Conceptualization of Breast Cancer and Attitudes toward Breast Cancer Screening: A Qualitative Study on Iranian and Australian Women.

OBJECTIVE: Regular screening can lead to early diagnosis of breast cancer. Australia is one of the countries with a high rate of participation in breast cancer screening, while in Iran, most patients are diagnosed in advanced stages. This qualitative study used a thematic analysis method to examine the attitudes and beliefs of Iranian and Australian women toward breast cancer and breast cancer screening. METHOD: In-depth interviews were conducted with eight Iranian and seven Australian women. Data were collected through semi-structured interviews and analyzed using thematic analysis with an inferential approach. RESULTS: According to the results, four main themes were extracted for the perceptions of breast cancer, including "the meaning of breast cancer", "causes of breast cancer", "prevention of breast cancer" and "effects of significant people in life". Considering the perceptions of breast cancer screening, three themes were identified, including "beliefs about breast cancer screening," "sources of information about breast cancer screening," and "barriers to breast cancer screening." CONCLUSION: Cultural and social factors influence women's perceptions of breast cancer and screening. Therefore, investigating the cultural meaning of breast cancer and breast cancer screening for women can be useful for screening and prevention purposes.

An exploration of women's sexual and reproductive health following traumatic brain injury.

AIMS AND OBJECTIVES: To develop a gendered understanding of sexual and reproductive health for Australian women following traumatic brain injury. BACKGROUND: The intersection of socialised normative expectations of sexuality and sexual health, and being a woman with a disability, can lead to inequity and a misconception that a woman with a disability is asexual. DESIGN: An equal weighting concurrent mixed methods design. METHODS: Twenty women participated in conversational interviews and 49 women completed an online survey. Equal priority was given to both qualitative and quantitative data which were collected concurrently. A separate analysis of data was performed and was later merged. This paper follows the Good Reporting of a Mixed Methods Study guidelines for reporting mixed methods research. RESULTS: Women reported changes in menstruation, reproduction, and sexual activity. Results identified that following traumatic brain injury, routine reproductive, and sexual health screening were neglected. Women revealed a personal reticence to discuss sexual health in a holistic sense and appeared more comfortable discussing reproductive health rather than sex for pleasure. Additionally, they perceived there was a reticence by clinicians to discuss sexual health as part of their rehabilitation. CONCLUSIONS: Shifting the focus to be on women's health through periodic comprehensive health assessments is essential to the delivery of holistic health care. These results can inform the provision of sexual health, sexual safety, and sexual assertiveness education and training for women and girls within a rehabilitation framework and would be a way of addressing what women in this study identified as an unmet need. RELEVANCE TO CLINICAL PRACTICE: Reproductive and sexual health are important elements of routine comprehensive health screening for women. Nurses are well positioned to begin discussions regarding sexual agency, sexual, and reproductive health to ensure person-centred care.

Becoming a non-resident father: Marginalised through distress, disadvantage and disempowerment.

ISSUE ADDRESSED: Becoming a non-resident father through divorce is stressful and this often results in compromised mental health and well-being. Non-resident fathers' mental well-being has been measured at very low levels which may require clinical treatment, especially when correlated with child access and family court issues. A United Nations report highlighted how non-resident fathers may be marginalised, but to date, limited literature considers the lives of non-resident fathers from their own perspective and reflecting their own voice and it has been claimed that as fathers are often absent from parenting research, this absence, they are not heard. The aim of this paper was to identify how non-resident fathers' interactions with legal and welfare services and ex-partners may result in their marginalisation and affect their mental health. METHODS: In-depth interviews with open-ended questions were conducted with 19 non-resident fathers, both long term, newly divorced or in the divorce process, so as to capture a long range view of their experiences. Thematic Analysis was used for data analysis and the generation of the themes. RESULTS: Three themes emerged from the data: (1) Becoming a non-resident father with two sub themes; (2) Being in a state of distress, with three sub-themes and (3) Managing distress and seeking help, with two sub-themes. Participants reported a lack of agency, lack of power in decision making and a lack of social and financial resources all contributing to the deterioration in their self-reported experiences of mental health. This impact was highlighted by the number of participants who undertook counselling or psychological assistance to deal with their perceived marginalisation, feeling of invisibility and disempowerment. CONCLUSIONS: The implications of marginalisation for non-resident fathers' mental health, as outlined by the participants, are discussed regarding the impact of becoming a non-resident father, legal aspects, welfare service experiences and relationship with ex-partner. The chronic stress experienced by non-resident fathers who often find themselves in a situation which is difficult to resolve without major compromises to their desired outcomes must be recognised. SO WHAT: One means of achieving better mental health for non-resident fathers is to address the impact of marginalisation and lack of agency and that court processes are resolved swiftly with a view to increasing non-resident father's agency in post-divorce decision making.

Co-designed, culturally tailored cervical screening education with migrant and refugee women in Australia: a feasibility study.

BACKGROUND: Participation of culturally and linguistically diverse (CALD) women from migrant and refugee backgrounds in cervical screening is crucial to eliminate cervical cancer as a public health problem within the next 20 years. However, CALD women report low participation in cervical screening. Barriers to participation can be addressed with culturally tailored, community-based programs. There is a need for research to explore the process, feasibility, acceptability and barriers to cultural tailoring in the delivery and evaluation of cervical screening health education. METHODS: CALD community health workers took part in a 2 day training program then co-designed, culturally tailored and co-facilitated cervical screening health promotion forums within their communities. Forums were delivered to a total of seven groups, involving 12 sessions and 71 CALD women. The forums were evaluated for feasibility, acceptability, implementation and effectiveness using a survey, interviews and observations. Data were collected from CALD women, facilitators and researchers. RESULTS: The co-design and co-delivery of cervical screening health promotion forums was time and resource intensive however allowed for deeper cultural tailoring resulting in engagement with 'hard to reach' CALD women, improved health literacy and intention to screen. Flexibility in the intervention implementation was crucial to ensure forums were responsive to community interests and needs. Online delivery of the forums in response to the COVID-19 pandemic was acceptable to most groups. CONCLUSIONS: Co-designed, culturally tailored cervical screening health promotion forums are feasible and acceptable to CALD women, in both face-to-face and online formats. Adjustments to the intervention protocol were recommended to improve future implementation.

Women's tenacity following traumatic brain injury: Qualitative insights.

AIM: To explore perspectives of Australian women who had sustained a traumatic brain injury to develop a gendered understanding of their experiences. DESIGN: Qualitative findings from a concurrent mixed methods study. METHODS: Australian women who had sustained a traumatic brain injury participated in conversational interviews. Data were collected from June 2017 - May 2018. Women's narratives were listened to in various ways (Anderson & Jack, Learning to listen: Interview techniques and analyses, 1991) and analysed using thematic analysis (Braun & Clark, Thematic analysis, 2016). RESULTS: Two overarching themes Loss-A life once lived and Realigning Self-A new way of being were identified. Women discussed many losses due to injury, loss of income and potential earnings, loss in relationships and loss of identity. These all took time to reconfigure in their lives, as they adjusted to a range of ongoing impairments from the traumatic brain injury. CONCLUSION: Socially constructed gendered norms continue to at times negatively inform delivery of health care for women following traumatic brain injury. Loss associated with the injury is felt for decades and regardless of time since injury realigning of self, requires remarkable tenacity. Readjustment often continues without end; therefore, individualized health and rehabilitation services must be offered across women's lifespans. IMPACT: There is limited research into women's experiences of traumatic brain injury which suggests experiences will be the same for men and women. This research highlights biological sex differences and socialized gendered roles are important factors to consider for women following traumatic brain injury. Differences are influenced by sociocultural factors and they relate to sexual and reproductive health and gendered roles such as caring for children, caring for ageing parents, employment and projected earnings. These findings should be used to inform the development of individualized health and rehabilitation services which women in this study have identified and must be offered across their lifespans.

Breast cancer screening beliefs questionnaire: psychometric properties of the Persian version.

BACKGROUND: Valid and reliable instruments are needed to assess such beliefs, attitudes, and knowledge. This study aimed to translate Breast Cancer Screening Beliefs Questionnaire into Persian and evaluate its psychometric properties among Iranian women. METHODS: In this methodological study, the twelve-item Breast Cancer Screening Beliefs Questionnaire was translated into Persian and filled out by 1256 Iranian women. Face, content, convergent, and discriminant validity were evaluated and exploratory and confirmatory factor analyses were performed for construct validity evaluation. Reliability was also evaluated through calculating Cronbach's alpha, McDonald's omega, Average inter-item correlation, and test-retest intraclass correlation coefficient and finally, composite reliability was estimated. RESULTS: Three factors were extracted in factor analysis which included screening attitude, screening knowledge and perception, and screening practice. These factors explained 55.71% of the total variance of breast cancer screening beliefs. This three-factor model was confirmed in confirmatory factor analysis based on model fit indices (PCFI = 0.703, PNFI = 0.697, CMIN/DF = 2.127, RMSEA = 0.30, GFI = 0.980, AGFI = 0.998, and CFI = 0.991). Convergent and discriminant validity were also confirmed. Composite reliability and test-retest intraclass correlation coefficient were more than 0.7. CONCLUSION: With a three-factor structure, the Persian Breast Cancer Screening Beliefs Questionnaire has acceptable validity and reliability and hence, can be used to evaluate Iranian women's breast cancer screening beliefs.

Breast cancer screening behaviors among Chinese women in Mainland China.

In the present study, we reported on the current breast cancer screening rates among Chinese women in China and examined whether demographic factors and cultural beliefs were associated with their screening behavior. A cross-sectional survey was conducted with a convenience sample of 494 Chinese women who completed the modified Breast Cancer Screening Beliefs Questionnaire (BCSBQ). Two-sample t-tests and multivariable logistic regression were employed to analyze the data. The results indicated that participation in screening practices ranged from 27.5% for breast self-examination (BSE), 36.4% for clinical breast examination, 23.5% for mammography, and 40% for ultrasonography. Women who had previously engaged in one of the four screening practices had significantly higher scores on the three subscales of the modified BCSBQ. Being older and having a friend who had been diagnosed with breast cancer were shown to be predictors for BSE and participation in either mammography or ultrasonography, respectively. Education levels were also shown to be positively associated with the four screening measures. We suggest that cultural beliefs about breast cancer and screening practices play a significant role in Chinese women's screening behavior.

Use of pragmatism to explore women's experiences of traumatic brain injury: a kaleidoscopic view of the world.

BACKGROUND: Although more men than women sustain a traumatic brain injury (TBI), approximately one quarter of people with TBIs are women. The experiences of TBI reported in the literature are informed from the masculine perspective and do not adequately represent women's experiences. Pragmatism provides an overarching methodological framework to explore and critique a broader perspective of health, including psychosocial, cultural, spiritual, political and environmental factors, while attempting to address gender inequity. AIM: To describe the philosophical background validating the use of pragmatism to research women's experiences of TBI. DISCUSSION: Given the limited understanding of the interplay of socially constructed barriers with the complex impairments women have following TBI, a novel approach to research is required. Pragmatism offers a way to incorporate critical thinking and advocacy into research designs. CONCLUSION: The critical feminist transformative framework presented in this paper demonstrates the strengths of using pragmatism as a framework to explore complex phenomena. IMPLICATIONS FOR PRACTICE: This paper illustrates how methodology, which is influenced by various philosophical perspectives, can be woven throughout the design of a research project.

Participation in treatment decision-making among Chinese-Australian women with breast cancer.

PURPOSE: Using Confucian philosophy as a conceptual framework, this article examines the extent to which cultural values and language affect the participation preferences and experiences of the breast cancer treatment decision-making (TDM) process among Chinese women with breast cancer in Australia. METHODS: Three focus groups were conducted with 23 Chinese-Australian women diagnosed with breast cancer in their native language (Mandarin and Cantonese). Each interview was translated and transcribed. Content analysis was used to uncover the major themes. FINDINGS: Four typologies emerged: the patient as an active decision maker, the patient as a passive decision maker, the patient as a reluctant decision maker and the patient as a reluctant passive decision maker. Language barriers, cultural expectation of doctor's role and family role in Chinese culture appear as influential factors in TDM process among this group of women. CONCLUSIONS: Intervention to improve doctors' cultural sensitivities in order to help them assess women's role preferences in TDM and the ability of doctors to communicate in a culturally appropriate manner, may improve the process of breast cancer TDM among women from Chinese background.

Breast cancer screening practices of African migrant women in Australia: a descriptive cross-sectional study.

BACKGROUND: Breast cancer is the most diagnosed cancer among women and a leading cause of mortality and morbidity, globally. Breast cancer mortality can be improved through routine cancer screening, yet migrant populations have lower participation rates. While African migrants are among the fastest growing migrant population in Australia, their breast cancer screening behaviour is under-studied. The aims of this study were to report breast cancer screening status of African migrant women and factors associated with their breast cancer screening behaviour in Australia. METHODS: A descriptive, cross-sectional approach was utilised for this study. Two hundred and sixty four African migrant women aged 18-69 years and recruited from a number of organisations responded to a self-reported African version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ). Main research variables are breast cancer screening practices and demographic characteristics and total scores on each of the BCSBQ subscales. Multivariable logistic regression analyses were performed to investigate the impact of the demographic variables on the likelihood of women in the target age range 50-74 years having screening practices as recommended. RESULTS: While most of the participants heard of breast awareness (76.1%) and mammogram (85.2%), only 11.4% practised monthly breast awareness, whereas 65.9% had ever had a mammogram as frequently as recommended. Age and employment were determining factors for participating in mammogram. Significant different scores were found in the "Practical barriers" between women at the target age who had and had not performed breast awareness (80.4 versus 77.5, p-value = 0.002) and mammogram (77.1 versus 70.3, p-value = 0.009) regularly as recommended. Moreover, attitudes towards general health check-ups subscale scores were significantly higher in women who had performed clinical breast examination as frequently as recommended than those who had not. CONCLUSIONS: The research reveals that practical barriers and attitudes towards general health check-ups are important factors to take into account in determining African migrant women's participation in breast cancer screening. Progress in reducing breast cancer deaths through early detection needs to focus on attitudinal change among African migrants.

Factors influencing cancer treatment decision-making by indigenous peoples: a systematic review.

OBJECTIVE: We aim to systematically review studies that identify factors influencing cancer treatment decision-making among indigenous peoples. METHODS: Following the outline suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis, a rigorous systematic review and meta-synthesis were conducted of factors that influence cancer treatment decision-making by indigenous peoples. A total of 733 articles were retrieved from eight databases and a manual search. After screening the titles and abstracts, the full text of 26 articles were critically appraised, resulting in five articles that met inclusion criteria for the review. Because the five articles to be reviewed were qualitative studies, the Critical Appraisal Skills Program toolkit was used to evaluate the methodological quality. A thematic synthesis was employed to identify common themes across the studies. RESULTS: Multiple socio-economic and cultural factors were identified that all had the potential to influence cancer treatment decision-making by indigenous people. These factors were distilled into four themes: spiritual beliefs, cultural influences, communication and existing healthcare systems and structures. CONCLUSION: Although existing research identified multiple factors influencing decision-making, this review identified that quality studies in this domain are scarce. There is scope for further investigation, both into decision-making factors and into the subsequent design of culturally appropriate programmes and services that meet the needs of indigenous peoples.

Advance care planning for haemodialysis patients.

BACKGROUND: End-stage kidney disease (ESKD) is a chronic, debilitative and progressive illness that may need interventions such as dialysis, transplantation, dietary and fluid restrictions. Most patients with ESKD will require renal replacement therapy, such as kidney transplantation or maintenance dialysis. Advance care planning traditionally encompass instructions via living wills, and concern patient preferences about interventions such as cardiopulmonary resuscitation and feeding tubes, or circumstances around assigning surrogate decision makers. Most people undergoing haemodialysis are not aware of advance care planning and few patients formalise their wishes as advance directives and of those who do, many do not discuss their decisions with a physician. Advance care planning involves planning for future healthcare decisions and preferences of the patient in advance while comprehension is intact. It is an essential part of good palliative care that likely improves the lives and deaths of haemodialysis patients. OBJECTIVES: The objective of this review was to determine whether advance care planning in haemodialysis patients, compared with no or less structured forms of advance care planning, can result in fewer hospital admissions or less use of treatments with life-prolonging or curative intent, and if patient's wishes were followed at end-of-life. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Specialised Register to 27 June 2016 through contact with the Information Specialist using search terms relevant to this review. We also searched the Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Social Work Abstracts (OvidSP). SELECTION CRITERIA: All randomised controlled trials (RCTs) and quasi-RCTs (RCTs in which allocation to treatment was obtained by alternation, use of alternate medical records, date of birth or other predictable methods) looking at advance care planning versus no form of advance care planning in haemodialysis patients was considered for inclusion without language restriction. DATA COLLECTION AND ANALYSIS: Data extraction was carried out independently by two authors using standard data extraction forms. Studies reported in non-English language journals were translated before assessment. Where more than one publication of one study exists, reports were grouped together and the publication with the most complete data was used in the analyses. Where relevant outcomes are only published in earlier versions these data were used. Any discrepancies between published versions were highlighted. Non-randomised controlled studies were excluded. MAIN RESULTS: We included two studies (three reports) that involved 337 participants which investigated advance care planning for people with ESKD. Neither of the included studies reported outcomes relevant to this review. Study quality was assessed as suboptimal. AUTHORS' CONCLUSIONS: We found sparse data that were assessed at suboptimal quality and therefore we were unable to formulate conclusions about whether advance care planning can influence numbers of hospital admissions and treatment required by people with ESKD, or if patients' advance care directives were followed at end-of-life. Further well designed and adequately powered RCTs are needed to better inform patient and clinical decision-making about advance care planning and advance directives among people with ESKD who are undergoing dialysis.

Validation of the Breast Cancer Screening Beliefs Questionnaire among African Australian women.

BACKGROUND: The Breast Cancer Screening Beliefs Questionnaire (BCSBQ) has been designed as a culturally appropriate instrument for assessing women's beliefs, knowledge and attitudes to breast cancer and breast cancer screening practices. While it has proved to be a reliable instrument when applied to women of Chinese, Arabic and Korean origin living in Australia, its psychometric properties among women from African backgrounds have not been tested. The aim of this study is to examine the psychometric properties of the BCSBQ among African Australian women. METHODS: The BCSBQ was administered to 284 African Australian women who were recruited from a number of African community organizations and churches. Factor analysis was conducted to study the factor structure. Construct validity was examined using Cuzick's non-parametric test while Cronbach alpha was used to assess internal consistency reliability. RESULTS: Exploratory factor analysis results demonstrated that the African-Australian BCSBQ can be conceptualized as a 4-factor model. The third factor, viz. "barriers to mammography", was split into two separate factors namely, "psychological" and "practical" barriers. The results indicated that the African-Australian BCSBQ had both satisfactory validity and internal consistency. The Cronbach's alpha of the three subscales ranged between 0.84-0.92. The frequency of breast cancer screening practices (breast awareness, clinical breast-examination and mammography) were significantly associated with attitudes towards general health check-ups and perceived barriers to mammographic screening. CONCLUSIONS: Our study provided evidence to support the psychometric properties of the BCSBQ.in African Australian women. The study moreover demonstrated that the use of the instrument can help health professionals to understand the beliefs, knowledge and attitudes to breast cancer among African Australian women and also the factors that impact on their breast cancer screening practices.

Evaluation of a Culturally Tailored Education to Promote Breast and Cervical Cancer Screening Among Chinese-Australian Women.

UNLABELLED: This paper aims to evaluate the impact of the culturally sensitive and linguistically appropriate education program on the following: (i) awareness of screening practices (breast awareness, mammogram, and Pap smear test); (ii) screening intention within the next six months; and (iii) knowledge about breast and cervical cancer among Chinese-Australian women. Titled "Happy and Healthy Life in Sydney," this was a quasi-experimental study with both pre- and post-test design. A convenience sample of 288 Chinese women was recruited through Chinese organizations such as churches and community centers. Participants completed the questionnaires before and after the educational program. The results show that the program was effective in promoting awareness of breast and cervical cancer screening and resulted in increased participative intentions in both mammogram and Pap smear testing within the next 6 months. Results also indicate that knowledge and belief scores were significantly increased. CONCLUSION: Our study supports that educational programs which use culturally sensitive and linguistically appropriate strategies are effective in improving both knowledge of breast and cervical cancer and awareness of their early detection practices among Chinese-Australian women.

Factors Influencing the Mammographic Screening Practices of South Asian Women in Hong Kong: A Qualitative Study.

BACKGROUND: Breast cancer is a common type of cancer in South Asian women. Early detection by mammographic screening plays a significant role in improving survival rates. South Asian minorities in many countries have reported low mammographic screening rates. OBJECTIVE: This study aimed to understand the factors that influence mammographic screening uptake among South Asian women in Hong Kong. METHODS: This was a qualitative exploratory descriptive study. South Asian women 40 years or older with no history of breast cancer were recruited. In-depth face-to-face interviews were conducted following a semistructured interview guide. Thematic analysis was conducted to analyze the data. RESULTS: A total of 31 South Asian women consented to participate. Among them, only 7 had ever undergone mammographic screening. The following themes of facilitating factors were identified: (1) influence of doctors, family, and friends; (2) strong sense of commitment to the family; and (3) accessibility and availability of mammographic screening information and services. The following themes for barriers to screening were identified: (1) beliefs about health management and social norms, (2) lack of knowledge and understanding of breast cancer and mammographic screening, (3) logistical barriers, and (4) physical barriers. CONCLUSION: This study identified important facilitators and barriers that influence the uptake of mammographic screening among South Asian women in Hong Kong. IMPLICATIONS FOR PRACTICE: The study findings can be used to guide the development and implementation of culturally relevant interventions to address barriers to screening, including the expected gender roles and responsibilities among women in their respective families.

Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study.

Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.

Fear in general populations: A cross-sectional study on perceived fear of common diseases, COVID-19, life events, and environmental threats in 30 countries.

Background: In this study, we assessed the general population's fears towards various diseases and events, aiming to inform public health strategies that balance health-seeking behaviours. Methods: We surveyed adults from 30 countries across all World Health Organization (WHO) regions between July 2020 and August 2021. Participants rated their fear of 11 factors on an 11-point Likert scale. We stratified the data by age and gender and examined variations across countries and regions through multidimensional preference analysis. Results: Of the 16 512 adult participants, 62.7% (n = 10 351) were women. The most feared factor was the loss of family members, reported by 4232 participants (25.9%), followed by cancer (n = 2248, 13.7%) and stroke (n = 1416, 8.7%). The highest weighted fear scores were for loss of family members (mean (x̄) = 7.46, standard deviation (SD) = 3.04), cancer (x̄ = 7.00, SD = 3.09), and stroke (x̄ = 6.61, SD = 3.24). The least feared factors included animals/insects (x̄ = 3.72, SD = 2.96), loss of a mobile phone (x̄ = 4.27, SD = 2.98), and social isolation (x̄ = 4.83, SD = 3.13). Coronavirus disease 2019 (COVID-19) was the sixth most feared factor (x̄ = 6.23, SD = 2.92). Multidimensional preference analyses showed distinct fears of COVID-19 and job loss in Australia and Burundi. The other countries primarily feared loss of family members, cancer, stroke, and heart attacks; this ranking was consistent across WHO regions, economic levels, and COVID-19 severity levels. Conclusions: Fear of family loss can improve public health messaging, highlighting the need for bereavement support and the prevention of early death-causing diseases. Addressing cancer fears is crucial to encouraging the use of preventive services. Fear of non-communicable diseases remains high during health emergencies. Top fears require more resources and countries with similar concerns should collaborate internationally for effective fear management.

Global impacts of COVID-19 on lifestyles and health and preparation preferences: An international survey of 30 countries.

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics.

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study.

Background: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences. Methods: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic. Results: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction). Conclusions: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

Strategies for piloting a breast health promotion program in the Chinese-Australian population.

In Australia, women from non-English-speaking backgrounds participate less frequently in breast cancer screening than English-speaking women, and Chinese immigrant women are 50% less likely to participate in breast examinations than Australian-born women. Chinese-born Australians comprise 10% of the overseas-born Australian population, and the immigrant Chinese population in Australia is rapidly increasing. We report on the strategies used in a pilot breast health promotion program, Living with Healthy Breasts, aimed at Cantonese-speaking adult immigrant women in Sydney, Australia. The program consisted of a 1-day education session and a 2-hour follow-up session. We used 5 types of strategies commonly used for cultural targeting (peripheral, evidential, sociocultural, linguistic, and constituent-involving) in a framework of traditional Chinese philosophies (Confucianism, Taoism, and Buddhism) to deliver breast health messages to Chinese-Australian immigrant women. Creating the program's content and materials required careful consideration of color (pink to indicate femininity and love), symbols (peach blossoms to imply longevity), word choice (avoidance of the word death), location and timing (held in a Chinese restaurant a few months after the Chinese New Year), communication patterns (the use of metaphors and cartoons for discussing health-related matters), and concern for modesty (emphasizing that all presenters and team members were female) to maximize cultural relevance. Using these strategies may be beneficial for designing and implementing breast cancer prevention programs in Cantonese-speaking Chinese immigrant communities.