Skip to main content
Top
Published in: BMC Women's Health 1/2012

Open Access 01-12-2012 | Research article

“Voices of Fear and Safety” Women’s ambivalence towards breast cancer and breast health: a qualitative study from Jordan

Authors: Hana Taha, Raeda Al-Qutob, Lennarth Nyström, Rolf Wahlström, Vanja Berggren

Published in: BMC Women's Health | Issue 1/2012

Login to get access

Abstract

Background

Breast cancer is the leading cause of cancer mortality among Jordanian women. Breast malignancies are detected at late stages as a result of deferred breast health-seeking behaviour. The aim of this study was to explore Jordanian women’s views and perceptions about breast cancer and breast health.

Methods

We performed an explorative qualitative study with purposive sampling. Ten focus groups were conducted consisting of 64 women (aged 20 to 65 years) with no previous history and no symptoms of breast cancer from four governorates in Jordan. The transcribed data was analysed using latent content analysis.

Results

Three themes were constructed from the group discussions: 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 women’s prioritizing children and family needs and in their experiencing family and social support towards seeking breast health care. The second theme was building on women’s perception of breast cancer as an incurable disease associated with suffering and death, their fear of the risk of diminished femininity, husband’s rejection and social stigmatization, adding to their apprehensions about breast health examinations. The third theme emerged from the women’s perceiving themselves as not being in the risk zone for breast cancer and in their accepting breast cancer as a test from God. In contrast, women also experienced comfort in acquiring breast health knowledge that soothed their fears and motivated them to seek early detection examinations.

Conclusions

Women’s ambivalence in prioritizing their own health and feelings of fear and safety could be better addressed by designing breast health interventions that emphasize the good prognosis for breast cancer when detected early, involve breast cancer survivors in breast health awareness campaigns and catalyse family support to encourage women to seek breast health care.
Appendix
Available only for authorised users
Literature
1.
go back to reference Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin. 2011, 61 (2): 69-90. 10.3322/caac.20107.CrossRefPubMed Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin. 2011, 61 (2): 69-90. 10.3322/caac.20107.CrossRefPubMed
5.
go back to reference Alhurishi S, Lim JN, Potrata B, West R: Factors influencing late presentation for breast cancer in the middle East: a systematic review. Asian Pac J Cancer Prev. 2011, 12 (6): 1597-1600.PubMed Alhurishi S, Lim JN, Potrata B, West R: Factors influencing late presentation for breast cancer in the middle East: a systematic review. Asian Pac J Cancer Prev. 2011, 12 (6): 1597-1600.PubMed
9.
go back to reference Jordan Department of Statistics: Estimated Population by Governorate and Sex and Pop. Density. 2009, Jordan in figures, Amman Jordan Department of Statistics: Estimated Population by Governorate and Sex and Pop. Density. 2009, Jordan in figures, Amman
11.
go back to reference Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, Chen FL, Porter P, Hu YW, Zhao GL, Pan LD, Li W, Wu C, Coriaty Z, Evans I, Lin MG, Stalsberg H, Self SG: Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst. 2002, 94 (19): 1445-1457. 10.1093/jnci/94.19.1445.CrossRefPubMed Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, Chen FL, Porter P, Hu YW, Zhao GL, Pan LD, Li W, Wu C, Coriaty Z, Evans I, Lin MG, Stalsberg H, Self SG: Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst. 2002, 94 (19): 1445-1457. 10.1093/jnci/94.19.1445.CrossRefPubMed
12.
go back to reference McCready T, Littlewood D, Jenkinson J: Breast self-examination and breast awareness: a literature review. J Clin Nurs. 2005, 14 (5): 570-578. 10.1111/j.1365-2702.2004.01108.x.CrossRefPubMed McCready T, Littlewood D, Jenkinson J: Breast self-examination and breast awareness: a literature review. J Clin Nurs. 2005, 14 (5): 570-578. 10.1111/j.1365-2702.2004.01108.x.CrossRefPubMed
13.
go back to reference Fancher TT, Palesty JA, Paszkowiak JJ, Kiran RP, Malkan AD, Dudrick SJ: Can breast self-examination continue to be touted justifiably as an optional practice?. Int J Surg Oncol. 2011, 2011: 965464-5 pagesPubMedPubMedCentral Fancher TT, Palesty JA, Paszkowiak JJ, Kiran RP, Malkan AD, Dudrick SJ: Can breast self-examination continue to be touted justifiably as an optional practice?. Int J Surg Oncol. 2011, 2011: 965464-5 pagesPubMedPubMedCentral
14.
go back to reference Lam WW, Chan CP, Chan CF, Mak CC, Chan CF, Chong KW, Leung MH, Tang MH: Factors affecting the palpability of breast lesion by self-examination. Singapore Med J. 2008, 49 (3): 228-232.PubMed Lam WW, Chan CP, Chan CF, Mak CC, Chan CF, Chong KW, Leung MH, Tang MH: Factors affecting the palpability of breast lesion by self-examination. Singapore Med J. 2008, 49 (3): 228-232.PubMed
15.
go back to reference Mant D, Vessey MP, Neil A, McPherson K, Jones L: Breast self examination and breast cancer stage at diagnosis. Br J Cancer. 1987, 55 (2): 207-211. 10.1038/bjc.1987.39.CrossRefPubMedPubMedCentral Mant D, Vessey MP, Neil A, McPherson K, Jones L: Breast self examination and breast cancer stage at diagnosis. Br J Cancer. 1987, 55 (2): 207-211. 10.1038/bjc.1987.39.CrossRefPubMedPubMedCentral
17.
go back to reference Smith RA, Caleffi M, Albert US, Chen TH, Duffy SW, Franceschi D, Nystrom L: Breast cancer in limited-resource countries: early detection and access to care. Breast J. 2006, 12 (Suppl 1): S16-26.CrossRefPubMed Smith RA, Caleffi M, Albert US, Chen TH, Duffy SW, Franceschi D, Nystrom L: Breast cancer in limited-resource countries: early detection and access to care. Breast J. 2006, 12 (Suppl 1): S16-26.CrossRefPubMed
18.
go back to reference Anderson BO, Tsu VD: Breast cancer in low and middle income countries: How can guidelines best be disseminated and implemented?. Breast Care. 2008, 3 (1): 6-8. 10.1159/000116365.CrossRefPubMedPubMedCentral Anderson BO, Tsu VD: Breast cancer in low and middle income countries: How can guidelines best be disseminated and implemented?. Breast Care. 2008, 3 (1): 6-8. 10.1159/000116365.CrossRefPubMedPubMedCentral
19.
go back to reference Miller AB, Baines CJ: The role of clinical breast examination and breast self-examination. Prev Med. 2011, 53 (3): 118-120. 10.1016/j.ypmed.2011.05.001.CrossRefPubMed Miller AB, Baines CJ: The role of clinical breast examination and breast self-examination. Prev Med. 2011, 53 (3): 118-120. 10.1016/j.ypmed.2011.05.001.CrossRefPubMed
21.
go back to reference Berg BL: Qualitative research methods for the social sciences. 2007, Allyn and Bacon, Boston, MA, 6 Berg BL: Qualitative research methods for the social sciences. 2007, Allyn and Bacon, Boston, MA, 6
22.
go back to reference Merriam SB, and Associates: Qualitative research in practice: Examples for discussion and analysis. 2002, Jossey-Bass Publishers, San Francisco Merriam SB, and Associates: Qualitative research in practice: Examples for discussion and analysis. 2002, Jossey-Bass Publishers, San Francisco
23.
go back to reference Patton MQ: Qualitative research and evaluation methods. 2002, Sage Publications, Newbury Park, CA, 3 Patton MQ: Qualitative research and evaluation methods. 2002, Sage Publications, Newbury Park, CA, 3
24.
go back to reference Crabtree BF, Miller WL: Doing qualitative research. 1992, Sage Publications, Newbury Park, CA Crabtree BF, Miller WL: Doing qualitative research. 1992, Sage Publications, Newbury Park, CA
25.
go back to reference Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004, 24 (2): 105-112. 10.1016/j.nedt.2003.10.001.CrossRefPubMed Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004, 24 (2): 105-112. 10.1016/j.nedt.2003.10.001.CrossRefPubMed
26.
go back to reference Creswell JW, Miller DL: Determining validity in qualitative inquiry. Theor Pract. 2000, 39 (3): 124-130. 10.1207/s15430421tip3903_2.CrossRef Creswell JW, Miller DL: Determining validity in qualitative inquiry. Theor Pract. 2000, 39 (3): 124-130. 10.1207/s15430421tip3903_2.CrossRef
27.
go back to reference Trigoni M, Griffiths F, Tsiftsis D, Koumantakis E, Green E, Lionis C: Mammography screening: Views from women and primary care physicians in Crete. BMC Womens Health. 2008, 8: 20-10.1186/1472-6874-8-20.CrossRefPubMedPubMedCentral Trigoni M, Griffiths F, Tsiftsis D, Koumantakis E, Green E, Lionis C: Mammography screening: Views from women and primary care physicians in Crete. BMC Womens Health. 2008, 8: 20-10.1186/1472-6874-8-20.CrossRefPubMedPubMedCentral
28.
go back to reference Lamyian M, Hydarnia A, Ahmadi F, Faghihzadeh S, Aguilar-Vafaie ME: Barriers to and factors facilitating breast cancer screening among Iranian women: a qualitative study. East Mediterr Health J. 2007, 13 (5): 1160-1169.PubMed Lamyian M, Hydarnia A, Ahmadi F, Faghihzadeh S, Aguilar-Vafaie ME: Barriers to and factors facilitating breast cancer screening among Iranian women: a qualitative study. East Mediterr Health J. 2007, 13 (5): 1160-1169.PubMed
29.
go back to reference Wagle A, Komorita NI, Lu ZJ: Social support and breast self-examination. Cancer Nurs. 1997, 20 (1): 42-48. 10.1097/00002820-199702000-00006.CrossRefPubMed Wagle A, Komorita NI, Lu ZJ: Social support and breast self-examination. Cancer Nurs. 1997, 20 (1): 42-48. 10.1097/00002820-199702000-00006.CrossRefPubMed
30.
go back to reference Flores ET, Mata AG: Latino male attitudes and behaviors on their spouses and partners cancer screening behavior focus group findings. J Natl Cancer Inst Monogr. 1995, 18: 87-93.PubMed Flores ET, Mata AG: Latino male attitudes and behaviors on their spouses and partners cancer screening behavior focus group findings. J Natl Cancer Inst Monogr. 1995, 18: 87-93.PubMed
31.
go back to reference Chamot E, Perneger TV: Men’s and women’s knowledge and perceptions of breast cancer and mammography screening. Prev Med. 2002, 34 (3): 380-385. 10.1006/pmed.2001.0999.CrossRefPubMed Chamot E, Perneger TV: Men’s and women’s knowledge and perceptions of breast cancer and mammography screening. Prev Med. 2002, 34 (3): 380-385. 10.1006/pmed.2001.0999.CrossRefPubMed
32.
go back to reference Remennick L: The challenge of early breast cancer detection among immigrant and minority women in multicultural societies. Breast J. 2006, 12 (Suppl 1): S103-110.CrossRefPubMed Remennick L: The challenge of early breast cancer detection among immigrant and minority women in multicultural societies. Breast J. 2006, 12 (Suppl 1): S103-110.CrossRefPubMed
33.
go back to reference Baron-Epel O, Granot M, Badarna S, Avrami S: Perceptions of breast cancer among Arab Israeli women. Women Health. 2004, 40 (2): 101-116. 10.1300/J013v40n02_07.CrossRefPubMed Baron-Epel O, Granot M, Badarna S, Avrami S: Perceptions of breast cancer among Arab Israeli women. Women Health. 2004, 40 (2): 101-116. 10.1300/J013v40n02_07.CrossRefPubMed
34.
go back to reference Bener A, Alwash R, Miller CJ, Denic S, Dunn EV: Knowledge, attitudes, and practices related to breast cancer screening: a survey of Arabic women. J Cancer Educ. 2001, 16 (4): 215-220.PubMed Bener A, Alwash R, Miller CJ, Denic S, Dunn EV: Knowledge, attitudes, and practices related to breast cancer screening: a survey of Arabic women. J Cancer Educ. 2001, 16 (4): 215-220.PubMed
35.
go back to reference Bener A, Honein G, Carter AO, Da'ar Z, Miller C, Dunn EV: The determinants of breast cancer screening behavior: a focus group study of women in the United Arab Emirates. Oncol Nurs Forum. 2002, 29 (9): E91-98. 10.1188/02.ONF.E91-E98.CrossRefPubMed Bener A, Honein G, Carter AO, Da'ar Z, Miller C, Dunn EV: The determinants of breast cancer screening behavior: a focus group study of women in the United Arab Emirates. Oncol Nurs Forum. 2002, 29 (9): E91-98. 10.1188/02.ONF.E91-E98.CrossRefPubMed
36.
go back to reference Petro-Nustas W: Young Jordanian women's health beliefs about mammography. J Community Health Nurs. 2001, 18 (3): 177-194.CrossRefPubMed Petro-Nustas W: Young Jordanian women's health beliefs about mammography. J Community Health Nurs. 2001, 18 (3): 177-194.CrossRefPubMed
37.
go back to reference Taha H, Halabi Y, Berggren V, Jaouni S, Nystrom L, Al-Qutob R, Wahlstrom R: Educational intervention to improve breast health knowledge among women in Jordan. Asian Pac J Cancer Prev. 2010, 11 (5): 1167-1173.PubMed Taha H, Halabi Y, Berggren V, Jaouni S, Nystrom L, Al-Qutob R, Wahlstrom R: Educational intervention to improve breast health knowledge among women in Jordan. Asian Pac J Cancer Prev. 2010, 11 (5): 1167-1173.PubMed
38.
go back to reference Ahmad F, Stewart DE, Cameron JI, Hyman I: Rural physicians’ perspectives on cervical and breast cancer screening: a gender-based analysis. J Womens Health Gend Based Med. 2001, 10: 201-208. 10.1089/152460901300039584.CrossRefPubMed Ahmad F, Stewart DE, Cameron JI, Hyman I: Rural physicians’ perspectives on cervical and breast cancer screening: a gender-based analysis. J Womens Health Gend Based Med. 2001, 10: 201-208. 10.1089/152460901300039584.CrossRefPubMed
39.
go back to reference Lurie N, Slater J, McGovern P, Ekstrum J, Quam L, Margolis K: Preventive care for women. Does the sex of the physician matter?. N Engl J Med. 1993, 329: 478-482. 10.1056/NEJM199308123290707.CrossRefPubMed Lurie N, Slater J, McGovern P, Ekstrum J, Quam L, Margolis K: Preventive care for women. Does the sex of the physician matter?. N Engl J Med. 1993, 329: 478-482. 10.1056/NEJM199308123290707.CrossRefPubMed
40.
go back to reference Leslie NS, Deiriggi P, Gross S: Knowledge, attitudes, and practices surrounding breast cancer screening in educated Appalachian women. Oncol Nurs Forum. 2003, 30 (4): 659-667. 10.1188/03.ONF.659-667.CrossRefPubMed Leslie NS, Deiriggi P, Gross S: Knowledge, attitudes, and practices surrounding breast cancer screening in educated Appalachian women. Oncol Nurs Forum. 2003, 30 (4): 659-667. 10.1188/03.ONF.659-667.CrossRefPubMed
41.
go back to reference Rosenstock I: The Health Belief Model: Explaining health behaviour through expectancies. Health behaviour and health education: Theory, research, and practice. Edited by: Glanz K, Lewis FM, Rimer BK. 1990, Jossey-Bass, San Francisco, CA, 39-62. Rosenstock I: The Health Belief Model: Explaining health behaviour through expectancies. Health behaviour and health education: Theory, research, and practice. Edited by: Glanz K, Lewis FM, Rimer BK. 1990, Jossey-Bass, San Francisco, CA, 39-62.
42.
go back to reference Juon HS, Kim M, Shankar S, Han W: Predictors of adherence to screening mammography among Korean American women. Prev Med. 2004, 39 (3): 474-481. 10.1016/j.ypmed.2004.05.006.CrossRefPubMed Juon HS, Kim M, Shankar S, Han W: Predictors of adherence to screening mammography among Korean American women. Prev Med. 2004, 39 (3): 474-481. 10.1016/j.ypmed.2004.05.006.CrossRefPubMed
43.
go back to reference Secginli S, Nahcivan NO: Factors associated with breast cancer screening behaviours in a sample of Turkish women: a questionnaire survey. Int J Nurs Stud. 2006, 43 (2): 161-171. 10.1016/j.ijnurstu.2005.02.004.CrossRefPubMed Secginli S, Nahcivan NO: Factors associated with breast cancer screening behaviours in a sample of Turkish women: a questionnaire survey. Int J Nurs Stud. 2006, 43 (2): 161-171. 10.1016/j.ijnurstu.2005.02.004.CrossRefPubMed
44.
go back to reference Petro-Nustas WI: Factors associated with mammography utilization among Jordanian women. J Transcultural Nurs. 2001, 12 (4): 284-291. 10.1177/104365960101200403.CrossRef Petro-Nustas WI: Factors associated with mammography utilization among Jordanian women. J Transcultural Nurs. 2001, 12 (4): 284-291. 10.1177/104365960101200403.CrossRef
45.
go back to reference Petro-Nustus W, Mikhail BI: Factors associated with breast self-examination among Jordanian women. Public Health Nurs. 2002, 19 (4): 263-271. 10.1046/j.1525-1446.2002.19406.x.CrossRefPubMed Petro-Nustus W, Mikhail BI: Factors associated with breast self-examination among Jordanian women. Public Health Nurs. 2002, 19 (4): 263-271. 10.1046/j.1525-1446.2002.19406.x.CrossRefPubMed
46.
go back to reference Azaiza F, Cohen M: Health beliefs and rates of breast cancer screening among Arab women. J Womens Health. 2006, 15 (5): 520-530. 10.1089/jwh.2006.15.520.CrossRef Azaiza F, Cohen M: Health beliefs and rates of breast cancer screening among Arab women. J Womens Health. 2006, 15 (5): 520-530. 10.1089/jwh.2006.15.520.CrossRef
47.
go back to reference Azaiza F, Cohen M: Between traditional and modern perceptions of breast and cervical cancer screenings: A qualitative study of Arab women in Israel. Psychooncology. 2008, 17: 34-41. 10.1002/pon.1180.CrossRefPubMed Azaiza F, Cohen M: Between traditional and modern perceptions of breast and cervical cancer screenings: A qualitative study of Arab women in Israel. Psychooncology. 2008, 17: 34-41. 10.1002/pon.1180.CrossRefPubMed
48.
go back to reference Baron-Epel O: Attitudes and beliefs associated with mammography in a multiethnic population in Israel. Health Educ Behav. 2010, 37 (2): 227-242. 10.1177/1090198109339460.CrossRefPubMed Baron-Epel O: Attitudes and beliefs associated with mammography in a multiethnic population in Israel. Health Educ Behav. 2010, 37 (2): 227-242. 10.1177/1090198109339460.CrossRefPubMed
49.
go back to reference Bigby J: Global understanding of barriers to breast cancer screening. J Womens Health. 2006, 15 (5): 484-10.1089/jwh.2006.15.484.CrossRef Bigby J: Global understanding of barriers to breast cancer screening. J Womens Health. 2006, 15 (5): 484-10.1089/jwh.2006.15.484.CrossRef
50.
go back to reference Shirazi M, Champeau D, Talebi A: Predictors of breast cancer screening among immigrant Iranian women in California. J Womens Health. 2006, 15 (2): 485-506.CrossRef Shirazi M, Champeau D, Talebi A: Predictors of breast cancer screening among immigrant Iranian women in California. J Womens Health. 2006, 15 (2): 485-506.CrossRef
51.
go back to reference Soskolne V, Marie S, Manor O: Beliefs, recommendations and intentions are important explanatory factors of mammography screening behavior among Muslim Arab women in Israel. Health Educ Res. 2006, 22 (5): 665-676. 10.1093/her/cyl132.CrossRefPubMed Soskolne V, Marie S, Manor O: Beliefs, recommendations and intentions are important explanatory factors of mammography screening behavior among Muslim Arab women in Israel. Health Educ Res. 2006, 22 (5): 665-676. 10.1093/her/cyl132.CrossRefPubMed
52.
go back to reference Donnelly T, Al-Khater A, Al-Kuwari M, Al-Meer N, Bujassoum Al-Bader S, Malik M, Singh R, Christie F: Study exploring breast cancer screening practices amongst Arabic women living in the State of Qatar. 2011, , Avicenna, http://www.qscience.com/toc/avi/2011, 1. Donnelly T, Al-Khater A, Al-Kuwari M, Al-Meer N, Bujassoum Al-Bader S, Malik M, Singh R, Christie F: Study exploring breast cancer screening practices amongst Arabic women living in the State of Qatar. 2011, , Avicenna, http://​www.​qscience.​com/​toc/​avi/​2011, 1.
Metadata
Title
“Voices of Fear and Safety” Women’s ambivalence towards breast cancer and breast health: a qualitative study from Jordan
Authors
Hana Taha
Raeda Al-Qutob
Lennarth Nyström
Rolf Wahlström
Vanja Berggren
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2012
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/1472-6874-12-21

Other articles of this Issue 1/2012

BMC Women's Health 1/2012 Go to the issue