纳米比亚女性的乳腺癌筛查：解释健康保险覆盖范围和获取信息对筛查行为的影响。

Breast cancer screening among women in Namibia: explaining the effect of health insurance coverage and access to information on screening behaviours.

机构信息

Department of Geography and Environment, University of Waterloo, Waterloo, Ontario, Canada.

Institute of Interdisciplinary Studies, Ottawa, Ontario, Canada.

出版信息

Glob Health Promot. 2019 Sep;26(3):50-61. doi: 10.1177/1757975917727017. Epub 2017 Sep 25.

DOI:10.1177/1757975917727017

PMID:28944716

Abstract

OBJECTIVES

Breast cancer contributes substantially to morbidity and mortality in Namibia as is the case in most countries in Sub-Saharan Africa (SSA). However, there is a dearth of nationally representative studies that examine the odds of screening for breast cancer in Namibia and SSA at large. This paper aims to fill this gap by examining the determinants of breast cancer screening guided by the Health Belief Model.

METHODS

We applied hierarchical binary logit regression models to explore the determinants of breast cancer screening using the 2013 Namibia Demography and Health Survey (NDHS). We accounted for the effect of unobserved heterogeneity that may affect breast cancer, testing behaviours among women cluster level. The NDHS is a nationally representative dataset that has recently started to collect information on cancer screening.

RESULTS

The results show that women who have health insurance coverage (odds ratio (OR) = 1.62, ≤ 0.01), maintain contact with health professionals (OR = 1.47, = 0.01), and who have secondary (OR = 1.38, = 0.01) and higher (OR = 1.77, ≤ 0.01) education were more likely to be screened for breast cancer. Factors that influence women's perception of their susceptibility to breast cancer such as birthing experience, age, region and place of residence were associated with screening in this context.

CONCLUSIONS

Overall, the health belief model predicted women's testing behaviours and also revealed the absence of relevant risk factors in the NDHS data that might influence screening. Overall, our results show that strategies for early diagnosis of breast cancer should be given major priority by cancer control boards as well as ministries of health in SSA. These strategies should centre on early screening and may involve reducing or eliminating barriers to health care, access to relevant health information and encouraging breast self-examination.

摘要

目的

乳腺癌在纳米比亚和撒哈拉以南非洲（SSA）的大多数国家一样，是发病率和死亡率的主要原因。然而，缺乏全国代表性的研究来检查纳米比亚和整个 SSA 地区乳腺癌筛查的几率。本文旨在通过检查健康信念模型指导下的乳腺癌筛查的决定因素来填补这一空白。

方法

我们应用分层二项逻辑回归模型，使用 2013 年纳米比亚人口与健康调查（NDHS）来探索乳腺癌筛查的决定因素。我们考虑了在妇女群集水平上可能影响乳腺癌、检测行为的未观察到的异质性的影响。NDHS 是一个最近开始收集癌症筛查信息的全国代表性数据集。

结果

结果表明，有医疗保险（比值比（OR）=1.62， ≤0.01）、与卫生专业人员保持联系（OR=1.47， =0.01）、接受过中等（OR=1.38， =0.01）和高等（OR=1.77， ≤0.01）教育的妇女更有可能接受乳腺癌筛查。影响妇女对乳腺癌易感性的感知的因素，如分娩经历、年龄、地区和居住地，与这方面的筛查有关。

结论

总体而言，健康信念模型预测了妇女的检测行为，同时也揭示了 NDHS 数据中缺乏可能影响筛查的相关风险因素。总体而言，我们的结果表明，早期诊断乳腺癌的策略应该成为 SSA 中癌症控制委员会和卫生部的首要任务。这些策略应集中在早期筛查上，并可能涉及减少或消除对医疗保健、获得相关健康信息的障碍，并鼓励进行乳房自我检查。