I Do Not Even Say "It" - a Mixed Methods Study on Breast Cancer Awareness of Omani Women

Abstract

Background: The incidence of breast cancer is rising in Oman, and the disease is diagnosed at late stages, when treatment success is limited. Omani women might benefit from better awareness, so that breast cancer can be detected early and treated. This study was conducted to assess Omani women's levels of breast cancer awareness and early detection practice, and explore factors which might influence these levels. Materials and Methods: A mixed methods study was conducted in 2014, including a quantitative survey of 1,372 and a qualitative assessment of 19 Omani women, aged ≥20 years from five Omani governorates using convenient sampling. Demographic information and scores for awareness levels were used in a multivariate regression model to investigate factors associated with awareness. Thematic analysis and interpretive description were used to analyse the qualitative data. Results: The overall means for early detection and general awareness scores were 0.58 (SD 0.24) and 0.46 (SD 0.21), respectively. General awareness was significantly associated with age, education, income and familiarity with cancer patients (p<0.05), while early detection was significantly associated with age, marital status and education. A majority of women (59.5%) agreed with a belief in 'evil eye' or envy as a risk factor for breast cancer. Women discussed various factors which may empower or inhibit awareness, including the cultural-religion-fatalistic system, personal-familial-environmental system, and healthcare-political-social system. Conclusions: The overall low scores for awareness and early detection, and the survey of local beliefs highlight a severe necessity for a contextually-tailored breast cancer awareness intervention programme in Oman.

Development and Validation of a Culturally-Tailored Breast Cancer Health Education Programme for Arab Women

“…3,5 In terms of awareness, Omani women show similar characteristics in comparison to those from other Arab countries, such as Qatar, Saudi Arabia and Jordan. [6][7][8][9][10] A previous qualitative study has highlighted various factors that influence breast cancer awareness among Omani women and the desire among this population for enhanced breast cancer information systems and programmes. 6 Various studies have recognised the need for breast cancer health education programmes.…”

“…[6][7][8][9][10] A previous qualitative study has highlighted various factors that influence breast cancer awareness among Omani women and the desire among this population for enhanced breast cancer information systems and programmes. 6 Various studies have recognised the need for breast cancer health education programmes. [11][12][13][14][15] However, it is necessary to address barriers to breast cancer awareness and early detection in the context of the local population's presiding social and cultural beliefs.…”

“…12,[23][24][25][26] The Enabling Systems Raising Awareness (ESRA) model is based on the following four premises: (1) that individuals can actively regulate their own behaviours; (2) that they interact with the environment on multiple biopsychosocial levels, eventually shaping and being shaped by the environment over time; (3) that health practitioners greatly affect individuals by exerting influence on them; and (4) that self-initiated reconstruction or empowerment of person-environment interactive patterns is essential to change behaviours. 6,27 Additionally, the ESRA model emphasises specific systems which either enable or inhibit Arab women in terms of health awareness. According to modifiability, these include personal (e.g.…”

“…familial or environmental factors) and healthcare-related systems [ Table 1]. 6 Furthermore, the model highlights the complete influence of external enabling systems on each other, known as the "pouring-in" process, while the influence of Omani women across systems to initiate interventions to increase awareness is an "out-pouring" process (i.e. an empowering internal enabling system).…”

“…As such, each Arab woman is considered an instrument or enabler for other women in the advocacy for breast cancer awareness [ Figure 1]. 6 This framework therefore suggests a sustainable method of improving breast cancer awareness in Arab countries, in that public health programmes can use existing enabling systems to improve awareness levels among groups of women, after which empowered women can then spread their knowledge to other women, resulting in a multiplier effect.…”