Cultural Determinants of Cancer Fatalism and Cancer Prevention Behaviors among Asians in Singapore

ABSTRACT

This research aims to better understand cultural disparities in cancer prevention behaviors. To do this, we investigate how four cultural beliefs – optimism, pessimism, naïve dialecticism, and superstition – associate with cancer fatalism, which has been recognized as a major barrier to cancer prevention behaviors. Based on an online survey of 1,021 Singapore residents, the results reveal that cancer fatalism is positively associated with pessimism, naïve dialecticism and superstitions, and associated negatively with optimism. Mediation analyses further reveal that cancer fatalism is a significant mediator between these four cultural beliefs and four cancer prevention behaviors including fruit and vegetable intake, regular exercise, avoidance of smoking, and sunscreen use. This study offers theoretical insights into the understanding of how people develop cancer fatalism and practical guidance on the promotion of cancer prevention behaviors, particularly among Asian populations.

Acknowledgments

This research was supported by a Start Up Grant (M4081367.060), Nanyang Technological University, Singapore. We are grateful to Nigel Lim and Gladys Lim for their valuable assistance with literature review and preliminary data analysis.

Notes

1. Out of 2,372 who initiated responding to the survey, 587 dropped out, 681 did not pass the attention checks (2 questions), 3 were screened by the speeder (who took less than 1/3 of the median completion time), and 80 did not consent to take part in the study, resulting the final analytic sample of N = 1,021.

2. SSI recruits its panel members from a broad and diverse pool including proprietary panels, online communities, websites and social media. All participants undergo quality checks upon entering the SSI system and their responses are constantly monitored for data quality. SSI has over 11.5 million qualified panelists across 21 countries (100,411 panelists in Singapore). Panelists are permission-based and cookie-enabled, preventing duplication of completed responses.

3. We used 5 items to assess the contradiction dimension and 4 items to assess the change dimension of naïve dialecticism. Although the principal factor analysis yielded three factor solutions (factor 1 eigenvalue = 3.02, factor 2 eigenvalue = 1.48, factor 3 eigenvalue = 1.07), individual items did not correctly load on the respective dimension as conceptualized and loaded mostly on the first factor. When divided by the respective dimensions, internal consistency among the items was low: (1) contradiction dimension, Cronbach’s alpha = .56, and (2) change dimension Cronbach’s alpha = .61. Thus, we treated naïve dialecticism as a single dimensional construct in this study.