health beliefs about medication use and to identify predisposing factors of these variables among older adults.

METHODS

A predictive correlational design was used. The study was completed with 500 older adults. A personal information form, the Fatalism Tendency Scale, and the Drug Use Health Beliefs Scale were used to collect data. Univariate and multiple linear regression analysis was performed for data analysis.

RESULTS

Fatalism tendency was found to be high in older adults who used medications prescribed by the physician in different ways, used the medications more than the recommended amount, and used medications at random intervals. Older adults who used over-the-counter medications and discontinued the medications before the due date had lower health beliefs about conscious and prescription medication use.

CONCLUSIONS

The study concluded that characteristics regarding medication use predicted both fatalism tendencies and medication use health beliefs. Health perception was found to be one of the predisposing factors of medication use health beliefs, whereas education level was another predictive factor of fatalism tendency.

Experiences of patients and their caregivers in a Virtual Ward in Singapore: A descriptive qualitative study

BACKGROUND

The experiences of COVID-19 patients admitted to Virtual Wards and their caregivers are underexplored in Asian communities. A COVID-19 Virtual Ward (CVW) was recently established in Singapore.

AIM

This study aims to describe the experiences of high-risk COVID-19 patients admitted to a Virtual Ward and their caregivers in a multi-racial Asian community.

METHODS

A descriptive qualitative study was conducted from November 2021 to March 22 among high-risk COVID-19 patients and their caregivers who had been admitted to a CVW. The CVW involved teleconsultation whereby patients submitted their vital signs via a chatbot on their mobile phone and were supported remotely by a team of allied health professionals. In-depth interviews were conducted with patients and their caregivers and analyzed thematically. Findings The findings were supported by three themes. First, CVW admissions were perceived to be safe and effective. The second emerging theme related to the benefits and burdens of receiving care at home. The benefits of CVW were perceived comfort and familiarity with the home environment, while burdens included ensuring discipline in submitting health data and self-isolating from other household members. Last, the role of external factors such as informal support, paid domestic workers, and work arrangements was highlighted by the participants. Overall, key enablers for a successful CVW experience were the availability of social support, timely care from the care team, and 24/7 access to the team.

CONCLUSION

In conclusion, CVW was perceived as a safe and effective strategy to manage high-risk patients at home. We recommend that Virtual Wards should be further developed to expand bed capacity in both pandemic and non-pandemic settings.

Factors influencing medication adherence in multi-ethnic Asian patients with chronic diseases in Singapore: A qualitative study

Background: Poor medication adherence can lead to adverse health outcomes and increased healthcare costs. Although reasons for medication adherence have been widely studied, less is explored about factors affecting medication adherence for patients in non-Western healthcare setting and from Asian cultures. This study aimed to explore cultural perspectives on factors influencing medication adherence among patients with chronic diseases in a multi-ethnic Asian healthcare setting.

Methods: We conducted a qualitative study involving in-depth interviews with patients with chronic conditions purposively recruited from a community hospital in Singapore until data saturation was achieved. A total of 25 patients participated in this study. Interviews were transcribed and thematically analyzed. Themes were subsequently mapped into the World Health Organization (WHO) Framework of Medication Adherence.

Results: Participants commonly perceived that sides effects (therapy-related dimension), poor understanding of medication (patient-related dimension), limited knowledge of condition (patient-related dimension), forgetfulness (patient-related dimension) and language issues within a multi-ethnic healthcare context (healthcare team and system-related dimension) as the main factors contributing to medication adherence. Importantly, medication adherence was influenced by cultural beliefs such as the notion of modern medicines as harms and fatalistic orientations towards escalation of doses and polypharmacy (patient-related dimension). Participants made various suggestions to foster adherence, including improved patient-physician communication, enhanced care coordination across providers, use of language familiar to patients, patient education and empowerment on the benefits of medication and medication adjustment.

Conclusion: A wide range of factors influenced medication adherence, with therapy- and patient-related dimensions more pronounced compared to other dimensions. Findings demonstrated the importance of cultural beliefs that may influence medication adherence. Future efforts to improve medication adherence should consider a person-centered approach to foster more positive health expectations and self-efficacy on medication adherence, supplemented with routine reviews, development of pictograms and cultural competence training for healthcare professionals.

Experiences of Patients and Their Caregivers Admitted to a Hospital-at-Home Program in Singapore: a Descriptive Qualitative Study

BACKGROUND

Hospital at Home (HaH) programs have been shown to improve clinical outcomes, quality of care, and patient satisfaction. However, how Asian patients experience HaH remained underexplored.

OBJECTIVE

To explore the perceptions and experiences of patients and caregivers admitted to a hospital-at-home program in Singapore.

DESIGN

Descriptive qualitative study design.

PARTICIPANTS

Purposive sampling was used to conduct 36 interviews with 13 patients, nine Legally Acceptable Representatives (LARs), and 14 caregivers until data saturation was achieved.

INTERVENTIONS

NUHS@Home is a HaH program providing care through a multi-disciplinary team, enabled by remote vital signs monitoring through a tablet and wireless blood pressure and oxygen meters.

APPROACH

This study used in-depth semi-structured individual interviews. Interviews were transcribed and thematically analyzed using Braun and Clark's six-step inductive approach.

KEY RESULTS

The overarching theme identified was "Enablers, difficulties, and improvements to the HaH experiences" which was supported by three key themes: (1) Perceived better care at home, (2) Importance of social support, and (3) Organizational structures required to support HaH. Participants described overall HaH experiences around factors contributing to their impeding engagement, overall satisfaction, and quality of care.

CONCLUSIONS

Although HaH is unfamiliar to the Singapore population, most of the participants in this study had an overall positive experience. The key challenges found in this paper were the stress and inconvenience caused to caregivers. The enablers for positive HaH experiences were (1) consideration of patient's family members as key participants in the patients' therapeutic alliance; (2) the HaH care team must be accessible, approachable, and reassuring, and communicate frequently and timely with patients and their families; and (3) financing strategies to ensure HaH out-of-pockets costs remain affordable which are critical to keeping HaH as an option for patients and families.

Disparities in access to cancer diagnostics in ASEAN member countries

Diagnostics, including laboratory tests, medical and nuclear imaging, and molecular testing, are essential in the diagnosis and management of cancer to optimize clinical outcomes. With the continuous rise in cancer mortality and morbidity in the Association of Southeast Asian Nations (ASEAN), there exists a critical need to evaluate the accessibility of cancer diagnostics in the region so as to direct multifaceted interventions that will address regional inequities and inadequacies in cancer care. This paper identifies existing gaps in service delivery, health workforce, health information systems, leadership and governance, and financing and how these contribute to disparities in access to cancer diagnostics in ASEAN member countries. Intersectoral health policies that will strengthen coordinated laboratory services, upscale infrastructure development, encourage health workforce production, and enable proper appropriation of funding are necessary to effectively reduce the regional cancer burden.

Extending the Risk Perception Attitude Framework to Predict Individuals' Engagement in Collective Actions Against Cancer

To identify the psychosocial determinants of individuals' intention to engage in collective actions against cancer, we extended and tested the risk perception attitude (RPA) framework at the level of social perceptions. The results of a large online survey of Hong Kong citizens (N = 1,005) revealed that perceived societal risk and perceived collective efficacy directly and jointly influenced respondents' intention to engage in collective actions against cancer, namely donating to cancer charities, volunteering at cancer-prevention organizations, and supporting public policies for cancer prevention. However, the interaction between perceived societal risk and perceived collective efficacy occurred in a direction opposite to the direction in the initial RPA framework. As suggested by the framework, we also categorized individuals into four attitudinal groups based on their perceptions of societal-level risk as well as efficacy and compared their demographic and psychological characteristics. Among the findings, the four groups significantly differed in their perceptions of individual-level risk as well as efficacy, in their family cancer history, and in their intentions to engage in individual-level behaviors to prevent cancer. Altogether, our findings contribute to the literature by extending the RPA framework to individuals' societal-level perceptions and by providing evidence that the framework can benefit the development of health communication campaigns to promote engagement in collective actions to support cancer prevention.

Eat, sleep, play: health behaviors and their association with psychological health among cancer survivors in a nationally representative sample

BACKGROUND

Cancer survivors are able to live much longer today than in the past due to advances in treatment. The promotion of health behaviors is important to address among cancer survivors. Not only can health behaviors reduce the risk of comorbidities, but they may also be key to improving psychological health among cancer survivors, such as psychological distress, perceptions of one's general health, and distress of cancer mortality (i.e., cancer fatalism). Our overall goal is to 1) determine which individual health behaviors (e.g., fruit consumption, physical activity, and sleep) are associated with psychological health among cancer survivors and 2) determine if the number of health behaviors engaged in is associated with better psychological health among cancer survivors.

METHODS

Using data from the HINTS 5 Cycle III survey (N = 856 cancer survivors), we compared whether participants who met guidelines for seven health behaviors (e.g., fruit and vegetable consumption, moderate physical activity, sleep duration) had improved psychological health. Multiple ordinal regression models controlling for sociodemographic variables were used to determine if meeting more recommendations was related to psychological health and then specifically which behaviors were of greatest importance to psychological health.

RESULTS

Meeting guidelines for sleep quality and moderate physical activity was associated with higher general health and meeting guidelines for vegetable intake and better sleep quality was associated with less psychological distress. Although the associations were not significant, cancer survivors who met more of the health behavior guidelines reported higher general health, lower psychological distress, and less distress about what could be done to lower one's chances to get cancer.

CONCLUSIONS

Meeting the guidelines for individual and multiple health behaviors is associated with favorable psychological health among cancer survivors. The findings can contribute to the development of health behavior interventions that focus on multiple health behaviors to improve psychological health and quality of life among cancer survivors.

The Determinants of Panic Buying during COVID-19

The COVID-19 pandemic has seen an unmatched level of panic buying globally, a type of herd behavior whereby consumers buy an uncommonly huge amount of products because of a perception of scarcity. Drawing on the health belief model, perceived scarcity, and anticipated regret theories, this paper formulated a theoretical model that linked the determinants of panic buying and analyzed their interrelationships. Subsequently, data were collated from 508 consumers through an online survey questionnaire in Singapore that was conducted during the early stage of the pandemic, before the onset of the circuit breaker in April 2020. Next, an analysis of the results was done through structural equation modeling. It showed that the effect of the health belief model dimensions (i.e., perceived susceptibility, perceived severity, outcome expectation, cues to action, and self-efficacy) on panic buying is partially mediated by the consumers' perceived scarcity of products. Furthermore, the effect of perceived scarcity on panic buying is partially mediated by consumers' anticipation of regret. This paper expands on the current theoretical understanding of panic buying behavior, giving insights into the possible measures and solutions that policymakers and relevant stakeholders can uptake to manage panic buying in future a pandemic or health crisis.

Media Exposure, Cancer Beliefs, and Cancer-Related Information-Seeking or Avoidance Behavior Patterns in China

This study explored the relationships between media exposure, cancer beliefs, and cancer information-seeking or information-avoidance behaviors. Based on the planned risk information-seeking model and its extended framework, two predictive models were constructed: one for cancer information seeking and the other for cancer information avoidance. A structural equation modeling strategy was applied to survey data from China HINTS 2017 (n = 3090) to compare the impact of traditional mass media and social media exposure to cancer-related information on cancer information-seeking and information-avoidance behaviors. The study findings suggest that health-related information exposure through different media channels may generate distinctive information-seeking or information-avoidance behaviors based on various cancer beliefs. Additionally, the findings indicate that social media exposure to health-related and cancer curability beliefs does not lead to cancer information avoidance; both mass media and social media exposure encourage people to seek cancer-related information. Cancer fatalism is positively associated with cancer information-seeking and avoiding intentions, suggesting that negative cancer beliefs predict seemingly contradictory yet psychologically coherent information intentions and behaviors.