J Canc Educ DOI 10.1007/s13187-014-0698-7
Cancer Prevention and Care: a National Sample from Jordan Muayyad M. Ahmad & Latefa Ali Dardas & Huthaifa Ahmad
# Springer Science+Business Media New York 2014
Abstract This survey was designed to enhance cancer prevention and care in a sample from the Arab world. A descriptive survey research design was adopted. A representative sample of 3,196 individuals from the three main regions of Jordan (north, middle, and south) was used. Data were collected through interviews. The tool for the study included the following aspects: identification and background information; health status; participant’s lifestyle; general beliefs about cancer prevention; screening and early detection; and communication channels and seeking information about cancer. The participants believed that the three greatest factors related to cancer specifically in Jordan were active cigarette smoking, exposure to radiation, and exposure to chemicals. The majority of the participants agreed that getting regular cancer checkup helps diagnose the disease early with a good prognosis. Interestingly, cancer checkup was about seven times greater among females than males. Married individuals performed checkup four times more than singles. The findings indicate that knowledge gaps and improper practices toward cancer existed among the participants and, if corrected, could facilitate the care, prevention, and early detection of cancer. The findings help in defining key areas that should be addressed in national cancer policies in Jordan.
M. M. Ahmad (*) : L. A. Dardas Faculty of Nursing, The University of Jordan, Amman 11942, Jordan e-mail: [email protected] M. M. Ahmad e-mail: [email protected] L. A. Dardas e-mail: [email protected] L. A. Dardas e-mail: [email protected] H. Ahmad Faculty of Medicine, The University of Jordan, Amman, Jordan e-mail: [email protected]
Keywords Cancer . Jordan . Knowledge . Attitude . Prevention . Care
Background Cancer is one of the most preventable noncommunicable chronic diseases. Nevertheless, the number of cancer patients is expected to reach 9 million by 2015 and increase to 11.5 million in 2030 [1]. Furthermore, cancer killed about 7.6 million people in 2005, and three quarters of them were in low- and middle-income countries [2]. Indeed, in developed countries, 50 % of cancer patients die of the disease, while in developing countries, 80 % of cancer patients already had latestage incurable tumors when they were diagnosed [3]. Jordan is one of the low-income developing countries that is located in Southwest Asia. The country is a relatively homogeneous society with 98 % of the total population extending from Arabic origins. The health sector in Jordan provides primary, secondary, and tertiary health care to the general population via a network of hospitals and health-care centers [4]. Cancer is the second leading cause of death in Jordan after heart diseases [5]. The most prevalent cancers in the country reported in 2008 were breast, colorectal, lung, lymphoma, leukemia, urinary bladder, stomach, prostate, brain, and thyroid cancers [6]. Cancer treatment in Jordan faces similar challenges to those faced by other countries in regard to the increasing costs and resources required to manage the disease [7]. Control of cancer includes several preventive approaches, such as lifestyle changes, as well as early detection practices [8]. However, there is evidence that knowledge gaps and other factors deter effective cancer prevention and early detection in Jordan [9]. In a study of 760 Jordanian women attending general obstetrics and gynecology clinics, it has been found that there was a lack of knowledge regarding diagnostic tests that should be performed for screening and diagnosing cervical cancer [10]. More recent national data are required to
J Canc Educ
understand the behavioral and environmental factors that influence cancer prevention and early detection, in order to recommend better strategies for preventing and decreasing the incidence, morbidity, and mortality rates of cancer in the country. Therefore, the purpose of this survey was to assess the knowledge, attitudes, and behaviors among people in general and high-risk groups in particular regarding cancer prevention and care in Jordan.
Methods Design, Setting, and Sample The knowledge, attitude, and practice (KAP) survey’s sample was designed using the 2004 Population and Housing Census as the sampling frame [11]. The sample was designed to produce reliable estimates for the populations’ KAPs in the 12 governorates in Jordan. The sampling frame was stratified by governorate, major cities, and other urban and rural areas within each stratum. In addition, each city with a population of more than 100,000 was considered a stratum (six cities). Thus, there were 12 urban strata, 12 rural strata, and 6 strata from large cities, with a total number of 30 strata included in the study. People who did not have a fixed place to live in and those who lived in places such as hotels, prisons, and hospitals were excluded from the sampling frame. The geographic distributions of participants in the study in comparison to the actual ratio of the Jordanian population in each governorate are presented in Table 1. Distribution of new cancer cases in 2010 by governorates is shown [12]. In addition, the table Table 1 The geographic distribution of respondents in the survey, in comparison to the population distribution in Jordan by governorate Governorate
Number
% in the study
% of population in Jordana
% of new cancer casesb
Amman Balqa Zarqa Madaba Irbid Mafraq Jarash Ajloun Karak Tafileh Ma’an Aqaba Total
1,479 166 367 43 560 127 91 65 120 35 75 69 3,196
46.3 5.2 11.5 1.3 17.5 4.0 2.8 2.0 3.7 1.1 2.4 2.2 100.0
38.7 6.7 14.9 2.5 17.8 4.7 3.0 2.3 3.9 1.4 1.9 2.2 100.0
60.4 4.3 10.2 1.8 13.5 1.6 1.7 1.2 2.0 0.9 1.1 1.1 100.0
a
According to DOS census data, 2004
b
Jordan MoH 2010 record
presents the percentages of new cancer cases in each governorate as reported by the Ministry of Health (MoH) in the year 2010. The sample was designed to provide estimates for the three main regions of Jordan: north, central, and south. A threestage sampling procedure was employed. First, blocks were selected systematically as primary sampling units (PSUs). A total of 300 PSUs were selected at this stage. Mapping operations were carried out and the sample units/blocks were identified through field visits. The sample size in this survey was 3,196 participants. The majority of the participants’ roles were distributed as head of the household (20 %), spouse (16 %), and son or daughter (59 %).
Recruitment of Staff The survey field-workers were recruited from those who were with experience, educational and personal qualifications, and familiarity with the geographic areas. The interviewers were all females with baccalaureate degrees. Field controllers, supervisors, and editors were recruited from among those who participated in other demographic surveys. Fifty-four qualified field-workers have been recruited to implement the fieldwork. All field-workers attended nine consecutive days of theoretical and practical training. After the training, a pilot study was conducted to test the survey tool, sampling technique, methodology, and interviewers’ qualifications.
Survey Instrument The survey tool which was developed by various health-care experts probed a multitude of aspects in order to comprehensively evaluate population perceptions regarding cancer. Specifically, the tool investigated the following areas: background information (demographic and socioeconomic factors); health status; participants’ lifestyle; general beliefs about cancer prevention, checkup and early detection; new trends/ new areas in cancer research and care in Jordan; communication channels and seeking information about cancer; health facilities and services; and treatment and health priorities. International references/tools were used to guide the development of the tool. Checklist, rating, and Likert scale format were used. Some examples for the questions were as follows: How often do you do routine health checkups?; As far as you know, how do the following types of food and drink affect cancer?; and, How would you describe your smoking habits of any tobacco products such as cigarettes, cigars, argelah, or pipes? The questionnaire was adapted to the local context and was validated by 10 advisory specialists from different health disciplines. Cronbach’s alpha of the checkup survey items in this study was 0.92.
J Canc Educ
Data Collection and Processing
Table 2 Demographic characteristics of the participants based on gender (N=3,196)
Data collection began 2 days after training when the final modifications to the survey tool had been made. Data collection spanned 2 months (January–March, 2011). Face-to-face interviews were conducted by data collectors in the interviewees’ homes. The time of the interviews ranged between 40 and 60 min. The field staff consisted of 18 teams; each team consisted of three data collectors, a controller, a field supervisor, and a driver. The controllers and supervisors conducted spot checks by randomly visiting some sampled households. The completed questionnaires were delivered to the central office in Amman for processing day by day. The Statistical Package for Social Sciences was used to run univariate and bivariate analyses [13]; the analysis techniques included the Kruskal-Wallis test and the logistic regression. Data collection and data processing activities proceeded almost simultaneously. Interviewers made repeated attempts to obtain the responses of eligible respondents by calling back to interview eligible respondents who were not home at the time of the first visit. This method of strictly observing each questionnaire has led to zero missing in the data.
Demographics
Age
Marital status
Education
Incomea
a
Category
Males
Females
n 1,647
% 51.5
n 1,549
% 48.5
18–29 30–39 40–49 50–59 ≥60 Single
488 478 348 106 227 423
29.6 29.0 21.1 6.4 13.8 25.7
475 438 280 165 192 212
30.7 28.3 18.1 10.6 12.4 13.7
Married Others ≤Elementary Preparatory to high school ≥Diploma
Cancer Prevention and Care: a National Sample from Jordan Muayyad M. Ahmad & Latefa Ali Dardas & Huthaifa Ahmad
# Springer Science+Business Media New York 2014
Abstract This survey was designed to enhance cancer prevention and care in a sample from the Arab world. A descriptive survey research design was adopted. A representative sample of 3,196 individuals from the three main regions of Jordan (north, middle, and south) was used. Data were collected through interviews. The tool for the study included the following aspects: identification and background information; health status; participant’s lifestyle; general beliefs about cancer prevention; screening and early detection; and communication channels and seeking information about cancer. The participants believed that the three greatest factors related to cancer specifically in Jordan were active cigarette smoking, exposure to radiation, and exposure to chemicals. The majority of the participants agreed that getting regular cancer checkup helps diagnose the disease early with a good prognosis. Interestingly, cancer checkup was about seven times greater among females than males. Married individuals performed checkup four times more than singles. The findings indicate that knowledge gaps and improper practices toward cancer existed among the participants and, if corrected, could facilitate the care, prevention, and early detection of cancer. The findings help in defining key areas that should be addressed in national cancer policies in Jordan.
M. M. Ahmad (*) : L. A. Dardas Faculty of Nursing, The University of Jordan, Amman 11942, Jordan e-mail: [email protected] M. M. Ahmad e-mail: [email protected] L. A. Dardas e-mail: [email protected] L. A. Dardas e-mail: [email protected] H. Ahmad Faculty of Medicine, The University of Jordan, Amman, Jordan e-mail: [email protected]
Keywords Cancer . Jordan . Knowledge . Attitude . Prevention . Care
Background Cancer is one of the most preventable noncommunicable chronic diseases. Nevertheless, the number of cancer patients is expected to reach 9 million by 2015 and increase to 11.5 million in 2030 [1]. Furthermore, cancer killed about 7.6 million people in 2005, and three quarters of them were in low- and middle-income countries [2]. Indeed, in developed countries, 50 % of cancer patients die of the disease, while in developing countries, 80 % of cancer patients already had latestage incurable tumors when they were diagnosed [3]. Jordan is one of the low-income developing countries that is located in Southwest Asia. The country is a relatively homogeneous society with 98 % of the total population extending from Arabic origins. The health sector in Jordan provides primary, secondary, and tertiary health care to the general population via a network of hospitals and health-care centers [4]. Cancer is the second leading cause of death in Jordan after heart diseases [5]. The most prevalent cancers in the country reported in 2008 were breast, colorectal, lung, lymphoma, leukemia, urinary bladder, stomach, prostate, brain, and thyroid cancers [6]. Cancer treatment in Jordan faces similar challenges to those faced by other countries in regard to the increasing costs and resources required to manage the disease [7]. Control of cancer includes several preventive approaches, such as lifestyle changes, as well as early detection practices [8]. However, there is evidence that knowledge gaps and other factors deter effective cancer prevention and early detection in Jordan [9]. In a study of 760 Jordanian women attending general obstetrics and gynecology clinics, it has been found that there was a lack of knowledge regarding diagnostic tests that should be performed for screening and diagnosing cervical cancer [10]. More recent national data are required to
J Canc Educ
understand the behavioral and environmental factors that influence cancer prevention and early detection, in order to recommend better strategies for preventing and decreasing the incidence, morbidity, and mortality rates of cancer in the country. Therefore, the purpose of this survey was to assess the knowledge, attitudes, and behaviors among people in general and high-risk groups in particular regarding cancer prevention and care in Jordan.
Methods Design, Setting, and Sample The knowledge, attitude, and practice (KAP) survey’s sample was designed using the 2004 Population and Housing Census as the sampling frame [11]. The sample was designed to produce reliable estimates for the populations’ KAPs in the 12 governorates in Jordan. The sampling frame was stratified by governorate, major cities, and other urban and rural areas within each stratum. In addition, each city with a population of more than 100,000 was considered a stratum (six cities). Thus, there were 12 urban strata, 12 rural strata, and 6 strata from large cities, with a total number of 30 strata included in the study. People who did not have a fixed place to live in and those who lived in places such as hotels, prisons, and hospitals were excluded from the sampling frame. The geographic distributions of participants in the study in comparison to the actual ratio of the Jordanian population in each governorate are presented in Table 1. Distribution of new cancer cases in 2010 by governorates is shown [12]. In addition, the table Table 1 The geographic distribution of respondents in the survey, in comparison to the population distribution in Jordan by governorate Governorate
Number
% in the study
% of population in Jordana
% of new cancer casesb
Amman Balqa Zarqa Madaba Irbid Mafraq Jarash Ajloun Karak Tafileh Ma’an Aqaba Total
1,479 166 367 43 560 127 91 65 120 35 75 69 3,196
46.3 5.2 11.5 1.3 17.5 4.0 2.8 2.0 3.7 1.1 2.4 2.2 100.0
38.7 6.7 14.9 2.5 17.8 4.7 3.0 2.3 3.9 1.4 1.9 2.2 100.0
60.4 4.3 10.2 1.8 13.5 1.6 1.7 1.2 2.0 0.9 1.1 1.1 100.0
a
According to DOS census data, 2004
b
Jordan MoH 2010 record
presents the percentages of new cancer cases in each governorate as reported by the Ministry of Health (MoH) in the year 2010. The sample was designed to provide estimates for the three main regions of Jordan: north, central, and south. A threestage sampling procedure was employed. First, blocks were selected systematically as primary sampling units (PSUs). A total of 300 PSUs were selected at this stage. Mapping operations were carried out and the sample units/blocks were identified through field visits. The sample size in this survey was 3,196 participants. The majority of the participants’ roles were distributed as head of the household (20 %), spouse (16 %), and son or daughter (59 %).
Recruitment of Staff The survey field-workers were recruited from those who were with experience, educational and personal qualifications, and familiarity with the geographic areas. The interviewers were all females with baccalaureate degrees. Field controllers, supervisors, and editors were recruited from among those who participated in other demographic surveys. Fifty-four qualified field-workers have been recruited to implement the fieldwork. All field-workers attended nine consecutive days of theoretical and practical training. After the training, a pilot study was conducted to test the survey tool, sampling technique, methodology, and interviewers’ qualifications.
Survey Instrument The survey tool which was developed by various health-care experts probed a multitude of aspects in order to comprehensively evaluate population perceptions regarding cancer. Specifically, the tool investigated the following areas: background information (demographic and socioeconomic factors); health status; participants’ lifestyle; general beliefs about cancer prevention, checkup and early detection; new trends/ new areas in cancer research and care in Jordan; communication channels and seeking information about cancer; health facilities and services; and treatment and health priorities. International references/tools were used to guide the development of the tool. Checklist, rating, and Likert scale format were used. Some examples for the questions were as follows: How often do you do routine health checkups?; As far as you know, how do the following types of food and drink affect cancer?; and, How would you describe your smoking habits of any tobacco products such as cigarettes, cigars, argelah, or pipes? The questionnaire was adapted to the local context and was validated by 10 advisory specialists from different health disciplines. Cronbach’s alpha of the checkup survey items in this study was 0.92.
J Canc Educ
Data Collection and Processing
Table 2 Demographic characteristics of the participants based on gender (N=3,196)
Data collection began 2 days after training when the final modifications to the survey tool had been made. Data collection spanned 2 months (January–March, 2011). Face-to-face interviews were conducted by data collectors in the interviewees’ homes. The time of the interviews ranged between 40 and 60 min. The field staff consisted of 18 teams; each team consisted of three data collectors, a controller, a field supervisor, and a driver. The controllers and supervisors conducted spot checks by randomly visiting some sampled households. The completed questionnaires were delivered to the central office in Amman for processing day by day. The Statistical Package for Social Sciences was used to run univariate and bivariate analyses [13]; the analysis techniques included the Kruskal-Wallis test and the logistic regression. Data collection and data processing activities proceeded almost simultaneously. Interviewers made repeated attempts to obtain the responses of eligible respondents by calling back to interview eligible respondents who were not home at the time of the first visit. This method of strictly observing each questionnaire has led to zero missing in the data.
Demographics
Age
Marital status
Education
Incomea
a
Category
Males
Females
n 1,647
% 51.5
n 1,549
% 48.5
18–29 30–39 40–49 50–59 ≥60 Single
488 478 348 106 227 423
29.6 29.0 21.1 6.4 13.8 25.7
475 438 280 165 192 212
30.7 28.3 18.1 10.6 12.4 13.7
Married Others ≤Elementary Preparatory to high school ≥Diploma
