MINISTRY OF MINISTRY OF HEALTH EDUCATION AND TRAINING 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 MINISTRY OF HEALTH EDUCATION AND TRAINING 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 SUPERVISOR: Assoc Prof Dr NGƠ VĂN TỒN HANOI - 2016 ACKNOWLEDGEMENT 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 Ngơ Văn Tồn, 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 COMMITMENT 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 in this thesis are to the best of my knowledge, true and accurate The work contained in this thesis has not been submitted elsewhere, as part of any other degrees or assignments I contend that the work presented in this thesis is my own, except in instances where due reference has been made to other referenced materials The author of thesis DOAN PHUONG NHUNG TABLE OF CONTENTS ABBREVIATION WHO: World Health Organization IARC: International Agency for Research on Cancer MOH: 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 INTRODUCTION Cancer is considered to be one the four major non-communicable diseases (NCDs), along with cardiovascular diseases, chronic respiratory diseases and diabetes [1] With 8,2 million of deaths every year, cancer is the second leading cause of NCD death worldwide, responsible for 21% of death [2] 895 billion dollars was recorded to be the overall economic impact causing by premature mortality and disability from cancer worldwide in the year 2008 [3] In 2012, the global load of cancer rose to an estimated 14 million new cases every year and expected to continue increasing to 22 million annually in the next 20 years [4] As a consequence of growing and aging populations along with unhealthy lifestyles, middle- and low- income countries are excessively affected by the arising cases of cancers More than 60% of the world’s new discovered cases occur in Africa, Asia and Central and South America [5] Such circumstance was the consequence of the lack of early detection and the effectiveness of prevention programs Researches conducted by World Health Organization (WHO) have shown that good health behaviors along with access to effectual and affordable cancer interventions in will remarkably reduce the number of new cases and deaths National strategy for cancer control has been developed by Vietnamese government since 2008, aiming to reduce the prevalence of cancer cases annually and to improve knowledge and behaviors of people towards cancer prevention Despite of the great efforts, the first stage result did not reach expectations [6] The second and third stages have been developed; with the priority purpose is to increase general knowledge about cancer, expecting to 10 reach 70% of adults having adequate knowledge towards cancers [7] Moreover, cancer control programs also emphasize the important part of local authorities in cancer prevention promotion [8] Such action has noted the importance of cancer prevention in National strategy of non-communicable diseases control as well as the improvement of knowledge of people about the fatal illness This addresses a necessary need to find out more about actual knowledge, attitude and practice of specific community in order to apply suitable interventions Even though the National program has proceeded in more than 37 provinces and cities [9], it stays mainly in big or easy-to-access regions Ethnic minorities living in Tay Nguyen area are one of special communities that are hard to acquire information This has addressed an urgent need to achieve data about their knowledge, attitude and practice towards cancer prevention 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 to achieve following purposes: To describe knowledge of cancer prevention of ethnic minorities in communes of Buon Don District, Dak Lak in 2015 To describe attitude and practice for cancer prevention of ethnic minorities in communes of Buon Don District, Dak Lak in 2015 15 WHO (2014) Cancer country profile: Vietnam, Cancer country profiles 16 Salma Abdel Atty Moawed; Jawaher A Bin Jumah (2013) "Knowledge & Practice of Saudi Women about the Prevention of Breast Cancer", International Journal of Applied Science and Technology 3(2), 17 Kandasamy Ravichandran, Nasser A Al-Hamdan, Gamal Mohamed (2011) "Knowledge, attitude, and behavior among Saudis toward cancer preventive practice", Journal of Family and Community Medicine, 18(3), 135-142 18 A O Aderounmu, B E Egbewale, E O Ojofeitimi et al (2006) "Knowledge, Attitudes and Practices of the Educated and NonEducated Women to Cancer of the Breast in Semi-Urban and Rural Areas of Southwest, Nigeria", Nigerian Postgraduate Medical Journal, 13(3), 182-188 19 Adenike O Akhigbe, Vivian O Omuemu (2009) "Knowledge, attitudes and practice of breast cancer screening among female health workers in a Nigerian urban city", BMC Cancer, 9(1), 1-9 20 P N Chong, M Krishnan, C Y Hong et al (2002) "Knowlegde and practice of breast cancer screening amongst public health nurses in Singapore", Singapore Med J, 43 21 Fon Peter Nde, Jules Clement Nguedia Assob, Tebit Emmanuel Kwenti et al (2015) "Knowledge, attitude and practice of breast selfexamination among female undergraduate students in the University of Buea", BMC Research Notes, 8, 43 22 Sreejata; Mandal Raychaudhuri, Sukanta (2012) "Socio-Demographic and Behavioural Risk Factors for Cervical Cancer and Knowledge, Attitude and Practice in Rural and Urban Areas of North Bengal, India", Asian Pacific Journal of Cancer Prevention, 13(4), 1093-1096 23 Saad Aliyu Ahmed, Kabiru Sabitu, Suleiman Hadejia Idris et al (2013) "Knowledge, attitude and practice of cervical cancer screening among market women in Zaria, Nigeria", Nigerian Medical Journal: Journal of the Nigeria Medical Association, 54(5), 316-319 24 Eyad Demyati (2014) "Knowledge, Attitude, Practice, and Perceived Barriers of Colorectal Cancer Screening among Family Physicians in National Guard Health Affairs, Riyadh", International Journal of Family Medicine, 2014, 457354 25 M Siahpush, G K Singh (2002), "Sociodemographic predictors of pap test receipt, currency and knowledge among Australian women", Prev Med, 35 26 Bùi Diệu, Nguyễn Bá Đức, Nguyễn Hoài Nga cộng (2010), "Khảo sát kiến thức, thực hành phòng số bệnh ung thư phổ biến cộng đồng dân cư số tỉnh thành", Tạp chí Ung thư học Việt Nam, 1, 118-122 27 Nguyễn Văn Qui (2010) "Khảo sát kiến thức - thái độ - thực hành phòng chống số bệnh ung thư phổ biến cộng đồng thành phố Cần Thơ (01/01/2008 - 31/12/2009)", Tạp chí Ung thư học Việt Nam, 1, 123-128 28 Trịnh Hữu Vách, Ngô Thị Thanh Thủy, Nguyễn Vân Anh (2010) "Nhu cầu truyền thông thay đổi hành vi liên quan phòng chống ung thư người dân Hà Nội, Huế TP Hồ Chí Minh", Tạp chí Ung thư học Việt Nam, 1, 129-137 29 Bùi Diệu, Nguyễn Ngọc Hùng (2012) "Nghiên cứu kiến thức, thái độ, thực hành người dân phòng chống ung thư số tỉnh/thành phố năm 2011", Tạp chí Ung thư học Việt Nam, 2, 42-46 30 Từ Quốc Hiệu, Trương Quang Vinh, Nguyễn Thị Thu Phương (2013) "Đánh giá kiến thức, thái độ, hành vi phòng chống ung thư người dân tỉnh Bắc Giang 2012", Tạp chí Ung thư học Việt Nam, 1, 65-71 31 Nguyễn Văn Xáng cộng (2013) "Điều tra kiến thức, thái độ thực hành phòng chống bệnh ung thư cộng đồng dân cư tỉnh Khánh Hòa năm 2012", Tạp chí Ung thư học Việt Nam, 1, 72-79 32 Bùi Diệu, Nguyễn Hồi Nga, Tơ Anh Dũng (2014) "Thực trạng kiến thức phòng phát sớm ung thư cộng đồng dân cư tỉnh Hà Nam", Tạp chí Ung thư học Việt Nam, 1, 9-15 33 Ngơ Văn Toàn, Nguyễn Ngọc Hùng, Trần Thị Hảo cộng (2013) Nghiên cứu cung cầu khám điều trị ung bướu vùng sinh thái Việt Nam 34 T Domi Le, Patricia A Carney, Frances Lee-Lin et al (2014) "Differences in Knowledge, Attitudes, Beliefs, and Perceived Risks Regarding Colorectal Cancer Screening Among Chinese, Korean, and Vietnamese Sub-Groups", Journal of community health, 39(2), 248-265 35 Goodarz Danaei, Stephen Vander Hoorn, Alan D Lopez et al (2005) "Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors", The Lancet, 366(9499), 1784-1793 36 Karimollah Hajian Tilaki, Sahar Auladi (2015) "Awareness, Attitude, and Practice of Breast Cancer Screening Women, and the Associated Socio-Demographic Characteristics, in Northern Iran", Iranian Journal of Cancer Prevention, 8(4), e3429 37 Samira Zoa Assoumou, Barthelemy Mabika Mabika, Angelique Ndjoyi Mbiguino et al (2015 "Awareness and knowledge regarding of cervical cancer, Pap smear screening and human papillomavirus infection in Gabonese women", BMC Women's Health, 15, 37 38 David Hui, Yee-Choon Meng, Sebastian Bruera et al (2016) "Referral Criteria for Outpatient Palliative Cancer Care: A Systematic Review", The Oncologist 39 David Hui, Yu Jung Kim, Ji Chan Park et al (2015) "Integration of Oncology and Palliative Care: A Systematic Review", The Oncologist, 20(1), 77-83 40 Justin C Brown, Kerri Winters-Stone, Augustine Lee et al (2012) "Cancer, Physical Activity, and Exercise", Comprehensive Physiology, 2(4), tr 2775-2809 APPENDIX KNOWLEDGE-ATTITUDE-PRACTICE FOR CANCER PREVENTION QUESTIONNAIRE (Interview 01 person/family) Introduction to the study: We are researchers from Cancer control program We are conducting a study on knowledge-attitude-practice of people for cancer prevention Thank you for your time for this survey Please not hesitate to answer Your answers would only be used for study purposes You could stop the interview at any time or deny answering any questions Therefore, your participation in this study is to your content Do you have any question? Are you willing to participate in this research?  Yes  No Province: District:……………… Commune : Name of respondents: Mobile/Telephone: …… …… Interview date: / /201 CONTENTS No Question Answer PART A GENERAL INFORMATION A1 Age …………………… A2 Gender Male Female A3 Ethnicity Kinh Khmer Tay Chinese Nung Other…… A4 Religion None Christianity Buddhism Protestantism No Question A5 Marriage status you Answer Other…………………… Single Married Separated/Divorced Widowed A6 Which grade have Grade:………… finished? A7 What is your main Farmer Student occupation? Handicrafter Homemaker Worker Retired Business Other Government officer A8 Economic situation of your Poor family? Near-poor Non-poor PART B KNOWLEDGE, ATTITUDE, PRACTICE FOR CANCER Have you ever heard of Yes cancer? No Which type of cancer did you hear of the most? (Interviewer does not read the answer Multiple choice question) Lung cancer Liver cancer Colorectal cancer Breast cancer Nas Prostatic cancer Skin cancer 10 Other… No Question Answer Cervical cancer Stomach cancer Please name most common types of cancer that you know (Interviewer does not read B3 the answer Multiple choice question) Lung cancer Liver cancer Nasopharyngea l cancer Cervical cancer Stomach cancer Colorectal cancer Breast cancer Prostatic cancer Skin cancer 10.Other… Please name types of Lung cancer cancer that have the most Liver cancer chance of prevention? Nasopharyn (Interviewer does not read geal cancer the answer Multiple choice Cervical question) cancer Stomach cancer Colorectal cancer Breast cancer Prostatic cancer Skin cancer 10.Other… Please name types of Lung cancer cancer that have the highest Liver cancer healing chance if detected Nasopharyn early? geal cancer (Interviewer does not read Cervical the answer Multiple choice cancer question) Stomach Colorectal cancer Breast cancer Prostatic cancer Skin cancer 10.Other… No Question Answer cancer In your opinion, which Bacterial infections factor could lead to the Viral infections development of cancer? Environmental pollution Genetics (Interviewer does not read Unhealthy diet the answer Multiple choice Contaminated food question) Tobacco use Alcoholic drink Occupational factors 10.Obesity/Being overweight 11.Physical inactivity 12.Other:……… …………………… 13.I don't know Please name warning sign(s) Long-lasting ulcers or symptom(s) of cancer Nagging cough/Chest pain (Interviewer does not read Indigestion/Trouble swallowing the answer Multiple choice Change in bowel/Urination habits question) Swollen lymph nodes Trouble hearing or seeing Abnormal vaginal bleeding/ Excessive vaginal discharge Lumps Unexplained weight loss 10 Other………………………… 11 I don't know In your opinion, is cancer Yes infectious? No I don't know No Question In your opinion, is cancer inherited? In your opinion, what should be done when detecting unusual signs or symptoms? (Interviewer does not read the answer Multiple choice question) Answer Yes No I don't know Go to healthcare centers as soon as possible Go to healers Seek advice professionals from health Wait for clearer signs Self-treat at home Other:…………………………… In your opinion, how to detect cancer early? (Interviewer does not read the answer Multiple choice question) In your opinion, is cancer preventable? In your opinion, what should be done to prevent cancer? (Interviewer does not read the answer Multiple choice question) As soon as detecting unusual signs Regular health examination Other: ……………………………… I don't know Yes No I don't know Eating vegetables and fruits Limiting oiled or grilled food Consuming clean food Regular physical activity Quitting tobacco use Reducing harmful use of alcohol Vaccination of Hepatitis B and HPV Regular health examination Other:…………………………… No Question What have you done to prevent cancer? (Interviewer does not read the answer Multiple choice question) In your opinion, is it necessary for a healthylooking person to have regular health examination? If yes, how frequent? Answer I don't know Eating vegetables and fruits Limiting oiled or grilled food Consuming clean food Regular physical activity Quitting tobacco use Reducing harmful use of alcohol Vaccination of Hepatitis B and HPV Regular health examination Other:…………………………… 10 I don't know Yes No I don't know months months Annual 4.Other……………………………… … If no, why? I don't know Not necessary (Multiple choice question) Waste of money Unavailable services Poor quality services No information 7.Other……………………………… … Do you have regular health Yes examination? No If yes, how frequent? months months Annual No Question Answer Other …………………………………… Have you ever had cancer Yes screening? No If yes, which type of cancer? Could you name some Breast self-examination (for screening methods that you women) know? Pap test (for women) (Interviewer does not read Upper endoscopy the answer Multiple choice Colonoscopy question) Other: In your opinion, cancer Clinical examination diagnosis should base on Blood test which method? Biopsy X-rays CT scan Other I don't know In your opinion, what is the Surgery treatment for cancer ? Radiation Chemotherapy Combination of treatments Traditional medicine I don't know Have you ever heard or Yes known of Palliative care No Move to D5 instructions for cancer patients released by MOH? What is palliative care? Prevention, early detection and (Interviewer does not read treatment of pain No Question the answer Multiple choice question) If the respondent could not answer, the interviewer reads the definition then asks again: “Palliative care is the improvement of patients' quality of life by prevention, early detection and treatment for pain and other complications, consulting and support social psychological problems of the patients and their relatives" In your opinion, what is the best time to perform palliative care? In your opinion, how to measure pain of cancer patients? (Interviewer does not read the answer Multiple choice question) In your opinion, which pain level is suitable for pain relief? In your opinion, what should be done for last-staged Answer Prevention, early detection and treatment of complications Social and psychological support for patients Social and psychological support for patients’ relatives Other I don't know After diagnosis When pain starts At the advanced stage Other I don't know Ask pain history Evaluate pain type Find pain cause Use pain scale Other I don't know Mild pain Moderate pain Severe pain I don't know Social and psychological support for patients and their No Question patient care? Answer relatives Respect the patient's decision (Interviewer does not read Spiritual support the answer Multiple choice Pain relief question) Instructions to pain killers usage (if patient treats at home) Nursing care instructions Care instructions when the patient dies Other I don't know In your opinion, where is the National hospitals/Cancer suitable place for last-staged specialized centers patient care? Provincial hospitals District hospitals (Interviewer does not read Local health station the answer Can only choose Clinics 01 answer) Healers At home Other: PART C ACCESSIBILITY OF CANCER DIAGNOSIS AND TREATMENT SERVICES Accessibility to information about cancer C1 In the last years, have you Yes ever heard or seen any No information about cancer on I don't remember TV? C2 Which ways did you receive Local health professionals information? Doctors in hospitals Local TV programs (Multiple choice question) National TV programs O2 TV National radio programs No Question Answer Local radio programs Newspaper……………………… … Internet 10.Leaflets, booklets 11.Other ……………………………… C3 Which type of document did Leaflets you obtain information? Booklets (Multiple choice question) Panels Photos Other ……………………………… C4 Which information did you Cancer risk factors pay attention the most? Cancer early detection Cancer early treatment Diet for cancer prevention Physical activity for cancer prevention Palliative care Other: C5 What type of difficulties did No TV or radio you meet when access to the Lack of time information? Lack of documents (Multiple choice question) Trouble understanding Other C6 Are you satisfied with Very unsatisfied current cancer information Unsatisfied or cancer education? Average Satisfied Very satisfied No answer Accessibility to cancer diagnosis and treatment No C7 Question Distance to the healthcare center Answer nearest (km) C8 Time to the nearest (mins) healthcare center or (hours) C9 Have you ever heard of Yes cancer diagnosis and No treatment information? C10 In your opinion, where could Local health station you have cancer diagnosed District hospitals and treated? Provincial hospitals Cancer specialized centers National hospitals Other C11 In your opinion, what type Cancer screening of services are available in Cancer early diagnosis cancer centers? Imaging procedures (Interviewer does not read Surgery the answer Multiple choice Chemotherapy question) Radiation Hormone therapy Palliative care Other C12 In your opinion, what is the Name: nearest healthcare center for cancer diagnosis and treatment? Address: (Interviewer asks the respondents to specify) C13 Distance from your house to that health center? (km) C14 Travel time from your house (minutes)