Beattie's Model of Health Promotion: Prevention of Breast Cancer in Childbearing Females at Risk - Research Paper Example

Beatties Model of Health Promotion: Prevention of Breast Cancer in Childbearing Females at Risk Table of Contents Introduction 3 Study Aims and Objectives 5 Method Used 6 Literature Review 9 Causes of Breast Cancer 9 Health Promotion Program Variables and Needs for Breast Cancer 14 Data Analysis and Synthesis 17 Health Persuasion 18 Legislative Actions 19 Personal Counselling 21 Community Development 21 Conclusions and Recommendations 22 Introduction Since the rise of modern human civilisation and socio-economic developmental models, its effective nurturing, emphasising societal health conditions based on mortality as well as morbidity rates within the mass population, has received much attention. Healthcare sciences have correspondingly been able to identify several causes to human mortality and morbidity, drawing the interests amid the professionals in this domain. One such identified cause to high mortality rates is the risk of breast cancer among childbearing females (Pasqualini, 2002). As Pasqualini (2002) argues, little was known about the causes and the symptoms of breast cancer in the earlier period of its diagnosis by medical practitioners, wherein a greater degree of significance was laid to the role played by the treatment facilities, childbearing history and the hereditary record of breast cancer among females. It was with the gradual progression in research and technology that linkage between age (reflecting on the childbearing phase of females) and the potential risks to breast cancer among females evolved as a major concern in the healthcare domain (American Breast Cancer Society, 2014). The fact that childbearing age of females show a direct linkage with their risks to breast cancer has been apparently addressed in a study by Collaborative Group on Hormonal Factors in Breast Cancer (2012). The study thus reveals 1% increase in the rate of breast cancer risks among the females in their premenopausal stage, i.e. during their childbearing age, which further declines in their postmenopausal phase (Collaborative Group on Hormonal Factors in Breast Cancer, 2012). In addition, a cohort study conducted by Ruddy & et. al. (2014) indicated highest risk to breast cancer faced by women at ≤ 40 years of age, when their fertility percentage is supposed to be at the peak. With more of such existing evidences, emphasis has been laid by healthcare professionals to introduce preventive approaches that will reduce the propensity and the extensiveness of breast cancer risks among the females in their childbearing age. Evaluating the current portrayals of healthcare practices in association with breast cancer risks among women at their childbearing age, a pre-supposition can be found existing within the medical domain that illustrates early diagnosis as the best possible prevention method to the issue. Apparently, constant significance to screening, mammography and biopsy procedures, as reflected by Miller & Baines (2011), Secginli & Nahcivan (2011) and Kearney & Murray (2009) among others, justifies the pre-supposition. Nevertheless, gaps identified in the study of factors stimulating breast cancer risks amid females at their childbearing age and the corresponding prevention methods undertaken by the healthcare institutions have been a subject of debate. The gap was apparently identified in the studies of Tarrant (2006) and Secginli & Nahcivan (2006) wherein the researchers intended to address the effectiveness of breast self-examination techniques in comparison with clinical breast examination that too with considerable importance to the degree of awareness channelized within the society. The role of infrastructural growth of the healthcare industry within an economic context has also been a debated subject in the field, which has often led to the conclusion that developing countries with poor healthcare infrastructure face greater risks to mortality due to breast cancer among females at their childbearing age. In justification to the aforesaid context, the studies conducted by Zhang & et. al. (2012) on China and Al-Moundhri & et. al. (2004) on Oman can be taken into reference, which proves that social constraints and industrial developments also play a crucial role in the prevention of breast cancer within the stated population (Kumar & et. al., 2011). Study Aims and Objectives Identifiably, numerous speculations, notions and attributions have created a degree of vagueness in the conceptualisation of preventive measures when concerning the spread of breast cancer risks among females at their childbearing age. Focusing on this gap, the study aims at assessing various attributes associated with the prevention methods undertaken to reduce breast cancer risks among the stated group of females. Correspondingly, the discussion will be based on the Beattie’s model for health promotion to accomplish the determined aim. Stating precisely, the aim and the objectives of the study have been presented below. Aim: To assess the factors creating an influence on the prevention of breast cancer risks among the females at their childbearing age, with the implementation of Beattie’s model for health promotion Objectives: To collect evidences addressing common factors that affect the prevention programs for females, facing high risks to breast cancer at their childbearing age To draw precise conclusions on the gaps prevailing within the currently applied prevention programs To identify the developmental scopes in the field based on Beattie’s model of health promotion To provide comprehensive suggestions for dealing with the identified problem with greater efficiency Method Used This study will be based on qualitative research approach, imbibing the deductive technique and utilising the secondary data available online. Subsequently, a thorough literature review will be conducted with the intention to identify the factors associated with the applied prevention techniques for breast cancer risks prevailing amid females in their childbearing age. The literature review is further intended to be based on a systematic process, initially identifying the causes to breast cancer risks among females, which is supposed to be the highest in their childbearing age. Correspondingly, taking note on the findings obtained through the literature review, the Beattie’s model will be applied as a data analysis technique to identify the gaps currently existing in the preventive measures taken to counter breast cancer risks within the identified female group. Accordingly, the variables considered in this study have been explained briefly hereunder. The targeted population in this study, presumably facing highest degree of breast cancer risks, comprises females at their childbearing age. By stating childbearing age of the females, practitioners often refer to their premenopausal phase, which begins at the age of approximately 15 years. However, the fertility rate of a woman is considered to reach its peak within the age of 20-25 years and ends at an age within 45-50 years, which can be better illustrated through the diagram below (The Society of Obstetricians and Gynaecologists of Canada (SOGC), n.d.). Source: (The Society of Obstetricians and Gynaecologists of Canada (SOGC), n.d.) In this study as well, the definition of females at their childbearing age will also focus on women at the age of 20 to 50 years, when their risks to breast cancer is deemed to be the highest. The other considered variable in this study is breast cancer. As the American Cancer Society defines – “Breast cancer is a malignant tumour that starts in the cells of the breast” (Collaborative Group on Hormonal Factors in Breast Cancer, 2012). Correspondingly, the term, ‘malignant tumour’ is defined as ‘cancerous tumours’. There are precisely two categorisations followed when testing a tumour identified, i.e. a benign tumour (which is non-cancerous and can be removed from the body on identification) and a malignant tumour (which is cancerous and has the tendency to spread to other tissues if not identified and removed within time). Hence, it can be noted that malignant tumours when found in the breast, increase the risk of breast cancer. Accordingly, breast cancer can be referred to as the stage wherein the malignant tumour already begins spreading cancerous virus, and affects other tissues as well, of that particular body part (Pancreatic Cancer Action, 2015). The corresponding aspect focused on this study is the Beattie’s Model of health promotion. Beattie’s model is based on the notion that health promotion is a process to enable self-control among the identified groups facing risk of a particular type of disease with the intent to reduce such risks and increase effectiveness of the healthcare process applied (Raingruber, 2009). Being a process of educating people to build up their self-control degree and augment the effectiveness of public policies enforced to reduce health risks, health promotion techniques are vividly influenced by a wide range of factors, which Beattie infers as health persuasions, legislative actions, personal counselling and community development elements. Beattie thus divides health promotion strategies into four dimensions, i.e. the authoritative dimension, the collective dimension, the negotiated dimension and the individual dimension (Green & et. al., 2015). These factors can be better observed from the below diagram. Source: (Green & et. al., 2015) To be summarised, the following discussion will be emphasising the above defined variables that this study intends to examine undertaken health promotion techniques to prevent breast cancer risks among females at their childbearing age. Furthermore, the study will make use of the Beattie’s model in developing suggestive measures for introducing more effective health promotion techniques with respect to the targeted population. Literature Review Causes of Breast Cancer As per the observation made by Allen & et. al. (2010), breast cancer is the second leading cause of mortality among females around the world. There are various factors identifiable for such huge mortality rates, as a consequence to breast cancer amongst which, its complicated diagnosis techniques and wide range of causes score as two of the leading ones(Moreira & Canavarro, 2010). It is therefore quite likely that a degree of vagueness persists when concerning the idea of what actually causes breast cancer. As pointed by Allen & et. al. (2010), breast cancer can be caused due to various reasons including the genetic construct of the female body. To put it simply, if the risk of cancer is found higher in the family history or rather in the family genes of a female, she is likely to possess greater risk to breast cancer. Association between the genetic construct of human body and its risks for cancer has attracted much attention from scholars. It is in this context that Hall & et. al. (1990) tested and verified that chromosome 17q21 is a common genetic attribute found in most breast cancer patients. Emphasising the same ground, Ford & et. al. (1998) revealed that women possessing deficiency in BCRA1 and BCRA2, which are referred as genes responsible to produce ‘tumor suppressor proteins’ (National Cancer Institute, 2015), qualify as a prominent cause to greater breast cancer risk. McPherson & et. al. (2000) also provided a similar inference highlighting a direct association between deficiency of tumor suppressing genes and greater risk to breast cancer. Tumor Causing Breast Cancer (Source: Buckland, 2012) The other major cause identified with respect to breast cancer risk is ‘Obstetric and gynaecologic history’ of the patients (Allen & et. al., 2010). This particular factor, as referred by Allen & et. al. (2010), may refer to several attributes that include early menarche, lower parity of the periodic cycle for menstruation, age of pregnancy getting deferred and the record of hormone replacement therapy undertaken by the clients. Studying the same relation between the menstrual cycle of females and their age of getting pregnant in association with the risk of breast cancer, McPherson & et. al. (2000) assessed a relative risk of 3% or more for breast cancer among females owing to their disparity in menstrual cycle and age of pregnancy. This further indicates the possible linkage between puberty and the risk for breast risk among females. Addressing this particular issue, MacMahon & et. al. (1970) had indicated a possible association between the numbers of offspring borne by a woman and her risk to breast cancer through indirect relationship. In further discussion, the study revealed that women giving birth to a child at their age below 18 to 20 years have much lesser risks, precisely by almost one-third, as compared to women giving birth after their 30 to 35 years of age (MacMahon & et. al., 1970). Ritte & et. al. (2012) also delivered substantial focus on studying the association between females’ exposures faced during their age of puberty and risks to developing breast cancer at their latter age. Ritte & et. al. (2012) thus asserts that even though a linkage can be found between the stated factors, influences of elements such as ‘height, leg length, sitting height and menarcheal age with hormone receptor-defined malignancies’ have made the study of such associations considerably vague. Nevertheless, through an in-depth study to the context with almost 4500 research participants, Ritte & et. al. (2012) was able to prove a positive association of high breast cancer risks among young females, witnessing greater exposure to early development or puberty signs in their childhood. Apparently, the interplay of different variables has hindered the optimum reliability of these inferences, as drawn by Ritte & et. al. (2012) and MacMahon & et. al. (1970) amongst several others, besides being affected negatively due to wide variances observed in the study population. The study conducted by Najjar & Easson (2010) correspondingly revealed that females, especially in the Arab nations, were mostly diagnosed with breast cancer at their age of 48 years, i.e. when their fertility rate begins to decline. This also proves a positive association between age and the risks to breast cancer (Najjar & Easson, 2010). However, the study conducted by Bodicoat & et. al. (2014) depicted a clear association between the timings of puberty stages and the risks of breast cancer. As per Bodicoat & et. al. (2014), breast cancer risks or causes directly indicate towards hormonal changes occurring during the puberty stage of an individual, mostly the females, wherein unusual deferment of puberty or early puberty changes may point to a greater risk of breast cancer. Illustratively, with the early development of puberty or thelarche, breast cancer risks become higher and hence, can be attributed as a causing factor to the disease (Bodicoat & et. al., 2014). Stretching on the issue, Houghton & et. al. (2014) further emphasised the assumed influence of demographics (in terms of ethnicity or culture) on the timings of puberty stages and correspondingly, on the degree of risks of breast cancer faced by females at their childbearing age. Contextually, Houghton & et. al. (2014) studied the variances likely to occur in terms of puberty timings and possible association of the same with breast cancer risks among the females belonging to various ethnic groups, which included the Bangladeshi immigrants, British-Bangladeshis and White-British or the native females belonging to the UK. The results however implied that ethnicity or cultural belongingness has a very insignificant role to play in causing a variance between puberty timings with cultural differences and risks to breast cancer. Although, the tendency of early puberty was higher among White-British females as compared to the other groups, which increases their potential risks to breast cancer (Houghton & et. al., 2014). To be noted in this context, studying the various genetic or demographic causes to breast cancer risks, a common link can be identified in terms of hormonal constructs of the female body, immediately before and during their childbearing age. Accordingly, lifestyle choices and family-making decisions or precisely, decisions of sexual health among females have also become a noteworthy aspect when assessing possible causes to breast cancer. For instance, as the study of Davis & et. al. (1993) revealed, continuous intake of Xenoestrogens, which refers to a medication process to control the estrogen hormones, may also increase breast cancer risks among the females at their childbearing age. As noted by Davis & et. al. (1993), level of risks are caused due to the genetic inheritance is limited, rather highlighting a higher possibility that acquired mutations through Xenoestrogens and pharmaceutical components such as chlorinated organics, triazine herbicides and Polyclynic Aromatic Hydrocarbons (PAHs), affect the hormonal reactions in the female body. This in turn causes the formation of breast fat as well as serum lipids, indicating the early signs of malignancy in the breasts, containing significant amounts of chlorinated organics (Davis & et. al., 1993). A similar observation can also be accounted on the grounds of oral contraceptive intake among females, as a birth control measure, which has increased chances of breast as well as ovarian cancer within the stated population. Beaber & et. al. (2014) contextually asserted that if not quite significantly, regular intake of oral contraceptives increases risks to breast cancer among young females, at their childbearing age. Focusing on the same issue, Phipps & et. al. (2010) also asserted the changes or the mutations caused due to oral contraceptives and consequent hormonally mediated risks to breast cancer. Health Promotion Program Variables and Needs for Breast Cancer Summarising from the above facts, it can be ascertained that common causes to breast cancer amongst the females at their childbearing age are mostly related to their hormonal mediations or changes. These changes are further observed to be influenced by their lifestyle choices, besides their genetic constructs and hormonal growth under given demographic circumstances (Undersecretariat for Planning Affairs, 2014). Perhaps, it has been due to these causes that the educating young females about their potentials risks to breast cancer have become too imperative in the current day context (Junaibi & Khan, 2011). Scholars and social investigators have often argued in the context of the rising number of breast cancer incidences around the world, making it an alarming issue related with female mortality. Results obtained from the studies conducted thereafter however revealed that females, especially in the developing regions around the world, often do hesitate to undergo required medical tests or clinical breast examinations, which augments the chances of non-identification of the disease at its early stage (Tarrant, 2005). As argued by several other researchers such as Secginli & Nahcivan (2011), Kearney & Murray (2009) and Al-Moundhri & et. al. (2004) among others, females often avoid screening sessions, such as mammography owing to the persistent cultural dogmas as well as due to various personal and social inhibitions. This has been the main reason to promote breast self-examination over clinical assessment of the risks to cancer, which will encourage the females having greater risks to obtain medical assistance within due time (Rosolowich & et. al., 2006; Tarrant, 2006). Undisputedly, the earliest identification of malignant tumor in breasts is duly considered to be the most viable means of avoiding breast cancer risks to a female (Secginli & Nahcivan, 2006; Tarrant, 2006). It is with this consideration that health educators as well as healthcare professionals have been emphasising the development and implementation of health promotion techniques based on the notion to develop awareness among the mostly affected population groups i.e. the females at their childbearing age (Secginli & Nahcivan, 2006). Contextually, Secginli & Nahcivan (2011) argued, taking the example of Turkish women, that the involvement of female health practitioners in the screening as well as in the other phases of health promotional programs imposes a positive impact on the behaviours of the women class. Emphasising the similar issue, Miller & Baines (2011) argued that lack of awareness causing reluctance amid women to actively participate in the treatment procedure for breast cancer has substantially increased chances of the disease getting identified at an advanced stage in numerous countries. The only possible solution to the issue is thus considered as the implementation of clinical breast examination methods in association with self-examination education of the disease that would help in reducing mortality rates within these populaces (Miller & Baines, 2011). Contextually, inadequate awareness is also identified as an issue to inhibit positive responses from women towards health promotion programs for breast cancer treatment with identifiable constraints in terms of their over-consciousness regarding their body image (Moreira & Canavarro, 2010). Chait & et. al. (2009) in relation to the above context argued that the intentions of the women class to undertake self-examination of their breasts is most commonly restrained by their over-consciousness to their body image. It is also a prominent reason to depression and other similar forms of psychological distress resulting in the post breast cancer treatment period (Ridolfi & Crowther, 2013; Moreira & Canavarro, 2012). These inhibitions have further increased challenges for health promotion programs in various geographic regions. According to Chouchane & et. al. (2013), country-wide health awareness programs have been negligibly considered in the health promotion strategies applied until date, which has been mostly organised by quasi-private non-governmental organisations or international healthcare institutions such as WTO. Considering the case example of Arabic nations, such deficiencies have limited the reach of health professionals to a wider number of potential patients and thus, have kept the degree of awareness within the population inadequate (El Saghir & et. al., 2006). As a consequence, the implications of these deficiencies have significant disease management implications considering the fact that geographic characteristics, denoted as molecular attributes of the country, are widely different from those observed in Western countries such as the UK and the US (Chouchane & et. al., 2013). Common format followed in treating breast cancer (Source: Forrest, 1986) Data Analysis and Synthesis As mentioned in the earlier section for research method, the objective of this study is to suggest corrective measures for the health promotion techniques in practice to confront breast cancer mortality rates, assessing the risks of the same among the females at their childbearing age. In order to attain this particular objective, the Beattie’s model for health promotion has been taken into account. In the following discussion therefore, the factors included in the Beattie’s model will be examined with reference to the current context of breast cancer risks prevailing amid the females in their childbearing age, which comprise heath persuasions, legislative actions, personal counselling and community development factors as associated with the health issue in concern. Health Persuasion Theoretically explaining, health persuasion refers to the inclusion of aspects that tend to answer why a particular behaviour takes place, either in a risk aversive manner or in a way of negligence, rather than only emphasising the risk behaviour. In simple terms, this attribute of Beattie’s model for health promotion refers to the factors underlying as the motivators to the reactions of the targeted populaces (Dixey, 2013). When concerning breast cancer related health promotion techniques, the most commonly considered persuasion is the Uninformative Persuasion, which gets channelized by the survivors of breast cancer to other populaces under risk through story telling or sharing their experiences (Woloshin & et. al., 2012). As Woloshin & et. al. (2012) asserts, “A simple recipe for persuasion is to make people feel vulnerable and then offer them hope, in the form of a simple strategy for protecting themselves”. Emphasising this particular notion, patient advocacy groups, public health organisations as well as clinicians and other healthcare professionals have been initially focusing on generating awareness about breast cancer and its possible consequences to the targeted population prior to informing them about the various ways of risk aversion through self-experiment of their breasts and clinical assistances (Woloshin & et. al., 2012). Such measures have until date yielded considerable advantages to health promotion programs, as these proved to be effective in lessening negative responses from the community. Although, the rate of attendance to such initiatives by the local communities of women is still a concern, as at often instances, these females are observed to face inhibitions to participate in these programs actively in public (Yi & Park, 2011). Such hindrances can be most apparently observed amid the African American Women. Nevertheless, mass media, especially the internet technology can play a major role in serving modern young women with sufficient knowledge and effective persuasion towards breast self-examination, without hindering their privacy interests (Hall & et. al., 2012). As Pérez & et. al. (2014) argued, inclusion of interactive technology as well as persuasive narrations also ensures that the targeted population is positively motivated to undertake the required measures to deal with breast cancer risks at their childbearing age. Legislative Actions Presumably, legislative actions related to health promotion programs refer to various policies and regulatory measures adopted and implemented within the selected field of social care. These policies primitively intend to suggest and control the lifestyle attributes and choices of the targeted population or the risk groups to help them in avoiding the consequences of the disease (Dixey, 2013). Relating the same factor with the context of breast cancer among females at their childbearing age, the implementation of country-wide legislations can be observed as relatively a new approach that was found absent even in the recent decade, with only a few Western nations as its exceptions. Legislative actions aimed at protecting the interests of breast cancer patients, treating them equally as any other cancerous patient, have been quite a recent approach, especially in the health insurance sector (Yang & et. al., 2013). Nevertheless, these measures have been identified as limited within the boundaries of the US, under political pressures as well as obtaining simultaneous encouragement from the healthcare society of the country. The implementation of Mammography Quality Standards Act (MQSA) has also been a newly adopted approach in the domain of breast cancer treatment, which emphasises regular screening of women aged 40-49 years in the US in the context of examining their breast density and identifying their risks to the disease. It is worth mentioning in this context that such an initiative has been contradicted by various social forces those have inhibited the notion of regularly screening women’s breast density after they are 40 years of age, i.e. by the end of their childbearing age and pre-menopausal stage (Lee & et. al., 2012; Levy & et. al., 2012). Source: (Screenings for Life, 2014) Personal Counselling This particular facet of the Beattie’s model for healthcare elucidates the cognitive needs of the patients through their psychological empowerment. This implies the technique of making the patients feel empowered with a degree of control on their disease risks, and therefore, avoiding any hindrance to their self-confidence (Dixey, 2013). In the context of breast cancer treatment through health promotion programs, personal counselling measures can be deemed to perform a key role, particularly owing to the observed inhibitions among women to join social groups or actively undertake breast self-examination (Eakin & et. al., 2011). According to Nisker (2013), there are several women around the world who chose to keep their problem or risk to breast cancer private in supposition and inhibition that its disclosure might affect their body image and hence, had to experience stress and post-traumatic consequences on the identification of the disease (Brunet & et. al., 2013; Ayers & Pickering, 2001). It is in this context that case examples of renowned celebrities and personalities, such as in the case of the famous actress Angelina Jolie, often tend to act as a personal counselling to the patients, making them feel less-inhibited (Nisker, 2013). Daniel & et. al. (2014) however considers it as a Protection Motivation Theory (PMT) to provide personal counselling to the sufferers of breast cancer or those bearing high risk to the same. Community Development Beattie’s model for health promotion is based on the notion that community pressures also play a significant role in either motivating or demotivating a particular group of patients in need for medical assistance (Dixey, 2013). Implications of this particular factor on the health promotion programs undertaken to deal with breast cancer risks is found to be severe. Evidences to this particular notion can be better illustrated with reference to the health promotion campaign organised in Qatar, wherein breast cancer screening rate remains considerably low irrespective of the continuous efforts delivered by national as well as international groups. A similar observation was also obtained from other middle-eastern countries. On investigation to the scenario, the findings revealed that community inhibitions and negative perceptions towards females with breast cancer restrained a major proportion of the targeted populaces from participating in the program. According to Hajj & Hamid (2010), although pharmacists reflected considerable enthusiasm towards participating in health promotion activities in Qatar, such programs were limited in terms of inadequate educational materials and severely lacking recognition from the community. Focusing on this particular aspect Simonds & et. al. (2013) argued on developing health promotion strategies taking due consideration to community development. Conclusions and Recommendations Recalling the project objectives, the aim determined was to investigate health promotion strategies adopted in relation to breast cancer risks, with due emphasis to the possible causing factors, especially when considering females at their childbearing age. The key findings thus obtained from the study revealed various factors responsible for a comparatively higher degree of risk faced by women concerning breast cancer possibilities in their elder age, presumably at their 40s, i.e. immediately before their menopausal stage and on the decline of their fertility. The findings obtained in the study also helped in addressing the fact that besides genetic factors, lifestyle choices, demographic factors as well as age form are also responsible for causing breast cancer risks amid the identified cluster. The identified key attributes of the health promotion strategies included their consideration made towards the cognitive demands of the targeted population, community influences as well as the educational infrastructure required to support such initiatives. Personal counselling sessions as well as considerable significance delivered to health persuasions in the initiatives have been identified as a few of the common strengths of the programs. On the other hand, limited significance delivered from the legislative ends and country-wide application of the programs constituted a few of the negatives or the gaps in the approaches undertaken until date. Based on the identified gaps of the applied health promotion techniques to control the spread and the rising mortality rates of females owing to breast cancer, it is suggestive that measures must be taken from the governmental end as well. Such measures, with governmental involvement, shall be strengthened in its worth and effectiveness, as it will allow better legislative actions to secure the interests of the groups facing substantial risks of breast cancer - referring to the females at their childbearing age. Notably, it will be quintessential to balance community wide approach with due consideration to the cognitive requirements of the targeted population, as they are observed to decipher a higher degree of reluctance in unveiling their problems within the society. Suggestively, greater stress can be provided on health persuasions amid the young adult females as well as females at their early puberty stage emphasising the common symptoms and causes of breast cancer. This particular measure is likely to create a degree of psychological pressure on the group and persuade them to take requisite actions for the early detection of breast cancer, either through clinical breast or self breast examination. 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