Breast Cancer and Screening Prevention Programmes: Perceptions of Women in a Multicultural Community in Southern Thailand.

BACKGROUND: Breast cancer is a leading cause of morbidity and mortality among women worldwide and in Thailand. OBJECTIVE: To explore perceptions of breast cancer and screening prevention programmes among a group of at-risk women in a multicultural setting in southern Thailand. METHODS: Semi-structured in-depth interviews were used for data collection with 30 at-risk group women. Women from Muslim and Buddhist backgrounds were purposively included in this study. The thematic analysis method was used to analyse the data. RESULTS: Four themes were identified from our data: perceptions of breast cancer, being diagnosed with breast cancer and anxiety, stigma: effects of breast cancer, and breast self-screening and prevention of breast cancer. The participants had some knowledge about the risk factors for breast cancer. However, participants perceived that breast cancer could occur to individual women at any time and that it was not possible to entirely prevent the disease, even when following a breast self-examination programme. However, most participants perceived that whether one would be afflicted by breast cancer depended also on Allah and their own karma. All participants were encouraged to attend breast self-screening training by healthcare providers of local health centres, but they had no confidence to perform self-screening soon after finishing the training programme. This became the reason for a lack of regular self-screening with responsibility left to health practitioners. Although participants were aware that breast self-screening should be their routine practice, there were multiple barriers to this, including accurate knowledge about breast cancer, belief, self-awareness, screening skills and healthcare facilities. Breast self-screening was recognised as an important means of early detection. However, most women did not perform this regularly, which could increase their risk of developing breast cancer. CONCLUSIONS: Public health providers need to be more concerned about the perceptions, beliefs and practices regarding breast cancer and develop prevention practices that work better for women living in more diverse cultural locations so that they may be able to follow preventive practices and reduce their vulnerability to breast cancer.

Exploring Readiness towards Effective Implementation of Safety and Health Measures for COVID-19 Prevention in Nakhon-Si-Thammarat Community-Based Tourism of Southern Thailand.

Thailand's community-based tourism (CBT) faces a challenging adaptation in response to COVID-19 prevention. This study aimed to assess the readiness for effective implementation of the Safety and Health Administration (SHA) for COVID-19 prevention in the tourism community. A qualitative approach was adopted for this study. Three communities covering all types of CBT in Nakhon-Si-Thammarat province, southern Thailand were purposively chosen. Fifteen key informants were invited to participate in the study. Semi-structured in-depth interviews were conducted, and the data were analysed using the thematic analysis method. The readiness stage was assigned by consensual comprehensive scores. The overall readiness of CBT is pre-planning stage, a clear recognition of the SHA benefit, and there are sufficient resources for implementation. At this stage, there is no planning because the business owners feel that they have inadequate knowledge about the SHA protocol. Another main barrier is having limited accessibility for SHA information which mainly provides through with technology platform. The CBT owner needs to improve public health-based knowledge, technology and cooperation skills to operate SHA efficiently. However, in order to embed SHA to the CBT, tourism and public health organisation should provide suitable methods at the initiation stage by considering the community readiness and need.

Early Detection of Breast Cancer and Barrier to Screening Programmes amongst Thai Migrant Women in Australia: A Qualitative Study

Background: Breast cancer screening programme is seen as the best practice to detect breast cancer early. However, there are circumstances that can prevent immigrant women from attending screening programmes. Little is known about Thai migrants and the barriers to their seeking breast cancer screening when living in a new homeland. This paper aimed to discuss the barriers to attending screening services among Thai migrant women living in Australia. Methods: This study adopted qualitative approach. Semi-structured in-depth interviewing and drawing methods were employed as data collection technique with 25 Thai migrant women who had not experienced breast cancer and were living in Metropolitan Melbourne, Australia. Thematic analysis method was employed to analyse the data. Results: Basing on the Health Belief Model, most Thai migrant women did not perceive that they were at risk of breast cancer. Despite seeing a breast cancer screening programme as important, the women rarely paid attention to breast cancer screening and used the mammography services provided by the Australian health care system. The barriers included the location of the services, unfamiliar patterns of health care provision, and language difficulties. Conclusions: There are many barriers that that they encountered in Australia that prevent Thai migrant women living in Melbourne Australia to pay attention to mammographic screening service provided by Australia health system. Our findings suggest that health services and interventions need to be designed more sensitive to the needs and socio-cultural context of migrant women in general and Thai migrant women in particular.

Physical and Emotional Experiences of Chemotherapy: a Qualitative Study among Women with Breast Cancer in Southern Thailand

Background: Chemotherapy treatment can increase survival rates among women with breast cancer elsewhere. However, it also has negative impact on women's general appearance, body image and psychological functioning. This study aimed to describe the experiences of chemotherapy treatment among Thai women with breast cancer in rural communities, sounthern Thailand. Methods: Qualitative approach was employed to gain insights about the experiences of the women. In-depth interviewing and drawing methods were conducted with 20 Thai women who had been diagnosed with breast cancer. Thematic method was used to analyse the data. Results: Three themes emerged from the findings: I feel so weak: Lack of physical energy; experiencing physical and emotional burdens and managing health and life. Women were traumatized by effects of chemotherapy and suffered severe physical side effects. Most received inadequate professional support from health care providers and had to rely on their own judgment and use local resources to deal with the effects of their treatment and to improve their health and well-being. Conclusions: Chemotherapy brought about traumatic experiences to Thai women with breast cancer. Continual support is needed for the women to reduce the difficulties they might encounter. Support groups should be established for these women when receiving and completing chemotherapy treatment. Our finding suggested that social support programs that meet their need are salient means that could reduce the sufferings of these women. Nurses and other health care professionals in the local community should play their important role to establish such group and make it accessible for all.

'I was told not to do it but ': Infant feeding practices amongst HIV-positive women in southern Thailand.

BACKGROUND AND OBJECTIVES: mothers living with HIV are encouraged not to breastfeed as it can transmit HIV to their infants. However, there is little known about how Thai women with HIV perceive and experience their infant feeding practices. This paper explores the breastfeeding experiences among Thai women living with HIV in southern Thailand. METHODS: semi-structured interviews and drawing methods were used with 30 HIV-positive women in rural communities of southern Thailand. Thematic analysis was used for data analysis. FINDINGS: HIV-positive mothers had ambivalent feelings about not being able to breastfeed their infants. They perceived themselves as a 'contaminated mother'. Healthcare centres and hospitals supply free infant formula for HIV-positive mothers up to one and a half years. Despite this, many mothers had to deal with some difficulties. Some infants developed an allergy to the infant formula. The free infant formula was not sufficient for some infants and the mothers had to find alternative means for the well-being of their infants: many mothers relied on condensed milk whereas some fed mashed banana. The women made every effort to fulfill their ideology of being a good and responsible mother. CONCLUSION: this paper contributes a conceptual understanding about the lived experiences of breastfeeding among women living with HIV in southern Thailand. The findings have implications for midwifery care and health policy. The provision of different options of feeding should be made available to infants along with accessible resources and professional support and guidance.

Breast Cancer Treatment: Experiences of Changes and Social Stigma Among Thai Women in Southern Thailand.

BACKGROUND: Women with breast cancer receive different forms of treatment. Although treatment can save the lives of women, they can result in adverse physical, psychological, and social effects that can impact the women's quality of life. OBJECTIVE: The objective of this study was to describe the experiences of breast cancer treatment among Thai women in southern Thailand. METHODS: This study used qualitative methods (in-depth interviewing and drawings) with 20 Thai women who had been diagnosed with breast cancer. Data were analyzed using thematic analysis methods. RESULTS: Three themes emerged: (a) being a breast cancer patient: visible signs and adverse effects of therapy, (b) experiencing emotional chaos, and (c) experiencing social dysfunction. The women had to deal with physical body changes, emotional burden, treatment-related social stigma, and being marginalized within their own social context. CONCLUSIONS: Women experienced changes including social stigma after receiving breast cancer treatments. They had to manage stigma and difficulties themselves without sufficient professional support. IMPLICATIONS FOR PRACTICE: It is important for nurses to understand such experiences so that they may support appropriate coping strategies suited to each woman. Community health nurses need to view each woman with breast cancer as a unique person and appreciate how to provide appropriate care and support based on each woman's experience with her illness and treatment.

Social Support and Women Living With Breast Cancer in the South of Thailand.

PURPOSE: To discuss social support among women with breast cancer in rural communities in southern Thailand. DESIGN: Qualitative research that allowed researchers to understand the lived experiences of women living with breast cancer and social support. METHODS: In-depth interviewing and drawing methods were adopted with 20 women with breast cancer. Thematic analysis was employed to analyze the data. FINDINGS: Most women with breast cancer received three types of social support: emotional support, tangible support, and informational support. Most support came from family members and relatives. Religion was also a form of social support for women. Many women, however, received insufficient social support from healthcare providers. This reduced their capacity to manage their illness, thus impacting their well-being. CONCLUSIONS: Various forms of support are essential for women with breast cancer so that they can better cope with their condition. CLINICAL RELEVANCE: Nurses and other health professionals are an important source of social support for women with breast cancer. Through having an understanding of and being sensitive to these women's experiences, culture, and challenges, nurses and healthcare professionals can provide more individualized support and care to women during a vulnerable period of their life. We contend that the cultural perspectives of patients are crucial in nursing science. Nurses need to appreciate the importance of culture for the support of patients with breast cancer.

Breast cancer diagnosis: biographical disruption, emotional experiences and strategic management in Thai women with breast cancer.

In this article we draw on Bury's theory of biographical disruption to discuss the meanings of, and emotional experiences related to, being diagnosed with breast cancer among southern Thai women. Qualitative methods, including in-depth interviewing and drawing methods, were used to collect data from 20 women with breast cancer. The women perceived breast cancer to be a rhok raai; an evil or dread disease. They believed that breast cancer would lead to death. The disruption in their biography occurred when they detected abnormalities indicating breast cancer. The women's narratives revealed their chaotic lives upon this diagnosis and the news precipitated in them shock, fear, anxiety and loss of hope. Although they experienced chaos and disruption, the women cultivated strategies that helped them cope with their experiences by accepting their fate and adhering to Buddhist beliefs and practices. Through their narratives of biographical disruption, the women in our study offer healthcare providers knowledge that could lead to an appreciation of their needs and concerns. This knowledge is crucial for health professionals who wish to provide emotional support to women who have been diagnosed with breast cancer in Thailand and elsewhere.

Therapeutic landscapes and living with breast cancer: the lived experiences of Thai women.

Breast cancer is an "emotionally debilitating disease" that affects the lives of women of all ages. In this paper, we discuss the lived experience of breast cancer among women in southern Thailand and situate our discussions within the concept of therapeutic landscapes. We adopted a feminist framework as our research methodology and employed qualitative and innovative methods. The therapeutic landscapes of healing involved multiple levels of landscape changes including body, home, neighbourhood, health care and cultural contexts. Our findings offer a particular insight into the role of emotions, cultural beliefs, and practices in forming therapeutic landscapes among women living with breast cancer in Thailand. It is crucial that health care providers understand the emotional experiences of women with breast cancer and their particular cultural needs for emotional healing landscapes. Our findings could be used as evidence for developing culturally appropriate therapeutic strategies and interventions for women with breast cancer in Thailand and elsewhere.

Seeking help chaow baan ways in southern Thailand.

Although modern health care facilities exist in rural areas, Thai people continue to seek help from traditional healers. This paper explores the perceptions and experiences of patients of traditional healers in southern Thailand. An ethnographic method was used comprising participant observation and in-depth interviews with 23 patients of traditional healers. Fieldwork data showed that patients sought help from traditional healers for both common and emergency illnesses, and for treatment of localised symptoms as well as chronic health conditions. The participants believed that there was no single healing system that could promote total well-being: they looked for the one that could best help them to return to normal health. Individuals expected that any healing form would be complementary or an alternative to another. The findings of this study have implications for the provision of health care to local people. They add weight to arguments that health policymakers could increase choice within the Thai health care system by formally incorporating and promoting the role of traditional healers, recognising them as an important resource in primary health care.

Existing roles of traditional healers (mor baan) in southern Thailand.

Traditional healers (mor baan) played an important role in Thai health long before the introduction of Western medicine. Although modern health professional play a key role of health care provider of Thai health care system, traditional healers and their practice still exist in most rural areas of Thailand. In this article, we address the roles and practices of traditional healers in southern Thailand. An ethnographic method was employed. This approach is the hallmark method used to describe the role and the practice of traditional healers and to grasp in-depth understanding of their everyday life. Participation observation and unstructured interview with 18 traditional healers were conducted. Thematic analysis method was used to analyse the data. Most of the traditional healers chose their role because they were influenced by their ancestors, although a few others chose it because of individual interests and a desire to help ill people. All are trained in multiple skills, using supernatural spirits, ceremonies and natural plant products as resources for counteracting various health problems. They refer patients to modern hospitals or other healers if they cannot adequately manage illness themselves. Their service provision is flexible and based on a holistic approach that suits people's lifestyles and needs. The role of traditional healer tends not to attract the interest of younger generations, although traditional healers have contributed greatly to people's health. Their presence improves people's access to healthcare and offers an alternative to modern medicine, which often has a limited role. We conclude that the services of traditional healers should be incorporated into contemporary healthcare provision of Thai health care system.

Traditional healers (mor pheun baan) in Southern Thailand: the barriers for cooperation with modern health care delivery.

Although the cooperation between modern and traditional medicine (TM) is increasingly promoted in health care system of nationwide, there remains many barriers. In this study, we examined the barriers and possible ways of promoting cooperation between traditional healers and modern health system. Ethnographic method including participant observations, in-depth interviews, focus groups, and unobtrusive methods were employed for data collection. Sixty six key participants of six stakeholders participated in this study. There are many barriers existing in relation to promote the legal role of traditional healers. This is because modern and traditional healers recognise health legalities differently. Modern health professionals try to motivate and require traditional healers to meet their standards, whereas traditional healers face integration difficulties and resist those approaches; rather, they are concerning with preserving their own traditions. Their traditional health practices do not meet the "best practice" standards necessary for them to gain the trust of modern doctors. Importantly, the licensing issue is key barrier creating difficulties for traditional healers. However, traditional healers are recognised for their benefit role in health care if cooperated with modern health professions. To make cooperation possible, all stakeholders need to understand cultural beliefs of traditional healers relating to cooperation with modern medicine. Supporting power for promotion of cooperation at the community level is the key strategy to suit community needs and contexts. In addition, cooperation requires clarification of the responsibilities of all stakeholders at the local and central levels.