Breast self-examination Among Akha women in Chiang Rai province Thailand: policy recommendations based on the formative research study design

Abstract

Background: The mortality rate of breast cancer has increased in several countries in Asia. In Thailand, this fact is confirmed by the hospital–based cancer registry annual report which ranked breast cancer as first of all female cancer patients. One an urgent concern of prevention and education on early detection is Breast Self-Examination (BSE). ‘Akha’ women, the largest ethnic group in Chiang Rai, northern part of Thailand, have a significantly low percentage of BSE practice because of language barrier and other problems. This study aims to identify factors associated with BSE among this ethic group to better understand the reasoning for this and also look at means to resolve the problem.

Methods: Two phase of study included a mixed methods and Quasi-experimental study. Firstly, study was conducted ‘Akha’ women in Mae Fah Luang district, Chiang Rai, Thailand. Quantitative in-person survey used a structured questionnaire with 296 Akha women aged 30-59 years old and qualitative assessed 24 participants (2 local health providers and 22 Akha women). Secondly, BSE program was created from first phase results and measured the effectiveness of program between intervention and control group. The survey tool contained information related to socio-demographic factors, risk factors, and lifestyle factors relevant to breast cancer, and self-practice on BSE. A semi-structured in-depth interview was used for qualitative part. Analysis of the quantitative data was done by descriptive statistics, chi-square test, binary logistic regression, and multiple logistic regression. Content analysis was used to analyze the qualitative data. As for intervention, this study conducted 44 intervention participants at Mae Fah Luang District but control used participant at Mae Lao district. The tool to measure effectiveness used a survey tool and BSE practice checklist compare in baseline, 3 moths, and 6 months.

Results: The majority of the participants were 45-59 years old. This study found that 24.70% women had done a good practice. Logistic regression analysis showed that women who received breast information were eight times more likely to report good BSE practice compared to those non receiving (Odd ratio (OR): 8.02; 95% CI: 1.89-33.96). In additional, knowledge, awareness, and local health staffs were related to good BSE practice from in-depth information. Intervention effectiveness were significantly at 0.016 in Different in Difference (DID) but the program is limitation of results.

Conclusion: BSE practice by Akha women was found main linked with perception towards of BSE and health care provider. Based on findings, we recommend implementing a new practical program to promote BSE followed social norm, lifestyle, and cultural.