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IntroductionStarting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment.MethodsMixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate.ResultsOf 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments.ConclusionDue to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.

Acculturation and enculturation are currently conceptualized as bilinear, multidimensional, and context-dependent cultural socialization processes (Yoon et al., 2013). Yet, this conceptualization requires further specification and empirical evidence. Our work is timely given the downward shift in productivity of traditional acculturation research and the need for a new direction. We examined the constructs and processes of acculturation and enculturation by meta-analytically synthesizing the findings of 255 publications (343 independent samples). In support of a bilinear (vs. unilinear) conceptualization, we found that acculturation and enculturation were only slightly associated with each other, r = −.18. In support of multidimensionality and context-dependency, their relationship varied by dimension (e.g., nonsignificant association of mainstream and ethnic identities vs. significant associations in other dimensions), geographic region, and race. Additionally, acculturation and enculturation rates/patterns varied by dimension; extrinsic changes (e.g., behavior) proceeded faster than intrinsic changes (e.g., values, identity). We discuss a direction for future research and implications for practice, advocacy, and education/training.

Purpose Mental health literacy (MHL) is key for mental health development, particularly in low-and-middle-income countries (LMIC) where mental health resources are limited. MHL development can be thought of as occurring at two levels: the individual person level (via direct contact, with specifically-targeted individuals), and the public health level (via indirect contact through public media, targeting the general public). Each approach has advantages and disadvantages. Methods The present mixed methods study assessed the status of and best approaches for development of mental health literacy in the Southeast Asian LMIC Vietnam. Because there has been relatively little discussion of MHL development at the public health level, this assessment focused on the public health level, although not exclusively. Because mental health professionals generally have the most in-depth understanding of their mental health system, study participants were 82 Vietnamese mental health professionals who completed a quantitative survey, with 48 participating in focus groups. Results Most of the professionals viewed MHL in Vietnam as low or very low, and that it was difficult or very difficult for the general public to find effective mental health services. Main barriers underlying these problems and more generally for developing MHL in Vietnam identified in the focus groups were: (a) misinformation in the media regarding mental health and mental illness; (b) lack of licensure for non-medical mental health professionals (e.g., psychologists; social workers); (c) lack of interest in mental health from upper-level leadership. Conclusions To the best of our knowledge, this is the first study assessing professionals’ perceptions regarding mental health literacy at both the public health and individual-person levels. Although sampling was restricted to Vietnamese professionals, results may provide initial preliminary guidance for other LMIC considering mental health literacy development at multiple levels.

Two cases of asymptomatic visceral larva migrans (VLM) involving the myocardium, discovered during open heart surgery, are reported. Only 7 cases of VLM myocarditis were found in recent English publications. All 7 cases involved children, with most of the patients acutely ill. Our 2 asymptomatic cases, coupled with the high rate of positive serologic tests in the general population, stress the widespread nature of Toxocara canis infection in human and the large number of subclinical, undetected cases.