ObjectiveTo explore barriers to early presentation and diagnosis with breast cancer among black women.DesignSystematic review.MethodsWe searched multiple bibliographic databases (January 1991–February 2013) for primary research, published in English, conducted in developed countries and investigating barriers to early presentation and diagnosis with symptomatic breast cancer among black women (≥18 years). Studies were excluded if they did not report separate findings by ethnic group or gender, only reported differences in time to presentation/diagnosis, or reported on interventions and barriers to cancer screening. We followed Cochrane and PRISMA guidance to identify relevant research. Findings were integrated through thematic synthesis. Designs of quantitative studies made meta-analysis impossible.ResultsWe identified 18 studies (6183 participants). Delay was multifactorial, individual and complex. Factors contributing to delay included: poor symptom and risk factor knowledge; fear of detecting breast abnormality; fear of cancer treatments; fear of partner abandonment; embarrassment disclosing symptoms to healthcare professionals; taboo and stigmatism. Presentation appears quicker following disclosure. Influence of fatalism and religiosity on delay is unclear from evidence in these studies. We compared older studies (≥10 years) with newer ones (<10 years) to determine changes over time. In older studies, delaying factors included: inaccessibility of healthcare services; competing priorities and concerns about partner abandonment. Partner abandonment was studied in older studies but not in newer ones. Comparisons of healthy women and cancer populations revealed differences between how people perceive they would behave, and actually behave, on finding breast abnormality.ConclusionsStrategies to improve early presentation and diagnosis with breast cancer among black women need to address symptom recognition and interpretation of risk, as well as fears of the consequences of cancer. The review is limited by the paucity of studies conducted outside the USA and limited detail reported by published studies preventing comparison between ethnic groups.

ObjectivesUnderstanding barriers to early diagnosis of symptomatic breast cancer among Black African, Black Caribbean and White British women in the UK.DesignIn-depth qualitative interviews using grounded theory methods to identify themes. Findings validated through focus groups.Participants94 women aged 33–91 years; 20 Black African, 20 Black Caribbean and 20 White British women diagnosed with symptomatic breast cancer were interviewed. Fourteen Black African and 20 Black Caribbean women with (n=19) and without (n=15) breast cancer participated in six focus groups.SettingEight cancer centres/hospital trusts in London (n=5), Somerset (n=1), West Midlands (n=1) and Greater Manchester (n=1) during 2012–2013.ResultsThere are important differences and similarities in barriers to early diagnosis of breast cancer between Black African, Black Caribbean and White British women in the UK. Differences were influenced by country of birth, time spent in UK and age. First generation Black African women experienced most barriers and longest delays. Second generation Black Caribbean and White British women were similar and experienced fewest barriers. Absence of pain was a barrier for Black African and Black Caribbean women. Older White British women (≥70 years) and first generation Black African and Black Caribbean women shared conservative attitudes and taboos about breast awareness. All women viewed themselves at low risk of the disease, and voiced uncertainty over breast awareness and appraising non-lump symptoms. Focus group findings validated and expanded themes identified in interviews.ConclusionsFindings challenged reporting of Black women homogenously in breast cancer research. This can mask distinctions within and between ethnic groups. Current media and health promotion messages need reframing to promote early presentation with breast symptoms. Working with communities and developing culturally appropriate materials may lessen taboos and stigma, raise awareness, increase discussion of breast cancer and promote prompt help-seeking for breast symptoms among women with low cancer awareness.

STUDY QUESTIONWhat is the relationship between children's thoughts and feelings about their donor and their security of attachment to their solo mothers in middle childhood?SUMMARY ANSWERChildren with higher levels of secure–autonomous attachment to their mothers were more likely to have positive perceptions of the donor, and those with higher levels of insecure–disorganized attachment to their mothers were more likely to perceive him negatively.WHAT IS KNOWN ALREADYThere is limited understanding of the factors that contribute to children's thoughts and feelings about their donor in solo mother families. In adolescence, an association was found between adolescents’ curiosity about donor conception and their security of attachment to their mothers.STUDY DESIGN, SIZE, DURATION19 children were administered the Friends and Family Interview and Donor Conception Interview between December 2015 and March 2016 as part of the second phase of a longitudinal, multi-method, multi-informant study of solo mother families.PARTICIPANTS/MATERIALS, SETTING, METHODSAll children were aged between 7 and 13 years and had been conceived by donor insemination to solo mothers. Interviews were conducted in participants’ homes. The Friends and Family Interview was rated according to a standardized coding scheme designed to measure security of attachment in terms of secure–autonomous, insecure–dismissing, insecure–preoccupied and insecure–disorganized attachment patterns. Quantitative analyses of the Donor Conception Interview yielded two factors: interest in the donor and perceptions of the donor. Qualitative analyses of the Donor Conception Interview were conducted using qualitative content analysis and thematic analysis.MAIN RESULTS AND THE ROLE OF CHANCEStatistically significant associations were found between the perception of the donor scale and the secure–autonomous and insecure–disorganized attachment ratings. Children with higher levels of secure–autonomous attachment to their mothers were more likely to have positive perceptions of the donor (r = 0.549, P = 0.015), and those with higher levels of insecure–disorganized attachment to their mothers were more likely to perceive him negatively (r = −0.632, P = 0.004). Children's narratives about the donor depicted him as a stranger (n = 8), a biological father (n = 4), a social parent (n = 3), or in ambivalent terms (n = 4).LIMITATIONS, REASONS FOR CAUTIONFindings are limited by the wide age range of children within a small overall sample size. Participants were those willing and able to take part in research on donor conception families. The statistical significance of correlation coefficients was not corrected for multiple comparisons.WIDER IMPLICATIONS OF THE FINDINGSFindings highlight the importance of situating children's ideas about the donor within family contexts. It is recommended that those working with donor conception families consider this when advising parents about whether, what and how to tell children about donor conception.STUDY FUNDING/COMPETING INTEREST(S)Th...

Understanding of emotional adjustment after stroke is limited. Under one-third of stroke survivors reporting emotional problems receive support. The aim of this study was to explore the process of emotional adjustment post-stroke and investigate the role played by participation in an online stroke community. We applied thematic analysis to 124 relevant posts within 114 discussion threads, written by 39 survivors and 29 carers. The contribution of online community engagement to emotional adjustment was explored using the Social Support Behaviour Code.Stroke survivors share common experiences of emotional adjustment and may not necessarily reach complete acceptance. Positive and negative trajectories of emotional adjustment were identified.Survivors progressed along, or moved between, positive and negative pathways not in a time-dependent manner but in response to 'trigger events', such as physical setbacks or anti-depressant treatment, which may occur at any chronological time. An adapted version of Suhr's 1990 Social Support Behaviour Code showed that support provided through the online community took many forms, including advice, teaching, empathy and normalisation of concerns. Participation in the stroke community was itself deemed to be a positive 'trigger event'.

This qualitative study explored how stay-at-home fathers (SAHFs) think and feel about transitioning back into paid employment. Findings from a thematic analysis on interviews with 21 SAHFs in the United Kingdom revealed that many of the SAHFs expected to return to work. However, most of the fathers suggested that this would be part-time, or self-employment, which would allow them to remain highly involved in caregiving, representing their commitment to moving away from the traditional gender roles that are largely evident in parenting. Some fathers expressed a desire to return to the paid workforce whilst others showed apprehension, indicating tensions over negotiating work and care. These findings have practical implications for fathers who are highly involved in caregiving.