Silence among Afro Caribbean men diagnosed with prostate cancer in Trinidad and Tobago : a grounded theory study.

Background: Prostate cancer (PCa) is the leading cause of death among Afro-Caribbean men in Trinidad and Tobago (TT). TT is listed as one among countries with the highest PCa mortality rates in the world (Hosein et al., 2016). A systematic review undertaken explored men’s cultural beliefs about prostate symptoms and help-seeking behaviours, which revealed a dearth of knowledge of Afro-Caribbean men and PCa (King-Okoye et al., 2017). This study aims to explore men and partners experiences along care pathways for PCa in TT, including the beliefs and meanings men associate with their illness and its presentation. Methods: Utilising Straussian grounded theory, semi-structured and focus-group interviews were conducted with men (n= 51) diagnosed with PCa and partners (n=16) at four (urology & oncology) centres throughout TT in 2015-2016. Results: Five categories: ‘Disrupting the Self’, ‘Disconnected to Health Services’, ‘The Silent Wall’, ‘Blame and Distrust’ and ‘Breaking the Silence’ and a core category, ‘Silence among Afro-Caribbean men’ (SAACM) were generated from the data. These connect with men’s late presentation of PCa at emergency services with severe and life-limiting symptoms associated with high mortality rates for this disease. The main reasons underlying men’s late presentation to health services with debilitating symptoms, concern masculinity norms, lack of awareness and knowledge of early stage PCa, cultural beliefs and practices and perceptions of an uncaring health system. These heavily influenced men’s ability to access care and move through routes to diagnosis for PCa in TT. Conclusion: The SAACM offers unique insight into identifying how men’s cultural beliefs, hegemonic masculinity and lack of knowledge and awareness of the prostate and PCa resulted in delays in help-seeking and subsequently late diagnosis. A better understanding of men and their partners’ experiences along routes to diagnosis for PCa can target specific public health messages to address barriers to early diagnosis for men. Key words: Trinidad and Tobago, experiences, beliefs, culture, silenc

Beliefs that contribute to delays in diagnosis of prostate cancer among Afro‐Caribbean men in Trinidad and Tobago

Objective: The aim of this study was to explore TT men’s pre-diagnosis experiences of prostate cancer (PCa). This study is part of a wider project that examined men and their partners’ experiences of routes to diagnosis for PCa in TT. Methods: Men (n=51) were voluntarily recruited to semi-structured interviews from four centres. Data were analysed following principles of Grounded Theory. Results: Major barriers to medical help-seeking were highlighted as lack of knowledge and awareness of the prostate gland and symptoms of PCa, the digital rectal exam (DRE), PSA, cultural and religious beliefs and hegemonic masculinity norms and non-reporting of bodily changes to GPs. Fear of DRE, distrust in providers and misinterpretation of bodily changes as related to ageing and diabetes mellitus also contributed to delays towards seeking medical help. Men’s interactions with pharmacists and traditional healers lengthened the time taken to consult with Health Care Providers for prostate concerns. Conclusions: TT men’s PCa pre-diagnosis experiences are important to unearth barriers and facilitators to care along routes to diagnosis for this disease. This can help target specific health promotion strategies to motivate men to seek medical care for symptoms in a timely manner.</p

Routes to diagnosis for men with prostate cancer: men's cultural beliefs about how changes to their bodies and symptoms influence help-seeking actions. A narrative review of the literature

Purpose: To examine the findings of existing studies in relation to men's cultural beliefs about changes to their bodies relevant to prostate cancer and how these affect interpretation of bodily changes and helpseeking actions. Method: We undertook a narrative review of studies conducted from 2004 to 2017 in 6 databases that highlighted men's beliefs and help-seeking actions for bodily changes suggestive of prostate cancer. Results: Eighteen (18) studies reflecting men from various ethnicities and nationalities were included. The belief that blood and painful urination were warning signs to seek medical help delayed helpseeking among men compared to men that did not experience these symptoms. The belief that urinary symptoms such as dribbling, cystitis and urinary hesitancy were transient and related to ageing, normality and infection significantly delayed symptom appraisal and help-seeking. Men also held the belief that sexual changes, such as impotence and ejaculation dysfunction were private, embarrassing and a taboo. These beliefs impeded timely help-seeking. Cultural beliefs, spirituality and the role of wives/partners were significant for men to help appraise symptoms as requiring medical attention thus sanctioning the need for help-seeking. Conclusions: This review underscores a critical need for further empirical research into men's beliefs about bodily changes relevant to prostate health and how these beliefs affect their interpretation of symptoms and subsequent help-seeking actions.</p

Routes to diagnosis for men with prostate cancer: men's cultural beliefs about how changes to their bodies and symptoms influence help-seeking actions. A narrative review of the literature

Purpose: To examine the findings of existing studies in relation to men's cultural beliefs about changes to their bodies relevant to prostate cancer and how these affect interpretation of bodily changes and helpseeking actions. Method: We undertook a narrative review of studies conducted from 2004 to 2017 in 6 databases that highlighted men's beliefs and help-seeking actions for bodily changes suggestive of prostate cancer. Results: Eighteen (18) studies reflecting men from various ethnicities and nationalities were included. The belief that blood and painful urination were warning signs to seek medical help delayed helpseeking among men compared to men that did not experience these symptoms. The belief that urinary symptoms such as dribbling, cystitis and urinary hesitancy were transient and related to ageing, normality and infection significantly delayed symptom appraisal and help-seeking. Men also held the belief that sexual changes, such as impotence and ejaculation dysfunction were private, embarrassing and a taboo. These beliefs impeded timely help-seeking. Cultural beliefs, spirituality and the role of wives/partners were significant for men to help appraise symptoms as requiring medical attention thus sanctioning the need for help-seeking. Conclusions: This review underscores a critical need for further empirical research into men's beliefs about bodily changes relevant to prostate health and how these beliefs affect their interpretation of symptoms and subsequent help-seeking actions.</p

Harvesting social media with artificial intelligence for medical threats mapping and analytics

The COVID-19 pandemic has exposed both national and organizational vulnerabilities to infectious diseases and has impacted, with devastating effects, many business sectors. Authors have identified an urgent need to effectively plan for future threats, by exploiting emerging technologies to forecast, predict and anticipate action at the strategic, operational and local level thus strengthening the capacity of national and international responders. In order to do this, we need an approach to increase awareness of actors involved. The purpose of this study is to investigate how improved medical intelligence, harvesting from big data available from social media, scientific literature and other resources such as local press, can improve situational awareness to take more informed decision in the context of safeguarding and protecting populations from medical threats. This paper focuses on the exploitation of large unstructured data available from microblogging service Twitter for mapping and analytics of health and sentiment situation. Authors tested an explainable artificial intelligence (AI) supported medical intelligence tool on a scenario of a megacity by processing and visualizing tweets on a GIS map. Results indicate that explainable AI provides a promising solution for measuring and tracking the evolution of disease to provide health, sentiment and emotion situational awareness