Journal of Public Health Advance Access originally published online on October 23, 2008
Journal of Public Health 2009 31(1):59-68; doi:10.1093/pubmed/fdn088
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Help-seeking patterns in Chinese women with symptoms of breast disease: a qualitative study
W. W. T. Lam, Assistant Professor in Psycho-oncology1,2
M. Tsuchiya, Research Officer in Psycho-oncology1,2
M. Chan, Medical Consultant in Breast Surgery3
S. W. W. Chan, Medical Officer in Breast Surgery4
A. Or, Nurse Specialist in Breast Cancer Care3
R. Fielding, Professor in Medical Psychology1,2
1 School of Public Health, 5/F, WMW Mong Building, The University of Hong Kong, Hong Kong, PR China
2 Centre for Psycho-Oncology Research & Training, The University of Hong Kong, Hong Kong, PR China
3 Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong, PR China
4 Department of Surgery, United Christian Hospital, Kowloon, Hong Kong, PR China
Address correspondence to W.W.T. Lam, E-mail: wwtlam{at}hku.hk
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Abstract |
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Background Prompt utilization of health services on detecting breast symptoms can improve breast cancer (BC) survival. Little is known about Chinese women's help-seeking behaviour. Our aim was to determine patterns of self-referral among Hong Kong Chinese women with self-detected breast symptoms.
Methods We recruited 37 women awaiting their first consultation at public hospitals for breast symptoms. Interviews were transcribed and analysed based on the grounded theory approaches.
Results A two-stage help-seeking model provided the best interpretation of the data. Symptom recognition was triggered by symptom interpretation, symptom progression and social messages. Painful lumps were seen as symptomatic, but atypical symptoms were often dismissed as benign as they responded to dietary change. Symptom intensification and discussions with someone who had faced BC prompted consultation. Service utilization involved fear of consequences, confirmation need, symptom distress, lay referral, media prompts and opportunistic presentation. Fearing cancer as incurable delayed consultation. Utilization barriers included cost, uncertainty about referral pathways, competing priorities and embarrassment.
Conclusions Atypical and painless presentation was more common among women delaying presentation. Barriers included cost, access, time and embarrassment. Education should emphasize atypical symptoms, the high-cure rate and the need for early presentation. Reduced cost and improved access to clinics would enhance early consultation.
Keywords: cancer, health promotion, health services