Khouzani Hassan Reyhani, Maleki Mohammad Reza, Zackery Ali, Mazloumi Ehsan, Jalilzadeh Mohsen, Sahebzadeh Mandana
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Department of Industrial Engineering and Futures Studies, Faculty of Engineering, University of Isfahan, Isfahan, Iran.
Heliyon. 2024 Nov 15;10(22):e40437. doi: 10.1016/j.heliyon.2024.e40437. eCollection 2024 Nov 30.
Gastric cancer is the leading cause of cancer mortality among men and the second leading cause among women in Iran. Given the high incidence and mortality rates of this disease in the country, a deeper investigation into its effective causes is essential. One effective approach to uncovering the unknowns related to gastric cancer is the application of critical-deconstructive future-thinking tools, particularly Causal Layer Analysis (CLA). This qualitative study involved a review of theoretical foundations and meta-documents, along with interviews with a group of experts. By employing triangulation, the findings from the literature review were integrated with thematic analysis of the interviews through the CLA framework. At the litany layer, gastric cancer is identified as the second most prevalent and deadly cancer in Iran. The systemic layer explores the "social, technological, economic, environmental, and political" origins of gastric cancer, highlighting factors such as globalization, governance weaknesses, and cultural shifts. The third layer challenges the conceptualization of cancer as a metaphysical sin, advocating for a new narrative centered on Fundamental Prevention. Effective cancer control should focus on preventing the emergence and institutionalization of factors at the worldview and metaphorical levels that contribute to economic, political, social, and cultural attitudes, ultimately manifesting in high-risk behaviors and pathogenic processes. Designing complex social nudges is crucial for establishing this new narrative based on fundamental prevention. This study effectively combines a systematic literature review and semi-structured interviews to investigate the factors influencing gastric cancer in Iran through Causal Layer Analysis (CLA) and proposes a new layer to the conventional three-pronged prevention model called "fundamental level prevention." The findings suggest that interventions targeting worldviews and cultural beliefs can promote behavior change and enhance health outcomes, particularly among marginalized groups. Furthermore, prioritizing fundamental changes at these layers can lead to positive reductions in disease incidence. This research holds significant implications for international audiences, highlighting the complexities of gastric cancer and the necessity for cultural interventions and global collaboration to address this pressing health issue.
在伊朗，胃癌是男性癌症死亡的首要原因，是女性癌症死亡的第二大原因。鉴于该国这种疾病的高发病率和死亡率，深入调查其有效病因至关重要。揭示与胃癌相关未知因素的一种有效方法是应用批判性解构未来思维工具，尤其是因果层次分析法（CLA）。这项定性研究包括对理论基础和元文献的回顾，以及对一组专家的访谈。通过采用三角互证法，文献综述的结果通过CLA框架与访谈的主题分析相结合。在连祷层，胃癌被确定为伊朗第二大最普遍和致命的癌症。系统层探讨了胃癌的“社会、技术、经济、环境和政治”根源，强调了全球化、治理薄弱和文化转变等因素。第三层挑战了将癌症概念化为形而上学之罪的观念，倡导以基本预防为中心的新叙事。有效的癌症控制应专注于预防在世界观和隐喻层面上导致经济、政治、社会和文化态度并最终表现为高风险行为和致病过程的因素的出现和制度化。设计复杂的社会助推对于基于基本预防建立这种新叙事至关重要。本研究有效地结合了系统的文献综述和半结构化访谈，通过因果层次分析法（CLA）调查影响伊朗胃癌的因素，并在传统的三管齐下预防模型中提出了一个名为“基本层面预防”的新层面。研究结果表明，针对世界观和文化信仰的干预措施可以促进行为改变并改善健康结果，特别是在边缘化群体中。此外，在这些层面优先进行根本性变革可以导致疾病发病率的积极下降。这项研究对国际受众具有重大意义，突出了胃癌的复杂性以及文化干预和全球合作应对这一紧迫健康问题的必要性。
