Acceptability of physical examination by male doctors in medical care: Taking breast palpation as an example.

In this study, we conducted an investigation among medical workers, patients and college students concerning their acceptability of breast palpation performed by male doctors (hereinafter referred to as "acceptability", or "the examination", respectively, if not otherwise indicated), to get the information about their acceptability and reasons for accepting or declining the examination among the three population. A questionnaire investigation was conducted in 500 patients with breast diseases, 700 students of medical colleges, and 280 medical workers working in hospitals. The subjects were asked to choose between two options: accept or do not accept (the examination). The subjects were asked to fill out the questionnaire forms on free and anonymous basis and the questionnaire forms were collected on spot, immediately after completion. The questionnaires collected were coded, sorted out and checked. Data of the eligible questionnaires were input into Epidata software and analyzed by SPSS. Upon the establishment of the database, the intra-group data were tested by utilizing χ(2) test. Among 1480 questionnaires, 1293 (90.41%) questionnaires were retrieved. Our results showed that 56.78% of patients reported that they could accept breast palpation by male doctors. About 59.66% of medical staff expressed their acceptance of the examination, but only 35.03% of students said the examination. On the basis of this study, we were led to conclude that the examination is not well accepted by different populations, and therefore, (1) medical professionals and administrators should pay attention to the gender-related ethics in their practice and the feeling of patients should be respected when medical examinations involve private or sensitive body parts; (2) to this end, related departments should be properly staffed with doctors of both sexes, and this is especially true of the departments involving the examination or treatment of private or sensitive body parts; (3) health education should, among other things, include helping female patients to overcome the fear and anxiety in such examinations. This is of great importance since some women may miss the opportunity to get timely diagnosis.

[Women's expectations towards gynaecological examination ]. / Oczekiwania kobiet wobec badan ginekologicznych.

INTRODUCTION: It is commonly known that gynaecologi- cal examinations cause a lot of negative emotions in the majority of women. The aim of my work was: 1. Getting to know women's views on the nature of a pelvic examination and their expectations regarding gynaecologists. 2. To determine the correlation between the examined views and independent variables such as the age of the respondents, residence, and place of examination. MATERIAL AND METHODS: The research material consisted of 1200 women living in the region of Western Pomerania and in Lódz. The measurement tool was a survey of my own authorship. CONCLUSIONS: 1. In the opinion of most women, gynaecological examination is embarrassing and stressful. It has not been proven that this opinion was related to age, residence or place of examination. 2. According to women, the most embarrassing moment of a visit to the gynaecologist is lying down on the gynaecological chair, and the gynecological examination. The most unpleasant aspect is palpation through the vagina and rectum. These feelings differ depending on age, residence and place of taking the examination. 3. The choice of the gynaecologist's gender is dependent on women's age. 4. The frequency of reporting for the gynaecological examination decreases with women's age, and is dependent on their place of residence. 5. A sense of safety and mental comfort during the gynaecological examination is provided by the lack of third parties, except for the presence of a midwife. It is also dependent on the patient's age, her place of residence, as well as the examination site. 6. Women's expectations of a gynaecologist are focused mainly on maintaining a sense of intimacy and safety, getting information about the procedures, as well as a pleasant and individual approach.

Attitudes and health beliefs associated with breast cancer screening behaviors among Turkish women.

PROBLEM: This research was undertaken to determine the attitudes and health beliefs of a sample of Turkish women about breast self-examination (BSE), clinical breast examination, and mammography. DESIGN: Data were collected by means of a researcher-designed questionnaire and the Champion Health Belief Model Scale. A total of 1,342 women participated in this study. RESULTS: It was found that 10.1% of the women practiced BSE once a month, 19.8% of the women had had a clinical breast examination, and 15.0% had had a mammogram. Age and marital status were significant variables that influenced whether the women used only one or multiple methods for early detection of breast cancer. Participants who had higher levels of confidence for BSE and lower perceptions of barriers to BSE were more likely to perform BSE. Participants who perceived higher levels of confidence to perform BSE were more likely to be using all three early detection methods. IMPLICATIONS FOR PRACTICE: Interventions and strategies that help women develop confidence in their abilities to perform early breast cancer detection methods are likely to encourage them to engage in regular screening for breast cancer.

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.

The obscuring object of race: clinical breast exams and coping styles in ethnic subpopulations of women.

OBJECTIVES: Differences in breast cancer screening rates have been linked to many factors including race, access to healthcare, and breast cancer knowledge and beliefs; less frequently studied has been the role of characteristic styles of coping. In this study, we examined ethnicity and the role of coping with a possible breast cancer diagnosis in the context of whether or not women obtained clinical breast examinations (CBE). DESIGN: To measure coping, a stressor, in the form of a vignette asking participants to imagine they had just received a breast diagnosis upon a doctor's visit, was used. METHOD: Three hundred and eight women from seven ethnic subpopulations (and from three racial groups) in the USA were interviewed regarding frequency of breast screening, as well as how they would likely cope with a diagnosis of breast cancer. RESULTS: CBE rates were similar across groups and were differentially predicted by the different coping styles. Analysing the results using typical racial categories (rather than distinct ethnic groupings) obscured these results. Furthermore, avoidance predicted CBE and mammogram rates differently, specifically, predicting mammogram rates differentially for each group, with no relation to CBE rates. CONCLUSION: Recognition of the roles of problem solving, social support, and avoidance in coping with a possible breast cancer diagnosis may guide the development and provision of interventions that are more sensitive to the characteristics of specific groups of women. Examinations of psychological variables in preventive health behaviours must begin to analyse diversity by paying attention to ethnic specificity, rather than race, as well as to the underlying nature of the screening task.

Pelvic examination of asymptomatic women - attitudes and clinical practice.

BACKGROUND: Many women see their general practitioner for 'well woman' checks, which often include Pap tests and a pelvic examination. A recent review of the evidence revealed pelvic examination in asymptomatic women is not a valid screening test, particularly with regard to ovarian cancer screening. METHOD: This project explored the attitudes of GPs regarding the performance of pelvic examinations in asymptomatic women. Twenty-seven GPs were interviewed about their current practice and opinions of the value, advantages and disadvantages of pelvic examinations in asymptomatic women. The interview data was analysed qualitatively. DISCUSSION: The majority of the GPs interviewed perform pelvic examinations as part of a well woman check. Despite broad consensus by the GPs that the value of a pelvic examination as a screening test was questionable, they were performed for a range of reasons including patient reassurance, documenting the norm, 'because I was taught to', for legal reasons, and for completeness. The disadvantages of performing pelvic examinations in asymptomatic women noted by the GPs were time constraints, chaperone issues, intimacy concerns, and false reassurance and unnecessary anxiety caused by unexpected findings. However, neither these disadvantages nor the presentation of evidence based guidelines dissuaded the doctors from performing the examinations. This highlights the ongoing discrepancy between the theoretical development of such recommendations and their practical implementation.

Women's satisfaction with breast and gynecological cancer screening.

PURPOSES: This study examined women's satisfaction with their breast and gynecological (GYN) cancer screening, clinical breast examination (CBE), mammogram (MAM), and pelvic examination (PE). Selected predictors (characteristics of the exam and characteristics of the health care provider) of satisfaction with their screening exams also were assessed. METHODS: Women (N = 242) ages 19 years and older were recruited from a residential mailing list, and from church and community organizations. Participants completed questionnaires in their homes or in the community setting where they had been recruited. Descriptive statistics were used to describe the level of women's satisfaction with their most recent exams. Hierarchical multiple regression was used to determine the influence of exam and health care provider characteristics on women's satisfaction with exams. RESULTS: We found that women were very satisfied with care received during all three screening exams. Women were more satisfied during CBE and PE if they perceived these exams as informative, clear and complete and if they perceived the provider as informative and responsive to them when they ask questions. Women also were more satisfied with all three exams when the provider was perceived as relaxed during these exams.

Alexithymia and hypersensitivity to touch and palpation.

Alexithymia appears to be directly related to the process of somatization of psychological distress that has not found verbal expression. The lack of a meaningful dialogue between mother and child in early infancy may predispose the development of an alexithymic strategy in expressing psychic and psychosocial stress. This can occur in the form of unpleasant bodily sensations or pain. The human skin is, in addition to the oral and gastrointestinal organs, the earliest contact sphere between the young infant and the environment. In a group of 312 randomly chosen patients at an outpatient primary health care clinic a significant relationship was found between palpational hypersensitivity to touch on the one hand and somatization proneness and the degree of alexithymia on the other hand.

Changes in breast self-examination behavior achieved by 89,835 participants in the Canadian National Breast Screening Study.

Breast self-examination (BSE) behavior was analyzed in 89,835 participants in the National Breast Screening Study (NBSS) of whom 64,619 were eligible for annual rescreening and 25,216 were followed by mail after a single screen exam. Among those eligible for rescreening, BSE competence scores based on seven BSE criteria significantly improved over time and correlated directly with reported BSE frequencies. Among all participants, the proportion reporting BSE frequencies of greater than or equal to 12/year increased over time from approximately 20% on entry to 50% to 64% at final screen. Similarly, reports of zero frequency diminished from 50% to 10% to 15%. Variables such as educational status, age (fifth versus sixth decades), eligibility for mammography, smoking history, and ethnic origin had negligible or no influence on BSE competence. However, women with first-degree relatives with breast cancer had significantly higher BSE scores. NBSS experience suggests that most women who enter screening programs will upgrade their BSE skills if subjected to brief episodes of repeated BSE instruction.

The effects of social demand on breast self-examination self-report.

The measurement of breast self-examination (BSE) adherence typically relies on verbal self-report. These studies systematically manipulated social demand within a face-to-face interview and examined the effects on self-reported BSE frequency. In Study 1, subjects (n = 37) received either a high-demand or a low-demand preface prior to being asked about BSE practice over the past year. Study 2 (n = 89) was a replication, with the addition of a no-preface (control) condition. Results from Study 1 indicated that although the conditions were comparable on demographic and breast cancer/BSE knowledge variables, the high-demand condition reported a significantly higher number of BSEs than the low-demand condition. An attenuation of this pattern was found in Study 2, with the control condition reporting a frequency between the low demand's and the high demand's reported frequencies. The implications for BSE intervention and prevalence research are discussed.

Encouraging the practice of testicular self-examination: a field application of the theory of reasoned action.

Identified factors associated with testicular self-examination (TSE) within the context of the theory of reasoned action. Subjects (232 male college students) received instruction in TSE and completed a questionnaire operationalizing the components of the theoretical model. During the following 6 weeks, a field intervention was conducted in which approximately half the subjects were exposed to posters reminding them to perform the exam. Multiple-regression analyses revealed that intention to perform TSE correlated significantly with attitude and subjective norm and that consideration of self-efficacy and TSE knowledge improved the prediction of intention. Significant differences in outcome expectancies and normative beliefs were found between subjects who intended to perform the exam and those who did not. Intention was moderately (r = .30, p less than .001) correlated with behavior; the intention-behavior correlation, however, was stronger among subjects who intended to perform the exam and were exposed to the posters (r = .55, p less than .001).

Women and medicalisation: an empirical examination of the extent of women's dependence on medical technology in the early detection of breast cancer.

Recent criticisms of the thesis of medicalisation focusing at the level of doctor-patient interaction have suggested that patient dependency on or addiction to modern scientific medicine and in particular medical scientific technology is overstated. However, empirical research to examine this is difficult to find. The study presented here throws some light on this issue as it looks at women's beliefs and feelings about breast screening and breast self-examination and the prospect of attending for breast screening or a class which teaches BSE. The results show that the generalised concept of patient dependence is limited although there was more support for women's dependence on medical technology than choosing to be directly responsible for identifying abnormalities themselves and managing them.