Older People's Beliefs on Prevention and Etiology of Cancer in Poland

Beliefs about cancer prevention

Małgorzata Synowiec-Piłat

Anthropological Review • Vol. 78 (3), 289–296 (2015)

Older people’s beliefs on prevention and etiology of cancer in Poland. Implications for health promotion

Małgorzata Synowiec-Piłat

Department of Humanistic Sciences in Medicine, Wrocław Medical University

Abstract: Introduction: Poland is among the countries with the highest mortality rates from cancer, and 75% of deaths from cancer occur after the age of 60. In the case of cancer, particular attention should be paid to beliefs people have in society. Aim of research: To learn about older people’s beliefs about the importance of preventive oncology care, individual’s responsibility for getting cancer, and the etiology of cancer. We analyzed the association between beliefs about cancer and the age of the respondents. Materials and Methods: The study was carried out in 2012 with a sample of 910 adult residents of Wrocław. An interview questionnaire was used. The article presents data on older adults (aged older than 56 years) (N = 188). Results: The vast majority of respondents recognize the need to engage in preventive oncology care. Only 5% of respondents hold fatalistic beliefs, 50% of older adults believe that “if someone is sick with cancer, it does not depend on them”. An association was confirmed that the oldest adults (65 years and older) are more likely to agree with the above statement, 34% disagree with the belief that “if someone is sick with cancer it depends largely on the lifestyle and the environment”. Discussion: In developing strategies for cancer prevention aimed at older adults, special attention should be paid to raising awareness about the impact of lifestyle on cancer incidence, increasing the sense of responsibility for their health, and reducing older adult’s “external locus of control” beliefs.

Key words: health beliefs, cancer, aging, health promotion, cancer prevention

Introduction cancer in our country will increase 1.5 times in comparison with 2006 (Didkow- Poland is among the countries with ska et al. 2009). It is worth noting that the highest cancer mortality rates (EU- the increase in the incidence of age-re- ROSTAT 2009). According to forecasts, lated diseases, which include cancer, is by 2025 the number of deaths caused by one of the consequences of aging pop-

Original Article Received: May 15, 2015; Accepted for publication: October 24, 2015 DOI: 10.1515/anre-2015-0022 © 2015 Polish Anthropological Society 290 Małgorzata Synowiec-Piłat ulation. Older people are at a 10 times sidering that cancer prevention activi- greater risk of getting cancer than peo- ties do not produce satisfactory results ple under the age of 65 (Yancik and Ries in the form of positive attitude change 1994). Throughout Europe and the U.S., and health behaviors and do not reduce over 60% of the total incidence of cancer cancer morbidity and mortality rates occurs in the elderly (≥65 years) popu- (Ostrowska, 2011; Januszek-Michalecka lation. In Poland, 75% of deaths from et al. 2013). In-depth knowledge of peo- cancer occurs after the age of 60 (Wojcie- ple’s beliefs regarding cancer and their chowska and Didkowska 2014). impact on health behaviors and attitudes Therefore, there is a need to develop appears to be a promising way to devel- effective strategies to fight this group op effective strategies in the fight against of diseases (Yancik and Ries 1994). In cancer. There is an extensive scientific the case of the older adults, it is all the literature concerning beliefs about can- more important because it almost always cer in the EU (Beeken et al., 2011; Mayo co-exists with other age-related chronic et al. 2001) and the USA (Powe 2001). diseases. Undoubtedly, it is necessary to However, very few studies on this topic intensify the activities at a macro-struc- were conducted in Poland, where psycho- tural level, aimed at increasing the quality logical research seems to dominate. This and accessibility of cancer services: treat- research focuses primarily on the fear of ment, rehabilitation and prevention. On cancer and its consequences (Ohnishi the other hand, considering that cancer 2001), and very rarely on the analysis of is primarily caused by environmental fac- people’s beliefs about cancer (Chojnac- tors related to lifestyle, particular atten- ka-Szawłowska 2005). One of the few tion should be paid to the fact that cancer examples is research on colorectal can- prevention is largely dependent on the cer (Tobias-Adamczyk et al. 1999). The individual; but also embedded in the so- analysis consist mainly of sick patients cio-cultural context i.e. decisions regard- (Chojnacka-Szawłowska et al. 2013), ing changing bad habits and tastes. The and in the case of healthy individuals it use of medical services depends not only typically covers a very narrow group of on the type and severity of symptoms, research participants (Chojnacka-Szaw- psychological and socio-cultural char- łowska 2007). Existing research on be- acteristics, but also on the individual’s liefs about cancer most often focuses on immediate environment (Freidson 1970; their correlation with SES (Schwartz et Cornford and Cornford, 1999). Individ- al. 2003; Wardle and Steptoe 2003) and uals take in certain beliefs and miscon- the impact of those beliefs on preventive ceptions about cancer from culture (Son- behavior of individuals (Peek et al. 2008; tag 1999; Leventhal et al. 2003). These Niederdeppe and Levy 2007). However, convictions represent a kind of “filter and there are relatively few studies of this interpretative schema,” which is used by type conducted on a sample of healthy people when making decisions and im- subjects and taking into account the age plementing specific health behaviors in variable exist (Royer et al. 2009). response to health problems (Hagger and Due to the fact that cancer is large- Orbell 2003: 145). Taking into account ly caused by inadequate health behavior the lay perspective on cancer- related is- of an individual (failure to undergo early sues seems all the more important con- detection, high-fat diet, obesity, lack of Beliefs about cancer prevention 291 physical activity, smoking, alcohol abuse, be presented for the entire study popu- etc.), it seems especially valuable to learn lation (N = 910); of which older adults about beliefs concerning the importance are part of, showing a general trend to- of cancer prevention care, the etiology of wards dependence. In order to examine cancer and the perceived responsibility of whether there are associations between the individual for getting this disease. individual pairs of nominal variables, the value of chi-square was calculated. The Materials and Methods strength of the relationship between variables was assessed on the basis of the From March to June of 2012, sociologi- V-Cramer (V) ratio. V values were at cal research was carried out based on an the level of 0.1–0.3, which in the case of interview questionnaire with a sample of random samples ensures significant rela- 910 adult residents of Wrocław. A quo- tionship. The level of significance was set ta sample, reflecting the structure of the at p-value <0.05. For a thorough evalu- study population in terms of gender and ation, correspondence analysis was used. age was used. In the present article, how- Data was analyzed using Statistica v. 9.0. ever, only data relating to older adults is The article focuses only on the associa- presented (respondents 56 and older, tion of analyzed variables with the age of N = 188). the entire study population (N = 910). The aim of the study was to answer the following research questions: Results What are older adult’s beliefs about: a) the importance of engaging in early The majority of respondents positively prevention behavior b) individual’s re- rated the significance of preventive- on sponsibility for getting cancer, and c) the cology care: according to 63% one should etiology of cancer? also engage in it even if there are no What is the impact of the age of the symptoms; in the opinion of 25% – only respondents (N = 910) on the above be- in situations where there are some wor- liefs about cancer? rying symptoms; 6% believe that if there To evaluate the beliefs of 1. a multi- is nothing wrong there is no need for ple-choice closed-ended questions com- cancer prevention. Only 5% of respond- posed of five statements, with the possi- ents hold fatalistic beliefs: 3% said that bility of choosing one answer were used. “what will happen, will happen”, and 2% In contrast to evaluate the beliefs of 1. that “if it’s cancer nothing can be done” b–c participants were asked to respond (1% – answered “hard to say”) (Table 1). to specific statements on a 4-point Lik- To study the beliefs regarding one’s ert like scale (the scale of forced choice). responsibility for getting cancer partici- Descriptive statistics will concern the re- pants were asked to respond to the fol- spondents aged 56 and older (N = 188. lowing statements: „if we get cancer it In this article, correlation between be- doesn’t depend on us”, „ if a person beliefs and the age of respondents is pre- comes sick with cancer it is their fault” sented. Older adults accounted for one of (Table 2). Half of the respondents think the age categories considered throughout that: „ if we get cancer it doesn’t depend the study. Therefore, the analysis of the on us” (21% strongly agree and 29% relationship between the variables will tend to agree with this belief). The rest 292 Małgorzata Synowiec-Piłat

Table 1. The importance of engaging in early cancer prevention behavior (N=188) Number of Do you it’s important to engage in early cancer detection behavior? % of N=188 responses yes, also in a situation when everything is ok and there are no symptoms; 119 63 yes, only in a situation where there are some worrying symptoms; 46 25 there is no reason to do tests if everything is ok; 11 6 no, what will happen, will happen; 5 3 no, if it’s cancer nothing can be done; 4 2 It’s hard to say 3 1 Source: own research. of the respondents disagree with this be- agreeing with this statement and the age lief (38% somewhat disagree and 12% of the respondents was found. strongly disagree). An association be- To study the beliefs regarding the eti- tween this belief and the age of the re- ology of cancer, participants were asked spondents was confirmed (Chi2=57.49; to respond to the following specific state- p-value=0; V=0.14). Correspondence ments: ”whether we get sick with cancer analysis showed that younger people largely depends on our lifestyle and the (18–25) more often strongly disagree environment,” and „if someone in the with this statement, respondents be- family was sick with cancer, I will certain- tween 46–55 years often somewhat agree ly get sick as well” (Table 3). The major- with this statement, and older adults ity of respondents (66%) agree with the (65 years and older) often strongly agree statement „it depends on our lifestyle...” with the above belief. No association was (19% strongly agree and 47% somewhat found between other pairs of variables. agree). One-third of respondents (34%) In addition, 90% of respondents do do not share this belief (7% strongly dis- not agree with the belief that „if a per- agree). No association between agreeing son becomes sick with cancer it is their with this statement and the age of the fault” (55% strongly disagree and 35% respondents was found. Nearly a quar- tend to disagree). Only 10% of respond- ter of the elderly (24%) is convinced ents agreed with this belief (including that “if someone in the family was sick 2% completely). No association between ... “ (3% strongly agree, and 21% somewhat agree). Almost half of respondents

Table 2. Beliefs about individual’s responsibility for getting cancer (N=188) Beliefs about in- Strongly agree Agree Disagree Strongly disagree dividual’s respon- Number Number Number Number % of % of % of % of sibility for getting of re- of re- of re- of re- N=188 N=188 N=188 N=188 cancer sponses sponses sponses sponses „if a person gets cancer it does not 39 21 54 29 71 38 24 12 depend on them” „if a person is sick with cancer it is 4 2 16 8 65 35 103 55 their fault” Source: own research. Beliefs about cancer prevention 293

Tabele 3. Beliefs about the etiology of cancer (N=188) Strongly agree Agree Disagree Strongly disagree Number Number Number Number % of % of % of % of Beliefs about the of re- of re- of re- of re- N=188 N=188 N=188 N=188 etiology of cancer sponses sponses sponses sponses ‘if someone in the family was sick with cancer, I will 5 3 40 21 93 49 50 27 certainly get sick as well’ ‘whether someone is sick with cancer depends largely on 36 19 89 47 50 27 13 7 their lifestyle and environment’ Source: own research.

(49%) do not share this belief. On the outlook that events are controlled by other hand, 27% of respondents strongly external forces and humans are pow- disagree with this statement. An associ- erless to influence them, has been pro- ation between agreeing with this state- posed as a barrier to cancer prevention, ment and the age of the respondents was (Straughan et al. 1998, Lannin et al. confirmed (chi2=33.26; p-value=0.004; 1998) screening, (Straughan et al. 1998, V=0.11): more often younger respond- Michielutte et al. 1996) and negatively ents (18–25 years) strongly disagreed affect survival (Chavez et al. 1997, Mayo with this statement; people aged 36–45 et al. 2001). Fatalistic beliefs are charac- and 46–55 somewhat disagreed with terized by pessimism, helplessness, and this statement, while older adults (65 confusion regarding ways to avoid get- years and older) often somewhat agreed ting cancer (Straughan et al. 1998). Wide with this statement. No association was dissemination of fatalistic beliefs about found between other pairs of variables. cancer prevention was confirmed among the adult population of Americans, half Discussion of who believe that “everything causes cancer” and that “little can be done Research shows that individuals have to prevent cancer” (Niederdeppe et al. a multi-faceted cognitive representa- 2007). It has been proven that fatalistic tion of various diseases that consists beliefs about cancer are more prevalent of various beliefs regarding the causes, among the poor (Freeman 1989, Free- symptoms, effects, and treatment of the man 1991) and with lower levels of ed- disease (Lykins et al. 2008). Beliefs re- ucation (Michielutte et al. 1996, Mayo garding the disease can affect whether et al. 2001). However, there are hardly and what steps the person will take to any studies on the beliefs that take into reduce the risk of developing the dis- account the age variable. Western stud- ease and minimize the risks associated ies show the existence of a number of with its duration (Leventhal et al. 1980, negative and often erroneous beliefs Lau et al. 1983). Fatalistic beliefs often of older adults on health issues. Older go together with cancer. Fatalism, an people, including those after treatment, 294 Małgorzata Synowiec-Piłat tend to identify their health problems wood 1992). Each of these may decrease with the natural aging process, treating the likelihood of an individual engaging the symptoms as something inevitable, in behaviors that reduce cancer incidence not suitable for treatment, and there- or mortality (Steptoe 2001). The fact that fore not requiring assessment or medi- half of the surveyed older adults think “if cal intervention (Heidrich et al. 2006; someone is sick with cancer, it does not Morgan et al. 1997). Royer et al. (2009) depend on them” is worrying. It was also have shown that older women suffer- confirmed that the older the respondent, ing from breast cancer described their the more frequently causes of cancer are symptoms as incurable and not subject attributed to factors beyond the control to examination. In other studies compar- of the individual. In addition, precisely ing older patients suffering from breast those aged 65 years and older more often cancer and healthy women it has been – than respondents in other age groups shown that older women – regardless of – completely agree with the above belief. the “history of cancer,” associated their It would also seem important to un- disease symptoms with aging rather than derstand, to what extent do we realize cancer or other diseases (Heidrich et al. that it is our lifestyle and environment 2006). Given the above issues, it is worth (e.g. pollution, exposure to carcinogens, noting that in the group of older people etc.) which may contribute to the devel- surveyed, only 5% manifested fatalistic opment of cancer. It is disturbing that beliefs. The vast majority of respondents one-third of respondents (34%) do not recognize the need to undergo preventive notice the correlation between certain oncology care: 63% believe one should elements of their lifestyle and the en- also do it, even if there are no symptoms vironment in which they function, and and 25% – only in situations where there the possibility for getting cancer. Lack of are some worrying symptoms. Aware- awareness is likely to result in inaction in ness of the importance of prevention po- changing their lifestyle. Understanding tentially increases the likelihood of early people’s beliefs about cancer helps in de- detection. However, a deeper analysis is signing more efficient health promotion needed to examine the direction of the and cancer prevention programs. Based association between older adult’s beliefs on the analysis of the research materials, about prevention and the actual imple- it can be stated that in developing strate- mentation of preventive practices. gies for cancer prevention aimed at older Health behavior is also influenced by adults, special attention should be paid how responsible we feel for our health. to raising awareness about the impact Psychological research shows that when of lifestyle on cancer incidence, increas- people shift the responsibility for their ing the sense of responsibility for their health „outside” (e.g. external locus of health, and reducing older adult’s “exter- control), they are less active in mak- nal locus of control” beliefs. ing health-related decisions. Besides, it Furthermore, due to a small survey can reduce the sense of self-efficiency sample further research is needed on (Straughan et al. 1998) and motivation a representative sample of Polish society. to perform preventive behaviors (Under- Beliefs about cancer prevention 295

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