Transcript 20131009-IBCN presen..

Fighting breast cancer - Qatar
research program: From secondary
to primary prevention
Professor Tam Truong Donnelly
Saumur, France
Oct 9-12, 2013
Acknowledgement
Funded by the Qatar National Research Fund,
National Priorities Research Program, in
Collaboration with the University of CalgaryQatar, Hamad Medical Corporation, Qatar
Primary Health Care, Qatar Supreme Council
of Health, Qatar University, University of East
Anglia.
Research Key Investigators
Tam Truong Donnelly
Al-Hareth Al-Khater
Mohamed Ghaith Al-Kuwari
Nabila Al-Meer
Salha Bujassoum Al-Bader
Mariam A Malik
Rajvir Singh
Research Key Investigators
Sheikha Al-Anoud bint Mohammad AlThani
Kathleen Benjamin
Kim Critchley
Mohamed Ahmedna
Tak Shing Fung
Ailsa Welch
Kevin Teather
Background
Qatar Statistics Authority, 2010
• Population: 1,696,563
• Qatari citizens represent 24.4% of the population
• Qatari female citizens represent 36.7% of the female
population
• GDP per capita: More than $88,000 for 2010
(http://www.forbes.com)
Background
• Breast cancer is the most common cancer in Qatar for women
• 20% cancer cases receiving treatment in 2007 at Al Amal
Hospital in Doha (Now Qatar Centre for Cancer Care and
Research), were breast cancer
Most frequent cancers for women in Qatar in 2008 (IARC, WHO 2008)
IARC International Agency for Research Cancer, WHO. World cancer
report 2008 and Global cancer statistics.
[http://globocan.iarc.fr/factsheet.asp]
17.6
Ageadjusted
incidence
and
mortality
rates of
Breast
Cancer
among
selected
countries
Data from
GLOBOCAN
2008 (IARC).
France
99.7
Israel
18.3
U.K.
18.6
96.8
89.1
Canada
15.6
U.S.
14.7
Ageadjusted
mortality
rate (per
100,000)
83.2
76
26.1
Lebanon
55.4
12.9
Qatar
38.1
Ageadjusted
incidence
rate (per
100,000)
10.9
U.A.E.
36.7
12.4
Turkey
28.3
10.4
Saudi
22.4
8.9
Iran
18.4
0
20
40
60
80
100
120
Background
• Arabic women are often diagnosed at advanced stages of
breast cancer
• Qatar National Cancer Society and Hamad Medical
Corporation recommend BSE for all women, yearly CBE for
women 35 +, and mammography every two years for women
40-69 unless otherwise advise by physicians.
• Among Qatari women, 24% do BSE, 23% have had CBE, and
23% have had a mammography (Bener et al., 2009).
• Low rate of screening suggest that Arab women in Qatar are
at risk for lack of early detection and treatment of breast
cancer in its early stages.
Research Goal
• To develop, implement, and sustain an intervention
program that will raise awareness of breast cancer
and increase women’s participation in breast cancer
screening activities and therefore reducing breast
cancer’s morbidity and mortality for Arab women
living in the State of Qatar
Ecological Conceptual Framework
• Individuals and their physical and socio-cultural
environment of individuals
• Health care behaviour and the physical
environmental variables, intrapersonal, and other
social determinants of health
• Health promotion and interventions should occur at
multiple social, cultural, and environmental levels
Kleinman’s Explanatory Model
• Individuals’ explanatory models are derived from
their knowledge and values, which are informed by
their specific socio-cultural backgrounds
• Providing effective health care requires that
providers be able to elicit and recognize clients’
beliefs and values with respect to their
understandings of illnesses and treatments, and to
negotiate these differing perspectives.
Study 1
• Cross-sectional Community -Based Survey of
Breast Cancer Screening Practices Amongst
Arabic Women Living in the State of Qatar
Study 1: Research Questions
1. What is the participation rate of Arabic women on
breast self examination, clinical breast examination,
and mammogram?
2. To what extent are Arabic women’s cultural
knowledge and values, knowledge of breast cancer
and its screening, socioeconomic status, and social
support networks, associated with their breast
cancer screening behaviours?
Methodology Study 1
• Sites: Doha, Al Wakrah (S), Al Khor (N)
Doha
Population of
women 35 years
and over
60,937
South of Qatar (W)
North of Qatar (K)
Total
7,909
3,394
72,240
Sample Size using Sample Size using
a margin of error a margin of error
of 3.5%
of 5%
640
315
83
36
759
41
18
374
Study sample size calculation based on Cochran’s formula for sample size
• Sample: convenience 1063 (87.5% response rate) Arabic
women aged 35+ various healthcare settings, live in Qatar for
at least 10 years
• Data collection: structured survey-face to face
• Data analysis: SPSS version 19
Results of the survey
BCS Awareness & Practice (n=1063)
100
90
80
70
41.8
60
50
40
31.3
28.9
26.4
26.9
13.9
30
20
10
0
BSE
CBE
Awareness
Mammogram
Practice (Mammogram, 40+ years old)
BCS Awareness is significantly related
to the following factors
•
•
•
•
•
•
Age (40-49 years old)
Marital Status (married)
Living area (mammogram - urban)
Education Levels – participants & husbands
Employment status (mammogram – employed)
Having an understandable doctor who talked about
breast cancer with participant
• Receiving BCS information from any source:
family/friend, doctor, media or other HCP.
BCS Practice is significantly
related to the following
socio-economic factors
• Being 40-49 years old, and married with 1-5
children
• Higher education levels (participant &
husband)
• Higher income levels
• Having BSE, CBE or mammogram awareness
BCS Practice is significantly related to
the following beliefs
• Having self-perceived Good – Excellent health
• Believing cancer can be prevented and may be
caused by heredity.
• Believing cancer is not due to God’s
punishment, bad luck or being contagious.
• Significant predictors of CBE or Mammogram
non-compliance : fear, embarrassment.
BCS Practice is significantly related to
the following social or HCP factors
•
•
•
•
Having a doctor who talked to her about breast cancer
Understanding her doctor
Trusting her doctor (CBE)
Not having a gender preference for her HCP when it
comes to clinical breast examinations (BSE, CBE).
• Having received BCS information from any of a variety
of sources: Doctor, Family/Friend, Media, or other HCP.
Study 2 – Methods
Study 2
• Aims/Research Questions:
– How do Arab women participate in BCS programs?
– How do contextual factors, such as social, cultural,
historical, and economic influence Arab women’s BCS
practices?
– What would be culturally and socially appropriate and
effective intervention strategies for increasing Arab
women’s participation in BCS activities?
• Data was collected from qualitative interviews
conducted from October 2011 to May 2012 with a
sample of 29 HCP, 56 women and 50 men living in
Qatar.
Study 2
Results
Overall Study 2 Results
• BCS practice is influenced by the following
basic factors by general themes:
– Cultural
– Religious
– Social
– Educational, and
– Economical factors.
Specific BCS Barriers Mentioned
• Fear of cancer, cancer stigma, lack of concern for
one’s health, embarrassment or shyness,
• Overall lack of awareness of BCS among men and
women, lack of encouragement or permission to
get BCS from husbands/family,
• High workload for doctors and lack of time with
patients, lack of doctor recommendations, lack of
delegation of BCS-related services to nurses,
• Transportation and language issues, and a public
health care system that is opportunistic with
cancer screenings.
Specific BCS Facilitators mentioned
• Fear of cancer, high concern for one’s health, socially
active and influential women,
• Religious beliefs that promote health and treatment,
• Higher education levels (especially for younger
generation of men and women), increasing awareness
and willingness to learn more about cancer and BCS,
media-savvy population,
• Free/affordable health care in Qatar, and expanding
health care services/facilities.
• Value health and individual responsibility to keep
oneself healthy; men are quite supportive of women
BCS activities.
Recommendations Given
• Establish population-based BCS programs
• Expand health care services and the role of HCPs:
– Increase doctor-patient time by reducing HCP
workload
– Increase mammogram facilities in public and
private facilities
– Mental health facilities and counseling services
must be made available for cancer patients (these
services must comply with religious and social
context of Qatar)
Recommendations (cont’d)
• Raise awareness of BCS with men and women
– HCPs -Doctors must discuss BCS with and give
recommendations to patients; must discuss the benefits
of early detection with every adult female and male
patient
– To help reduce fear of cancer :
• Emphasize gender-appropriate HCPs and facilities are
available
• Religious messages must be utilized for public
health/early detection awareness campaign, along
with cooperation with religious/community leaders
– Media campaign must address benefits of BCS and early
detection
Recommendations (cont’d)
• Health centers must have readily available
brochures, posters, workshops, lectures,
videos to display/distribute
– More health lectures on cancer, especially for males
– Pamphlets are useful for those who are too shy to
bring up BCS
– Videos on cancer prevention and early detection
should be played in health centers/hospitals for
patients to watch during wait time.
Recommendations (cont’d)
• Other
– Schools/universities should raise awareness of
health promotion, cancer and screening among
younger generations
– Utilize media and SMS messages to send
reminders and cover importance of BCS and early
detection.
– Mobile clinics and mammograms clinic at the
malls can reach more people.
Fostering Active Living and Healthy
Eating Through Understanding of
the Physical Activity and Dietary
Behaviours of Arabic-Speaking
Adults Living in Qatar
Background
• Association between breast cancer and physical inactivity and
high fat diet.
• In 2006, in the State of Qatar, nearly 50% of young adults 18
to 19 years of age had insufficient levels of physical activity;
75% of people 60-69 years of age had inadequate levels of
physical activity.
• 2006 World Health Survey : 24% of the people surveyed in
Qatar were of normal weight, 39% were overweight, and
nearly 29% were obese. Factors contributing to obesity in the
Middle East and United Arab Emirates (UAE) included
unhealthy diets that is high in carbohydrates and fats, and
physical inactivity.
Objectives
1. To determine the physical activity levels and food habits of
Arabic-speaking adults, 18 years of age and older, in Qatar;
2. To assess the attitudinal, normative, and control beliefs of
Arabic-speaking adults in Qatar regarding physical activity and
healthy diet;
3. To determine significant predictors of Arabic-speaking adults’
intentions to engage in physical activity and healthy eating;
4. To gain an in-depth understanding of factors (e.g.,
environmental, social, cultural, policy) that influence the
physical activities and eating behaviours of Arabic-speaking
adults in Qatar ;
5. To identify tailored health promoting strategies to increase
active living and healthy diets for Arabic-speaking adults in
Qatar.
Phase1: cross sectional survey,
quantitative research design
Goals
• Determine participants’ Physical Activity (PA)
levels and food habits
• Assess participants attitudinal, normative and
control beliefs regarding PA and healthy diet
• Determine predictors of participants’
intentions to engage in PA and healthy eating
Tasks Completed Year 1
Recruitment and Data Collection
• Recruit 42 participants for the elicitation
study- (6 focus groups)
• Recruit 24 people for pilot testing
• Finalize survey items
• Recruit 1565 participants for the main survey
• Data collection/analyses ongoing
• Begin writing articles on the quantitative
results
Phase 2-Qualitative
Goals
• Gain in depth understanding of the
influencing factors related to PA and healthy
diet
• Identify health promoting strategies to foster
active living and healthy diets.
Tasks Completed Year 2
Recruitment and Data Collection
• Recruit 42 participants for pilot testing-(6 focus
groups)
• Finalize focus group questions and protocols
• Pilot testing
• Recruit 168 participants for 24 focus groups
• Data collection /analyses ongoing
• Recruit 24 participants (2 focus groups for member
checking)
• Complete data analyses
• Begin writing articles on the qualitative results
Tasks Completed Year Three –
Dissemination
• Presentation of the findings at local, regional,
international conferences and/or workshops
• Submission of articles to international and
national peer-reviewed journals
• Preparation of final progress report
Anticipated Outcomes
Knowledge Development and Awareness
Raising -Year Three
• Identification of participants’ salient beliefs about PA and
healthy diet
• Identification of significant predictors of participants’
intentions to engage in PA and healthy diet
• Development of recommendations for health policy, health
care delivery, and future research
• Development of an Arabic survey to assess people’s
attitudinal, normative, and control beliefs regarding their
intentions to engage in PA and healthy eating.
• Raise international awareness of the research activities
related to active living and healthy diet in Qatar
Thank you