Fatalistic Beliefs Research Articles

Relationship of fear and fatalism with breast cancer screening among women using health belief model

Despite the potential benefits of screening in discovering breast cancer, many women still do not follow recommended screening regimens. Fear of cancer detection and fatalistic beliefs were identified by previous studies as the main reasons given by women for noncompliance with breast cancer screening. The aim of this descriptive study is to explore relationship of fear and fatalism with breast cancer screening among a convenience sample of 136 women recruited during their visit to the Gynecology Clinic at the Maternity University Hospital in Alexandria, Egypt. The study tool consists of four parts: (1) Bio-sociodemographic information; (2) Champion Breast Cancer Fear Scale (CBCFS); (3) Powe Fatalism Inventory (PFI); (4) abridged version of the Champion Health Belief Model Scale (CHBMS). The findings revealed that only 3.7% and 14.7% of women practiced regular breast self-examination and had previously had mammography, respectively. Negative correlations were found between fatalism and health beliefs; and between fear and health belief. A positive correlation was found between fatalism and fear. The findings of this study add some experimental support for the relationships between fear, fatalism, and breast cancer screening behavior. Â

Face, fate and brand equity: service recovery justice and satisfaction

PurposeCan we always expect that service recovery justice leads to satisfaction? Literature has shown that a number of moderating factors impact the recovery justice-satisfaction link in different cultures. However, there is a dearth of research that has indicated the key cultural variables that play a moderating role. This study aims to attempt to fill the research gap by investigating the moderating role of concern for face, belief in fate and brand equity in the relationship between perceived justice and satisfaction in Chinese culture during service recovery.Design/methodology/approachThe hypothesized relationships are tested using data from interviews with 600 persons who have recently complained about their telecommunications services. Structural equation modeling is applied in analyzing their responses.FindingsConcern for face is found to strengthen the relationship between interactional justice perceptions and satisfaction, but to weaken the relationship between distributive justice perceptions and satisfaction. Belief in fate weakens the link between perceptions of interactional justice and satisfaction. Brand equity positively moderates the relationship between perceptions of interactional justice and satisfaction, but it negatively moderates the relationship between perceptions of distributive justice and satisfaction.Practical implicationsThe cultural variables, namely, face, fate and brand equity, are found to serve as a moderating role in the relationship between recovery justice dimensions and satisfaction. They are more salient when it is related to social element. Face and brand equity, as interpersonal constructs, aggravate the impact of interactional justice on satisfaction. Fate, as non-social factor, weakens the impact of interactional justice on satisfaction. It is argued that managers should provide staff training in product knowledge and customer service as a preventive measure against damage to the brand. Regular customer satisfaction research and benchmarking exercises should be conducted to understand how customers perceive interactional justice.Originality/valueThis has been the first research to examine the impact of concern for face, belief in fate and brand equity in the relationship between justice perceptions and post-recovery satisfaction during service recovery.

Oral self-care practices and treatment seeking behavior in patients with diabetes at a tertiary care government hospital in Delhi, India

Background and aimsto determine the oral health practices in patients with DM and to identify their perspectives on treatment-seeking for oral health. MethodsWe conducted a cross-sectional study in the diabetes clinic of a government hospital in Delhi, India. Data was collected through face-face interviews with the patients. ResultsWe enrolled a total of 339 participants having a mean (SD) age of 46.1 (5.4) years. An optimal glycemic control was present in 109 (32.2%) participants. Self-reported poor or very poor condition of teeth and gums was reported by 161 (47.5%) and 69 (20.35%) participants, respectively. The awareness that DM worsens oral health was correctly reported by 15.2% participants. The prevalence of twice-daily brushing was 18.6%, and 15.6% participants underwent a dental examination in the previous 12 months. ConclusionThere exists a high prevalence of poor oral care despite unsatisfactory oral health status among patients with DM in India. SummaryWe recruited 339 patients with DM in Delhi, India. Twice-daily brushing was practiced by 18.6% participants. Self-reported poor or very poor condition of teeth and gums was reported by 47.5% and 20.3% participants, respectively. Patients avoided dental visits when asymptomatic, if not referred and due to fatalistic health beliefs.

Development and validation of the Fatalistic Causal Attributions of Cancer Questionnaire: A three-phase study.

Tools have been developed to assess the existence and intensity of fatalistic beliefs. Causal attributions of cancer, referring to the foundation for fatalistic views of cancer as being predetermined or reflecting an unavoidable death, are lacking. The aim was to develop and validate the Fatalistic Causal Attributions of Cancer Questionnaire, a measurement tool for studying the causal attributions of cancer. Three-phase study. Phase I: Item extraction and development based on focus groups (N = 30) and assessment of content validity. Phase II: Assessment of quality of items and construct validity (exploratory factor analysis, confirmatory factor analysis, and convergent validity) of data from 252 participants (aged 50-75). Phase III: Confirmatory factor analysis and assessment of the discriminant validity and reliability of the questionnaire with 127 online respondents (aged 20-70). In Phase I, an initial questionnaire was constructed. In Phase II, four factors were identified: Belief in divine providence, belief in personal resilience as a protective factor, belief in chance or luck, and belief in inevitable environmental or genetic factors. The factorial structure of an 18-item version that emerged in the confirmatory factor analysis had good fit indexes and reliability measures. In Phase III, the 18-item questionnaire and its factorial structure and reliability were confirmed. The findings show acceptable psychometric properties for the questionnaire. We suggest that this questionnaire should be used with an existing questionnaire that assesses the intensity of fatalistic perceptions for a more comprehensive assessment of fatalism in research and in promoting adherence to screening.

Perceived Barriers to Early Detection of Breast Cancer in Iranian Women: A Qualitative Content Analysis

Background: Breast cancer is one of the most common cancers among Iranian women. The early diagnosis of this disease can decrease the mortality rate and promote patient survival. Objectives: This study aimed at identifying the barriers to early detection of breast cancer in Iranian women. Methods: In this qualitative study, which was extracted from a large research project, an exploratory sequential mixed-methods design was used, and conventional content analysis was carried out. Twenty-one participants were selected by purposeful sampling (ten health professionals and 11 female patients with breast cancer). Data were collected through in-depth, semi-structured interviews from July 2018 to June 2019. Results: The content analysis revealed three major themes related to delay in presentation: individual barriers (limited/lack of knowledge, other life preferences, negative reactions to the disease, and belief in fate), environmental barriers (insufficient social support, inaccurate information sources, and alternative therapy recommendations), and organizational barriers (poor quality of health services, inadequate access to health services, and role of media in informing people). Conclusions: Various perceived barriers, at different levels, play influential roles in the patients’ early detection. Therefore, collaboration between public health professionals, healthcare providers, and policymakers seems necessary for reducing delays in presentation among women.

Beliefs and Information Seeking in Patients With Cancer in Southwest China: Survey Study.

BackgroundAlthough previous studies have reported the cancer information-seeking behaviors among patients in high-income countries, the cancer information-seeking practices of patients living in low- and middle-income areas are less known.ObjectiveThis study investigated the beliefs and information-seeking patterns of cancer patients in southwest China.MethodsA questionnaire was designed, and data were collected in two hospitals (N=285) in southwest China. Statistical analyses included bivariate analyses and regressions.ResultsPatients’ attitudes towards cancer fatalism were significantly influenced by marital status (P<.001), education (P<.001), and household income (P<.001). Moreover, endorsing fatalistic belief was positively associated with age (r=0.35, P<.001). The regression model showed that younger patients (odds ratio [OR] 0.96, 95% CI 0.93-0.99) and those with higher education (OR 1.75, 95% CI 1.09-2.81) were more likely to seek information. Additionally, patients who were less confident in getting information were more likely to find information (OR 1.70, 95% CI 1.15-2.52), while fatalism belief was not significant in the regression (OR 0.65, 95% CI 0.22-1.95).ConclusionsThis study explored the information-seeking patterns of cancer patients in southwest China. It was found that many Chinese people endorsed cancer fatalism. These pessimistic beliefs about the potential to prevent and to cure cancer correlate with rather than cause cancer-related information seeking. However, self-efficacy about the confidence in finding needed cancer information was a significant predictor of information-seeking.

Fatalistic Cancer Beliefs Across Generations and Geographic Classifications: Examining the Role of Health Information Seeking Challenges and Confidence.

Information seeking is an active health behavior that influences cancer fatalism; however, people commonly experience challenges in accessing high-quality and actionable health information that is personally relevant. This is especially common among older and rural adults who have a high cancer risk. The purpose of this study was to examine the theoretical assumption that enhancing perceived confidence to overcome health information seeking challenges will alleviate cancer fatalism. In 2017, 895 adults from a large southeastern medical university's cancer catchment area participated in a random digit dial survey. Participants were Millennials (18-35; 19%), Generation X (36-51; 23%), Baby Boomers (52-70; 40%), and Silent Generation (71-95; 16.9%) who had equal representation across metro (78.9%) and nonmetro (21.1%) counties. Younger generations (Millennials and Generation X) held stronger fatalistic cancer beliefs ("It seems like everything causes cancer," "When I think about cancer, I automatically think about death") than older generations. Most participants believed that precautionary efforts exist to reduce their chances of getting cancer, which was strongest among individuals residing in metro counties. In controlling for generation and geographicresidence, individuals who experienced challenges in the process of accessing health information had stronger fatalistic beliefs about cancer prevention; however, this relationship was most pronounced among individuals with confidence to ultimately obtain information that they needed. This study contributes to evidence for health information equity in combatting fatalistic cancer beliefs. Findings have important implications for the optimized dissemination of culturally adapted cancer education and skill-based training to efficiently access and evaluate relevant cancer education.

“Escape from Freedom”: Authoritarianism-related traits, political ideology, personality, and belief in free will/determinism

Philosophers have long speculated that authoritarianism and belief in determinism are functionally related. To evaluate this hypothesis, we assessed whether authoritarianism and allied personality and political variables predict varieties of belief in determinism in three community samples (N1 = 566 to 20,010; N2 = 500; N3 = 419). Authoritarianism and allied variables manifested moderate to large positive correlations with both fatalistic and genetic determinism beliefs. Controlling for political conservatism did not meaningfully attenuate these relations. Further, openness was negatively related to fatalistic determinism beliefs and agreeableness was negatively related to genetic determinism beliefs. Taken together, our findings clarify the nature of relations between authoritarianism and general personality, on the one hand, and free will/determinism beliefs, on the other, and suggest intriguing intersections between worldviews and personality traits.

How do fatalistic beliefs affect the attitudes and pedestrian behaviours of road users in different countries? A cross-cultural study

This paper reports on an exploratory investigation of the influence of five different fatalistic belief constructs (divine control, luck, helplessness, internality, and general fatalism) on three classes of self-reported pedestrian behaviours (memory and attention errors, rule violations, and aggressive behaviours) and on respondents’ general attitudes to road safety, and how relationships between constructs differ across countries. A survey of over 3400 respondents across Bangladesh, China, Kenya, Thailand, the UK, and Vietnam revealed a similar pattern for most of the relationships assessed, in most countries; those who reported higher fatalistic beliefs or more external attributions of causality also reported performing riskier pedestrian behaviours and holding more dangerous attitudes to road safety. The strengths of relationships between constructs did, however, differ by country, behaviour type, and aspect of fatalism. One particularly notable country difference was that in Bangladesh and, to a lesser extent, in Kenya, a stronger belief in divine influence over one’s life was associated with safer attitudes and behaviours, whereas where significant relationships existed in the other countries the opposite was true. In some cases, the effect of fatalistic beliefs on self-reported behaviours was mediated through attitudes, in other cases the effect was direct. Results are discussed in terms of the need to consider the effect of locus of control and attributions of causality on attitudes and behaviours, and the need to understand the differences between countries therein.

Outcome Expectancies, Health Information Seeking, and Cancer Beliefs Associated with Multivitamin/Mineral Use in a National Sample, HINTS-FDA 2015

BackgroundDietary supplements, including multivitamins/minerals, are commonly reported by adults, yet little is known about multivitamin/mineral use in relation to information seeking, cancer-specific outcome expectancies, and cancer beliefs. ObjectiveTo examine the relationship of heath information seeking, beliefs about cancer, and outcome expectancies with multivitamin/mineral use within a national sample. DesignA secondary analysis of data collected by The Health Information National Trends Survey (HINTS) and the US Food and Drug Administration (FDA) (HINTS-FDA 2015) was conducted. HINTS-FDA 2015 evaluated information seeking, beliefs about cancer, and health behaviors and was a self-administered, two-stage mail survey sent to a random sample of US postal addresses stratified by county smoking rates. ParticipantsAdult household residents were invited to participate, resulting in a 33% response rate (n=3,738). Main outcome measuresParticipants self-reported use of multivitamin/mineral products. Statistical analysesAdjusting for covariates (demographics, single-ingredient and herbal supplement use) weighted stepwise binary logistic regression was used to examine correlates of self-reported multivitamin/mineral use. ResultsIntake was associated with less than a high school education, having health insurance, and single-ingredient and herbal supplement use. Trust in health organizations (odds ratio [OR]=1.67, P<0.001) and the expectancy that cancer could be avoided with dietary supplements (OR=1.76, P<0.001) correlated with use. Agreement that supplements labeled as “anticarcinogenic” could treat (OR=3.07, P<0.001) or prevent cancer (OR=6.06, P<0.001) correlated with multivitamin/mineral use. Fatalistic beliefs (P<0.001) and negative information-seeking experiences (P<0.001) were associated with slightly lower odds of use. ConclusionsDespite leading health organizations’ discouragement of dietary supplements for cancer prevention, this study found that trust in health organizations and outcome expectancies were associated with multivitamin/mineral use. This divergence presents a need to explore how dietary supplement evidence based recommendations can be translated and disseminated for the public.

The effect of Islamic culture’s constituents on decision-making

PurposeThis paper aims to enumerate the factors influencing the process of decision-making, those which are mostly related to personality affected by cultures and sub-cultures dominating the individual’s life, such as possessing internal and external control agents, tolerating or avoiding ambiguities and its comparison with a belief in fatalism or free will and the effect of these beliefs and traits on the personality.Design/methodology/approachThis paper demonstrates that these beliefs would result in the formation of different personal characteristics; for instance, active and passive individuals and those who are keen to discover problems to solve them and change the existing state of affairs to the desired ones. Some individuals can make decisions and some cannot.FindingsThe researcher has tried to make a comparative study and address the genuine Islamic culture as manifested in the Quran, Prophet’s Tradition and Shiite way of life. In this relation, the case studies are the Battle of Uhud and the Quranic verses related to the research to demonstrate that a Muslim manager, by dismissing fatalism while trusting in God’s blessing, could be distinguished from others.Originality/valueThis study adds to our knowledge that managers can make sound decisions by relying on their Shiite culture, self-confidence, rational thinking, consulting the wise people and above all trusting in God.

Cancer Fatalism and Cancer Information Seeking Among Black Women: Examining the Impact of Aretha Franklin's Death on Cancer Communication Outcomes.

Information seeking is often heightened following news coverage of cancer announcements from prominent celebrities or public figures. While scholars have sought to explicate the mechanisms influencing cancer information seeking following celebrity health announcements, the focus has primarily been on cognitive and emotional factors. Other influences such as sociocultural constructs have largely been ignored in this domain. Additionally, few studies have examined the health communication behaviors of minority individuals. The purpose of this study was to examine Black women's information seeking behaviors as a response to the death of the singer Aretha Franklin from pancreatic cancer and the role of fatalistic beliefs about cancer in the information seeking process. Using a survey conducted a few weeks after Franklin's death (N= 164), we found moderate amounts of pancreatic cancer information seeking, with almost 30% of women looking for information. Younger Black women were much more likely to search for information after Franklin's death than older women. Moreover, while we found fatalistic beliefs to be associated with pancreatic cancer information seeking, the findings were driven by younger women. In particular, younger women were more likely to seek pancreatic cancer information regardless of their beliefs about cancer. This study advances the understanding of cancer information seeking among Black women. Implications for cancer communication with Black women are discussed.

Abstract TP308: Fatalism or Realism? Racial Differences in the Beliefs of Stroke Survivors

Introduction: Fatalistic beliefs which contribute to worse health outcomes are believed to be more common in African Americans (AA). Hypothesis: AA stroke survivors exhibit more fatalistic beliefs about stroke and stroke recovery than White stroke survivors. Methods: A 20-item fatalism scale was administered to 63 AA and 22 white stroke survivors within 30 days of their stroke. The fatalism scale measured predetermination, luck and pessimism. Responses to the 20 questions included: strongly disagree, disagree, neutral, agree and strongly agree. Results: The mean age for the sample was 58 years and 58% were female and there were no racial differences in either age or sex. More Whites (77 vs 35%) reported being college educated than AAs (p=.006). There were no racial differences in the mean total fatalism score or the predetermination, luck and pessimism subtest scores. When the responses were examined in categorical fashion utilizing their combined responses of: strongly disagree/ disagree, neutral and agree/strongly agree racial differences were present on select questions. Predetermination: AAs were more likely to agree or strongly agree (52% vs 40%) that if someone is meant to get a serious disease they will (p=.04). In contrast, AAs were more likely to strongly disagree or disagree (43% vs 22%) that how long you live is predetermined (p=.03). Luck: AAs were more likely to strongly disagree or disagree (86% vs 77%) or to be neutral (0% vs 14%) that they will get diseases if they are unlucky (p=.011). Pessimism: AAs were more likely strongly disagree or disagree (77% vs 50%) and less likely to agree or strongly agree (16% vs 41%) that they often feel helpless dealing with the problems of life (p=.043). AAs were also more likely to strongly disagree or disagree (81% vs 64%) and were less likely to be neutral (2% vs 18%) that there is really no way they can solve the problems they have (p=.017). Conclusions: The general health literature suggests AAs exhibit more fatalistic beliefs. AAs in this stroke sample were less fatalistic on select questions and did not differ on others. Fatalism is a complex construct and questions designed to examine fatalism should be carefully examined particularly when race comparisons are being considered.

The Hierarchical Position and Length of Service as Determinants of Accidents Naive Explanations: A Study of a Romanian Enterprize

This article aimed at examining accidents' causal attributions by employees from a Romanian company according to their hierarchical position and their length of service. We particularly investigated how workers and their supervisors perceived risks and occupational accidents' causes. Participants were 114 employees, included 30 supervisors and 84 workers. They all belonged to the most exposed departments of the factory observed. The material used derived from the fatalism scale elaborated by Kouabenan (1998) and his risk perception and accidents' causal explanation scale (Kouabenan (1996). As far as possible we adapted this material to the Romanian context. The results showed that the employees had an accurate perception of the risks inherent in their work environment (pollution, occupational accidents, traffic accidents). There was no clear effect of the hierarchical position on causal attributions for the accidents. Both workers as well as their supervisors made more external attributions. However, workers held more fatalistic beliefs than supervisors. In the same way, the length of service didn't affect causal attributions for accidents, but affect the adherence to fatalistic beliefs. Less experienced employees believe more in fate than more experienced employees. All in all, the results of this study tend to confirm those of previous work (Kouabenan, 1996; Beauvois &amp; Dubois, 1988; Yeray &amp; Oskelys, 2001). Implications and possible preventive measures derived from these results were discussed.

Examining the roles of multidimensional fatalism on traffic safety attitudes and pedestrian behaviour

This paper examines the roles of fatalistic beliefs on attitudes towards traffic safety and pedestrian behaviour using the data from a questionnaire survey with a sample of 835 road users in Vietnam. A multidimensional fatalism scale was used to measure distinct facets of fatalistic beliefs. The data showed that fatalism could be represented by four factors including divine control (a belief in divine influence over one’s life), luck, internality (or locus of control), and general fatalism. Results from a structural equation model indicated that several of these fatalistic belief facets, namely internality, divine control, and luck significantly associated with traffic safety attitudes above demographic variables. In addition, internality was found to be significantly related to pedestrian behaviour after controlling for demographic variables and attitudes towards traffic safety. The findings are discussed with respect to practical implications for traffic safety interventions.

The role of explanatory models of breast cancer in breast cancer prevention behaviors among Arab-Israeli physicians and laywomen.

'Explanatory Models' (EMs) are frameworks through which individuals and groups understand diseases, are influenced by cultural and religious perceptions of health and illness, and influence both physicians and patients' behaviors. To examine the role of EMs of illness (cancer-related perceptions) in physicians' and laywomen's behaviors (decision to recommend undergoing regular mammography, adhering to mammography) in the context of a traditional-religious society, that is, the Arab society in Israel. Two combined samples were drawn: a representative sample of 146 Arab physicians who serve the Arab population and a sample composed of 290 Arab women, aged 50-70 years, representative of the main Arab groups residing in the north and center of Israel (Muslims, Christians) were each randomly sampled (cluster sampling). All respondents completed a closed-ended questionnaire. Women held more cultural cancer-related beliefs and fatalistic beliefs than physicians. Physicians attributed more access barriers to screening as well as fear of radiation to women patients and lower social barriers to screening, compared with the women's community sample. Higher fatalistic beliefs among women hindered the probability of adherence to mammography; physicians with higher fatalistic beliefs were less likely to recommend mammography. The role of cultural perceptions needs to be particularly emphasized. In addition to understanding the patients' perceptions of illness, physicians must also reflect on the social, cultural, and psychological factors that shape their decision to recommend undergoing regular mammography.

Effects of an oral health program: Community-based education among mothers of young children living in socioeconomically disadvantaged neighborhoods.

INTRODUCTION:An oral health program for mothers starting from pregnancy in a disadvantaged district of İzmir was performed in 2013–2016. Dental behaviors and their determinants among intervention and control groups were compared in the third phase of the program.METHODS:This nonrandomized-controlled study was conducted in Phase 3. The intervention group began with 248 pregnant women; 69.4% (n = 172) of mothers with 6–9-month-old babies participated in Phase 2, 2014. At Phase 3 (18–24 months), 68.6% (n = 118) of mothers in the intervention group and 113 mothers living in another district as controls were included. Sociodemographic characteristics, determinants of behaviors, and outcomes defined as dental behaviors in the last week were assessed using a questionnaire.RESULTS:Regarding knowledge, perceived severity, and fatalistic beliefs, the intervention group had higher correct answer percentages. The percentage of mothers who could clean their children's teeth before sleep was higher in the intervention group (76.3%; P < 0.05), but the difference was lost by a child's resistance. The significant difference on avoiding bedtime nursing (65.3%) and sugary snacks (74.4%) in the intervention group disappeared with the obstacle of a child's protests or interference from relatives. In the intervention group, 32.2% of the mothers reported that they did not give any sugary snacks, 43.2% had never fed during sleep, and 26.3% cleaned their children's teeth during the last week. The results in the control group were 24.8%, 18.6%, and 8.8%, respectively (P < 0.05).CONCLUSIONS:The program improved the mothers' views regarding the determinants of dental behaviors, but greater support against obstacles was needed. Social environmental support is planned for the following stages of the program.

Patient Privacy Perspectives on Health Information Exchange in a Mental Health Context: Qualitative Study.

BackgroundThe privacy of patients with mental health conditions is prominent in health information exchange (HIE) discussions, given that their potentially sensitive personal health information (PHI) may be electronically shared for various health care purposes. Currently, the patient privacy perspective in the mental health context is not well understood because of the paucity of in-depth patient privacy research; however, the evidence suggests that patient privacy perspectives are more nuanced than what has been assumed in the academic and health care community.ObjectiveThis study aimed to generate an understanding on how patients with mental health conditions feel about privacy in the context of HIE in Canada. This study also sought to identify the factors underpinning their privacy perspectives and explored how their perspectives influenced their attitudes toward HIE.MethodsSemistructured interviews were conducted with patients at a Canadian academic hospital for addictions and mental health. Guided by the Antecedent-Privacy Concern-Outcome macro-model, interview transcripts underwent deductive and inductive thematic analyses.ResultsWe interviewed 14 participants. Their privacy concerns varied, depending on the participant’s privacy experiences and health care perceptions. Media reports of privacy breaches and hackers had little impact on participants’ privacy concerns because of a fatalistic belief that privacy breaches are a reality in the digital age. Rather, direct observations and experiences with the mistreatment of PHI in health care settings caused concern. Decisions to trust others with PHI depended on past experiences with the individual (or institution) and health care needs. Participants had little knowledge of patient privacy rights and legislation but were willing to participate in HIE because of perceived individual and societal benefits.ConclusionsThis study introduces evidence that patients with mental health conditions would support HIE. Participants were pragmatic, supporting HIE because they wanted the best care possible. They also understood that their PHI was critical in supporting the single-payer Canadian health care system. Participant health care experiences informed their privacy perspectives, trust, and PHI sharing attitudes—all accentuating the importance of the patient experience in building trust in HIE. Their lack of knowledge about patient rights and PHI uses highlights the degree of trust they have in the health care system to protect their privacy. These findings suggest that the patient privacy discourse should extend beyond the oft-cited barrier of patient privacy concerns to include discussions about building trust, communicating the benefits of HIE, and improving patient experiences. Although our findings are in the Canadian context, this study highlights the importance of engaging patients in privacy policy discussions, regardless of jurisdiction, to ensure their nuanced perspectives are reflected in policy decisions on their PHI.

Ethnic differences in barriers to symptomatic presentation in primary care: A survey of women in England.

The majority of cancers are diagnosed following a decision to access medical help for symptoms. People from ethnic minority backgrounds have longer patient intervals following identification of cancer symptoms. This study quantified ethnic differences in barriers to symptomatic presentation including culturally specific barriers. Correlates of barriers (eg, migration status, health literacy, and fatalism) were also explored. A cross-sectional survey of 720 White British, Caribbean, African, Indian, Pakistani, and Bangladeshi women aged 30 to 60 (n = 120/group) was carried out in England. Barrier items were taken from the widely used cancer awareness measure; additional culturally specific barriers to symptomatic presentation were included following qualitative work (11 barriers in total). Migration status, health literacy, and fatalism were included as correlates to help-seeking barriers. Ethnic minority women reported a higher number of barriers (P < .001, 2.6-3.8 more than White British women). Emotional barriers were particularly prominent. Women from ethnic minority groups were more likely to report "praying about a symptom" (P < .001, except Bangladeshi women) and "using traditional remedies" (P < .001, except Caribbean women). Among ethnic minority women, adult migration to the United Kingdom, low health literacy, and high fatalistic beliefs increased likelihood of reporting barriers to symptomatic presentation. For example, women who migrated as adults were more likely to be embarrassed (OR = 1.83; CI, 1.06-3.15), worry what the GP might find (OR = 1.91; CI, 1.12-3.26), and be low on body vigilance (OR = 4.44; CI, 2.72-7.23). Campaigns addressing barriers to symptomatic presentation among ethnic minority women should be designed to reach low health literacy populations and include messages challenging fatalistic views. These would be valuable for reducing ethnic inequalities in cancer outcomes.

Factors Associated with Mammogram Use in Korean American Immigrant Women.

Objectives: In this study, we assessed breast cancer screening in Korean American immigrant women and identified factors associated with adherence to American Cancer Society mammography screening guidelines. Methods: We carried out a cross-sectional survey with 182 Korean American immigrant women in Los Angeles County, California. Andersen's Behavioral Model of Health Services Use guided this study's design and analysis. We used hierarchical logistic regression to identify predisposing, enabling, and need factors associated with mammography adherence. Results: Nearly all respondents (95.1%) had a mammogram at some point in their lifetime. Mammography adherence based on age was 22.2% (45-49 years), 29.0% (50-54 years), and 67.7% (55 years and older). The strongest correlates of mammogram adherence were having a regular primary care check-up and hearing about a mammogram experience from family members, friends, or neighbors. Awareness of free or low-cost mammogram service, family cancer history, and having fatalistic beliefs also were associated with mammogram adherence. Conclusions: The findings highlight the primacy of health education messages that emphasize the importance of regular check-ups and personal screening experiences to promote mammography use in this population. Additional research is needed to understand Korean American immigrant women's perspectives on breast cancer and breast cancer screening in relation to fatalism.