Early Breast Cancer Detection in Multicultural Societies

1
Early Breast Cancer Detection in Multicultural
Societies

• Immigrant/minority women as HC users
• Structural and cultural barriers to PrevHC
• HBM gap between cognitions and practices
• Fatalism, fear of cancer, mistrust of therapy
• BC as a threat to the gender role/worth
• Older women as a special target group
• Possible policies and solutions

2
Minority Women Barriers to Preventive HC

• Financial limited or lacking health insurance
• Organizational distance, no car, office hours
• Cultural language, attitudes towards health
  illness, providers gender
• Psychosocial low health motivation
  over-burdened personal agenda caring for family
  members, not self
• Emphasis on curative not preventive services

3
Examples from Israel Bi-annual Mammo Prevalence,
age 50-74

• Mainstream Jewish women 50-60
• Russian Jewish Immigrants 40
• Ethiopian Jewish Immigrants 20
• Israeli Palestinian (Arab) Women 20
• No group data on BSE or clinical exams

4
Health Belief Model Cognitions, Attitudes, and
Practices

• Ideas not leading to action Women are informed
  about BC risks, admit personal susceptibility,
  but Not seek early detection
• Attitudes expressed in surveys do not reflect
  innermost feelings about cancer, esp. in minority
  groups (in-depth interviews do better)
• Broader cognitions-practice gap among
  immigrant/minority women due to low health
  motivation higher barriers to mainstream HC

5
Underlying Reasons for Non-Action in BC Screening

• Denial This cannot happen to me
• Fatalism towards cancer as enigmatic and menacing
  disease (reflects external locus of control and
  low self-efficacy)
• Doubts about benefits of early detection
• (Dont trouble the trouble before the trouble
  troubles you)
• Mistrust of possible cure, perceived futility
  of harsh cancer treatments, fear of becoming a
  burden on family members

6
BC and Womans Worth in Traditional Patriarchal
Societies

• Any chronic disabling condition is perceived as
  endpoint of my life as a woman a sick
  homemaker is devalued and eventually discarded
• Women give care to men and children, not receive
  care from them role reversal is hard to take
• I dont want to bring this trouble on myself
• Id rather not know and not tell others
  until the
• very end

7
Targeting Older Minority Women (age 60)

• Relational Self In non-western cultures, older
  women view themselves as secondary and
  subservient to the needs of children
  grandchildren, i.e. with especially low
  preventive motivation and high fatalism/low
  self-worth
• Isolation from the mainstream, high cultural
  barriers to HC services, poor personal resources
• Discomfort about visiting womens health clinics
  or gynecologists perceived as catering mainly for
  younger fertile and sexually active women
• Media image of BC as younger womens problem

8
Some Approaches to Policy

• Empower minority women, enhance their sense of
  self-worth and self-care
• Educate men in ethnic communities so that they
  encourage women to get screened
• Design specially tailored educational programs to
  dispel common myths and misperceptions of BC
  among minorities and marginal social groups
• Cultural sensitivity/competence training for the
  mainstream service providers
• Introduce more minority health professionals to
  target their co-ethnics