Fighting breast cancer - Qatar research program: From secondary to primary prevention

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Fighting breast cancer - Qatar research program
From secondary to primary prevention

• Professor Tam Truong Donnelly
• Saumur, France
• Oct 9-12, 2013

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Acknowledgement

• Funded by the Qatar National Research Fund,
  National Priorities Research Program, in
  Collaboration with the University of
  Calgary-Qatar, Hamad Medical Corporation, Qatar
  Primary Health Care, Qatar Supreme Council of
  Health, Qatar University, University of East
  Anglia.

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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

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Research Key Investigators

• Sheikha Al-Anoud bint Mohammad Al-Thani
• Kathleen Benjamin
• Kim Critchley
• Mohamed Ahmedna
• Tak Shing Fung
• Ailsa Welch
• Kevin Teather

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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)

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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

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Most frequent cancers for women in Qatar in 2008
(IARC, WHO 2008)
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IARC International Agency for Research Cancer,
WHO. World cancer report 2008 and Global cancer
statistics. http//globocan.iarc.fr/factsheet.asp

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• Age-adjusted incidence and mortality rates of
  Breast Cancer among selected countries
• Data from GLOBOCAN 2008 (IARC).

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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.

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Research Goal

• To develop, implement, and sustain an
  intervention program that will raise awareness of
  breast cancer and increase womens participation
  in breast cancer screening activities and
  therefore reducing breast cancers morbidity and
  mortality for Arab women living in the State of
  Qatar

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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

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Kleinmans 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.

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Study 1

• Cross-sectional Community -Based Survey of Breast
  Cancer Screening Practices Amongst Arabic Women
  Living in the State of Qatar

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Study 1 Research Questions

• What is the participation rate of Arabic women on
  breast self examination, clinical breast
  examination, and mammogram?
• 2. To what extent are Arabic womens cultural
  knowledge and values, knowledge of breast cancer
  and its screening, socioeconomic status, and
  social support networks, associated with their
  breast cancer screening behaviours?

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Methodology Study 1

• Sites Doha, Al Wakrah (S), Al Khor (N)
• Study sample size calculation based
  on Cochrans 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

Population of women 35 years and over Sample Size using a margin of error of 3.5 Sample Size using a margin of error of 5
Doha 60,937 640 315
South of Qatar (W) 7,909 83 41
North of Qatar (K) 3,394 36 18
Total 72,240 759 374
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Results of the survey
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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.

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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

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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 Gods punishment,
  bad luck or being contagious.
• Significant predictors of CBE or Mammogram
  non-compliance fear, embarrassment.

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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.

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Study 2 Methods
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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
  womens BCS practices?
• What would be culturally and socially appropriate
  and effective intervention strategies for
  increasing Arab womens 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.

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• Study 2 Results

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Overall Study 2 Results

• BCS practice is influenced by the following basic
  factors by general themes
• Cultural
• Religious
• Social
• Educational, and
• Economical factors.

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Specific BCS Barriers Mentioned

• Fear of cancer, cancer stigma, lack of concern
  for ones 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.

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Specific BCS Facilitators mentioned

• Fear of cancer, high concern for ones 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.

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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)

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Recommendations (contd)

• 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

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Recommendations (contd)

• 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.

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Recommendations (contd)

• 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.

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Fostering Active Living and Healthy Eating
Through Understanding of the Physical Activity
and Dietary Behaviours of Arabic-Speaking Adults
Living in Qatar
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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.

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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.

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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

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Tasks Completed Year 1Recruitment 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

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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.

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Tasks Completed Year 2Recruitment 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

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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

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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
  peoples 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

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• Thank you