A qualitative study to critically explore the socio-ecological determinants influencing screening mammography uptake amongst Kerala migrant women
in the United Arab Emirates

R David, L

Abstract

Background

Significant evidence demonstrates that undergoing screening mammography, is effective in detecting breast cancer early enabling better treatment and longer survival. Breast cancer is the most common type of cancer among females in Kerala (India) and is diagnosed at advanced stages of the disease. Keralite women residing in Kerala are less likely to undergo screening and more likely to be diagnosed with breast cancer in its advanced stages. Social, cultural, and ecological factors can influence whether a woman will undergo breast cancer screening. The factors influencing the uptake of screening mammography amongst Kerala migrant women is not yet known. The principle migration destination of Keralites is the United Arab Emirates (UAE).

Aim
This is the first study aimed to critically explore and identify the socio-ecological determinants for the informed uptake of screening mammography amongst Keralite women residing in the UAE.

Objectives
- identify the attitudes of Keralite women residing in the UAE towards breast cancer screening using screening mammography;
- identify and categorise the influencing factors for the uptake of screening mammography as voiced by the target population;
- devise strategies for increasing the informed uptake of screening mammography for Keralite women in the UAE based on the participants recommendations.

Methods
The study adopted a qualitative research approach using five focus group discussions. This enabled exploration of the collective experiences and views of participants who had undergone a screening mammogram and those who had not undergone screening mammography in the UAE or Kerala. The socio-ecological model of health promotion that includes five levels such as individual, interpersonal, community, organisational and policy was utilised as a theoretical framework to collate and organise the findings, discuss and put forward the recommendations.

Findings
The individual level socio-ecological factors were identified as self-efficacy, attitudes, beliefs, and knowledge. The interpersonal level influencers were family, peers, and friends. The community level factors were cultural beliefs, media, medical professionals, community organisations and breast cancer survivors. Further, the organisational factors were health care facilities, health insurance, specialised breast cancer screening services, and academic institutions. Finally, the policy level factors were found to be Kerala and UAE government, psychological support team, automatic invitation system and International health collaboration. Participants appreciated the initiatives by the UAE towards the health of all residents, while they highlighted the requirement of the Kerala government’s initiative on the health and screening mammography of Kerala migrants in the UAE. The socio-ecological factors identified by the participants were multifactorial, reciprocal and are interconnected.

These findings indicate that a comprehensive approach is required to change health behaviour in order to increase the informed uptake of screening mammography by Keralite women residing in the UAE. Careful plans should be implemented in each level of socio-ecological influencers to alter attitudes, initiate, reinforce changes towards breast cancer early detection. The findings of this study further provide a foundation for practical plans to improve the screening behaviour among Keralite women residing in the UAE.
Recommendation
The interplay between various socio-ecological factors is evident in this study. Therefore, the contemporary trend in health behavioural change involves more than simply addressing and educating individuals’ healthy practices. It includes efforts to change the external factors that are beyond the control of a single individual or a community. Community organisations and governments should initiate and develop comprehensive approaches to promote the informed uptake of screening mammography by Keralite women residing in the UAE. The study also put forward the responsibilities of the Kerala government and the importance of developing initiatives towards the health of Kerala migrants in the UAE.

Keywords
Breast cancer, Kerala, Keralite, Screening mammography, Socio-ecological model, United Arab Emirates

Citation

in the United Arab Emirates. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Oct 7, 2020
• Publicly Available Date: Oct 7, 2020
• Award Date: Sep 30, 2020