Values and their relationship with emotion processing and physical and psychological symptoms among Jewish and Arab breast cancer survivors.

Introduction: Individuals from different cultures differ in their values, which encompass belief systems that individuals develop based on their culture, and play a pivotal role in shaping their perspectives. These values may affect emotion processing (EP): the recognition, interpretation, expression and response to bodily sensations, translated as emotions. These varying values may contribute to distinct emotional experiences, impacting physical and psychological symptoms in breast cancer (BC) survivors. Methods: This cross-sectional study investigated how EP including acceptance, expression (avoidance and approach coping), and awareness, may mediate the relationship between conservation values and symptoms of pain, fatigue, and depression among Arab (n = 62) and Jewish (n = 179) women BC survivors in Israel. Conservation values include tradition, conformity, and security. Results: Depression and fatigue were negatively correlated with acceptance of emotions, and positively correlated with avoidance and conservation levels. Emotion processing mediated the relationship between conservation and fatigue and depression. Arab women reported higher levels of various values, emotional acceptance, pain, fatigue, and depression symptoms compared to Jewish women. Conservation was higher in Arab women and correlated with both approach and avoidance coping which was not the case in Jewish women. Avoidance coping had a positive relationship with fatigue in the Jewish, but not the Arab women. Similarly, approach coping was negatively related to depression in Jewish, but not in Arab women. Discussion: Cultural differences are important for understanding the experience of cancer in individuals from different cultures. Future interventions for more conservative BC survivors should take culture into account.

The Moderating Role of Clinical Experience in the Relationship Between Patient Characteristics, Attributed Barriers to Mammography, Beliefs About Cancer, and Clinical Decisions: a Study of Israeli Arab Physicians.

This study examined whether clinical experience moderates the relationship between three potential physician biases (patient characteristics; cancer-related beliefs, i.e., traditional and fatalistic beliefs; and attributed barriers to mammogram performance) and clinical decisions (recommending and discussing mammography with Arab women patients). A survey was conducted among 146 randomly sampled (cluster sampling) Arab physicians who serve the Arab population in Israel. We found that the least experienced physicians recommended and discussed mammography to a lesser extent than experienced doctors. Less experienced physicians were also less inclined to discuss and recommend mammography to women with specific characteristics (religious women, women with lower education levels, and women who expressed high fatalistic beliefs) and held significantly higher traditional beliefs concerning cancer. The correlation between patient characteristics and clinical decision making was both direct and moderated by clinical experience (stronger for the least experienced and moderately experienced physicians). Cancer-related beliefs had a direct negative effect on recommending and discussing mammography. The findings suggest that greater clinical experience with Arab women patients might reduce physician bias pertaining to patient characteristics among less experienced doctors who serve patients of the same ethnicity. Nonetheless, the findings imply that anti-stigma interventions should not rely on prolonged contact and should be implemented among all physicians, regardless of their clinical experience.

Cultural Barriers to Breast Cancer Screening and Medical Mistrust Among Arab American Women.

Breast cancer is a common cancer among women in the US and cultural barriers and medical mistrust have been associated with breast cancer screening (BCS) rates among minority populations. A heterogeneous sample of Arab women (N = 196) were recruited from across the Detroit metropolitan area and administered a questionnaire. Multiple regression analyses revealed an association between Arab Cultural Specific Barriers (ACSB) to BCS and Group-Based Medical Mistrust Scale. The environmental ACSB to BCS was associated with the medical mistrust-suspicion of HC providers (ß = 0.363, p = 0.01), lack of HC provider support (ß = 0.396, p = 0.001), and Arab inequities (ß = 0.250, p = 0.05). Findings suggest that ACSB to BCS are predictive of medical mistrust for Arab American women. This study illuminates the need to emphasize strategies that will target the medical care system and the cultural barriers to BCS that Arab American women face in the health care system.

The role of explanatory models of breast cancer in breast cancer prevention behaviors among Arab-Israeli physicians and laywomen.

BACKGROUND: 'Explanatory Models' (EMs) are frameworks through which individuals and groups understand diseases, are influenced by cultural and religious perceptions of health and illness, and influence both physicians and patients' behaviors. AIMS: To examine the role of EMs of illness (cancer-related perceptions) in physicians' and laywomen's behaviors (decision to recommend undergoing regular mammography, adhering to mammography) in the context of a traditional-religious society, that is, the Arab society in Israel. METHODS: Two combined samples were drawn: a representative sample of 146 Arab physicians who serve the Arab population and a sample composed of 290 Arab women, aged 50-70 years, representative of the main Arab groups residing in the north and center of Israel (Muslims, Christians) were each randomly sampled (cluster sampling). All respondents completed a closed-ended questionnaire. RESULTS: Women held more cultural cancer-related beliefs and fatalistic beliefs than physicians. Physicians attributed more access barriers to screening as well as fear of radiation to women patients and lower social barriers to screening, compared with the women's community sample. Higher fatalistic beliefs among women hindered the probability of adherence to mammography; physicians with higher fatalistic beliefs were less likely to recommend mammography. CONCLUSIONS: The role of cultural perceptions needs to be particularly emphasized. In addition to understanding the patients' perceptions of illness, physicians must also reflect on the social, cultural, and psychological factors that shape their decision to recommend undergoing regular mammography.

Psychometric properties of the Arabic version of the Activities-Specific Balance Confidence (ABC) scale in ambulatory, community-dwelling, elderly people.

Background: Fear of falling (FOF) is common among elderly individuals and can appear independently of a previous fall. FOF can start a vicious cycle by leading to a sedentary lifestyle and further FOF, with negative physical and mental consequences. The Activities-Specific Balance Confidence (ABC) scale is a popular, theoretically based, reliable and valid tool designed to assess FOF in ambulatory, community-dwelling, elderly people. A balance confidence measurement tool for Arabic-speaking ambulatory, community-dwelling, elderly individuals is lacking. The objective of the present study was to translate and culturally adapt the ABC to Arabic and to determine its psychometric properties in ambulatory, community-dwelling elderly people. Materials and methods: This two-stage exploratory study included a forward and backward translation process and the administration of the Arabic ABC (A-ABC) via face-to-face interviews. In addition, performance-based clinical measures of balance were assessed, and two self-report physical function and disability questionnaires were administered. The study included 60 volunteers (34 women), with a mean age of 74.1±6.23 years, recruited from the Arab population of northern Israel. To determined test-retest reliability, the questionnaire was re-administered to 40 of the 60 participants twice at a 6-8-day interval. Results: One of the 16 A-ABC scale items was modified to adjust for local climate. The main results included high internal consistency (Cronbach's α=0.97), good to excellent structural coherence (corrected item-total correlation: 0.77-0.92); excellent test-retest reliability (ICC=0.98, confidence interval =0.08-3.05); low standard error of measure and low smallest real difference (3.5% and 9.64%, respectively); strong-to-moderate correlations with performance-based clinical measures of balance and self-report physical function and disability questionnaires; and a ceiling effect. A significant difference between genders and between fallers and non-fallers was demonstrated. Conclusions: The A-ABC demonstrated excellent psychometric properties in elderly, Arabic-speaking, independently living individuals and can be used as a balance confidence measurement tool in research and clinical settings.

Factors associated with routine screening for the early detection of breast cancer in cultural-ethnic and faith-based communities.

OBJECTIVES: Studies have shown a lower adherence to health behaviors among women in cultural-ethnic minorities and faith-based communities, especially lower screening attendance for the early detection of breast cancer. This study compares factors related to cancer screening adherence in two distinct cultural-ethnic minorities in Israel: Arab women as a cultural-ethnic minority and Jewish ultra-Orthodox women as a cultural-ethnic faith-based minority. DESIGN: During the year 2014, a total of 398 Jewish ultra-Orthodox women and 401 Arab women between the ages of 40-60, were randomly selected using population-based registries. These women answered questionnaires regarding adherence to mammography and clinical breast examination (CBE), health beliefs and cultural barriers. RESULTS: Arab women adhered more than ultra-Orthodox women to mammography (p < .001) and CBE exams (p < .01). Religious beliefs, exposure barriers and perceived risk were higher among the ultra-Orthodox women, while social barriers, accessibility barriers and perceived severity were higher among the Arab women (p < .01). Adjusting for background factors, higher adherence to CBE and mammography were associated with lower levels of religious beliefs (AOR = 0.90, 95% CI = 0.69-1.17 AOR = 0.62, 95% CI = 0.39-0.82, respectively), perceiving a higher risk of cancer (AOR = 1.93, 95% CI = 1.23-3.04 and AOR = 3.22, 95% CI = 1.53-6.61), and having more fears related to cancer-related losses (AOR = 1.51, 95% CI = 1.19-3.00 and AOR = 1.24, 95% CI = 0.63-1.22). In addition, perceiving greater advantages of CBE was associated with higher adherence to CBE (AOR = 1.82, 95% CI = 1.45-2.29), while not receiving a physician's recommendation was associated with lower adherence to mammography (AOR = 1.82, 95% CI = 1.45-2.29). CONCLUSION: This study addressed a lacuna in screening behaviors of women from cultural-ethnic and faith-based communities. In order to increase adherence, health care professionals and policymakers should direct their attention to the specific nature of each community.

Culture as a Double-Edged Sword: The Posttraumatic Experience of Indigenous Ethnic Minority Veterans.

The applicability of Western concepts regarding the treatment of trauma in soldiers from indigenous ethnic minority backgrounds has scarcely been researched. This study explored the subjective meaning of living with chronic posttraumatic stress disorder (PTSD) among indigenous Bedouin veterans of the Israel Defense Forces (IDF), who are of Arab ethnicity and Muslim faith. In-depth, semistructured qualitative interviews were conducted with 10 Bedouin veterans suffering from PTSD and three Bedouin mental health clinicians working with this population. Two themes emerged: "I wanted to be like everyone else," referring to participants' experiences during their military service, and "Fluctuating between belonging and abandonment," referring to veterans' experiences of living with mental health problems in a traditional minority community. These findings highlight the importance of conducting a comprehensive inquiry into the complex cultural and social backgrounds of indigenous minority veterans suffering from PTSD, and the interplay between the conflicted identities and multiple "realities" they experience.

Coming of age: health-care challenges of an ageing population in Israel.

Although Israel is still young in years, with relatively high birth rates and older people (individuals aged 65 years or older) constituting only about 11% of its population, the absolute number of older people is growing rapidly. Life expectancy is high, and increasing numbers of people are living to advanced old age (older than 85 years). A wide spectrum of geriatric care is provided within a universal system providing health services to all citizens. Community and institutional care is available, and many innovative programmes are being developed. The unique demographic characteristics of the ageing society in Israel reflect cultural and multiethnic diversity, in addition to a high rate of immigration of older people. To meet the growing challenges, address disparities, and search for innovation will require planning and development of adequate services at the highest level.

Expression of emotions related to the experience of cancer in younger and older Arab breast cancer survivors.

OBJECTIVES: Researchers have suggested that older adults express less negative emotions. Yet, emotional expression patterns in older and younger breast cancer survivors, have barely been examined. This study aimed to explore types and intensity of negative and positive emotional expression related to the breast cancer experience by younger and older Arab breast cancer survivors. DESIGN: Participants were 20 younger (aged 32-50) and 20 older (aged 51-75) Muslim and Christian Arab breast cancer survivors (stages I-III), currently free of disease. Data were gathered through in-depth semi-structured interviews. Mixed methods analyses were conducted, including: (1) frequency analysis of participants' emotional expressions; (2) content analysis of emotional expressions, categorized according to negative and positive emotions. RESULTS: Three emotional expression modalities were revealed: (1) Succinct versus comprehensive accounts; (2) expression of emotions versus avoidance of emotions; (3) patterns of expression of positive emotions and a sense of personal growth. Younger women provided more detailed accounts about their illness experiences than older women. Older women's accounts were succinct, action-focused, and included more emotion-avoiding expressions than younger women. CONCLUSIONS: Understanding the relationships between emotional expression, emotional experience, and cancer survivors' quality of life, specifically of those from traditional communities, is necessary for developing effective psycho-social interventions.

Translation and validation of the Arab version of the Late-Life Function and Disability Instrument: a cross sectional study.

BACKGROUND: The Late-Life Function and Disability Instrument (LLFDI) provides a comprehensive, reliable, and valid assessment of physical function and disability in community-dwelling adults. There does not appear to be a validated, comprehensive instrument for assessing function and disability in Arabic. The objective of the present study was to translate and culturally adapt the LLFDI to Arabic, and to determine its test-retest reliability and validity. METHODS: The LLFDI was translated to Arabic through a forward and backward translation process, and approved by a bilingual committee of experts. Sixty-one (26 male and 35 female) Arabic speaking, healthy, older adults, ages 65-88, living in northern Israel participated in the study. To determine test-retest reliability, the questionnaire was administered twice to 41 subjects with a 6 to 8day interval. Construct validity was examined by correlating the LLFDI responses with the 10-item physical function (PF-10) subscales of the General Health Survey (SF-36), with the physical component of SF-36 (SF-36 PCS), and with two performance measures, the Berg Balance Scale (BBS) and Time Up and Go (TUG) test. Additionally, gender and fall related differences in the LLFDI were also examined. RESULTS: Internal consistency (Cronbach's alpha) was good to excellent (0.77 to 0.97). Test-retest agreement was good to very good (function component: 0.86-0.93, disability component: 0.77-0.93). Correlation with the SF-36 PCS and PF-10 was moderate to strong for both LLFDI components (function, r = 0.53-0.65 and r = 0.57-0.63, and LLFDI disability, r = 0.57-0.76 and 0.53-0.73, respectively). Significant, moderate-to-strong correlations between the LLFDI and BBS (r = 0.73-0.87) and a significant, moderate, negative correlation between LLFDI and TUG test (r = -0.59- -0.68) were noted. The standard error of measure was 6-12%, and the smallest real difference was 18-33%. Discriminative validity for both gender and fall status were also demonstrated. CONCLUSIONS: The Arabic version of the LLFDI is a highly reliable and valid instrument for assessing function and disability in community dwelling, Arab older adults. The translated instrument has a discriminative ability between genders and between fallers and non-fallers. The translated instrument may be used in clinical settings and for research purposes.

Prevalence of illicit substance use among Arab adults in Israel: Findings from a national survey.

INTRODUCTION AND AIMS: The aim of this study was to examine illicit psychoactive substance use rates among adult Arabs in Israel. DESIGN AND METHODS: Cross-sectional survey of 1200 Arab adults recruited nationwide via cluster sampling and interviewed using a structured questionnaire was conducted. RESULTS: Fourteen percent of respondents reporting illegal substance use with increased odds of use among males and those who were secular/not religious. DISCUSSION AND CONCLUSIONS: These findings show for the first time the extent of illegal substance use among Arab adults in Israel and suggest the possibility for targeted interventions in certain population groups.

Tobacco and alcohol use among Arab adults in Israel: findings from a nationwide study.

OBJECTIVE: This comprehensive study focuses exclusively on adult Arabs in Israel and is aimed at examining tobacco and alcohol use rates and their predictors. METHODS: One thousand and two hundred Arab adults were randomly sampled via cluster sampling and interviewed using a structured questionnaire. RESULTS: Forty-four per cent of respondents reported tobacco use while 39% reported alcohol use. There were notable gender gaps in use, as well as differences between Muslims and Christians. Odds of using both tobacco and alcohol increased with having a greater tendency towards risk-taking and more time spent partying. Odds of alcohol use also increased with having positive attitudes towards use, lower perceived risk and greater intention to use. CONCLUSIONS: These findings add a more complete understanding to the phenomenon of tobacco and alcohol use among Arab adults in Israel and carry important implications for future research and practice.

The doctor is just a messenger: beliefs of ultraorthodox Jewish women in regard to breast cancer and screening.

Screenings for the early detection of breast cancer greatly improve survival odds. Studies of minority groups have shown lower attendance of screenings; however, these studies seldom focused on religious minorities. This study examines perceptions of cancer and cancer screening among healthy ultraorthodox women in order to gain insight about ways to promote screening. In this qualitative-phenomenological study of two focus groups, three main themes were found: faith in God; the Rabbi as a guide; one's relationship with the community. The study's findings point to the importance of studying the unique needs of members of certain religious groups.

Being within or being between? The cultural context of Arab women's experience of coping with breast cancer in Israel.

BACKGROUND: Coping with cancer is affected by cultural norms, beliefs, and perceptions. To date, only a few studies have examined how Arab women cope with breast cancer and how the illness affects their lives. We aimed to study how Arab women perceive and ascribe meaning to their illness and its personal, familial, and social implications and to examine their coping strategies within the religious and traditional cultural context. METHODS: The study was qualitative. Participants were 20 Muslim and Christian Arab women with breast cancer (stages I-III) from northern Israel, aged 20-50 years. Participants were between 1 and 5 years after chemotherapy and radiotherapy. In-depth, semi-structured interviews were conducted and later transcribed. RESULTS: Four main themes emerged: (i) "Family Comes First": The Woman and Her Family; (ii) To Expose or not to Expose? That's the Dilemma; (iii) Faith in God as a Source of Coping; and (iv) Constructing New Meanings Following Recovery from Cancer. Findings stressed a duality in participants' cancer coping experience according to the traditional cultural norms of concealment, while simultaneously encountering more open Western attitudes through interactions with healthcare providers and Jewish women receiving treatment alongside them. CONCLUSIONS: Healthcare professionals should be aware of the unique implications of cancer in the context of the traditional Arab culture intertwined with modernization processes. This context calls for interventions that consider the understandings depicted in the present study.

Attachment patterns of Arabs and Jews in Israel--are we really so different?

BACKGROUND: Attachment orientations reflect internal representations of self, others, and relationships. Studies revealed meaningful cultural differences in attachment orientations, but few included Arab samples. to fill this gap, we compared attachment orientations of Jews and Arabs in Israel using valid measures. METHOD: Israeli participants (292 Arabs and 206 Jews) described their attachment figures and completed the Experiences in Close Relationships questionnaire which measures anxious and avoidant attachment orientations in Arabic and Hebrew, respectively. RESULTS: Israeli Arabs reported higher attachment anxiety than Israeli Jews, but no difference was found in avoidance. Both groups reported that attachment figures were similar in gender and relationship type, and included romantic partners, relatives and friends. LIMITATIONS: Findings should be considered cautiously due to sampling limitations. CONCLUSIONS: the results complement previous cross-cultural findings and Arabs-Jews differences in relationship-related norms/values. Higher attachment-anxiety scores observed among Israeli Arabs may be considered culturally normative with implications for the development of culturally competent interventions.

Traditional-Westernizing continuum of change in screening behaviors: comparison between Arab women in Israel and the West Bank.

Health perceptions are changing, but the pace of change varies across societies, exercising different effects on women's screening behaviors. Our aim is to assess the rate of mammography and clinical breast examination (CBE) attendance in younger and older Arab women in Israel and in the West Bank, and the effect of health beliefs on the screening behaviors. A random sample of 697 Arab women, 300 from Israel and 397 from the West Bank, aged 30-65 years, answered questionnaires on screening behaviors, the Arab culture-specific barriers, fatalism, worry, and health beliefs. The participation rate was 93.5% in Israel and 98.3% in the West Bank. Higher fatalistic perceptions, traditional beliefs, barriers to bodily exposure, and social, environmental, and personal barriers to screening were reported by women from the West Bank compared to Arab women in Israel and by older women compared to the younger women. Adjusted lower likelihood of attending screening was predicted by group (AOR 3.55, 95% CI 1.25-10.11 for mammography and AOR 2.36, 95% CI 1.19-3.65 for CBE), higher fatalism (AOR 0.52, 95% CI 0.30-76 for mammography and AOR 0.68, 95% CI 0.54-92 for CBE), more traditional beliefs (AOR 0.61, 95% CI 0.48-0.80 for mammography and AOR 0.51, 95% CI 0.39-0.68 for CBE), and higher barriers to self-exposure (AOR 0.69, 95% CI 0.48-0.83 for mammography and AOR 0.76, 95% CI 0.62-0.95 for CBE), higher perceived personal barriers (AOR 0.36, 95% CI 0.12-1.08 for mammography and AOR 0.77, 95% CI 0.60-0.98 for CBE), and lower perceived benefits (AOR 1.98, 95% CI 1.17-3.34 for mammography and AOR 1.39, 95% CI 1.06-1.81 for CBE). Also, adjusted lower likelihood of CBE attendance was predicted by younger age, higher religiosity, and higher social barriers. Differences in screening behaviors of younger and older Arab women from the West Bank and from Israel represent a traditional-westernizing continuum of change, but are also related to the social and situational context.

Death and dying anxiety among bereaved and nonbereaved elderly parents.

This study examines differences in death and dying anxiety between bereaved and nonbereaved elderly Israeli parents, as well as correlates of these factors among bereaved parents. A total of 97 parents (49 bereaved, 48 nonbereaved) completed measures of death and dying anxiety and religiosity. Bereaved parents reported significantly higher dying anxiety scores than nonbereaved parents, but there were no significant differences between the 2 groups in death anxiety. Religiosity was unrelated to death and dying anxiety. Dying anxiety was higher among bereaved mothers than bereaved fathers. Death and dying anxiety were not associated with the length of time since the loss of the child or the nature of the child's death. Results are discussed in light of the difficulties that bereaved parents experience after the loss of their child. Implications for theory, for health and welfare professionals, and for policy are suggested.

Increasing breast examinations among arab women using a tailored culture-based intervention.

This study aimed to assess outcomes of a culture-specific intervention devised to reduce barriers to breast cancer screening among Arab women in Israel. Women in intervention (n = 42) and control (n = 24) groups answered breast examination performance and Arab culture-specific barriers and health beliefs questionnaires at pre- and postintervention. Women in the study group received tailored telephone intervention between the 2 interviews. Although the study and control groups did not differ in rate of attending clinical examinations and mammography at pre-intervention, at post-intervention, almost 48% of the intervention group and 12.5% of the control group scheduled or attended a clinical examination, and 38.5% of women in the intervention group and 21.4% of the control group attended or scheduled a mammography. Of the cultural barriers, a significant group x time effect was found for the cultural barriers of exposure, social barriers, and self-uneasiness with body, with a higher decrease in the intervention group. Of the health beliefs, a group x time effect was found for perceived vulnerability and perceived barriers to clinical examination and mammography, which significantly decreased in the intervention group, but not in the control group. The preliminary results showed that the culture-based intervention was effective in reducing barriers and increasing the rate of breast cancer examinations.

Factors associated with low screening for breast cancer in the Palestinian Authority: relations of availability, environmental barriers, and cancer-related fatalism.

BACKGROUND: The current study was conducted to assess screening behaviors in relation to cultural and environmental barriers among Palestinian women in the West Bank. METHODS: The participants were 397 women, ages 30 to 65 years, residing in the Palestinian Authority, and a stratified sample method was used (98.3% participation rate). The participants completed questionnaires on breast examination behaviors and knowledge, on perceived cancer fatalism and health beliefs, and on environmental barriers scales. RESULTS: Greater than 70% of the women had never undergone mammography or clinical breast examination (CBE), whereas 62% performed self breast examination (SBE). Women were more likely to undergo mammography if they were less religious (odds ratio [OR], 0.59; 95% confidence interval [95% CI], 0.47-0.81) and if they expressed lower personal barriers (OR, 0.59; 95% CI, 0.29-0.76) and lower fatalism (OR, 0.39; 95% CI, 0.28-0.63). A higher likelihood for CBE was related to being Christian (OR, 2.91; 95% CI, 1.49-5.73) and being less religious (OR, 0.32; 95% CI, 0.13-0.78), to perceived higher effectiveness of CBE (OR, 1.46; 95% CI, 1.20-1.79), and to perceived lower cancer fatalism (OR, 0.35; 95% CI, 0.28-0.60). Women were more likely to perform SBE if they were more educated, resided in cities, were Christian, were less religious, had a first-degree relative with breast cancer, perceived higher effectiveness and benefits of SBE, and perceived lower barriers and fatalism. CONCLUSIONS: Participants reported a combination of personal, cultural, and environmental barriers, which should be addressed by educational programs and followed by the allocation of resources for early detection and treatment of breast cancer.

Druze adolescent dropouts in Israel and their use of psychoactive substances.

The current study examines rates of psychoactive substance use among Druze adolescent dropouts and links between use rates and socio-demographic, interpersonal, cognitive, and personality characteristics. 204 adolescents took part in the study in late 2004. Approximately 21% had consumed tobacco 10 times or more in the last year, 25% reported consuming alcohol in the same timeframe, and nearly 6% used an illegal substance at least once in the last year. Boys had significantly higher rates of alcohol and tobacco use than girls. Religiosity, attitudes and behavioral intentions regarding use were also linked with consumption of the three substances.