KNOWLEDGE, ATTITUDE AND PRACTICE FOR CANCER PREVENTION AMONG ETHNIC MINORITIES IN TWO COMMUNES OF BUON DON, DAKLAK, 2015

HANOI MEDICAL UNIVERSITY INSTITUTE FOR PREVENTIVE MEDICINE AND PUBLICHEALTH DOAN PHUONG NHUNG KNOWLEDGE, ATTITUDE AND PRACTICE FOR CANCER PREVENTION AMONG ETHNIC MINORITIES IN TWO COMM

HANOI MEDICAL UNIVERSITY INSTITUTE FOR PREVENTIVE MEDICINE AND PUBLIC

HEALTH

DOAN PHUONG NHUNG

KNOWLEDGE, ATTITUDE AND PRACTICE

FOR CANCER PREVENTION AMONG ETHNIC MINORITIES

IN TWO COMMUNES OF BUON DON, DAKLAK, 2015

GRADUATION THESIS

2010 – 2016

HANOI - 2016 MINISTRY OF

EDUCATION AND TRAINING

MINISTRY OF HEALTH

HANOI MEDICAL UNIVERSITY INSTITUTE FOR PREVENTIVE MEDICINE AND PUBLIC

HEALTH

DOAN PHUONG NHUNG

KNOWLEDGE, ATTITUDE AND PRACTICE

FOR CANCER PREVENTION AMONG ETHNIC MINORITIES

IN TWO COMMUNES OF BUON DON, DAKLAK, 2015

First and foremost, I would like to thank the Boards of Hanoi Medical University and Institute for Preventive Medicine and Public Health as well as the staffs in the Department of Environmental Health for supporting me to complete this graduation thesis.

I would like to express my gratitude to my supervisor, Assoc Prof Dr Ngô Văn Toàn, Head of Department of Environmental Health for his meaningful support and encouragement throughout this thesis His advice has helped me so much during the study period

I would like to thank Dr Bùi Văn Nhơn for helping me solve many problems during the time of completing the thesis.

I would like to send the biggest thank to my mother Without you, I could not be where I am now Thank you for all of sacrifice, your encouragement and your endless love to me You have given me courage.

Finally, to my dearest friends, thank you for sharing all the difficulties with me during this time and for always staying next to me through every happiness and hardships.

Thank you very much.

Hanoi, June 2016

Respectfully addressed to:

 Board of Training – Hanoi Medical University

 Board of Training, Health Research and International Collaboration –Institute for Preventive Medicine and Public Health

 Department of Environmental Health

 Board of Dissertation Assessment

I guarantee that this is my own thesis The data and results presented inthis thesis are to the best of my knowledge, true and accurate The workcontained in this thesis has not been submitted elsewhere, as part of any otherdegrees or assignments I contend that the work presented in this thesis is myown, except in instances where due reference has been made to otherreferenced materials

The author of thesis

DOAN PHUONG NHUNG

COMMITMENT 4

ABBREVIATION 1

LIST OF TABLES 2

LIST OF GRAPHS 3

INTRODUCTION 1

CHAPTER I LITERATURE REVIEW 3

1.1 Cancer in general 3

1.2 Previous researches on knowledge, attitude and practice for cancer prevention 9

CHAPTER II METHOD 14

2.1 Study settings 14

2.2 Study subjects 14

2.3 Study design 15

2.3.1 Sample size and sampling 15

2.3.2 Study instruments 15

2.3.3 Variables 16

2.3.4 Definitions 17

2.3.4 Data collection techniques 18

2.3.5 Data management and analysis 18

2.3.6 Bias controlling 18

2.3.7 Ethics 19

CHAPTER III RESULTS 20

3.1 Characteristics of ethnic minorities 20

3.2 Knowledge of cancer prevention among ethnic minorities 21

3.2.1 General knowledge of cancer 21

3.2.2 Knowledge of risk factors for cancer 24

3.2.3 Knowledge of cancer early detection 26

3.2.4 Knowledge of cancer diagnosis and treatment 27

3.2.5 Knowledge of palliative care 30

3.3 Attitude and practice for cancer prevention among ethnic minorities .33 3.3.1 Attitude for cancer early detection 33

3.3.2 Practice for cancer prevention 35

3.3.3 Practice for cancer diagnosis and treatment 36

3.3.4 Practice for regular health examination 37

CHAPTER IV DISCUSSION 40

4.1 Characteristics of ethnic minorities 40

4.2 Knowledge of cancer prevention among ethnic minorities 41

4.2.1 General knowledge of cancer 41

4.2.2 Knowledge of risk factors for cancer 43

4.2.3 Knowledge of cancer early detection 44

4.2.4 Knowledge of cancer diagnosis and treatment 46

4.2.5 Knowledge of palliative care 47

4.3 Attitude and practice for cancer prevention among ethnic minorities .48 4.3.1 Attitude for cancer early detection 48

4.3.2 Practice for cancer prevention 49

4.3.3 Practice for cancer diagnosis and treatment 50

4.3.4 Practice for regular health examination 51

CONCLUSION 53

RECOMMENDATION 54 REFERENCE

APPENDIX

WHO: World Health Organization

IARC: International Agency for Research on CancerMOH: Ministry of Health

NCDs: Non-communicable diseases

HPV: Human papillomavirus

HBV: Hepatitis B virus

Pap test: Papanicolaou test

BSE: Breast self-examination

EGD: Upper enscopy

RHE: Regular health examination

KAP: Knowledge, attitude and practice

LIST OF TABLES

Table 3.1 Characteristics of participants 20

Table 3.2 General knowledge of cancer 22

Table 3.3 Knowledge of risk factors among participants 25

Table 3.4 Awareness of warning signs and symptoms among participants 26 Table 3.5 Knowledge of cancer screening methods among respondents 27

Table 3.6 Knowledge of cancer diagnosis among participants 27

Table 3.7 Knowledge of cancer treatment among subjects 28

Table 3.8 Awareness of healthcare center for cancer diagnosis and treatment among participants 28

Table 3.10 Knowledge of palliative care among subjects 30

Table 3.11 Knowledge of suitable time for palliative care among respondents 31

Table 3.12 Knowledge of last-staged patient care among participants 32

Table 3.13 Attitude for early diagnosis among participants 33

Table 3.14 Attitude for early detection among participants 33

Table 3.15 Frequency of health examination according to participants 34

Table 3.16 Practice for cancer prevention among respondents 35

Table 3.17 Practice for cancer diagnosis and treatment service among participants 37

Table 3.18 Practice for the frequency of RHE among respondents 38

Table 3.19 Reasons for not having health examination of participants 38

Graph 3.1 Awareness of cancer among participants 21

Graph 3.2 Common types of cancers among respondents 23

Graph 3.3 Awareness of cancer prevention among participants 24

Graph 3.4 Attitude for regular health examination among respondents 34

Graph 3.5 Numbers of participants who had cancer diagnosis and treatment 36

Graph 3.6 Practice for regular health examination among respondents 37

INTRODUCTION

Cancer is considered to be one the four major non-communicable diseases(NCDs), along with cardiovascular diseases, chronic respiratory diseases anddiabetes [1] With 8,2 million of deaths every year, cancer is the secondleading cause of NCD death worldwide, responsible for 21% of death [2] 895billion dollars was recorded to be the overall economic impact causing bypremature mortality and disability from cancer worldwide in the year 2008[3] In 2012, the global load of cancer rose to an estimated 14 million newcases every year and expected to continue increasing to 22 million annually inthe next 20 years [4]

As a consequence of growing and aging populations along with unhealthylifestyles, middle- and low- income countries are excessively affected by thearising cases of cancers More than 60% of the world’s new discovered casesoccur in Africa, Asia and Central and South America [5] Such circumstancewas the consequence of the lack of early detection and the effectiveness ofprevention programs Researches conducted by World Health Organization(WHO) have shown that good health behaviors along with access to effectualand affordable cancer interventions in will remarkably reduce the number ofnew cases and deaths

National strategy for cancer control has been developed by Vietnamesegovernment since 2008, aiming to reduce the prevalence of cancer casesannually and to improve knowledge and behaviors of people towards cancerprevention Despite of the great efforts, the first stage result did not reachexpectations [6] The second and third stages have been developed; with thepriority purpose is to increase general knowledge about cancer, expecting to

reach 70% of adults having adequate knowledge towards cancers [7].Moreover, cancer control programs also emphasize the important part of localauthorities in cancer prevention promotion [8] Such action has noted theimportance of cancer prevention in National strategy of non-communicablediseases control as well as the improvement of knowledge of people about thefatal illness This addresses a necessary need to find out more about actualknowledge, attitude and practice of specific community in order to applysuitable interventions.

Even though the National program has proceeded in more than 37provinces and cities [9], it stays mainly in big or easy-to-access regions.Ethnic minorities living in Tay Nguyen area are one of special communitiesthat are hard to acquire information This has addressed an urgent need toachieve data about their knowledge, attitude and practice towards cancerprevention in order to find the most applicable and suitable interventions.Therefore, we would like to conduct a research on knowledge, attitude as well

as practice of ethnic communities living in Tay Nguyen region in order toachieve following purposes:

1 To describe knowledge of cancer prevention of ethnic minorities in 2 communes of Buon Don District, Dak Lak in 2015.

2 To describe attitude and practice for cancer prevention of ethnic minorities in 2 communes of Buon Don District, Dak Lak in 2015.

CHAPTER I LITERATURE REVIEW

1.1 Cancer in general

1.1.1 Cancer and health

Cancer is known as an uncontrollable creation of abnormal cells thatcan affect any part of the body as well as spread to other organs Cancer isfigured to be one of the leading causes of morbidity and mortalityworldwide, accounting for approximately from 8,2 million to 13 milliondeaths per year [4]

According to WHO, the most common cancer deaths are caused bycancers of lung, liver, stomach, colorectal, breast and esophageal cancer [4]

By gender, while men are most affected by lung cancer, stomach cancer, livercancer, colorectal cancer and esophageal cancer, five of the most commoncancer types that kill women worldwide are breast, lung, stomach, colorectaland cervical cancer [10]

1.1.2 Risk factors for cancer

According to the International Agency for Research on Cancer, morethan 30% of cancer incidences can be prevented by reducing risk factors [10].The most common risk factors of cancers are:

 Tobacco use

 Abuse of alcohol

 Unhealthy diet including low fruit and vegetable consumption

 Lack of physical inactivity

 Overweight and obesity

On the other hand, exposures to other environmental and occupationalrisk factors also contribute a considerable chance of cancer incidence Theseexposures can be named as:

1.1.3 Signs and symptoms

Early detection of cancer increases the chances of successful treatment.Recognizing warning signs or symptoms can have a considerable impact onthe disease Several common signs and symptoms of cancer include:

 A sore, wart or a spot that does not heal

 Persistent cough, chest pain in spite of treatment

 Indigestion or trouble swallowing

 Change in bowel habits or bladder function

 Swollen but painless lymph nodes

 Unusual vaginal bleeding or discharge

 Breast lumps or in other parts of the body

 Unexplained weight loss

1.1.4 Diagnosis of cancer

Cancer diagnosis consists of various medical techniques and proceduresused in order to detect or confirm the presence of cancer Diagnosis usuallyincludes patient’s history review, clinical examinations, laboratory test results(for example: blood testing and PSA tests) and radiological data (X-ray, CTscan, MRI scan, etc.) as well as microscopic examination acquired by biopsy orfine-needle aspiration However, appropriate tests and/or scans will be applieddepending on specific type of cancer

Cancer diagnosis procedure does not only help doctors confirm thepresence of cancer but also show in which stage the disease is Cancer stagingbases on the extent of the tumor, which means how distant cancer hasdeveloped from its original organ The staging process plays an irreplaceablepart of determining the most effective and appropriate treatment for thepatient As the development of cancer have 4 stages, stages I and II arereferred as “early cancer” while “advanced cancer” belong to stages III and

IV Stage of disease is generally the most important factor of the survival ofcancer patients

1.1.5 Treatment of cancer

Cancer treatment mostly refers to various kinds of interventions.Suitable interventions are mostly decided by the type of cancer along with itsstage Main types of cancer treatment include:

 Stem cell transplant

 Targeted therapy and precision medicine [12]

1.1.5 Palliative care

According to WHO, palliative care is an approach that improves thequality of life of patients and their families facing the problems associatedwith life-threatening illness, through the intervention and relief of suffering

by means of early identification and impeccable assessment and treatment ofpain and other problems – physical, psychological and spiritual [13] Whileclinical interventions are created to prolong patients’ lives considerably,palliative care is not only the pain treatment but also includes spiritualsupports for both patients and their relatives when the patient is in advancedstages and has a very low chance of being cured or when they are in theterminal phase of the fatal illness

Because of its arising needs such services are recommended to beprovided from the diagnosing period of cancer and be combined with othertreatments in order to improve the patient’s life physically andpsychologically Moreover, effectual palliative care is gradually integrated

into health systems at all levels, especially at community and home-basedcare, in both public and private healthcare sections, therefore it can adapt toparticular social, cultural and economic background

1.1.6 Early detection of cancer

Early detection allows recognition of the disease at an early stage when

it has a high potential for cure (for example: cervical and breast cancer) Themain purpose of such services is to detect cancer before it metastasizes toother organs or to some situations, is to detect a precancerous lesion An earlydetection program, therefore, is the organized and systematic combination of:early diagnosis and/or screening; diagnosis; treatment and follow-up Amongthese processes, two key components are:

- Early diagnosis: refers to the act of recognizing early signs andsymptoms of the disease in order to support diagnosis before it becomesadvanced Patients and health professionals both play a significant role in thisphase Early diagnosis does not only make the treatment become moreeffective and simpler but also helps prolong the patient’s life considerably

- Screening: applies on symptomless and apparently healthy peoples todiscover precancerous lesions or cancer at its early stage It involves manytypes of screening tests such as PAP cytology test for cervical cancer ormammography created to detect breast cancer These methods are especiallyeffectual for common cancer types and designed to be cost-effective,affordable, acceptable and accessible for the population at risk Screeningtests can be organized in national or regional borders

1.1.7 Cancer burdens worldwide and in Vietnam

The year 2012 saw the detection of 14.1 million new cancers cases, 8.2million deaths caused by cancer and 32.6 million patients living with cancer

(within 5 years if diagnosis) worldwide [14] The number of new discoveredcases is expected to increase by approximately 70% in the next 20 years [10].Global burden cost of cancer has been estimated to reach an excessive number

of 1,16 trillion dollars a year in 2010 [4] Due to industrialized lifestyles andthe burden of growing populations, cancer has gradually become a considerableload on healthcare system in less developed nations: more than 60% of newcases and 70% of cancer deaths compared with worldwide data [1]

Each year, Vietnam records a number of more than 100 000 newdiagnosed cases of cancers with nearly 70% of patients are having cancertreatments in oncological specialized centers [7] The most common types ofcancers in Vietnam are liver, lung, stomach, colorectal and nasopharyngealcancer in men; and breast, lung, liver, cervical and stomach cancer are themost common among women [7, 15] While liver cancer is the leading causes

of deaths in Vietnamese men, accounting for a prevalence of 26.9%, womenare killed by respiratory-related cancers with 14.5% of deaths, followed byliver cancer [15]

Even though the government has applied a tobacco control, the currentsmoking status in men is still high, taking a noteworthy proportion of morethan 45.1% [15] The coverage of HBV vaccination is still low, only 59% ofinfants in comparison with an expected number of 100% [6, 15] Such resultscould be explained by shortage of resources, lack of data on anti-tobaccoprogram and limited knowledge of general practitioners and public aboutcancer There is no comprehensive program for screening and early detectioncommon cancers cover nationwide In the treatment of cancer patients, thelack of equipment, hospital specialized in cancer is also a problem Theservices for pain relief and palliative care usually do not exist A major

A study of Ravichandran et al (2011) also pointed out the same issuewith only 23.1% female respondents having practiced breast self-examination, 14.2% having had clinical breast checks and 8.1% have hadmammography The practice of breast cancer early detection was significantlyrelated to educational level [17].

Aderounmu et al found that despite the difference in educational level,more than 70% of women in rural areas of Southwest Nigeria had previousknowledge about breast cancer, however, not half of the participants couldprovide adequate answers on typical symptoms of the disease Besides, nearly50% of asked individuals have been practicing self-examination as well asregistering for available clinical tests [18]

To explore the practice of breast screening of health professionals inNigeria, Akhigbe and Omuemu had carried out a research on 393 femalehealth workers Although the awareness of mammography as a diagnostictechnique was high, not so many people knew it was also a screening methodand only a poor number of 3.1% of asked healthcare providers actuallypracticed the test Moreover, a high proportion of respondents did not knowrisk factors for breast cancer and the awareness of breast self-examinationwas low [19]

A study on nurses in Singapore has shown an optimistic result on breastcancer awareness with over 93% of nurses did self-examination and morethan 50% of participants had clinical breast examination and mammogramscreening While exploring the associated factors, the authors has recognizedmarital status, age and cancer history in family affecting the practice of earlydetection by nurses [20]

A research on undergraduate female students in Cameroon, 2015 byFon Peter Nde et al has also shown that nearly 75% of the respondents wereaware of BSE and 88.0% considered the screening to be necessary, only 9.0%

of them know how to perform BSE correctly and a poor number of 3.0%practice the test regularly [21]

On the other hand, a rural region in North Begal, India had aremarkably low rate of women who had essential knowledge on cervicalcancer, with only 3.6%, 6.3%, 9.5% and 14.5% of female respondents havingawareness of causes, signs and symptoms, prevention of the cancer as well asPAP test and HPV vaccination respectively The difference in livingconditions between rural and urban areas also contributed to the difference inknowledge of women [22]

Eyah Demyati (2014) has carried out a research on colorectal screeningamong family doctors The outcome indicated that even though a remarkableproportion of 94.6% thought that the screening was important, only more thanhalf of them performed the technique The main explanation for suchcircumstance were mainly because of the lack of awareness of colorectalcancer screening among patients [24].

Using data from Australian National Health Survey, a study bySiahpush and Singh also pointed out that among risked women, marital status,educational level and different ethnicities were at a greatest risk of lackingknowledge of PAP test [25]

1.2.2 Vietnam

A survey conducted in 2008 on cancer patients and their relatives byBui Dieu et al has shown that the proportion of population that was aware ofcancer prevention recorded low, with only 35% Moreover, the knowledge ofbreast and cervical cancer early detection among participants was also poor,remarking numbers of 53% and 48.7% respectively [26]

In order to investigate KAP on common types of cancers such as livercancer, stomach cancer, lung cancer, breast cancer and cervical cancer,Nguyen Van Qui has carried out a study on 2400 people in Can Tho As forthe types of cancers that had been well propagandized like lung, breast andcervical cancer, from 62.5% to 93.6% of participants had good understanding

and from 56.0% to 98.1% of respondents performed correct practice for thesediseases However, with less known cancers such as liver or stomach cancer,these numbers were not as high, remarking only 41.9% for liver cancer and51.6% to 62.8% for the other [27].

A research by Trinh Huu Vach et al has exhibited limited awareness ofcancer and its risk factors among dwellers in three big cities of Hanoi, Hueand Ho Chi Minh City: there were still 2% of respondents who did not knowany types of cancer; 16.7% of population did not have the awareness of anycancer risk factors and nearly 5.0% were not knowledgeable of any ways ofcancer prevention Although, there were a remarkable of people who hadknown of the negative effect of tobacco and alcohol, the prevalence ofsmoking male was still noteworthy, with nearly 50% No more than 43.0% ofthe people knew how to reduce secondhand smoking The rate of vaccinationamong the research subjects was insignificant, taking account of only 13% forHepatitis B and 3.6% for HPV [28]

This was similar to a research in 2011 in 6 cities and provincesnationwide Even though the awareness of people of cancer was high (nearly93%), there were still 30.5% who did not know of any risk factors and only5.4% had adequate understanding of vaccination Despite that, most ofrespondents had correct attitude for cancer detection, with 85.1% knew ofseeking service from healthcare centers and nearly 50% understood thenecessity of regular health examination However, the real practice of studysubjects was poor Only 23.4% changed their diet habits and 3.6% hadvaccination The number of people who had health check twice per year wasmerely 53.2% [29]

A research in Bac Giang 2012 also showed that 62.2% of thepopulation had basic understandings of cancer However, there was still aremarkable proportion having wrong knowledge of the disease Yet from73.3% to 93.3% of respondents knew of the relationship between tobacco andcancer, there were 23.6% of people smoking, mostly male The prevalence ofusing animal fats in cooking was still high [30]

Khanh Hoa province remarked a rather high number of people who hadlimited understandings of cancer, with more than half of the respondents saidthat cancer was unpreventable, 21.8% thought cancer was an infectiousdisease The knowledge and practice for reducing risk factors were also low.More than 20% of participants usually ate too much salt or chili; 25.7% ofyoung adults smoked Nevertheless, the prevalence of the people who wereaware of healthy diets with vegetables and fruits consumption was high, with63.3% [31]

Bui Dieu et al conducted a research on knowledge of four commontypes of cancers in Ha Nam in 2014 The study has given that only one third

of the respondents had fundamental consciousness of cancer Among fourtypes of cancers, the most known was breast cancer (73.0%), cervical cancerfollowed by 59% The awareness of cancer warning signs was also limited,with only 22.3% of the participants could name more than 4 signs orsymptoms Only 21% to 58% of the population has information on cancerscreening methods However, among these people, more than 73% of womenhad basic understanding of BSE and more than half of them knew severalwarning symptoms of cervical cancer such as excessive vaginal discharge orunusual period [32]

CHAPTER II METHOD

2.1 Study settings

The study was conducted in Tan Hoa and Cuorknia commune of BuonDon District, Dak Lak province from July 2015 to June 2016 Data collectingwas from October 2015 to December 2015 The purpose of the research was

to provide information about knowledge, belief as well as practice of localethnic minorities for the prevention of cancer

Tan Hoa and Cuorknia are two communes of Buon Don – a ruraldistrict in Dak Lak, located near Cambodia border, where the accessibility ofhealthcare system is still limited The locations were also included in aresearch conducted by Hanoi Medical University in order to evaluate theeffectiveness of health education on cancer prevention in Buon Don District,along with Tan Hoa commune

Exclusion criteria: People were excluded from the study if they did notreach 18 years of age or were not available at the data collection period (fromOctober 2015 to December 2015) Respondents who were not capable of

understanding or completing the survey or did not volunteer to answer thequestions were also excluded

2.3 Study design

This study was a cross-sectional study

2.3.1 Sample size and sampling

- Sampling:

Lists of households of each ward were achieved from the localgovernment The first household which lies next to the local People’sCommittee was picked randomly Left-handed door-to-door technique wasapplied in order to accomplish next families One person represented theirfamily answer the questionnaire

- Sample size:

The sample size was calculated based on the following formula Thefollowing assumptions were used for sample size calculation: level ofconfidence 95%, proportion of participants that have adequate knowledgeabout cancer prevention (p) is 50% and absolute precision d = 0.05

n=Z1−2 ∝/ 2 p (1−p )

d2

Therefore, 385 people were needed for each location To allow for 5%

of missing data, we would need to gather surveys from 800 participants Infact, 812 questionnaires were collected

2.3.2 Study instruments

A structured questionnaire was developed to collect information aboutthese main sections: general characteristics of participants; knowledge for

characteristics

General understandings

of cancer

NominalNominal

Nominal

Awareness of healthcare center for cancer

diagnosis and treatment

Nominal

Awareness of services in hospitals

NominalKnowledge of palliative Nominal

careKnowledge of suitable time for palliative care

Nominal

Knowledge of last-stagedpatient care

The standard to evaluate economic situation of a households was based

on Decision 59/2015/QĐ-TTg released on November 19, 2015 of The PrimeMinister The classification was as followed:

Types of households Income (VND/person/month)

Near-poor > 700 000 to ≤ 1 000 000 > 900 000 to ≤ 1 300 000

2.3.4 Data collection techniques

Eligible participants were interviewed by trained interviewers using astructure questionnaire The consent for the study was achieved before theinterview began As for those who disagreed, they were immediately excludedfrom the study

Investigators then acquired information from eligible respondents bycompleting the questionnaire

2.3.5 Data management and analysis

Survey data was entered using Epi Data 3.1 Software The digital datafile was then exported and analyzed using Stata 12.0 Software

2.3.6 Bias controlling

Investigators were trained carefully about the study procedure and thestructure of the questionnaire in order to avoid missing data Special termswould be explained if needed

The questionnaire was developed using familiar terms to studyparticipants If necessary, special terms would be explained carefully by theinvestigators In case of missing information, data would be acquired viatelephone or mobile phone if needed

Chosen people were provided with detailed information on the studyobjectives and procedures as well as an opportunity to have any questionsanswered to their satisfaction Informed consent was collected from all theparticipants If in any case the subject did not want to precede the survey, theyhave the right to terminate the interview any time All personal identities ofthe participants will be protected

6

197

24.3

3

102

24

8

183

22.5

26

2

224

27.6

17.0

44

2

368

45.3

55

8

444

54.7

60

0

389

51.5

19.9

25.6

27.5Secondary school 17

5

43

8

155

37

6

330

40.6High school and

above

87 21

7

172

41

8

259

31.9

69

2

629

77.5

More than half of the respondents were over 40 years of age Among

812 participants, there were 44 female, taking accounts for 54.7% Ethnicities

of research subjects were various, however, Ede minority recorded as themost popular with 51.5%, followed by Nung 25.6% Most of the peoplefinished secondary school People who had high school or higher educationalso took a significant proportion of more than 30% Agriculture was the mostcommon occupation among the population, with more than 77.5% Theprevalence of non-poor households was high, more than 83.6% Despite that,the amount of poor and near-poor families was still remarkable, recording as7.4% and 9.0% respectively

3.2 Knowledge of cancer prevention among ethnic minorities

3.2.1 General knowledge of cancer

Cuorkinia Tan Hoa Both 0%

Graph 3.1 Awareness of cancer among participants

The graph above shows the awareness of cancer among ethnicminorities More than 98% of respondents heard of cancer or tumor Theproportion of people in Tan Hoa who knew of cancer was slightly higher than

in the other commune, 99.3% in comparison with 98.3% There was still a

small number of 1.2% that did not have the awareness of the disease in bothlocations

Table 3.2 General knowledge of cancer

The general understandings of cancer among respondents were shown

in Table 3.2 More than 61.1% of the respondents said that cancer was notcontagious while 15.9% believed that cancer could spread by close contacts

As for the inheritance of cancer, more than half of the participants thoughtthat cancer was inherited The proportion of people living in Tan Hoa whobelieved that cancer was hereditary was two times higher than in Cuorknia.People who did not know the answers were more than 20%

Stom

ach

cancer

cancer

Skin

cancer 0.0%

Graph 3.2 Common types of cancers among respondents

Liver, lung, stomach, cervical and breast cancer were the most commontypes of cancer among participants Liver cancer was the most known typewith more than 90% of the people Lung cancer followed by 78.8% Theproportion of respondents who were conscious of colorectal cancer were low,nearly 11% Prostatic cancer and skin cancer recorded the smallest rate of9.2% and 9.9% accordingly In general, the knowledge of cancer types amongpeople living in Tan Hoa was higher than in Cuorknia

3.2.2 Knowledge of risk factors for cancer

Graph 3.3 Awareness of cancer prevention among participants

65.8% of respondents answered that cancer was preventable Thepercentage of participants who knew of cancer prevention in Tan Hoa washigher than in the other commune, 80.3% in comparison with 50.8%.However, there were still remarkable amounts of people that did not have theawareness of such disease, recording more than 20% among all subjects

Table 3.3 Knowledge of risk factors among participants

3.2.3 Knowledge of cancer early detection

Table 3.4 Awareness of warning signs and symptoms among participants

a

Tan Hoa Both

n % n % n %

0

120

29

1

188

23.2

8

181

43

9

240

29.6

41

5

274

33.7

Change in bowel/Urination habits 31 7.8 56 13.

10.7

0

184

44

7

244

30.1

7

103

12.7

Abnormal vaginal bleeding/Excessive

vaginal discharge

128

32

0

110

26

7

238

29.3

38

6

296

36.5

6

46

5

166

40

3

352

43.4

Table 3.4 demonstrates the knowledge of warning signs or symptomsamong ethnic respondents No more than half of the research subjects couldmention a sign or symptom of cancer The greatest part, recording a number

of 43.4%, agreed that unexplained weight loss was a sign of cancer, followed

by lumps at any part of the body with 36.5% 29.3% of the respondents knew

of the warning signs for cervical cancer The least aware symptom among thepopulation was change in bowel or urination habits with a slight number of

10.7% The awareness of Tan Hoa dwellers was better than Cuorkniarespondents in most of the categories

Table 3.5 Knowledge of cancer screening methods among respondents

Screening methods Cuorknian % Tan Hoan % nBoth%Breast self-examination 97 24.3 148 35.9 245 30.2

in the other commune Colonoscopy was the least known technique, with only22.8% of all the research subjects Merely 30.2% of ethnic people were aware

of BSE, recording 24.3% of people in Cuorknia and 35.9% of people in TanHoa Pap test had slightly higher amount of 36.6%

3.2.4 Knowledge of cancer diagnosis and treatment

Table 3.6 Knowledge of cancer diagnosis among participants

Table 3.7 Knowledge of cancer treatment among subjects

Table 3.8 Awareness of healthcare center for cancer diagnosis

and treatment among participants

The awareness of cancer diagnosis and treatment location was differentamong health centers The major part of participants in Tan Hoa believed thatcancer should be diagnosed and treated at a specialized hospital while