HEALTH BELIEF MODEL OF PATIENT AND CAREGIVER FOR BREAST CANCER

Abstract

This qualitative feminist ethnographic research is situated within the domains of medical anthropology, feminism and anthropology of body. It explores the health related beliefs of breast cancer, which has a high incidence rate and an alarming rise in young women in Pakistan where 30.8% of the 52,500 cancer related deaths in females are due to breast cancer (WHO, 2014). The research objectives were to understand the pathway to care and the complementary and alternative treatment or practices adopted by the affected families. This could not be done without exploring the gendered understanding of breast cancer in the patriarchal setup and stigma that act as a barrier to care. The main theoretical framework employed in the study was the Health Belief Model (HBM) proposed by Hochbaum, Rosenstock and Kegels (1950) while for stigma, the six dimensions of stigma by Jones et al (1983) was used. After approval from IRB, 37 research participants (22 Patients who had undergone mastectomy and 15 Caregivers) with an age range of 30-60 years were approached via non-probability sampling. Thematic analysis was done for the data collected via in-depth interviews and focus group discussions. The significant themes for all the theoretical constructs of HBM were related to (perceived susceptibility) dietary patterns, reproductive health decisions, deviation from religion, technological dependence and genetic pre-disposition, (perceived benefits) breast self-examination, chemotherapy and surgery, “Damm and Dawa” serving complementary purposes and significance of second opinion. For stigma or perceived barriers, concepts of shame, self-disclosure of serious illness, loss of breast, motherhood, beauty, femininity, ‘othering’ the patient by labels connoting vulnerability, adjusting to a ‘new identity’: alopecia and overburdening the caregiver were prominent themes. The discussion highlights that patients and caregivers sought multiple medical systems for breast cancer and the three sectors of health, popular, professional and folk (Klienman, 1980) are overlapping because the roles played by the members of the sectors and its associated functions related to health are similar. There is need to understand, document and integrate the folk sector of health. The patriarchal structure of the Pakistani society reinforces the traditional gender role socialization where women are conceived of as wives, mothers and homemakers. Breast cancer poses a threat to femininity by distorting the beauty ideals and disrupting the roles of the woman which stigmatizes the patient and double investment is made to restore it.