Chatting over the fence: A qualitative study of cancer and prevention behavior in a high-risk rural area

Abstract

Poor cancer prevention practice leads to morbidity and mortality, with negative social consequences for individuals, families, and communities. The lay experience of poor prevention practice is not well understood by professionals, which limits the effectiveness of interventions to decrease the physical and social effects of cancer. Therefore, a qualitative approach was used to explore prevention behavior in a geographic region with high cancer morbidity and mortality rates. Extensive data were collected through a total of thirty interviews with ten informants over a period of six months. Field notes and transcripts were organized and sorted using the Ethnograph software package. Employing the constant comparative method of data collection and analysis, concepts and themes related to cancer and prevention were identified, systematically linked, and distilled into grounded theory. Trustworthiness was insured by triangulation of data collection methods, interview audits and debriefing. Analysis found informants had negative impressions of cancer, and little hope about cancer prevention, cancer treatment and cancer survivorship, despite accurate knowledge of prevention behavior guidelines. Hope was related to the individual's experience of five key elements: (a) the content and source of prevention guideline messages; (b) the individual's (emic) understanding of the disease; (c) experience of the disease; (d) religious/philosophical outlook; and (e) perceptions of the resources needed for prevention. The greater disparity between prevention messages and the other variables, the less hope individuals expressed for efficacy of cancer prevention, and the less likely they were to follow prevention guidelines. Significance of these findings for social work education, direct intervention, community action and public policy is that hope is as important to consider in the fight against cancer as is development of technology and access to care. An argument is made for social workers to be involved in primary prevention rather than tertiary treatment of coping with symptoms. Social workers need to be aware of opportunities to assess hope and empower persons to protect themselves, their families and communities. The role of social workers as advocates for "noncompliant" persons, interpreters/teachers to other health professionals, and lobbyists for cancer research is also discussed.