UNIVERSITY OF CALGARY

UNIVERSITY OF CALGARY
Factors Influencing Breast Cancer Screening Practices Among Arabic Women Living in
the State of Qatar: The Health Care Providers’ Perspective
by
Jasmine Jihye Hwang
A THESIS
SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF MASTER OF NURSING
FACULTY OF NURSING
CALGARY, ALBERTA
JULY, 2013
© Jasmine Jihye Hwang 2013

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Abstract
Breast cancer is the most common cancer contributing to morbidity and mortality
among Arabic women in Qatar. Arabic women are at risk primarily due to their low
participation rates in breast cancer screening practices. Therefore, there must be a strong
emphasis on the health care system to increase efforts in early detection of breast cancer.
Using critical ethnography, the purpose of this study was to explore, understand, and
describe factors influencing Arabic women’s breast cancer screening practices. Fifteen
health care providers in Qatar were interviewed. An analysis of the data revealed
influences of (a) knowledge and awareness and pain perception, (b) culture, (c) gender
and power relations, and (d) systemic factors on women’s breast cancer screening
practices. Study findings suggest that Arabic women’s health cannot be understood in
isolation from the environment in which they live; therefore, solutions need to address the
context and not be limited to the individual.

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Acknowledgements
This thesis would not have been possible without the support and assistance of
many people, and I would like to acknowledge contributions of them. Foremost are the
health care providers who participated in the study, sharing their valuable time and
insights with me patiently and openly. I offer them my deepest respect and gratitude.
I have been blessed with many mentors on my life journey of learning from the
time I entered Nursing as a freshman.
In particular, I thank Dr. Tam Truong Donnelly with all my heart who has been
there for me since my undergraduate years as an inspirational academic mentor who
taught and guided me throughout past seven years and as a life mentor, whom I
sometimes felt she is like my mother and the only support, who has been there for me
during the most difficult times of my life. I also appreciate you so much for the Graduate
Studentship Award from the Qatar National Research Fund, which provided me with
funding to conduct this research and pay tuitions. You have the greatest influence on my
life in every possible way. Without you, I am not here.
I offer my deepest appreciation to Dr. Carol Ewashen for her endless,
inspirational, and intellectual support and warm, heartfelt understanding and
encouragements. Thank you for being always there for me when I needed you and during
the times I felt lost, preparing and guiding me throughout the whole thesis process. I
greatly appreciate your time and energy.
My special thanks go to Dr. Janice Kinch and Dr. Elaine McKiel, who have been
there for me since my undergraduate years as academic mentors who showed and amazed
me with their endless passions for teaching, mentoring, and sharing their most special

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gems with students. Dr. Kinch is my role model for her mentorship and political activism.
Dr. McKiel is my role model for excellent mentorship even after her retirement. These
two professors are not just professors to me, but they are like my grandmothers and
family. I have a personal and professional responsibility to pass down what I have
received from all my mentors to other nursing students in the future.
I also appreciate Dr. Shelly Raffin, for your time and support in this thesis
research and your expertise and feedback in qualitative research methodologies that made
this thesis stronger.
My appreciation also goes to a dear friend, Roqaia Dorri, who helped me
throughout the data collection in Qatar and offered me unwavering support and cheer
while writing.
Finally, I would like to thank my mother and brother who shared every moment
together with me whether it was happy, sad, difficult, or excited. I believe that I am also
here because of my family. I also thank God for being my strength and hope.

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Table of Contents
Abstract ............................................................................................................................... ii
Acknowledgements ............................................................................................................ iii
Table of Contents .................................................................................................................v
List of Tables ..................................................................................................................... xi
List of Symbols, Abbreviations, Nomenclatures .............................................................. xii
CHAPTER ONE: INTRODUCTION .........................................................................................1
1.1 Background ....................................................................................................................2
1.2 Problem Statement .........................................................................................................4
1.3 Research Purpose ...........................................................................................................4
1.4 Research Question .........................................................................................................5
1.5 Significance and Relevance of the Study .......................................................................5
1.5.1 Significance to health care professionals and the population .................................5
1.5.2 Significance to health care, policy, and research ....................................................6
CHAPTER TWO: LITERATURE REVIEW ..............................................................................7
2.1 Biomedical Explanations of Breast Cancer ...................................................................7
2.1.1 Etiology ...................................................................................................................7
2.1.2 Breast cancer screening measures ...........................................................................8
2.2 Individual and Environmental Factors Affecting Screening Practices ........................10
2.2.1 Individual factors ..................................................................................................10
2.2.2 Environmental factors ...........................................................................................11
2.3 Cultural Beliefs and Factors Affecting Breast Cancer Screening ................................12
2.3.1 Causes of cancer ...................................................................................................12
2.3.2 Treatment and cure ...............................................................................................14
2.3.3 Screening practices ...............................................................................................15
2.3.3.1 Screening will not prevent breast cancer ......................................................15
2.3.3.2 Screening will do more harm than not knowing and living with cancer ......16
2.3.3.3 Screening is invasive of a personal, private body ........................................17
2.4 Summary of Literature Review ....................................................................................18