Voices of fear and safety : women’s ambivalence towards breast cancer and breast health practices in Jordan

Abstract: Background: Although early detection is associated with better prognosis, still, breast malignancies are detected at late stages in Jordan. This thesis aimed to explore women’s and men’s perceptions about breast cancer and breast health in Jordan and to assess the effectiveness of breast health promotion interventions in improving women’s breast health knowledge and practices. Methods: The data for this thesis was collected from six governorates in Jordan and is organized into four studies (I - IV). In study I, pre - and post - tests data was collected for 2554 women who at tended 105 breast health educational lectures. In study IV, 2400 breast health awareness home visits were conducted in a less privileged area in Amman and 2363 women answered a pre - test. After a home - based educational session, 625 women were referred to free mammography screening. Six months later follow - up home vi sits were conducted to 596 homes and 593 women answered a post - test. In studies I and IV, breast health knowledge and practices were assessed using multivariable analysis . Purposive sampling was used in study II to recruit 64 women for ten focus group disc ussions and 28 men in study III for semi - structured interviews . The transcribed data in studies II and III was subjected to latent content analysis . Main Findings: In studies I and IV, low proportion of women reported practicing breast health examination s in the pre - test despite the noticeable level of breast health knowledge at the baseline. In both studies , the mean knowledge scores increased significantly in the post - tests (p<0.001). O ut of the 625 women who rece ived free mammography vouchers, 73% use d them. The post - test showed also a significant improvement (p<0.001) in women’s reported perceived knowledge and practice of breast - self - examination. In study II, three themes were constructed: a) Ambivalence in prioritizing own health; b) Feeling fear of breast cancer; and c) Feeling safe from breast cancer. The first theme was seen in prioritizing children and family and in experiencing family and social support. The second theme was building on perceiving breast cancer as an incurable disease associated with suffering and death, fear of the risk of diminished femininity, husband’s rejection, social stigmatization and apprehensions about breast health examinations. The third theme was seen on their perceiving themselves as not being in the risk zone for b reast cancer, accepting breast cancer as a test from God and comfort in acquiring breast health knowledge and skills. In study III, three themes were identified: a) Supporting one’s wife; b) Marital needs and obligations c) Constrained by a culture of dest iny and shame. The first theme was built on men’s responsibility for the family’s wellbeing, encouraging the wife to seek health care and providing counselling and instrumental support. The second theme was constructed from men’s views about other men’s re jection of a wife inflicted by breast cancer, their own perceptions of diminished femininity and their concerns about protecting the family from the hereditary risk of breast cancer. The third theme was seen in perception of breast cancer as an inevitable act of God that is far away from own family, in associating it with improper behaviour and in readiness to face the culture of Eib (shame). Conclusions: Women’s ambivalence towards breast health and their feelings of fear and safety could be addressed by emphasizing the good prognosis of breast cancer when detected early, engaging breast cancer survivors in breast health campaigns, involving husbands to capitalize on family support, conducting culturally appropriate educational lectures and home visits by local community workers and offering free mammography vouchers to women in less privileged areas.