Early Breast Cancer Detection in Multicultural Societies

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Minority Women: Barriers to Preventive HC. Financial: limited or lacking health insuranceOrganizational: distance, no car, office hoursCultural: language, attitudes towards health

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Early Breast Cancer Detection in Multicultural Societies

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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, provider’s 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 (“Don’t 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 “Woman’s 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 don’t want to bring this trouble on myself”; “I’d 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 women’s health clinics or gynecologists perceived as catering mainly for younger fertile and sexually active women Media image of BC as younger women’s 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

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