Anticipated time to seek medical advice for possible lung cancer symptoms and barriers to timely presentation in Palestine: a national cross-sectional study.

BACKGROUND: Lung cancer (LC) has poor survival outcomes mainly due to diagnosis at late stages. This study explored the anticipated time to seek medical advice for possible LC symptoms and barriers to early presentation in Palestine. METHODS: This cross-sectional study recruited adult participants from hospitals, primary healthcare centers, and public spaces of 11 governorates using convenience sampling. A modified, translated-into-Arabic version of the validated LC awareness measure was used to assess LC symptom awareness, the time needed to seek medical advice and barriers to early presentation. RESULTS: A total of 4762 participants were included. The proportion that would immediately seek medical advice for possible LC symptoms varied according to the symptoms' nature. For respiratory symptoms, this ranged from 15.0% for 'painful cough' to 37.0% for 'coughing up blood'. For non-respiratory symptoms, this ranged from '4.2% for 'unexplained loss of appetite' to 13.8% for 'changes in the shape of fingers or nails'. Participants with good LC symptom awareness were more likely to seek medical advice within a week of recognizing most LC symptoms. About 13.0% would delay their visit to see a doctor after recognizing an LC symptom. The most reported barriers were emotional with 'disliking the visit to healthcare facilities' (59.8%) as the leading barrier. CONCLUSION: LC respiratory symptoms were more likely to prompt early seeking of medical advice. Good LC symptom awareness was associated with a higher likelihood of help-seeking within a week. Educational interventions are needed to promote LC awareness and address the perceived barriers to early presentation in low-resource settings, such as Palestine.

Myths and common misbeliefs about cervical cancer causation among Palestinian women: a national cross-sectional study.

BACKGROUND: Cervical cancer (CC) myths and beliefs can negatively impact women's preventive behaviors, including vaccination against human papillomavirus and having regular screening tests. This study aimed to examine awareness of Palestinian women about myths related to CC causation and investigated factors associated with good awareness. METHODS: A national cross-sectional study was conducted to recruit adult Palestinian women from hospitals, primary healthcare facilities, and public areas in 11 Palestinian governorates. A translated-into-Arabic version of the Cancer Awareness Measure-Mythical Causes Scale was used to collect data. Awareness level was determined based on the number of CC myths around CC causation recognized to be incorrect: poor (0-4), fair (5-9), and good (10-13). RESULTS: A total of 7058 questionnaires were included. Myths unrelated to food were more commonly recognized as incorrect compared to those related to food. The most recognized food-unrelated myth was 'having a physical trauma' (n = 3714, 52.6%), whereas the least recognized was 'using mobile phones' (n = 2238, 31.7%). The most recognized food-related myth was 'drinking from plastic bottles' (n = 2708, 38.4%), whereas the least recognized was 'eating food containing additives' (n = 1118, 15.8%). Only 575 participants (8.1%) displayed good awareness and promptly recognized at least 10 out of 13 myths around CC causation as incorrect. Factors associated with lower likelihood of displaying good awareness of myths around CC causation included living in the West Bank and Jerusalem, being married, widowed or divorced, knowing someone with cancer, and visiting hospitals or primary healthcare centers. CONCLUSIONS: A very small proportion of Palestinian women recognized 10 or more myths around CC causes as incorrect. Initiatives addressing CC myths are needed in the Palestinian community.

Awareness of human papillomavirus and acceptability of the vaccine among women in Palestine: is it time for policy adjustment?

BACKGROUND: Progress has been made in the reduction of morbidity and mortality of cervical cancer by the implementation of human papillomavirus (HPV) vaccination programs. This study aimed to assess the awareness of Palestinian women about HPV as well as their knowledge and acceptability of the HPV vaccine and to examine the factors associated with good awareness. METHODS: This was a national cross-sectional study. Adult women were recruited from hospitals, primary healthcare centers, and public spaces in 11 Palestinian governorates using convenience sampling. A structured questionnaire was used for data collection. For each correctly answered question, one point was given. The total score was calculated and categorized into poor (0-10) and good awareness (11-21). RESULTS: The questionnaire was completed by 7223 women out of 8086 who were approached (response rate = 89.3%). A total of 7058 questionnaires were included in the final analysis; 4403 from the West Bank and Jerusalem (WBJ) and 2655 from the Gaza Strip. Women recruited from the Gaza Strip were younger, getting lower monthly incomes, and with fewer chronic diseases than women recruited from the WBJ. Only 33 women (0.5%) displayed good awareness of HPV and its vaccine with 0.7% of women from WBJ and only 0.2% of women from the Gaza Strip. Completing post-secondary education, being employed or a student, and having a higher monthly income were associated with an increase in the likelihood of having good awareness. Among women who had heard of HPV (n = 571, 8.1%), only 46 women (8.1%) reported familiarity with its vaccine. Women from the WBJ were more likely than women from the Gaza Strip to have heard about the HPV vaccine (0.9% vs. 0.2%). Most women agreed to receive the HPV vaccine themselves or for their daughters if it was given without cost or with a co-payment. No differences were found in the likelihood of agreeing to receive the HPV vaccine among women in the WBJ versus the Gaza Strip. CONCLUSION: The overall awareness of HPV and its vaccine was extremely low. Inclusion of the HPV vaccine in the national immunization program could change this, especially as the HPV vaccine appeared to be acceptable.

Awareness of Palestinians about lung cancer symptoms: a national cross-sectional study.

BACKGROUND: The majority of lung cancer (LC) cases are diagnosed at an advanced stage. Poor awareness of LC symptoms is a contributor to late diagnosis. This study aimed to assess the awareness of LC symptoms among Palestinians, and to examine the factors associated with displaying good awareness. METHODS: Participants were recruited from hospitals, primary healthcare centers and public spaces using convenience sampling. A translated-into-Arabic version of the validated LC awareness measure was used to assess recognition of 14 LC symptoms. One point was given for each recognized symptom. The total score was calculated and categorized based on the number of symptoms recognized: poor (0-4), fair (5-9), and good (10-14). Multivariable logistic regression was used to examine the association between participant characteristics and having good awareness. The multivariable analysis adjusted for age-group, gender, education, monthly income, occupation, residence, marital status, any chronic disease, knowing someone with cancer, smoking history, and site of data collection. RESULTS: Of 5174 potential participants approached, 4817 completed the questionnaire (response rate = 93.1%) and 4762 were included in the final analysis. Of these, 2742 (56.9%) were from the West Bank and Jerusalem (WBJ) and 2020 (43.1%) were from the Gaza Strip. Participants from the WBJ were older, had higher monthly income but lower education, and suffered from more chronic diseases. The most recognized respiratory LC symptom was 'worsening in an existing cough'(n = 3884, 81.6%) while the least recognized was 'a cough that does not go away for two or three weeks'(n = 2951, 62.0%). The most recognized non-respiratory LC symptom was 'persistent tiredness or lack of energy'(n = 3205, 67.3%) while the least recognized was 'persistent shoulder pain'(n = 1170, 24.6%). A total of 2466 participants (51.8%) displayed good awareness of LC symptoms. Participants from both the Gaza Strip and the WBJ had similar likelihoods to have good awareness levels. Factors associated with a higher likelihood to display good awareness included female gender, having post-secondary education, being employed, knowing someone with cancer, and visiting hospitals and primary healthcare centers. CONCLUSION: About half of the study participants displayed a good level of awareness of LC symptoms. Further improvement in public awareness of LC symptoms by educational interventions might reduce LC mortality by promoting early diagnosis.

Knowledge, attitudes, practices and perceived barriers towards research in undergraduate medical students of six Arab countries.

BACKGROUND: The involvement of the undergraduates in the research field requires a better view of their potential and the anticipated barriers facing them. This study aims to assess the undergraduates' knowledge, attitudes, practices and perceived barriers towards research in six Arab countries. METHODS: A cross sectional study included medical students from six Arab countries, where a self-administered five-section questionnaire was used to assess the students' demographics, knowledge, attitudes, practices and perceived barriers. The questionnaire was distributed in the online educational platforms of the participating medical schools in the six included countries. RESULTS: The total sample of recruited students was 2989, the majority of students (91.6%) showed poor level of knowledge regarding research. Generally high levels of positive attitudes towards research, research relevance and usefulness were found, with moderate levels of perception of research anxiety and difficulty. 33.7% (n = 1006) participated in an actual research project before with a mean of .5 publications per student. Cross-sectional studies were the most common type of studies conducted by students (38.6%), followed by case reports (23.9%). Lack of access to lab equipment for lab research (68.1%), the priority of education over research (66.8%), and lack of time because of educational tasks (66.1%) were generally the top perceived barriers towards research practice. CONCLUSION: In the current study, the participants showed a poor knowledge level with associated positive attitudes towards research. One third of the students participated in research projects that mostly were cross-sectional studies and case reports. Educational tasks and lack of support were the most prevalent barriers. The students' positive attitudes towards research need to be translated into better knowledge and appropriate practice, which can be done by development of better training systems and more structured mentoring.

The perceived threat of COVID-19 and its impact on hygienic precautionary behaviors: A multi-countries study.

OBJECTIVE(S): To explore the perceived threats of COVID-19 and how it changed the personal hygienic precautionary behaviors across multiple countries in the Middle East and North Africa (MENA) region. DESIGN: A cross-sectional descriptive design was used to survey the four targeted MENA countries: Jordan, Palestinian territories, Saudi Arabia, and Egypt. SAMPLE: A nonprobability convenience sampling design was utilized. The link to the survey questionnaire was distributed through social media groups within Facebook® and Twitter® . The groups are known and accessible by known across the general population at the targeted countries. MEASUREMENT: Data was collected using The Brief Illness Perception Questionnaire and an adapted instrument that examine the hygienic precautionary behaviors during COVID-19 pandemic. RESULTS: Answers of participants (n = 2604) were valid and included in the study. The results show that a minimal perception of threat among the participants on most of the BIP-Q5 items (M = 12.9, SD = 7.2). Moreover, the highest compliance rates to recommended hygienic precautionary behaviors were found among populations above the age of 50 years (F = 2.89, p = .04), females (t = 5.18, p = .003), being married (F = 3.09, p = .029), and being a health care professional (t = -2.20, p = .028). CONCLUSION: The perceived threat of COVID-19 and compliance rates with the recommended hygienic precautionary behaviors among Arab societies were found to below and need critically urgent attention.

Knowledge of cervical cancer risk factors among Palestinian women: a national cross-sectional study.

BACKGROUND: High awareness of cervical cancer (CC) risk factors is important to decrease the morbidity and mortality associated with CC. This study aimed to assess the knowledge level of Palestinian women about CC risk factors and to determine the factors associated with good knowledge. METHODS: This was a national cross-sectional study. Adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates in Palestine were recruited using a stratified convenience sampling. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess the knowledge about the 11 CC risk factors. For each correctly identified risk factor, the participant was given one point. The total score was calculated and was categorized into three categories: poor knowledge (0-3), fair knowledge (4-7), and good knowledge (8-11). RESULTS: A total of 7223 participants completed the Arabic CeCAM (response rate = 89.3%) and 7058 questionnaires were included in the final analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem. Participants recruited from the Gaza Strip were younger, getting lower monthly incomes, and with less chronic diseases than participants recruited from the West Bank and Jerusalem. The most frequently identified risk factor was 'having a weakened immune system' (n = 5458, 77.3%) followed by 'infection with a sexually transmitted infection' (n = 5388, 76.3%). The least identified risk factor was 'having many children' (n = 1597, 22.6%). Only 1670 women (23.7%) had good knowledge of CC risk factors. Women living in the Gaza Strip were more likely than women living in the West Bank and Jerusalem to have good knowledge (25.2% vs 22.7%). Completing a secondary or diploma degree, being employed, and having a monthly income of ≥ 1450 NIS (around $450) were all associated with lower likelihood of having good knowledge of CC risk factors. Conversely, knowing someone with cancer was associated with higher likelihood of having good knowledge. CONCLUSION: The overall awareness of CC risk factors was low. There is a substantial need to establish educational programs to promote Palestinian women's awareness of CC.

Knowledge of Palestinian women about cervical cancer warning signs: a national cross- sectional study.

BACKGROUND: Timely presentation and diagnosis of cervical cancer (CC) are crucial to decrease its mortality especially in low- and middle-income countries like Palestine. This study aimed to evaluate the knowledge of Palestinian women about CC warning signs and determine the factors associated with good knowledge. METHODS: This was a national cross-sectional study conducted between July 2019 and March 2020 in Palestine. Stratified convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess women's knowledge of 12 CC warning signs. RESULTS: Of 8086 approached, 7223 participants completed the CeCAM (response rate = 89.3%). A total of 7058 questionnaires were included in the analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem (WBJ). The median age [interquartile range] for all participants was 34.0 [24.0, 42.0] years. Participants recruited from the WBJ were older, getting higher monthly income, and having more chronic diseases than those recruited from the Gaza Strip. The most frequently identified warning sign was 'vaginal bleeding after menopause' (n = 5028, 71.2%) followed by 'extreme generalized fatigue' (n = 4601, 65.2%) and 'unexplained weight loss' (n = 4578, 64.9%). Only 1934 participants (27.4%) demonstrated good knowledge of CC warning signs. Participants from the Gaza Strip were slightly more likely than participants from the WBJ to have a good level of knowledge. Factors associated with having good knowledge included having a bachelor or postgraduate degree, being married, divorced, or widowed as well as knowing someone with cancer. CONCLUSION: The overall awareness of CC warning signs was low. Educational interventions are needed to increase Palestinian women's awareness of CC warning signs.

Current situation and future directions of lung cancer risk factor awareness in Palestine: a cross-sectional study.

OBJECTIVES: To evaluate lung cancer (LC) risk factor awareness among Palestinians and identify factors associated with good awareness. DESIGN: Cross-sectional study. SETTINGS: Participants were recruited using convenience sampling from hospitals, primary healthcare centres (PHCs) and public spaces located at 11 governorates in Palestine. PARTICIPANTS: Of 5174 approached, 4817 participants completed the questionnaire (response rate=93.1%). A total of 4762 questionnaires were included: 2742 from the West Bank and Jerusalem (WBJ) and 2020 from the Gaza Strip. Exclusion criteria were working or studying in a health-related field, having a nationality other than Palestinian and visiting oncology departments or clinics at the time of data collection. TOOL: A modified version of the validated LC Awareness Measure was used for data collection. PRIMARY AND SECONDARY OUTCOMES: The primary outcome was LC risk factor awareness level as determined by the number of factors recognised: poor (0-3), fair (4-7) and good (8-10). Secondary outcomes include the recognition of each LC risk factor. RESULTS: Smoking-related risk factors were more often recognised than other LC risk factors. The most recognised risk factors were 'smoking cigarettes' (n=4466, 93.8%) and 'smoking shisha (waterpipes)' (n=4337, 91.1%). The least recognised risk factors were 'having a close relative with LC' (n=2084, 43.8%) and 'having had treatment for any cancer in the past' (n=2368, 49.7%).A total of 2381 participants (50.0%) displayed good awareness of LC risk factors. Participants from the WBJ and the Gaza Strip had similar likelihood to display good awareness (50.6% vs 49.1%). Being≥45 years, having higher education and monthly income, knowing someone with cancer and visiting hospitals and PHCs seemed to have a positive impact on displaying good awareness. CONCLUSION: Half of study participants displayed good awareness of LC risk factors. Educational interventions are warranted to further improve public awareness of LC risk factors, especially those unrelated to smoking.

Myths and Misconceptions Around Lung Cancer Causation in Palestine: Is It Time to Intervene?

PURPOSE: Having an accurate knowledge of what truly increases the likelihood of developing lung cancer (LC) may help people make better decisions about lifestyle changes that could potentially lower their risk. This study assessed current beliefs in LC causation myths among Palestinians and explored factors associated with displaying good recognition of such myths. METHODS: A national cross-sectional study was conducted from July 2019 to March 2020. A modified version of the Cancer Awareness Measure-Mythical Causes Scale was used for data collection. The awareness level of LC causation myths was determined based on the number of myths recognized to be incorrect: poor (0-4), fair (5-9), and good (10-13). RESULTS: A total of 4,817 participants completed the questionnaire of 5,174 approached (response rate = 93.1%). In total, 4,762 participants were included in the final analysis. Myths unrelated to food were more commonly recognized than food-related myths. The food-related myth most frequently recognized was eating burnt food (n = 1,427; 30.0%) followed by drinking from plastic bottles (n = 1,389; 29.2%). The food-related myth least commonly recognized was eating food containing additives (n = 737; 15.5%). The most frequently recognized myth unrelated to food was having a physical trauma (n = 2,903; 61%), whereas the least was using cleaning products (n = 1,140; 23.9%). Only 287 participants (6%) displayed good awareness. Having a chronic disease and knowing someone with cancer were associated with a decrease in the likelihood of displaying good awareness. Conversely, participants who were smoking cigarettes/shisha and those recruited from hospitals had an associated increase in the likelihood of displaying good awareness. CONCLUSION: This study found very poor awareness of LC causation myths, with only 6% recognizing ≥10 myths. Initiatives addressing LC mythical causes are needed.