Anthropological Approaches to Cancer Prevention and Control in  New Brunswick:  Pilot Study Results

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Funded by the New Brunswick Regional Research Development Program in partnership with the National Cancer Institute of Canada and the Canadian Cancer Society January 1999

Principal Investigator:

    Dr. Koumari Mitra


    Professor, Department of Anthropology


    University of New Brunswick, Fredericton

Co-Investigator:

    Dr. Peter Lovell


    Associate Professor, Department of Anthropology


    University of New Brunswick, Fredericton

Research Coordinators:

    Julie Easley and Monica Ott

Research Assistants:

    Catherine Ahern, Sarah Hillier and James Thibodeau

1.  Scope:

Medical Anthropologists have increasingly become interested in examining the social and cultural construction of bio-medically defined diseases and their significance for specific groups under study (Chavez et al. 1995). In his book "The Illness Narrative" (1988), Arthur Kleinman distinguishes between disease and illness. Disease represents organ dysfunction which can be measured by the pathologist and measured in the laboratory, while illness is shaped by culture and is what that dysfunction means to the person suffering it. In understanding health and illness, cultural aspects include people’s beliefs and practices about health, illness and healing. Social aspects, on the other hand, include a person’s position and relationships in the workplace, family, and medical settings, as well as such social status indicators as gender, ethnicity, age and class (Freund and McGuire 1998). The term “bio-medicine” refers to the tradition of scientific, biologically oriented methods of diagnosis and cure. While the practice of bio-medicine is almost universal, professional medical knowledge is nonetheless influenced by social, economic and political factors (Brown 1998; Freund and McGuire 1998). Moreover, social and cultural factors influence not only perceptions but also the experience  of the disease process itself.

Although cancer prevention and control issues have dominated public consciousness for many years, the anthropological analysis of whether cancer is culturally constituted has only recently been addressed (Chavez et al. 1995; Ritenbaugh 1995). The premise of this study, therefore, is that anthropological perspectives can be applied to the study of cancer prevention and control by addressing cancer as a social issue which may be culturally constituted and environmentally influenced. Since environmental conditions can be modified by social changes, identifying and changing relevant social conditions should be seen as the most urgent cancer-related task (Sherwin 1996).

Following a bio-cultural approach to health and illness, key elements have been identified in the field of medical anthropology. While other variables may be important (e.g., socio-demographic factors such as age and class), the present study focused principally on the environmental perception, gender ideology and ethnic differences. The following variables were posed as research questions:

i) Environmental perception:

How do people perceive the role of the environment with respect to cancer prevention and control?

Research indicates that modification of the environment through social awareness and change can prevent most forms of cancer (Brady 1991; Proctor 1995; Sherwin 1996).   An urgent need exists to understand cancer in terms of the social construction of ignorance.  Ignorance is not just a natural consequence of the ever-shifting boundary between the known and the unknown, but a political consequence of decisions concerning how to approach (or neglect) what could and should be done to eliminate the disease (Proctor 1995). Most researchers feel that the preventive focus is overwhelmingly concentrated on individual lifestyles and treatment facilities (Brady 1991; Sherwin 1996). Therefore, public awareness of addressing cancer prevention and control as a broad social issue is required.

ii). Gender ideology:

Are there gender differences, in the perception of cancer its causes, prevention and treatment?

Expressions of gender and power can play a role in providing decisions concerning treatment andmoral dilemmas in medical care (Clark 1998; Rapp 1998; Sargent et al. 1996). Gender ideology influences an individual’s experience of sickness, sense of empowerment, and relationship with family, physicians and other health care providers. Furthermore, expressions of gender and power can play a role in providing decisions concerning treatment and moral dilemmas in medical care (Sargent et al. 1996; Clark 1998; Rapp 1998). Thus, the  importance of comparing the experiences of women and men with respect to cancer can reveal the social constructions of gender roles that can influence health seeking behaviour and control strategies.

iii). Ethnic differences:

Are there ethnic differences in the perception of causes of cancer?

A recent study of beliefs about cervical cancer showed a marked difference between the beliefs of Latina immigrants,  who viewed cervical cancer as a consequence of immorality and “promiscuity”, and those of their physicians (Brown 1998; Chavez et al. 1995; Martinez et al. 1997). The term ethnicity refers to social categories of identity and sub-cultural differences based on cultural distinctions of history, heredity, religion and language. When members of a group share a common explanatory model of their illnesses, it is referred to as the “folk model of illness” (Brown 1998). However, not every member of an ethnic group will have identical beliefs about health and illness (Harwood 1981). Health care professionals, therefore, need to understand the range of health beliefs in a population and be sensitive to the possibility that cultural factors may interfere with effective communication (Brown 1998; Bates and Edwards 1998; Hahn 1998).

2.   Specific Objectives of the Pilot Study:

  • (i). Examine available literature on the status of cancer prevention and control pertaining to New Brunswick.
  • (ii). Examine the beliefs, practices and attitudes with regard to cancer prevention and control in the population groups of New Brunswick selected for study. The study sample will be represented by medical practitioners and other heath care professionals as well as by members of university population groups.
  • (iii). From the examination described in “ii” above, determine possible gender-based differences in the perception of cancer causation and treatment choices in these population groups under study. In particular, the study proposes to identify perceptions of males and females (a). within the university population groups as well as (b). amongst medical practitioners and other health care professionals.

3.  The Study Population:

The present  pilot study was conducted on population groups selected from within the province of New Brunswick as follows:

  • (i). University population groups including students, faculty members and staff drawn from the University of New Brunswick, Fredericton. We are interested in extending our study to Saint John campus as well as to include Université de Moncton, however, due to budgetary and time constraints the pilot study was restricted only to Fredericton.  The University population group was suitable for the purpose of pilot study and  provided diversity in terms of ethnic and gender components.
  • (ii). Male and female medical practitioners and other health care professionals drawn from Fredericton and Moncton area.
  • (iii). Interviews of male and female participants from a First Nation community.

The scope of the pilot study also allowed us to pretest some of the research techniques that will prove to be useful for conducting in depth studies in different communities of New Brunswick at a later phase.  A stratified random sampling procedure was used to select our study group as described in Bernard (1994)

4. Research Design

Our research study involved an in-depth examination of beliefs concerning cancer prevention and control with respect to the selected New Brunswick  population groups. Using both open-ended interviews and systematic data collection techniques, we examined whether there exists a broad cultural consensus about a core set of beliefs, causes, symptoms and treatments regarding cancer. Thereafter, the selected population groups were  categorized according to gender, ethnicity, age, and socioeconomic background to assess whether possible differences exist in the perception of cancer causation and treatment choices within these categories.

5.  Sources of Data and Methods:

  • i). Secondary Data: Relevant data were  collected from a variety of sources including publications and database resources at the University of New Brunswick, Department of Health and Community Services, Dr. Everett Chalmers Hospital and Saint John Regional Hospital.
  • ii). Primary Data: Qualitative data were collected mainly from the university population as well as from the medical and health care professionals. Primary data were also collected from the male and female participants at the Eel Ground Reserve. Qualitative data collection methods were followed using techniques described in Bernard (1994), Mikkelsen (1997) include:
  • a) Focus group discussions and semi-structured interviews involving participants from the study population groups with regard to their attitudes toward cancer risk  factors, screening programs and available treatment facilities.
  • b) Semi structured interviews of  physicians, health care professionals, cancer societies and others involved in cancer care and treatment.
  • c) Case studies with the help of in-depth interviews with members of the study population.

6.  Major Observations:

Our research study involved an in-depth examination of beliefs concerning cancer prevention and control with respect to the selected New Brunswick population groups. The following salient features emerged from this pilot study:

  • Available literature regarding cancer prevention and control are mostly situated elsewhere in Canada and the United States.  Although the incidence of cancer in New Brunswick is comparable to other provinces in Canada, there is very little information on the status of cancer and health seeking behaviour in New Brunswick. Our pilot study indicates that in-depth studies are required to identify regional factors contributing to types of cancer development which will enable policy makers to design locally competent cancer prevention and control strategies specific to New Brunswick. An examination of epidemiological factors along with the role played by cultural factors is necessary for developing and implementing culturally sensitive and locally competent intervention strategies.  Therefore, there exists a need for comprehensive examination of people’s  beliefs, practices and attitudes and their effect on health seeking behaviour with respect to cancer prevention in New Brunswick.
  • The results of this research study propose that  majority of the participants perceived  environment and lifestyle as playing an important role in cancer development. Our findings indicate that the role played by environmental factors, such as exposure to radiation, pesticides and other carcinogenic compounds needs to be examined carefully. But the environmental factors should be examined with particular interest to the populations who are at a higher risk of exposure because of their occupations or their lifestyle practices than the general population.  The existence of  broader social and political issues which influence cancer prevention strategies also need to be adequately addressed.Thus, public awareness of addressing cancer prevention and control strategies both  as a social issue and an individual responsibility is required.
  • Gender was believed to be influential in both the development of cancer, as well as in an individual’s perception of cancer and health seeking behaviour.  The participants believed that females are more active to seek cancer screening as a preventative measure against cancer development in comparison to males who “don’t go for prostate exams a fraction as much.”  Males were identified as “more macho” than females and that males “are supposed to be tougher and don’t go to the doctor as often.”  The results from our study further indicate the importance of comparing experiences of women and men with respect to cancer since it can reveal the social constructions of gender roles that can influence health seeking behaviour and control strategies. Even though, our study was from the university population where  educational background was relatively similar for most participants, yet there were considerable variations in perceptions along gender lines.
  • Ethnicity was believed to affect the likelihood of an individual to develop cancer since some groups are a higher risk for contracting certain types of cancer than others. Also, our results indicate that cultural beliefs  play a role in the perceptions of an individual towards the understanding of cancer. For instance, Caucasian and South Asian focus groups believed that religious values play a role in cancer prevention and curative practices. Similarly, First Nation participants emphasized the role of spiritual healing as an integral part of cancer therapy.
  • The views and concerns expressed by the physicians and other health care professionals were generally in agreement with the study group. As most of the participants from the study group were exposed only to biomedicine, therefore, accepting and trusting biomedical treatment strategies were not difficult for them.  It is clear from our study that participants were also in favour of alternative medicine, particularly in utilising alternative medicine as a preventive or coping strategy. However, alternative medical intervention is not covered by  existing insurance policies, therefore, alternative therapy is available only to a specific category of people who can afford it.
  • In conclusion, results from this study emphasize the importance of anthropological research on knowledge, beliefs and practices regarding  perceptions of cancer risk factors  influencing health seeking behaviour. More in depth studies examining the role of cultural factors in the epidemiology of cancer are required in order to provide culturally sensitive and locally competent, preventive and curative services to population groups in New Brunswick.

7 . Significance of the Pilot Study:

The pilot study was used as a template to pretest the qualitative methods of data collection as well as to determine the influence of gender, ethnicity and the role of the  environment towards the understanding of cancer prevention and control in a selected population from New Brunswick. Results of the pilot study are encouraging for an in- depth examination of issues pertaining to attitudes, beliefs and health  practices related to cancer in New Brunswick. Most of the available literature regarding cancer prevention and control are situated elsewhere in Canada and the United States.  The incidence of cancer in New Brunswick is comparable to other provinces in Canada, yet there is a paucity of information on the status of cancer prevention and control strategies in New Brunswick. Therefore, there exists a need for comprehensive examination of people’s  beliefs, practices and attitudes towards cancer prevention and control in New Brunswick.

Further, as societies increasingly move toward multicultural orientation, anthropological research on intra-cultural and inter-cultural variations regarding the perceptions of health and disease becomes crucial. An anthropological perspective will allow us to explore the attitudes, beliefs and practices concerning cancer causation and prevention from diverse socio-demographic groups.

8. Acknowledgements

We wish to acknowledge financial assistance provided by New Brunswick Regional Research Development Program and National Cancer Institute of Canada (NBRRD/ NCIC)  for the successful completion of this pilot study. We are also grateful to Jeanette Holden and Sherrie Blakney for their help with the relevant interview data. We thank Dr. G. R. Pool, Professor, Department of Anthropology , University of New Brunswick for his help and input during the preparation of the research proposal.

For more information contact Dr. Koumari Mitra