School of Health Sciences, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK.
Brighton and Sussex University Hospitals, UK.
Soc Sci Med. 2019 Jan;220:150-158. doi: 10.1016/j.socscimed.2018.11.009. Epub 2018 Nov 8.
Cancer is a leading cause of premature death in women worldwide, and is associated with socio-economic disadvantage. Yet many interventions designed to reduce risk and improve health fail to reach the most marginalised with the greatest needs. Our study focused on socially marginalised women at two women's centres that provide support and training to women in the judicial system or who have experienced domestic abuse.
This qualitative study was framed within a sociological rather than behavioural perspective involving thirty participants in individual interviews and focus groups. It sought to understand perceptions of, and vulnerability to, cancer; decision making (including screening); cancer symptom awareness; and views on health promoting activities within the context of the women's social circumstances.
Women's experiences of social adversity profoundly shaped their practices, aspirations and attitudes towards risk, health and healthcare. We found that behaviours such as unhealthy eating and smoking need to be understood in the context of inherently risky lives. They were a coping mechanism whilst living in extreme adverse circumstances, navigating complex everyday lives and structural failings. Long term experiences of neglect, harm and violence, often by people they should be able to trust, led to low self-esteem and influenced their perceptions of risk and self-care. This was reinforced by negative experiences of navigating state services and a lack of control and agency over their own lives.
Women in this study were at high risk of cancer, but it would be better to understand these risk factors as markers of distress and duress. Without appreciating the wider determinants of health and systemic disadvantage of marginalised groups, and addressing these with a structural rather than an individual response, we risk increasing cancer inequities by failing those who are in the greatest need.
癌症是全球女性早逝的主要原因之一，且与社会经济劣势相关。然而，许多旨在降低风险和改善健康的干预措施未能覆盖最边缘化、需求最迫切的人群。我们的研究聚焦于两个妇女中心的社会边缘化女性，这些中心为司法系统中的女性或遭受过家庭暴力的女性提供支持和培训。
这项定性研究从社会学而非行为学的角度出发，涉及 30 名参与者的个人访谈和焦点小组。它旨在了解女性对癌症的认知和易感性、决策（包括筛查）、癌症症状意识，以及在女性社会环境背景下对促进健康活动的看法。
女性的社会逆境经历深刻地塑造了她们的行为、愿望和对风险、健康及医疗保健的态度。我们发现，不健康的饮食和吸烟等行为需要在其风险生活环境中得到理解。在极端不利的环境中生活、应对复杂的日常生活和结构性缺陷时，这些行为是一种应对机制。长期遭受忽视、伤害和暴力的经历，往往来自于她们本应信任的人，导致了自尊心低下，并影响了她们对风险和自我护理的认知。这种情况因对国家服务的负面体验以及对自己生活缺乏控制和代理而加剧。
本研究中的女性患癌症的风险很高，但将这些风险因素理解为痛苦和困境的标志会更好。如果不了解健康和边缘化群体系统劣势的更广泛决定因素，并通过结构性而非个体性的应对措施来解决这些问题，我们将有可能通过未能满足最需要的人群而加剧癌症不公平现象。
