Cancer Stigma Among Women in Semi-Urban Nepal

Cancer is a major cause of death around the world. In 2020, about 100 people out of every 100,000 died from cancer. Most of these deaths happened in poorer countries. In Nepal, the cancer rates were slightly better, with 80 people per 100,000 getting cancer and 54 dying from it in the same year. Even though treatments have improved recently, many people still fear cancer and feel ashamed to talk about it.

Stigma related to health issues can lead to people being excluded or looked down upon because of their health conditions. This stigma often comes from negative views people have about illnesses. For example, some people think that cancer survivors are contagious or incapable of normal activities. Such beliefs can cause others to avoid interacting with them, which can also affect job opportunities. This stigma makes it harder for those affected to seek medical help.

While many studies have looked at the stigma surrounding other diseases, like leprosy or AIDS, there has been less focus on cancer stigma, especially in healthy people who do not have cancer. It is important to look at how cancer stigma affects people for various reasons. First, stigma can stop people from getting screened for cancer, which can lead to later diagnoses and higher death rates. Second, public health campaigns that teach about cancer risks, like smoking and poor diet, might unintentionally create stigma by suggesting that people can avoid cancer if they make better choices. Lastly, stigma can create inequalities in health care access, especially for vulnerable groups who already face challenges in getting medical help.

Few studies have looked into cancer stigma and how it relates to different social and demographic factors. Research has shown that younger, single individuals may experience stigma differently based on their age, gender, and living situations. A study in England found higher cancer stigma among men and ethnic minorities, but did not link stigma to age or social status. However, this study only used part of the available measurement tools, which could affect the results. There have been no studies in low-income countries like Nepal on this topic. Our research aimed to find out how common cancer stigma is among women in semi-urban areas of Nepal and what factors contribute to it. By understanding these factors, we can create programs to reduce stigma and improve health outcomes for everyone.

#Study Design and Setting

We conducted our research in two areas of the Kavrepalanchow district in Nepal, Dhulikhel and Banepa, located about 30 kilometers from Kathmandu. Dhulikhel has around 32,000 people, while Banepa has about 55,000. The main ethnic group is Newar, and around 70% of people can read and write. About 75% of the women in these areas are literate.

#Study Participants

We focused on women aged 30 to 60 living in Dhulikhel or Banepa. We excluded those who had hearing problems, severe mental health issues that prevented them from understanding the study, or who were not residents of these areas.

From May to September 2021, we recruited 426 women from a group of about 1,800 who were screened for cervical cancer at Dhulikhel Hospital. Our sample size was based on the idea that around 51% of women might have cancer stigma, using a standard level for accuracy in research.

Our research assistants worked with local female health volunteers who helped share information about the study. These volunteers have been helping with health issues in Nepal for many years and are key figures in local health education. Interested women were contacted by phone, and those willing to participate were enrolled in the study after providing verbal consent. We conducted interviews over the phone to keep everyone safe from COVID-19. The study was approved by an ethical board to ensure that everything was done correctly.

#Data Collection

Trained researchers conducted telephone interviews using a detailed questionnaire that covered social factors and cancer stigma.

#Cancer Stigma Measurement

We used a tool called the Cancer Stigma Scale (CASS) that had been validated for use in Nepal. This scale has been shown to be reliable for measuring stigma. It contains 25 questions that fall into six areas:

1. Awkwardness: How comfortable people feel around someone with cancer.
2. Severity: How serious people think cancer is and the chances of recovery.
3. Avoidance: How much people try to stay away from cancer patients.
4. Personal Responsibility: How much people believe individuals are to blame for getting cancer.
5. Policy Opposition: How much people think the government should help cancer patients.
6. Financial Discrimination: Whether cancer patients might be denied financial services like loans.

Participants rated their feelings from strong disagreement to strong agreement on a scale. We calculated mean scores for each category.

#Research Findings

In total, we had 426 women in our study. The average age was 42 years, and most were from the Brahmin/Chhetri ethnic group and Hindu. A significant number had no formal education, and many were farmers.

#Stigma Score Results

The overall mean score for cancer stigma was 2.6 out of 6. The highest level of stigma was in the personal responsibility area, where participants felt that people are to blame for getting cancer. The severity domain showed that many believed that cancer leads to a life that is hard to return to normal. Financial discrimination was also a significant concern, with some thinking that banks could refuse to lend money to cancer patients. The area regarding government support had a lower score, showing that participants were more supportive of helping cancer patients.

#Socio-Demographic Factors

We found that older women tended to have higher cancer stigma scores. Education also played an important role; more educated women had lower stigma levels. When looking closely at the numbers, we saw that with every additional year of education, the stigma score dropped slightly. Other factors like ethnicity, occupation, and number of children did not show a significant relationship with stigma levels.

#Discussion

Our study indicated that cancer stigma is low among seemingly healthy women in semi-urban Nepal, but it still exists. The main areas of concern were personal responsibility, severity, and financial discrimination. This suggests that many still blame cancer patients for their condition.

In comparison to studies from other countries, the level of stigma we found was lower. However, our population felt more stigma related to personal responsibility and severity than some other groups. It highlights that stigma can vary depending on social and cultural contexts. People in Nepal may be less informed about cancer, which could lead to different perceptions.

Older age was linked to higher stigma levels in our study, which was different compared to findings from other countries. This might be linked to limited access to information and media among older women in Nepal, compared to those in places with better internet access. Our study emphasizes the need for programs aimed at increasing knowledge about cancer, especially for older women.

This is the first study in Nepal that looked at cancer stigma in healthy women. Previous studies usually focused on patients. Using a standardized tool like CASS helps in measuring stigma more accurately.

#Limitations

Our study has a few limitations. There may be bias in how participants responded since some might have downplayed their true feelings. We also used a convenience sample, which may not fully represent all women in Nepal. More research using random samples would help to confirm these findings. Lastly, the study only captures a moment in time, and we cannot track how stigma changes.

#Conclusion

In summary, this study found a low level of cancer stigma among women in semi-urban Nepal, though some stigma remains. This stigma could hinder cancer screening participation, so focusing on reducing stigma, particularly among older and less educated women, is essential for improving health outcomes.