![Page 1: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/1.jpg)
Fighting breast cancer - Qatar research program: From secondary
to primary preventionProfessor Tam Truong Donnelly
Saumur, FranceOct 9-12, 2013
![Page 2: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/2.jpg)
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.
![Page 3: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/3.jpg)
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
![Page 4: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/4.jpg)
Research Key Investigators
Sheikha Al-Anoud bint Mohammad Al-Thani
Kathleen BenjaminKim Critchley
Mohamed AhmednaTak Shing Fung
Ailsa Welch Kevin Teather
![Page 5: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/5.jpg)
![Page 6: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/6.jpg)
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)
![Page 7: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/7.jpg)
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
![Page 8: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/8.jpg)
Most frequent cancers for women in Qatar in 2008 (IARC, WHO 2008)
![Page 9: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/9.jpg)
IARC International Agency for Research Cancer, WHO. World cancer report 2008 and Global cancer statistics. [http://globocan.iarc.fr/factsheet.asp]
![Page 10: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/10.jpg)
Age-adjusted incidence and mortality rates of Breast Cancer among selected countries
Data from GLOBOCAN 2008 (IARC).
![Page 11: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/11.jpg)
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.
![Page 12: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/12.jpg)
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
![Page 13: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/13.jpg)
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
![Page 14: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/14.jpg)
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.
![Page 15: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/15.jpg)
Study 1
• Cross-sectional Community -Based Survey of Breast Cancer Screening Practices Amongst Arabic Women Living in the State of Qatar
![Page 16: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/16.jpg)
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?
![Page 17: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/17.jpg)
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 41North of Qatar (K) 3,394 36 18
Total 72,240 759 374
Methodology Study 1• Sites: Doha, Al Wakrah (S), Al Khor (N)
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
![Page 18: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/18.jpg)
Results of the survey
![Page 19: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/19.jpg)
![Page 20: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/20.jpg)
BCS Awareness BCS Awareness is significantly related is significantly related to the following factorsto 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.
![Page 21: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/21.jpg)
BCS Practice BCS Practice is significantly is significantly related to the following related to the following socio-economic factorssocio-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
![Page 22: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/22.jpg)
BCS Practice BCS Practice is significantly related to is significantly related to the following beliefsthe 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.
![Page 23: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/23.jpg)
BCS Practice BCS Practice is significantly related to is significantly related to the following social or HCP factorsthe 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.
![Page 24: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/24.jpg)
Study 2 – Methods
![Page 25: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/25.jpg)
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.
![Page 26: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/26.jpg)
Study 2 Results
![Page 27: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/27.jpg)
Overall Study 2 Results
• BCS practice is influenced by the following basic factors by general themes: – Cultural– Religious– Social– Educational, and – Economical factors.
![Page 28: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/28.jpg)
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.
![Page 29: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/29.jpg)
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.
![Page 30: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/30.jpg)
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)
![Page 31: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/31.jpg)
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
![Page 32: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/32.jpg)
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.
![Page 33: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/33.jpg)
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.
![Page 34: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/34.jpg)
Fostering Active Living and Healthy Eating Through Understanding of the Physical Activity and Dietary Behaviours of Arabic-Speaking
Adults Living in Qatar
![Page 35: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/35.jpg)
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.
![Page 36: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/36.jpg)
Objectives1. 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.
![Page 37: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/37.jpg)
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
![Page 38: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/38.jpg)
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
![Page 39: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/39.jpg)
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.
![Page 40: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/40.jpg)
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
![Page 41: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/41.jpg)
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
![Page 42: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/42.jpg)
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
![Page 43: Fighting breast cancer - Qatar research program: From secondary to primary prevention Professor Tam Truong Donnelly Saumur, France Oct 9-12, 2013](https://reader036.vdocument.in/reader036/viewer/2022062421/56649d025503460f949d573b/html5/thumbnails/43.jpg)
Thank you