An exploration of lay epidemiology and cancer

Macdonald, Sara (2011) An exploration of lay epidemiology and cancer. PhD thesis, University of Glasgow.

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Some estimates suggest that as much as 70% of cancer is preventable by disease modification alone (Peto 1991). Disease prevention via behavioural change is a challenging endeavour. There is widespread recognition that for behaviour to be better understood there is a need to understand the context in which it occurs, and the beliefs that underpin it. Lay epidemiology illustrates the sophistication of belief formation. The arrival at a coronary candidate provides according to Davison, Frankel and Davey Smith (1991), a cultural mechanism that aids the estimation of risk as observed from known cases in the family and wider society. Consequently, the estimate provides the potential motivation for behavioural choices. Other studies that followed the original model of lay epidemiology have similarly described the coronary candidate (Preston 1997; Emslie, Hunt & Watt 2001a; Frich, Malterud & Fugelli 2007; Weiner 2009) and suggest that the lay public have an understanding of the risk profile for Coronary Heart Disease.
This study aimed to explore the utility of the elements held within lay epidemiology in cancer beliefs. Do the lay public recognise a ‘cancer candidate’?
Method: A series of 31 in-depth semi-structured interviews were conducted between November 2007 and October 2008. Interviews took place in two communities in Glasgow, Scotland – one affluent, one deprived. The sample was drawn from a number of community organisations and leisure clubs in the communities to facilitate accessing an ‘ordinary’ view. Cancer sufferers were excluded from the study. A topic guide was used to ensure consistency throughout interviews and focused on participants’ experience of cancer. Although the study did not adhere to a strict grounded theory approach, the analytic method of constant comparative analysis was followed.
Findings: The complexity of the scheme described by Davison, where a wide range of sources of knowledge to inform beliefs resonated. Sophisticated and complex explanatory models of cancer were described. Cancer inhabited an important cultural position and was most commonly associated with fear and dread. Possible aetiological explanations included behavioural, environmental, biological and psychological factors. Smoking was the most widely recognised risk factor. Knowledge of other risk factors for individual cancers was patchy. Candidacy therefore was not as unequivocal for cancer. Many ‘anomalous cases’ (those without obvious explanation) were proffered. Ultimately the randomness of cancer was emphasised.

Conclusion: Cancer is a more complex disease than CHD, both culturally and biomedically and this is reflected in the beliefs voiced by participants in this study. This complexity is a barrier to the adoption of a cancer candidate.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: health beliefs, lay public, cancer
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Colleges/Schools: College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing
Supervisor's Name: Macleod, Professor Una
Date of Award: 2011
Depositing User: Ms Sara Macdonald
Unique ID: glathesis:2011-2583
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 19 May 2011
Last Modified: 10 Dec 2012 13:57

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