University of Florida Thesis Or Dissertation

A SYSTEMATIC SCOPING REVIEW OF COMMUNICATION-BASED STUDIES ON CANCER PREVENTION AND DETECTION IN BANGLADESH By AANTAKI RAISA A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN MASS COMMUNICATION UNIVERSITY OF FLORIDA 2019 © 2019 Aantaki Raisa To my mom, sister and mentor, whose unconditional love, support and guidance have brought me where I am today, including the completion of this thesis ACKNOWLEDGMENTS I would like to take this opportunity to thank Dr. Janice Krieger, my mentor, my advisor, who has taught me to be my best version, and inspired me to try relentlessly to excel. My gratitude is extended towards my thesis co-chair Dr. Carma Bylund, who has been my North Star, providing me directions in the very maze-like world of systematic reviews. I could not thank Dr. Frank Waddell enough, who took the time and effort to guide me through my thesis with his feedback, challenging insights and positivity. I would also like to take this opportunity to thank Mr. Reza Salim. I am forever in debt to him as he had introduced me to the world of translational science and to Dr. Krieger, where it all started for me. Finally, I would like to thank Taylor Thelander, a fellow master’s student, who came into my rescue to co-code within a short notice. I would also like to thank Dr. Alyssa Jaisle, who kept me accountable with my daily writing goals. Last but definitely not the least, I want to shout out to my STCC family, who has been a pillar of strength, support and love in my journey. 4 TABLE OF CONTENTS page <a href="#4_0">ACKNOWLEDGMENTS.................................................................................................. 4 </a><a href="#8_0">LIST OF TABLE</a><a href="#8_0">S</a><a href="#8_0">.</a><a href="#8_0">........................................................................................................... 8 </a><a href="#9_0">LIST OF FIGURES.......................................................................................................... 9 </a><a href="#10_0">LIST OF ABBREVIATION</a><a href="#10_0">S</a><a href="#10_0">.</a><a href="#10_0">.......................................................................................... 10 </a><a href="#12_0">ABSTRAC</a><a href="#12_0">T</a><a href="#12_0">.</a><a href="#12_0">.................................................................................................................. 12 </a>CHAPTER 12 <a href="#14_0">INTRODUCTION .................................................................................................... 14 </a><a href="#17_0">BACKGROUND AND NEED................................................................................... 17 </a><a href="#17_1">Country Overview ................................................................................................... 17 </a><a href="#18_0">Healthcare Infrastructure in Bangladesh................................................................. 18 </a><a href="#20_0">Health Policy Infrastructure in Bangladesh ............................................................. 20 </a><a href="#0_0">Burden of Cancer in Banglades</a><a href="#0_0">h</a><a href="#0_0">.</a><a href="#0_0">........................................................................... 21 </a> <a href="#0_1">Burden of Cancer Based on Cancer Type</a><a href="#0_1">s</a><a href="#0_1">.</a><a href="#0_1">..................................................... 21 </a><a href="#0_2">Environmental and Other Systemic Factors Contributing to the Risk of </a> <a href="#0_2">Cancer........................................................................................................... 21 </a> <a href="#0_3">Resources Available to Reduce the Risk of Cance</a><a href="#0_3">r</a><a href="#0_3">.</a><a href="#0_3">........................................ 23 </a> <a href="#0_4">Implementing Policies Based on Research............................................................. 24 </a> <a href="#0_5">Knowledge-to-Action (KTA) Model ................................................................... 25 </a><a href="#0_3">Cancer Communicatio</a><a href="#0_3">n</a><a href="#0_3">.</a><a href="#0_3">................................................................................... 27 </a> <a href="#0_6">Systematic Literature Reviews................................................................................ 30 </a><a href="#0_7">Theoretical Underpinning</a><a href="#0_7">s</a><a href="#0_7">.</a><a href="#0_7">..................................................................................... 32 </a><ul style="display: flex;"><li style="flex:1">3</li><li style="flex:1"><a href="#0_8">METHOD ................................................................................................................ 36 </a></li></ul><a href="#0_9">Eligibility Criteria ..................................................................................................... 36 </a> <a href="#0_7">Inclusion Criteria............................................................................................... 37 </a><a href="#0_0">Exclusion Criteria ............................................................................................. 38 </a> <a href="#0_10">Information Sources................................................................................................ 38 </a><a href="#0_11">Search Strateg</a><a href="#0_11">y</a><a href="#0_11">.</a><a href="#0_11">..................................................................................................... 39 </a><a href="#0_12">Study Records ........................................................................................................ 39 </a><a href="#0_0">Data Items .............................................................................................................. 40 </a><a href="#0_13">Risk of Bias in Individual Studie</a><a href="#0_13">s</a><a href="#0_13">.</a><a href="#0_13">........................................................................... 40 </a><a href="#0_0">Data Synthesis........................................................................................................ 41 </a><a href="#0_14">Meta-Bias................................................................................................................ 42 </a><ul style="display: flex;"><li style="flex:1">4</li><li style="flex:1"><a href="#0_8">RESULTS ............................................................................................................... 44 </a></li></ul>5<a href="#0_15">Article</a><a href="#0_15">s</a><a href="#0_15">.</a><a href="#0_15">................................................................................................................... 44 </a><a href="#0_16">Receiver.................................................................................................................. 46 </a> <a href="#0_17">Population ........................................................................................................ 47 </a> <a href="#0_18">Female-only participant</a><a href="#0_18">s</a><a href="#0_18">.</a><a href="#0_18">........................................................................... 47 </a><a href="#0_7">Male and female participants combined..................................................... 48 </a><a href="#0_17">Other.......................................................................................................... 50 </a> <a href="#0_19">Breast Cancer .................................................................................................. 50 </a> <a href="#0_3">Knowledge ................................................................................................. 51 </a><a href="#0_11">Misconceptions .......................................................................................... 52 </a><a href="#0_20">Predictors of knowledge/awareness .......................................................... 52 </a><a href="#0_0">Attitude....................................................................................................... 53 </a><a href="#0_21">Barriers to screenin</a><a href="#0_21">g</a><a href="#0_21">.</a><a href="#0_21">................................................................................. 53 </a><a href="#0_17">Risk factors ................................................................................................ 55 </a> <a href="#0_10">Cervical Cance</a><a href="#0_10">r</a><a href="#0_10">................................................................................................ 55 </a> <a href="#0_0">Knowledge ................................................................................................. 56 </a><a href="#0_22">Knowledge about symptom</a><a href="#0_22">s</a><a href="#0_22">.</a><a href="#0_22">..................................................................... 57 </a><a href="#0_20">Misconceptions .......................................................................................... 57 </a><a href="#0_0">Attitude....................................................................................................... 58 </a><a href="#0_6">Perceived severity...................................................................................... 59 </a><a href="#0_23">Barriers to screenin</a><a href="#0_23">g</a><a href="#0_23">.</a><a href="#0_23">................................................................................. 59 </a><a href="#0_24">Risk factors ................................................................................................ 60 </a> <a href="#0_21">Tobacco Contro</a><a href="#0_21">l</a><a href="#0_21">.</a><a href="#0_21">.............................................................................................. 60 </a> <a href="#0_6">Knowledge ................................................................................................. 61 </a><a href="#0_0">Attitude and perceived severity of tobacco consumption ........................... 62 </a><a href="#0_18">Barriers to and predictors of cessation....................................................... 62 </a><a href="#0_14">Risk factors ................................................................................................ 63 </a> <a href="#0_25">Sender .................................................................................................................... 63 </a> <a href="#0_0">Trust in Sender................................................................................................. 64 </a><a href="#0_26">Source/Channel of Information......................................................................... 64 </a> <a href="#0_24">Breast cancer studies ................................................................................ 65 </a><a href="#0_12">Cervical cancer studie</a><a href="#0_12">s</a><a href="#0_12">.</a><a href="#0_12">............................................................................. 65 </a><a href="#0_27">Tobacco control studies ............................................................................. 66 </a> <a href="#0_28">Message ................................................................................................................. 67 </a><a href="#0_0">Other Cancers ........................................................................................................ 71 </a> <a href="#0_23">Lung Cancer..................................................................................................... 71 </a><a href="#0_29">Oral Cance</a><a href="#0_29">r</a><a href="#0_29">.</a><a href="#0_29">..................................................................................................... 71 </a><a href="#0_11">Testicular Cancer ............................................................................................. 72 </a><ul style="display: flex;"><li style="flex:1">5</li><li style="flex:1"><a href="#0_8">DISCUSSION ......................................................................................................... 87 </a></li></ul><a href="#0_30">Audience Analysis .................................................................................................. 87 </a> <a href="#0_31">Knowledge about Cancer ................................................................................. 87 </a><a href="#0_32">Perceived Barriers to Cancer Prevention ......................................................... 88 </a> <a href="#0_24">Low perceived susceptibility to cancer</a><a href="#0_24">.</a><a href="#0_24">.</a><a href="#0_24">..................................................... 89 </a><a href="#0_23">Low perceived self-efficacy of cancer screening........................................ 89 </a><a href="#0_0">Poor healthcare infrastructure.................................................................... 90 </a><a href="#0_0">Literacy. ..................................................................................................... 91 </a>6<a href="#0_10">Gender Differences .......................................................................................... 91 </a><a href="#0_14">Geographic Differences.................................................................................... 92 </a> <a href="#0_0">Theoretical Implications .......................................................................................... 93 </a><a href="#0_33">Practical Implications .............................................................................................. 95 </a><a href="#0_34">Limitations & Future Research................................................................................ 97 </a><ul style="display: flex;"><li style="flex:1">6</li><li style="flex:1"><a href="#0_8">CONCLUSIO</a><a href="#0_8">N</a><a href="#0_8">...................................................................................................... 101 </a></li></ul>APPENDIX A <a href="#0_8">ARTICLE SEARCH STRATEGY .......................................................................... 103 </a>B <a href="#0_35">QUALTRICS SURVEY.......................................................................................... 105 </a><a href="#0_0">LIST OF REFERENCES ............................................................................................. 109 </a><a href="#0_0">BIOGRAPHICAL SKETCH.......................................................................................... 119 </a>7 LIST OF TABLES <ul style="display: flex;"><li style="flex:1">Table </li><li style="flex:1">page </li></ul><a href="#0_0">3-1 </a><a href="#0_14">3-2 </a><a href="#0_36">3-3 </a><a href="#0_37">3-4 </a><a href="#0_14">3-5 </a><a href="#0_38">3-6 </a> <a href="#0_0">Journal impact factor. ......................................................................................... 73 </a><a href="#0_14">Review articles by cancer type. .......................................................................... 74 </a><a href="#0_36">Articles about Breast Cancer Prevention and Detection</a><a href="#0_36">.</a><a href="#0_36">.</a><a href="#0_36">................................... 74 </a><a href="#0_37">Articles about Cervical Cancer Prevention and Detection. ................................. 78 </a><a href="#0_14">Articles about Tobacco Control and Prevention.................................................. 83 </a><a href="#0_38">Articles on other types of cancers....................................................................... 86 </a>8 LIST OF FIGURES <ul style="display: flex;"><li style="flex:1">Figure </li><li style="flex:1">page </li></ul><a href="#0_39">2-1 </a><a href="#0_40">3-1 </a> <a href="#0_39">Knowledge to action process.............................................................................. 35 </a><a href="#0_40">Flowchart of systematic scoping review process</a><a href="#0_40">.</a><a href="#0_40">.</a><a href="#0_40">.............................................. 43 </a>9 LIST OF ABBREVIATIONS Breast Self-Examination Central Intelligence Agency BSE CIA <ul style="display: flex;"><li style="flex:1">COPD </li><li style="flex:1">Chronic Obstructive Pulmonary </li></ul>Disease <ul style="display: flex;"><li style="flex:1">CBE </li><li style="flex:1">Clinical Breast Exam </li></ul>CHW CMMU Community Health Worker Construction Maintenance and Management Unit <ul style="display: flex;"><li style="flex:1">DHHS </li><li style="flex:1">Department of Health and </li></ul>Human Services <ul style="display: flex;"><li style="flex:1">DDT </li><li style="flex:1">Dichlorodiphenyltrichloroethane </li></ul><ul style="display: flex;"><li style="flex:1">DGFP </li><li style="flex:1">Directorate General of Health </li></ul>Services <ul style="display: flex;"><li style="flex:1">DDA </li><li style="flex:1">Directorate of Drug </li></ul>Administration <ul style="display: flex;"><li style="flex:1">DNS </li><li style="flex:1">Directorate of Nursing Services </li></ul><ul style="display: flex;"><li style="flex:1">EPPM </li><li style="flex:1">Extended Parallel Process </li></ul>Model <ul style="display: flex;"><li style="flex:1">HMN </li><li style="flex:1">Health Metrics Network </li></ul><ul style="display: flex;"><li style="flex:1">HNAP </li><li style="flex:1">Health National Adaptation </li></ul>Plan HDI HPV HRW IF Human Development Index Human Papillomavirus Human Rights Watch Impact Factor <ul style="display: flex;"><li style="flex:1">IAEA </li><li style="flex:1">International Atomic Energy </li></ul>Agency 10 <ul style="display: flex;"><li style="flex:1">ITC </li><li style="flex:1">Internaitonal Tobacco Control </li></ul><ul style="display: flex;"><li style="flex:1">Knowledge-to-Action </li><li style="flex:1">KTA </li></ul><ul style="display: flex;"><li style="flex:1">LMIC </li><li style="flex:1">Low to Middle Income </li></ul>Countries mHealth MOHFW Mobile Health Ministry of Healthand Family Welfare <ul style="display: flex;"><li style="flex:1">NCCP </li><li style="flex:1">National Cancer Control </li></ul>Program NNP NGO National Nutrition Programme Non-Governmental Organization PLoS RCT SJR Public Library of Science Randomized Controlled Trial SCImago Journal Rank <ul style="display: flex;"><li style="flex:1">Socioeconomic Status </li><li style="flex:1">SES </li></ul><ul style="display: flex;"><li style="flex:1">SDG </li><li style="flex:1">Sustainable Development </li></ul>Goals TSE TPB VIA Testicular Self-Examination Theory of Planned Behavior Visual Inspection with Acetic Acid <ul style="display: flex;"><li style="flex:1">WHO </li><li style="flex:1">World Health Organization </li></ul>11 Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Arts in Mass Communication A SYSTEMATIC SCOPING REVIEW OF COMMUNICATION-BASED STUDIES ON CANCER PREVENTION AND DETECTION IN BANGLADESH By Aantaki Raisa August 2019 Chair: Janice Krieger Cochair: Carma Bylund Major: Mass Communication The aim of this systematic scoping review is to review all the peer-reviewed journal articles on communication-based studies for cancer prevention and detection conducted in Bangladesh. By doing so, this study aims to synthesize and aggregate the primary research on cancer communication in a low-to-middle income country (LMIC), in order to create second-generation knowledge, proposed by the Knowledge-to-Action (KTA) model. A systematic scoping review method was applied to synthesize review articles from three academic databases: PsycINFO, Academic Search Premier, and PubMed. Out of 985 citations resulting from the initial search, 35 were selected for inclusion. Analysis of these articles found that uneducated, rural, slum-dwelling people are more vulnerable to cancer due to their lack of knowledge, awareness, and access to care than the urban, educated people. Overall, the samples in the articles showed high perceived severity of different types of cancer, and high perceived response efficacy of different screening methods. However, due to the low perceived susceptibility of cancer, and low perceived self-efficacy of screening, overall screening uptake is low. While major barriers to seeking care differs based on cancer type, common ones include lack 12 of symptoms, lack of knowledge regarding the screening process, and lack of access. Additioanlly, social and infrastructural barriers persist. Social barriers include stigma, misconceptions, fear of being screened positive, as well as fear of being abandoned by family. The main infrastructural barriers are lack of access and low priority of women’s health in the family. Culturally sensitive (i.e. language, gender and race concordant) and environmentally appropriate (effective channel of message dissemination) interventions are required for increasing knowledge and awareness of cancer and cancer care. 13 CHAPTER 1 INTRODUCTION Globally, one in six people die of cancer (Cancer, 2018) making cancer the second leading cause of death worldwide with 9.6 million cancer deaths in 2018. Seventy percent of cancer deaths occur in Low-to-Middle-Income countries (LMICs), such as Bangladesh (Cancer, 2018). Healthcare disparities are influenced by geography (Ndiaye et al., 2008), race/ethnicity (Krieger, 2003), economy (Lown & Banerjee, 2006), and religious beliefs (Padela & Curlin, 2012). Seven and a half trillion U.S. dollar is spent annually on healthcare worldwide. Of this only 20% is spent in LMICs where 80% of the world population reside (Xu et al., 2018). Being a LMIC, Bangladesh has internal factors which make its population vulnerable to cancer. For example, a healthcare infrastructure that is inadequate for supporting the 160 million people residing in the country, especially in the rural areas; the absence of a national cancer registry; primary care that lacks cancer screening; unavailability of expert oncologists; and an overall low level of cancer literacy among the general population (Hussain & Sullivan, 2013; Hussain, 2013). Only one in five LMICs have the necessary data to drive cancer policy (Cancer, 2018). According to the last published health policy of Bangladesh in 2011, there is no specific plan for cancer control (National Health Plan, 2011). Proposed by the World Health Organization (WHO), the Bangladesh Health-National Adaptation Plan (HNAP) is still pending and thereby lacks cancer-specific prevention plans (HNAP, 2018). The National Cancer Control Strategy and Plan of Action (2008) finalized by the government of Bangladesh expired in 2015 and has not been updated. 14 Countries like Bangladesh are also vulnerable to external factors which increase the risk of cancer among its populations. According to the WHO, the most important risk factors for cancer are tobacco use, obesity, and unhealthy diet such as excessive consumption of processed food (Cancer, 2018). While high income countries are implementing strict policies to restrict companies from exploiting their citizens by pushing these products, LMICs have yet to catch up with such policies (What ministries of information and communication need to know, 2016). As a result, companies producing tobacco, processed food, and sugar/beverages are targeting LMICs, taking advantage of the lack of policies to protect their citizens. Implementing evidence-based policies for cancer control can be an effective step for Bangladesh. According to the knowledge-to-action (KTA) model, the translation of empirical evidence into policies can be achieved in two basic steps: knowledge creation and action (Graham, 2006). The knowledge is created in three phases: inquiry or firstgeneration knowledge, synthesis or second-generation knowledge, and knowledge tools/products or third-generation knowledge. Local cancer researchers, along with researchers in collaboration with foreign partners have conducted numerous studies to evaluate the cancer scenario in Bangladesh. Therefore, the first step in the KTA model, creation of first-generation knowledge, is present and continuing. The second step is to synthesize this available eclectic knowledge of various cancers, and various strategies among different population groups within the country to obtain a comprehensive and systematic overview of cancer beliefs, preventive interventions, and awareness in Bangladesh. This synthesized knowledge helps inform the third generation of knowledge, such as policies, frameworks and health promotion campaigns. Usually,

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