title: Breast cancer awareness among female residents of Kuwait
Creators: name: Almajed, Hanan
Publisher: name: University of Glasgow
Year: 2023

description: Background and aim Breast cancer is the most common cancer among females and the second leading cause of death worldwide. Incidence in developed countries is slightly higher than developing countries; yet mortality rate in developing countries is higher than developed ones. A main reason for this is late presentation of the disease, which is common in Gulf Coorporation Council countries (GCC), and in Kuwait especially. Evidence regarding the reasons behind late presentation is insufficient. This thesis aimed to provide a comprehensive insight into breast cancer awareness and its screening methods among females in Kuwait. Method A multi-method approach was adopted to address the research objectives and gain a deeper understanding in a robust way. Three interlinked studies were carried out. A systematic review of literature attempted to understand the awareness, beliefs and attitudes towards breast cancer and breast cancer screening behavior in GCC countries region. The second epidemiological study was conducted to evaluate the level of knowledge and awareness about breast cancer non-lump symptoms, risks, and screening programs in the general population of females in Kuwait. The research was done using an internationally validated tool, the Breast Cancer Awareness Measure (BCAM). Participants were women who attended primary healthcare centres in the five districts of Kuwait and selected by systematic random sampling. Analysis included multivariable logistic regression analysis to quantify the relationship between the domains of the BCAM and breast cancer awareness. The qualitative study sought to explore and identify the best approaches to improve breast cancer awareness in Kuwait. Key stakeholders involved in breast cancer and breast screening awareness were selected because of their role. Individual in-depth interviews were built around video elicitation, where key stakeholders viewed a series of international breast cancer campaign videos. Reaction to the videos and a topic guide that included ten open-ended questions allowed the exploration of their views of breast cancer awareness in Kuwait. An Inductive thematic analysis was applied to the interview data. Results A total of 53 studies were eligible for inclusion in the systematic review. A narrative synthesis approach resulted in five main themes, each with sub-themes. The synthesis of included studies concluded that awareness about breast cancer and its screening method was low compared to developed countries. Similarly, findings from the cross-sectional BCAM survey shown a lack of knowledge about breast cancer and breast screening methods. In the qualitative study, 14 participants were interviewed. The analysis identified eight themes and sub-themes. Participants discussed the reasons responsible for the low awareness of breast cancer and low uptake of mammography. Fear was a major resisting factor to screening, others mentioned social stigma and taboo and feeling shy, reflecting the cultural norm. Participants also explored different approaches to improve breast cancer awareness among the population of Kuwait. Conclusion Findings from all three studies confirmed the low awareness about breast cancer and its screening methods among female residents of Kuwait. Areas of improvement were discussed and shared by interviewees. A number of recommendations for future awareness raising campaigns have been made. Improvement lies in the form of targeting campaigns for both healthcare professionals and females. Introducing factual females’ health programmes in early school was recommended by most stakeholders.