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

Author

Mohamedraed Elshami, Nawras Sawafta, Ahmad Mansour, Mohammed Alser, Ibrahim Al-Slaibi, Hanan Abukmail, Hanan Shurrab, Shahd Qassem, Faten Darwish Usrof, Malik Alruzayqat, Wafa Aqel, Roba Nairoukh, Rahaf Kittaneh, Yousef Mahmoud Nimer Habes, Obaida Ghanim, Wesam Almajd Aabed, Ola Omar, Motaz Daraghma, Jumana Aljbour, Razan E. M. Elian, Areen Zuhour, Haneen Habes, Mohammed Al-Dadah, Shurouq I. Albarqi, Bettina Bottcher, and Nasser Abu-El-Noor

Subjects
Lung cancer, Awareness, Early presentation, Barriers, Early diagnosis, Palestine, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract 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.

Published
2024
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2. Myths and common misbeliefs about cervical cancer causation among Palestinian women: a national cross-sectional study

Author

Mohamedraed Elshami, Hanan Abukmail, Mariam Thalji, Ibrahim Al-Slaibi, Mohammed Alser, Afnan Radaydeh, Alaa Alfuqaha, Salma Khader, Lana Khatib, Nour Fannoun, Bisan Ahmad, Lina Kassab, Hiba Khrishi, Deniz Elhussaini, Nour Abed, Aya Nammari, Tumodir Abdallah, Zaina Alqudwa, Shahd Idais, Ghaid Tanbouz, Ma’alem Hajajreh, Hala Abu Selmiyh, Zakia Abo-Hajouj, Haya Hebi, Manar Zamel, Refqa Najeeb Skaik, Lama Hammoud, Saba Rjoub, Hadeel Ayesh, Toqa Rjoub, Rawan Zakout, Amany Alser, Shurouq I. Albarqi, Nasser Abu-El-Noor, and Bettina Bottcher

Subjects
Cervical cancer, Myths, Mythical causes, Beliefs, Behavioral changes, Palestine, Public aspects of medicine, RA1-1270
Abstract

Abstract 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.

Published
2024
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3. Awareness of Palestinians about lung cancer symptoms: a national cross-sectional study

Author

Mohamedraed Elshami, Hanan Abukmail, Wafa Aqel, Mohammed Alser, Ibrahim Al-Slaibi, Hanan Shurrab, Shahd Qassem, Faten Darwish Usrof, Malik Alruzayqat, Roba Nairoukh, Ahmad Mansour, Rahaf Kittaneh, Nawras Sawafta, Yousef M. N. Habes, Obaida Ghanim, Wesam Almajd Aabed, Ola Omar, Motaz Daraghmeh, Jomana Aljbour, Razan Elian, Areen Zuhour, Haneen Habes, Mohammed Al-Dadah, Nasser Abu-El-Noor, and Bettina Bottcher

Subjects
Lung cancer, Awareness, Symptoms, Survival, Early presentation, Palestine, Diseases of the respiratory system, RC705-779
Abstract

Abstract 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.

Published
2022
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4. معرفة المرأة الفلسطينية للعلامات التحذيرية لسرطان عنق الرحم: دراسة مقطعية وطنية

Author

Lana Khatib, Afnan Radaydeh, Bisan Ahmad, Zakia Abo-Hajouj, Shahd Idais, Bettina Böttcher, Nour Fannoun, Ibrahim Al-Slaibi, Manar Zamel, Nour Abed, Toqa Rjoub, Alaa Alfuqaha, Hala Abu Selmiyh, Lina Kassab, Ma’alem Hajajreh, Siba Rjoub, Hiba Khrishi, Refqa Najeeb Skaik, Mohamedraed Elshami, Lama Hammoud, Haya Hebi, Deniz Elhussaini, Mariam Thalji, Rawan Zakout, Nasser Ibrahim Abu-El-Noor, Mohammed Alser, Aya Nammari, Amany Alser, Salma Khader, Hanan Abukmail, Tumodir Abdallah, Hadeel Ayesh, Ghaid Tanbouz, and Zaina Alqudwa

Subjects
Adult, Health Knowledge, Attitudes, Practice, Palestine, medicine.medical_specialty, Survival, Cross-sectional study, Symptom, Uterine Cervical Neoplasms, Early presentation, Warning sign, Interquartile range, Surveys and Questionnaires, Epidemiology, medicine, Humans, Vaginal bleeding, Cervical cancer, business.industry, Research, Public health, Public Health, Environmental and Occupational Health, Early detection, Awareness, medicine.disease, Arabs, Menopause, Cross-Sectional Studies, Knowledge, Family medicine, Female, Public aspects of medicine, RA1-1270, Biostatistics, medicine.symptom, business
Abstract

"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. Keywords: Cervical cancer, Early detection, Survival, Symptom, Warning sign, wareness, Knowledge, Early presentation, Palestine" "الخلفية: يعد تشخيص سرطان عنق الرحم وتشخيصه في الوقت المناسب أمرًا بالغ الأهمية لتقليل معدل الوفيات خاصة في البلدان المنخفضة والمتوسطة الدخل مثل فلسطين. هدفت هذه الدراسة إلى تقييم معرفة النساء الفلسطينيات بعلامات التحذير الخاصة بسرطان عنق الرحم وتحديد العوامل المرتبطة بالمعرفة الجيدة. الطرق: كانت هذه دراسة مقطعية وطنية أجريت بين تموز 2019 وآذار 2020 في فلسطين. تم استخدام عينات من النساء البالغات من المستشفيات ومراكز الرعاية الصحية الأولية والأماكن العامة في 11 محافظة. تم استخدام نسخة مترجمة إلى العربية من مقياس الوعي (CeCAM) الذي تم التحقق من صحته لتقييم معرفة النساء بـ 12 علامة تحذير من سرطان عنق الرحم. النتائج: أكمل 7223 مشاركًا CeCAM (معدل الاستجابة = 89.3 ٪). تم تضمين ما مجموعه 7058 استبانة في التحليل: 2655 من قطاع غزة و 4403 من الضفة الغربية والقدس. كان المشاركون من الضفة الغربية و القدس أكبر سناً ، ويحصلون على دخل شهري أعلى ، ولديهم أمراض مزمنة أكثر من أولئك الذين من قطاع غزة. كانت علامة التحذير الأكثر تحديدًا هي ""النزيف المهبلي بعد انقطاع الطمث"" (العدد = 5028 ، 71.2٪) يليه ""التعب الشديد العام"" (العدد = 4601 ، 65.2٪) و ""فقدان الوزن غير المبرر"" (العدد = 4578 ، 64.9٪) . أظهر 1934 مشاركًا (27.4 ٪) معرفة جيدة بعلامات التحذير من سرطان عنق الرحم. كان احتمال حصول المشاركين من قطاع غزة على مستوى جيد من المعرفة أكثر بقليل من المشاركين من الضفة الغربية. تشمل العوامل المرتبطة بالحصول على معرفة جيدة الحصول على درجة البكالوريوس أو الدراسات العليا ، والحالة الاجتماعية وكذلك معرفة شخص مصاب بالسرطان. الخلاصة: كان الوعي العام بعلامات التحذير من سرطان عنق الرحم منخفضًا. هناك حاجة إلى تدخلات تثقيفية لزيادة وعي المرأة الفلسطينية بعلامات التحذير من سرطان عنق الرحم. "

Published
2021
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5. Knowledge of cervical cancer risk factors among Palestinian women: a national cross-sectional study

Author

Lana Khatib, Shahd Idais, Nour Fannoun, Ibrahim Al-Slaibi, Haya Hebi, Hadeel Ayesh, Mariam Thalji, Hala Abu Selmiyh, Mohammed Alser, Bettina Böttcher, Refqa Najeeb Skaik, Aya Nammari, Amany Alser, Deniz Elhussaini, Ma’alem Hajajreh, Nasser Ibrahim Abu-El-Noor, Alaa Alfuqaha, Hiba Khrishi, Toqa Rjoub, Saba Rjoub, Afnan Radaydeh, Lama Hammoud, Salma Khader, Rawan Zakout, Hanan Abukmail, Zakia Abo-Hajouj, Tumodir Abdallah, Ghaid Tanbouz, Zaina Alqudwa, Bisan Ahmad, Manar Zamel, Nour Abed, Mohamedraed Elshami, and Lina Kassab

Subjects
Adult, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, Palestine, Survival, Cross-sectional study, Reproductive medicine, Uterine Cervical Neoplasms, Early presentation, Adult women, Risk Factors, medicine, Humans, Risk factor, Child, Cervical cancer, Gaza strip, business.industry, Knowledge level, Research, Prevention, Obstetrics and Gynecology, Early detection, General Medicine, Gynecology and obstetrics, Awareness, medicine.disease, Arabs, Cross-Sectional Studies, Knowledge, Reproductive Medicine, RG1-991, Female, Public aspects of medicine, RA1-1270, business, Demography
Abstract

"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." "خلفية البحث: الوعي العالي بعوامل الخطر لسرطان عنق الرحم مهم لتقليل نسبة المرض والوفيات المرتبطة بسرطان عنق الرحم. هدفت هذه الدراسة إلى تقييم مستوى معرفة النساء الفلسطينيات حول عوامل خطر الإصابة بسرطان عنق الرحم وتحديد العوامل المرتبطة بالمعرفة الجيدة. منهجية البحث: كانت هذه دراسة مقطعية وطنية. تم اختيار المشاركات في هذا البحث من النساء البالغات و تم جمع البيانات من النساء من المستشفيات ومراكز الرعاية الصحية الأولية والأماكن العامة في 11 محافظة في فلسطين باستخدام عينة ملائمة طبقية. تم استخدام نسخة مترجمة إلى العربية من مقياس الوعي لسرطان عنق الرحم (CeCAM) لتقييم المعرفة حول عوامل الخطر ذات العلاقة بسرطان عنق الرحم. لكل عامل خطر تم تحديده بشكل صحيح ، تم إعطاء المشارك نقطة واحدة. تم حساب النتيجة الإجمالية وتم تصنيفها إلى ثلاث فئات: ضعف المعرفة (0-3) ، ومتوسطة (4-7) ، والمعرفة الجيدة (8-11). النتائج: أكمل ما مجموعه 7223 مشاركًا اختبار CeCAM باللغة العربية (معدل الاستجابة = 89.3٪) وتم تضمين 7058 استبيانًا في التحليل النهائي: 2655 من قطاع غزة و 4403 من الضفة الغربية والقدس. كان المشاركون من قطاع غزة أصغر سناً, ويحصلون على دخل شهري أقل ، ولديهم أمراض مزمنة أقل من المشاركين من الضفة الغربية والقدس. كان عامل الخطر الأكثر تحديدًا هو ""ضعف الجهاز المناعي"" (العدد = 5458 ، 77.3٪) متبوعًا بـ ""الإصابة بعدوى تنتقل عن طريق الاتصال الجنسي"" (العدد = 5388 ، 76.3٪). كان عامل الخطر الأقل تحديدًا هو ""إنجاب العديد من الأطفال"" (العدد = 1597 ، 22.6٪). فقط 1670 امرأة (23.7٪) لديهن معرفة جيدة بعوامل خطر الإصابة بالسكري. كانت النساء اللواتي يعشن في قطاع غزة أكثر عرضة من النساء في الضفة الغربية والقدس للحصول على معرفة جيدة (25.2٪ مقابل 22.7٪). إن إكمال الشهادة الثانوية أو الدبلوم ، والتوظيف ، والحصول على دخل شهري قدره 1450 شيكل إسرائيلي جديد (حوالي 450 دولارًا) ، كلها مرتبطة بانخفاض احتمالية امتلاك معرفة جيدة بعوامل خطر الإصابة بسرطان عنق الرحم. على العكس من ذلك ، ارتبطت معرفة شخص مصاب بالسرطان بارتفاع احتمالية امتلاك معرفة جيدة. الخلاصة: كان الوعي العام لعوامل الخطر ذات العلاقة بسرطان عنق الرحم منخفض. هناك حاجة جوهرية لإنشاء برامج تثقيفية لتعزيز وعي النساء الفلسطينيات ببرنامج سرطان عنق الرحم."

Published
2021

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