The influence of Malay cultural beliefs on breast cancer screening and genetic testing: A focus group study

Abstract

Objective: Malays comprise an Asian cultural group reported to have low breast cancer screening uptake rates and poor cancer outcomes. Little is known about Malay cultural factors influencing beliefs and practice of cancer screening and genetic testing. Our study aims to explore health beliefs of Malay women around breast cancer screening and genetic testing. Methods:We conducted focus groups among healthy English-speaking Malay women in Singapore, aged 40 to 69 years, using a structured guide developed through literature review, expertise input and participant refinement. Thematic analysis was conducted to extract dominant themes representing key motivators and barriers to screening and genetic testing. We used grounded theory to interpret results and derive a framework of understanding, with implications for improving uptake of services. Results: Five focus groups (four to six participants per group) comprising 27 women were conducted to theme saturation. Major themes were (a) spiritual and religious beliefs act as barriers towards uptake of screening and genetic testing; (b) preference for traditional medicine competes with Western medicine recommendations; (c) family and community influence health-related decisions, complexed by differences in intergenerational beliefs creating contrasting attitudes towards screening and prevention. Conclusions: Decisions to participate in breast cancer screening and genetic testing are influenced by cultural, traditional, spiritual/religious, and intergenerational beliefs. Strategies to increase uptake should include acknowledgement and integration of these beliefs into counseling and education and collaboration with key influential Malay stakeholders and leaders. KEYWORDS Breast cancer screening, cancer, culture, genetic testing, Malay beliefs, oncology 1 | BACKGROUND Diverse cultural groups across the world have varying values, norms, and beliefs, which often influence health-related behaviors and decisions. 1 'Culture' is a concept that defines the shared values, beliefs, behaviors, and practices of a particular community, communicated from one generation to the next. 2 Among Asian societies, religious, and spiritual beliefs have been shown to significantly impact cancer beliefs and prevention and treatment practices. 3 For example, among the Malay population, the use of traditional medicine and/or

Perspectives of the Asian Standardised Patient

“…Asian women seem to be more conservative as only 53% of respondents in a study did breast self-examinations (Sim et al, 2009;Tan et al, 2005) reported that, between 2000 and 2003, 21.5% of women in Singapore presented with stage III or IV breast cancer which may potentially be due to cultural attitudes toward breast cancer screening tests and modesty, which inhibit Asian women from participating in breast cancer screening (Parsa et al, 2006). Spiritual and religious beliefs were found to act as a barrier to breast cancer screening in Singaporean Malay women (Shaw et al, 2018). As expected, more than half of our female SPs were uncomfortable with breast examination.…”

Adaptation and validation of the health belief model scale for colorectal cancer screening

“…A literature review of CRC screening research revealed two significant issues. First, although many researchers reported that culturespecific health beliefs significantly influenced cancer screening behaviors in diverse racial and ethnic groups (Lee, 2015;Lu et al, 2016;Shaw et al, 2018), only a few studies examined health beliefs about CRC screening behavior as factors that influence CRC screening utilization in Koreans (Bae, Park, & Lim, 2014;. Most CRC screening studies focused on the demographic characteristics and health behavioral factors (e.g.…”

Breast cancer screening adherence rates and barriers of implementation in ethnic, cultural and religious minorities: A systematic review

“…By contrast, the rates of adherence to MAM at one point during the womens' lifetimes varied between 29.9 and 90%, with x=63.5% and M=71%. Regarding adherence to CBE in the last 2 years, the rates ranged from 5.6 to 31.9%, with x=18.7% and M=18.6% (details are available in Table SI) (17)(18)(19)(20)(23)(24)(25)(26)(27)(28)(29)(30).…”

“…Factors associated with the participants culture and religion were mentioned in a few articles, most of which had a qualitative design. Shaw et al (29) revealed, through focus groups, that spiritual and religious beliefs (for example, Aurat, fatalism and black magic) play an important role in BC screening among Malay women in Singapore. Furthermore, the confidence in traditional medicine and the distrust in western practices among those women, as well as the role of family and community ties and shared beliefs, were also among the factors mentioned.…”