| Abstract |
Social capital is a valuable concept that is consisted of a great variety of social
parameters. Health, according to social model of health, is a very complicated social
issue. Exploration of their possible association is τhe leading causes of this doctorate
thesis.
The aim of this doctorate thesis is to determine the association between
individual social capital with breast and cervical cancer screening guidelines.
Additionally, it assesses women’s’ health needs and explored women’s’ health issues
such as self reported cancer screening adherence and researcher’s profession and the
ecology of self reported health.
Social Capital and Adherence to Breast and Cervical Screening Guidelines:
Breast and cervical cancer are among the leading causes of female mortality.
The reasons that make women adhere, or not, to screening guidelines are not only
related to their individual and health characteristics but are also placed in a wider
social and cultural context.
This cross-sectional study explores the association of individual-level social
capital with breast and cervical cancer screening and the knowledge of relevant
screening tests (Pap test and mammography). A random sample of 120, of the 592
women of the 2001 electoral registers, in the municipality of Gorgolaini, a rural area
in Crete, Greece, was participated in the study. Women were eligible to participate if
they were aged 35-75.
Our results suggest that knowledge of breast and cervical cancer screening
guidelines was negatively associated with age (OR 0.41. 95% CI 0.18 – 0.95) and is
positively associated with total social capital score (OR 1.08, 95%CI 1.00 – 1.17).
Same variables had a positive association with the adherence of test pap and
mammography (age: OR 0.54, 95%CI 0.36-0.81, social capital: OR 1.08, 95% CI
1.02- 1.15).
Our results suggest that knowledge and adherence to breast and cervical
cancer screening guidelines are positively associated with total social capital and its
confounders such as tolerance of diversity, participation in the community, feelings of
safety, and family and friends connections.
Self Reported Cancer Screening Adherence and Researcher Profession:
Self reporting health is an easy method to determine the breast and cervical
screening adherence. However, its validity is questioned. Many individual,
demographic, social and cultural factors and the researcher profession account for
assessing subjectivity health. Also researcher’s profession has a key role.
Study’s objective was to determine whether individuals report in the same way
their test–pap and mammography screening behaviors, when the interviews are
conducted by researchers of different professions, in this case a social worker and a
general practitioner. Two studies assessing adherence to cervical and breast cancer
screening guidelines were conducted during late 2006 - early 2007 in the same sample
of 114 women.
Kappa coefficient was used to measure the agreement of participants’ answers
to the same questions between the two interviewers. There is a slight agreement
(kappa= 0.189, p΄&λτ0.001) between the answers given in the question “Have you ever
had gynecological exams?” in both interviewers. Agreement was also weak
(Kappa=0.386 and 0.235) for self-reported mammography and Pap smear tests,
respectively.
Women overestimated their self-reported adherence to mammography when
the interviewer was a doctor (64.4%) once their responses were matched to those
given to a social worker (35.6%). The same was for test pap. The percentage for
doctor was (52.6%) and for social worker (47.34).
There were no significant differences in major demographic characteristics
between women who provided, or not, the same answers in both interviewers (age p=
0.255, marital status p=0.522, number of children p=0.436, education p=0.140,
income p=0.806 and working status p= 0.759).
Our results suggest that the researcher role is core in self reporting screening
health. Empathy – driven attitude might influence the interaction between
interviewers and women and enable the women to minimize respondents’ bias and to
give responses that reflect more correctly their real screening behaviors
Ecology of Self Reported Health:
Self –reported health is influenced by socioeconomic, cultural, and
demographic variables. So, the validity of health information depends on the way of
interpreting it.
On the present study, selected variables were used, from two cross- sectional
studies carried out in 2007- 2008, in the municipality of Gorgolaini, a rural area in
Crete, Greece. The ecology of self –reported health throughout the social capital and
its subscales and the knowledge and adherence to breast and cervical screening rules
were explored. A common sample of 114 women, participated in these two studies is
used.
Our results suggest that good subjectivity health is positively associated with
total social capital (OR: 1.05, 95%CI: 1.00-1.11) and its parameters value of life (OR:
1.12 95%CI: 1.02-1.23), feelings of safety (OR: 1.63, 95%CI: 1.08-2.47) and family
and friends (OR: 1.72, 95%CI: 1.14-2.61). An almost similar pattern is observed for
bad subjectivity health and total social capital and its subscales. Additionally women
who adhere in screening rules have more possibilities to self rate good health.
According to this study, the ecology of self reported health is socially
constructed through social capitals and its variables and the pathways that influence
health outcomes such as breast and cancer screening adherence. So, adherence of
screening behavior might enable good self- rated health.
Women’s Health Needs Assessment:
Women’s health is constructed according to their social, geographic and
cultural environment. It is influenced by external social determinants of health (such
as welfare state, education, income, work and gender) and by internal (like ways of
coping with anxiety). So an assessment of women’s health needs should be in a
holistic way and take into consideration every aspect of the factors that contribute to
their health.
This was a qualitative research that took place during the period (January-
December 2007) and used semi structured interviews. Fourteen Key informants were
drawn by a broad sample of 30 people, from those working for women in the local
community (social and health professionals, administrators and local politician who
are responsible for the setting of women’s social policy agenda). Data were analysed
by framework analysis.
Our findings suggest that women’s position on Greek welfare system play an
active role on their health. It put barriers on women’s rights and does not enable them
to strength their role in their households and their society. Lack of social services,
forces women to confirm their traditional role as caregivers. Additionally, social and
cultural context put burdens on women to follow social norms about their social role.
So, women have not all the resources to fulfil their needs, according to social model
of health.
Our study indicates that women have many unmet health needs. Existing
public social and health services do not enable them to overcome their difficulties.
Our findings making suggestions for improving women’s health through reforming
the local policy agenda for women.
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Συσχέτιση του κοινωνικού κεφαλαίου και της γυναικείας υγείας, σε ένα αγροτικό δήμο της Κρήτης
