Background:
Culture is a social determinant of health that acts on a community and population level. Migration from developing to developed countries is growing rapidly. It is important to understand the impact cultural beliefs have on help-seeking and timely cancer diagnosis which can influence culturally safe and appropriate health services worldwide. This is the first systematic review and meta-synthesis of culturally specific factors influencing symptom appraisal and help-seeking in culturally or ethnically diverse populations.
Aim:
To identify, compare and synthesise published qualitative evidence regarding culturally specific beliefs that influence help-seeking in symptomatic cancer patients from culturally or ethnically diverse populations.
Methods:
Systematic review and meta-synthesis of qualitative research using Critical Interpretative Synthesis. Searches of Web of Science, Medline, CINAHL and PsycINFO databases for relevant research published in English between the years 2004-2014.
Results:
167 abstracts were retrieved and reviewed by two experienced researchers. 47 full papers were retrieved and evaluated for relevance to the research question and methodological quality. 12 papers met these criteria and were included in the meta-synthesis. Critical Interpretative Synthesis was conducted by three experienced qualitative researchers. The constant comparative method was used to identify which themes were most relevant for each ethnic group. Five major themes of faith, health-care access, knowledge, fear and attitude were identified across all ethnic groups; with variations in sub-themes (i.e. health literacy, god’s will) found among the ethnic groups.
Conclusions:
For health services to be evidence-based and effective in meeting the needs of all patients, culturally specific beliefs must be considered. This review found that culturally-specific faith-based understandings of the causes and progression of cancer and inadequate knowledge about the causes, signs and symptoms of cancer can impact timely diagnosis. These findings will inform the development of campaigns to promote earlier presentation for cancer diagnosis in patients from culturally or ethnically diverse backgrounds.