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Modesty and healthcare for women: Understanding cultural sensitivities

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Abstract

Across diverse cultures and ethnicities, many women have named modesty as the reason they do not obtain cervical cancer screening or mammography. This article is based on original research, exploring and defining modesty among Jewish women in Baltimore, MD, and is part of a series of studies related to modesty and healthcare utilization. Information from the literature on Muslim, Hispanic, and Asian forms of modesty are included for comparison. Understanding phenomena such as modesty and the role it plays in women's health will significantly impact both intervention design and treatment practices. Culture and health, partnered in care, could have an impact on utilization of healthcare services and the relaying of health messages.
July 2006 COMMUNITY ONCOLOGY 443
Volume 3/Number 7
Modesty may be a barrier to healthcare.
By taking modesty into account during examination and
treatment, healthcare providers can improve the care of
and sensitivity toward patients.
Perspectives of modesty among Asian, Hispanic,
Muslim, and Jewish female cultures are offered, so
that practitioners can better understand how modesty
influences healthcare.
Data for this article were based on personal interviews
with women from the three main branches of Judaism
(Reform, Conservative, and Orthodox), as well as
the unaffiliated. Additionally, literature from several
disciplines, including psychology and nursing, as well as
religious and lay sources were used to define modesty.

M
odesty has been suggested
as a variable that may in-
fluence healthcare utiliza-
tion.1–4 Regarding cancer
care, Chinese and Islamic
women have cited modes-
ty as the reason they do not obtain cervical cancer
screening or mammography.5,6
By understanding different norms of modes-
ty and the way women feel when modesty is pre-
served, providers will have a new insight into the
sensitivities and values of certain cultures, which
can enhance their ability to deliver quality care.
For example, among Jewish women, modes-
ty does not mandate female providers, whereas in
the Chinese culture this is much more important.
Some cultures value modesty as a way of protecting
women from the wider world. Providers can take
this into account when discussing private issues by,
for example, making sure the door is closed, rec-
ognizing signs of discomfort when talking about
sensitive subjects, and asking the individual if she
would like another person present. Some cultures
actually require a family member to be present even
during noninvasive physical exams.
This paper is an overview of perspectives of
modesty among Asian, Hispanic, Muslim, and
Jewish female cultures, with some suggestions for
enhancing the healthcare practitioner’s knowledge
of how modesty influences healthcare. The article
is based on original research, the first of a series of
small studies undertaken to define modesty and de-
scribe its attributes.7 Subsequent studies were then
conducted to develop and test a new instrument
Modesty and healthcare for women:
understanding cultural sensitivities
Caryn Scheinberg Andrews, PhD, CRNP
Alvin and Lois Lapidus Cancer Institute, Northwest Hospital Center, Randallstown, MD
Across diverse cultures and ethnicities, many women have named modesty as the reason they do not obtain
cervical cancer screening or mammography. This article is based on original research, exploring and defining
modesty among Jewish women in Baltimore, MD, and is part of a series of studies related to modesty and
healthcare utilization. Information from the literature on Muslim, Hispanic, and Asian forms of modesty are
included for comparison. Understanding phenomena such as modesty and the role it plays in women’s health
will significantly impact both intervention design and treatment practices. Culture and health, partnered in
care, could have an impact on utilization of healthcare services and the relaying of health messages.
to measure modesty, called Your Views of Mod-
esty,” in the context of breast, cervical, and general
healthcare utilization by Jewish women.
Defining modesty
Modesty is not just about covering up or wear-
ing specific clothing. By definition, modesty is
about respect. A provider who takes cultural mod-
Psychosocial Oncology
Commun Oncol 2006;3:443–446 © 2006 Elsevier Inc. All rights reserved.
Manuscript received May 1, 2006; accepted June 27, 2006.
Correspondence to: Caryn Andrews, PhD, CRNP, Lifebridge
Health, Alvin and Lois Lapidus Cancer Institute, Northwest
Hospital Center, 5401 Old Court Road, Randallstown, MD
21133; telephone: 410-521-8393; fax: 410-521-7385; e-mail:
caryn.andrews@comcast.net.
444 COMMUNITY ONCOLOGY July 2006 www.CommunityOncology.net
esty into account is someone who
shows respect and caring in the high-
est degree.
Modesty is a multidimensional
construct with various categories,
including:
culture,
appearance or dress,
behavior,
beliefs and values,
relationships between genders, and
relationships among patients and
healthcare providers.
Modesty also appears to have
four different dimensions, related
to:
religious practices,
self-esteem,
public behavior, and
the environment.7
To patients, modesty is not only
important from a cultural viewpoint;
it’s important throughout all aspects of
healthcare. In fact, many people regard
modesty as a contemporary answer to
invasion of privacy. Preserving one’s
modesty promotes a sense of control
and respect, beating back the indignity
that can come with being a cancer pa-
tient. Note the following excerpt from
a personal communication with Kath-
leen M. Dietz (2005):
“Two of the three places I have had
mammograms over the years have been
great for women. One of them, however,
had no privacy. I was required to change
clothes in a booth with a curtain that
couldn’t quite close, while other patients,
including men, sat facing the booths less
than 5 feet away. It was also necessary to
walk by this row of men while clutching
my purse and trying to keep the skimpy
paper top I was wearing from flopping
open.
In 2001 I went through breast cancer
treatments. I handled the surgery, chemo,
and radiation treatments just fine. But
I was very upset at my prep session for
the radiation. I spent 2 hours in a closed
room, while strange men drew things on
me. The worst was at one point when
there were three of them in the room at
once (no females at all), and I was ly-
ing completely naked from the waist up,
hands over my head in a position right
out of Playboy magazine, my disfigured
breast exposed to anyone who walked
in, while they calmly discussed me as if
I wasn’t there—or worse, as if I was a
breast with no person attached. I left the
place and cried for an hour. If they had
just put a light cover over me during the
times when I did not need to be exposed,
I would never have been so upset.
Modesty across cultures
Modesty is not unique to certain
cultures. “Keeping covered” is an in-
tegral aspect of modesty among His-
panic, Islamic, Chinese, and Jewish
women. Pudor, the Spanish word for
modesty, has been described in rela-
tion to issues of privacy and bodi-
ly exposure.8 In the Chinese culture,
modesty relates to the relationship be-
tween genders, specifically in health-
care.9 Modesty among Islamic wom-
en, called hejab, has aspects of both
the Hispanic and Chinese cultures,
whereby modesty is about keeping
covered and relationships between
genders.10
The following section is a brief
summary of Asian, Hispanic, Jew-
ish, and Muslim expressions of mod-
esty. These summaries were based on
an extensive review of the literature
about modesty.
Asian modesty (mapagpakumbaba)
In one review, a female Chinese-
American author described modes-
ty as a cultural value that prevents
women from obtaining breast ex-
ams and mammography.11 Chinese
women are not comfortable being
examined by a male provider, but
in China, most obstetrical or gy-
necological providers are women,
averting the problem. In the United
States, however, this gender diffi-
culty remains a problem for Chinese
women. This was demonstrated by
the Chinese-American community’s
response to a breast-health program.
Attendance by women in the com-
munity was poor; the lack of par-
ticipation in breast cancer screening
was attributed to the utilization of
male healthcare providers for breast
examinations.11
In a follow-up program, com-
munity participation increased
substantially when female nurs-
es were assigned to perform the
clinical breast examinations. In
contrast, preliminary research with
Jewish women indicated that having a
male or female provider did not mat-
ter with regard to modesty.7 Though
modesty may have “gender” impli-
cations, these may not be the same
across cultures.
In another study on breast self-
examination among Chinese wom-
en, research was aimed at identify-
ing factors influencing the decision
to seek a healthcare provider’s eval-
uation for self-discovered breast
symptoms. African-American, His-
panic, and non-Hispanic white wom-
en were compared with Chinese wom-
en. Though the sampling and design
of the focus groups were not optimal
for this type of research, results were
Is there something “wrong
with cultures that maintain strong
levels of modesty?
Women in these cultures have
been called subservient and con-
trolled, dominated by men im-
posing rules upon them. My re-
search on Jewish women showed
that for most of them, modes-
ty is an attribute to be admired
and attained. However, some of
the women disagreed; essentially,
they were apologetic about their
modesty. But, overall, modesty in
the Jewish culture is imposed by
the women themselves as a way
to keep boundaries of privacy and
respect. For some, it also reflects
their vulnerability.
What’s wrong with
this picture?
PSYCHOSOCIAL ONCOLOGY Scheinberg Andrews
July 2006 COMMUNITY ONCOLOGY 445
Volume 3/Number 7
similar to the study by Mo.11 One of
the themes reported was that having
a female provider for invasive ex-
ams is optimal; Chinese women
reported feeling uncomfortable if
their clothes were removed by a
male healthcare provider during
the examination.6,12
Hispanic modesty (pudor)
The word for modesty in Span-
ish is pudor. It is associated with con-
cepts of dignity and authority and is
a “quality of reserve, humility, and
modesty.”13 In a study conducted in
Spain, results of a qualitative study
showed a strong affinity among
Spanish people for privacy and mod-
esty. 14 The roots of modesty were
thought to be imposed by the Cath-
olic Church. For example, the dress
and behavior of nuns reflect the same
strict rules about keeping covered,
maintaining a posture of quiet, non-
flamboyant behavior, and separating
males and females. The opposite of
excitability, pudor considers self-
disclosure or the use of voice in-
tonation (either high or low) in
poor taste.
With pudor, telling a patient
about a poor diagnosis is con-
sidered to be in poor taste. As a
measure of respect, it’s prefera-
ble to have a physician withhold
bad news to preserve a patient’s
dignity. For an American practitio-
ner, it might be preferable, when tak-
ing care of some Hispanic patients,
to inform a family member first so
that they can break the news in pri-
vate and then return to the physician
with the patient.
Modesty is considered an impor-
tant aspect of a number of Hispanic
cultures, especially for older women.
As with Chinese and Muslim women,
“keeping covered” is an integral part
of the culture. In a study of Mexican-
American patients, keeping covered
included issues of privacy about any
medical procedures, such as breast ex-
amination or Pap tests.15
Jewish modesty (tznuit)
My research on modesty and
healthcare was based on the hypoth-
esis that the more a woman main-
tained high levels of modesty related
to religious practices, the lower her
utilization of healthcare. However,
the hypothesis was not supported by
my results.
Extreme modesty is found among
married Orthodox Jewish women who
cover their hair with a wig, scarf, or hat.
They cover their arms to at least be-
low the elbow; their necklines extend
past the collarbone; and they wear only
dresses or skirts, which cover the knee
and usually extend to the ankle.
Less-observant Orthodox women
may wear only dresses but leave their
heads uncovered. My research with
this group of women showed that the
degree of modesty was divided es-
sentially by the issue of head cover-
ing. Some groups, considered ultra-
Orthodox or haredi, wear stockings
or socks so that none of the body can
be viewed by an outsider; some dress
in the dark or under covers so as not
to expose the body at all.7,16 Mod-
esty implies a sense of humility and
downplaying one’s attributes,17 con-
sistent with the definition of modes-
ty used in research with children, in
which modesty is explored in relation
to self-enhancement,18 and is similar
to the Spanish concept of pudor.
Jewish modesty was described as
“beneath the surface,” that is, not just
about dress or clothing.19 Modesty,
accordingly, applies to both genders.
One explanation for modesty involves
the perception of women having a
“deeper understanding” of life and
possessing “powerful insights.” Keep-
ing covered is a way of differentiating
oneself or separating oneself from reg-
ularity or mediocrity and elevates the
individual to a higher level of respect.
Coopersmith stated that “danger ex-
ists if women are downgraded when
the societal focus is external such as
clothing or how one is physically at-
tractive. Although being “beautiful” is
still considered good, it is still possi-
ble to be attractive while covering the
physical body.19
Modesty was also described as a
way to maintain borders, implying
the border around someone to protect
their inner sense of who they are. It
is the “curtain that marks the transi-
tion—the border from what is not per-
sonal to what is personal, from what is
not private to what is private.”20
Muslim modesty (hejab)
Muslim modesty is described as
one of the five pillars of the Islamic
faith and includes restrictions on:
Asian (mapagpakumbaba)
Humbleness in behavior and dress
Female healthcare provider essential
Western medicine is invasive
Eastern medicine does not involve
taking off one’s clothes
Hispanic (pudor)
Dignity
Authority
Privacy
Modest appearance and behavior
Respect based on age and
relationship
Jewish (tznuit)
All females, married or unmarried,
cover torso (up to the neck), arms,
and legs in public
Married women cover their hair
No boasting or bragging
No flamboyance
Women and men sit separately
Women do not wear pants
Muslim (hejab)
Clothing must cover the entire body
(including the neck and head)
Clothing should not be form-fitting,
sheer, or eye-catching
Female clothing should not be similar
to male clothing
Must not suggest fame or status
Eye contact is not made between
members of opposite sexes
Aspects of modesty in
different cultures
Modesty and healthcare for women PSYCHOSOCIAL ONCOLOGY
446 COMMUNITY ONCOLOGY July 2006 www.CommunityOncology.net
ABOUT THE AUTHOR
Affiliation: Dr. Scheinberg Andrews is a hema-
tology/medical oncology nurse practitioner at
Lifebridge Health and an infusion therapist at
Northwest Hospital Center, Randallstown, MD.
Conflicts of interest: None disclosed.
dress;
privacy;
the mention of anything related to
bodily functions;
direct eye contact with the oppo-
site gender; and
opposite gender medical care pro-
viders, except in cases of extreme
medical necessity.21
There have been several studies con-
ducted on Islamic culture and breast
healthcare. Muslims have specific laws
regarding modesty that are similar to
Jewish laws of modesty. “Keeping cov-
ered” is essential for traditional Mus-
lim women. Hair, body, arms, and legs
must be covered any time a woman
may come into contact with men who
are not family members. Touching be-
tween members of the opposite gender
is also forbidden.10
In a focus-group study on the veil
as a symbol of modesty, conducted in
an American-Muslim population,23
the results indicated that even though
Muslim law supported the ideal of
preventive healthcare, prevention was
not a “reality.” Because strict rules
about dress, manner, and be-
havior are considered so impor-
tant, “bodily exposure” preclud-
ed women from obtaining breast
health exams.22
Since preventive healthcare was
not considered essential in the Mus-
lim culture, subjects reported that
“there was no reason to expose one’s
body for the exam.”22 In addition,
women in the focus groups said
that they would rather obtain
healthcare from female health-
care providers.
Finally, this study touched upon an
important aspect not found in other
studies: Islamic women’s healthcare
diminished after their childbearing
years, since pregnancy care was
no longer important. Consequently,
older women, who are at much higher
risk of disease, access healthcare only
for illness.22 This is important because
exposure of the body, related to laws of
modesty and similar to other cultures,
is considered a barrier to healthcare
utilization, especially of Islamic wom-
en beyond their childbearing years.
Women who are at the highest risk
for breast cancer and most in need of
screening are those who are no longer
having children. Thus, they are not ob-
taining preventive healthcare.
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PSYCHOSOCIAL ONCOLOGY Scheinberg Andrews
... Experiential and psychological factors may also play a role in mammogram screening rates. Pain and embarrassment associated with the mammographic protocol, lack of trust in healthcare or insufficient cultural competency of hospitals and doctors, fear of bad news, and reluctance due to perceived susceptibility to breast cancer have previously been cited as barriers [9][10][11][12]. Other observed risk factors for failing to completing mammogram screenings include language barriers, lack of transportation, younger age, more recent health plan acquisition, and obesity [8,10]. ...
... Other observed risk factors for failing to completing mammogram screenings include language barriers, lack of transportation, younger age, more recent health plan acquisition, and obesity [8,10]. Modesty norms amid differing cultural groups also contributes to differing screening adherence rates [12]. Conversely, frequently reported motivators were perceived benefits of early detection for cancer management and the belief that mammograms can detect pre-symptomatic breast cancer [11]. ...
Article
Full-text available
Purpose Women with breast cancer diagnosed from mammogram screenings have a lower mortality risk than women diagnosed from symptoms. Currently, the U.S Preventive Services Task Force recommends biannual screening for women aged 50–74 years old. In this study, we aimed to identify factors associated with inadequate screening defined as “no mammogram screening within past 2 years” to guide cancer prevention and early detection efforts. Methods This study utilized area-based probabilistic sampling survey data, collected across Oregon in 2019. Dataset weights were calculated using a raking approach. Demographic and behavior information were collected with existing validated questionnaire items from national surveys. Weighted multivariable logistic regression analyses with missing-value imputations were conducted to identify factors associated with inadequate mammogram screening. Results The study included 254 women 50–74 years old without previous breast or ovarian cancer history. 19.29% of the sample reported no mammogram within two years, including 1.57% with no previous mammograms. Following unadjusted analyses, the significant factors included education, occupation status, health insurance and smoking and were therefore included into the adjusted model. In the multivariate adjusted model education remained significant while occupation status, health insurance and smoking were no longer significant. Compared to women with a college graduate degree, women with less than college graduate degree were at higher risk of inadequate screening [OR (95% CI) = 3.23 (1.54, 6.74)]. Conclusions Lack of education was significantly associated with inadequate mammogram screening even after adjusting for occupation status, health insurance and smoking, which should prompt further outreach and education.
... Experiential and psychological factors may also play a role in mammogram screening rates. Pain and embarrassment associated with the mammographic protocol, lack of trust in healthcare or insu cient cultural competency of hospitals and doctors, fear of bad news, and reluctance due to perceived susceptibility to breast cancer have previously been cited as barriers (9)(10)(11)(12). Other observed risk factors for failing to completing mammogram screenings include language barriers, lack of transportation, younger age, more recent health plan acquisition, and obesity (8, 10). ...
... Other observed risk factors for failing to completing mammogram screenings include language barriers, lack of transportation, younger age, more recent health plan acquisition, and obesity (8, 10). Modesty norms amid differing cultural groups also contributes to differing screening adherence rates (12). Conversely, frequently reported motivators were perceived bene ts of early detection for cancer management and the belief that mammograms can detect pre-symptomatic breast cancer (11). ...
Preprint
Full-text available
Purpose: Women with breast cancer diagnosed from mammogram screenings have a lower mortality risk than women diagnosed from symptoms. Currently, the U.S Preventive Services Task Force recommends biannual screening for women aged 50-74 years old. In this study, we aimed to identify factors associated with inadequate screening defined as “no mammogram screening within past 2 years” to guide cancer prevention and early detection efforts. Methods: This study utilized area-based probabilistic sampling survey data, collected across Oregon in 2019. Dataset weights were calculated using a raking approach. Demographic and behavior information were collected with existing validated questionnaire items from national surveys. Weighted multivariable logistic regression analyses with missing-value imputations were conducted to identify factors associated with inadequate mammogram screening. Results: The study included 254 women 50-74 years-old without previous breast or ovarian cancer history. 19.29% of the sample reported no mammogram within two years, including 1.57% with no previous mammograms. Following unadjusted analyses, the significant factors included education, occupation status, health insurance and smoking and were therefore included into the adjusted model. In the multivariate adjusted model education remained significant while occupation status, health insurance and smoking were no longer significant. Compared to women with a college graduate degree, women with less than college graduate degree were at higher risk of inadequate screening [OR (95% CI) =3.23 (1.54, 6.74)]. Conclusions: Lack of education was significantly associated with inadequate mammogram screening even after adjusting for occupation status, health insurance and smoking, which should prompt further outreach and education.
... The review of studies of Korean Americans also found modesty to be a barrier to mammography screening [11]. In fact, modesty is known to be a barrier to all forms of cancer screening, and developers of mammography screening interventions need to consider how modesty in Asian American women influences their health care behaviors [38][39][40]. Each culture has its own unique characteristics, and each needs to be studied carefully for its background related to health awareness and behavior. ...
Article
Full-text available
Asian American women, both immigrant and US-born, are known to have low mammography screening rates. To reduce health disparities and address community health needs, we undertook a systematic review to identify factors that affect mammography uptake among Asian American women following a mammography screening intervention. Following the PRISMA guidelines, we searched four databases and selected 12 studies that met our inclusion criteria. We identified 22 relevant factors and developed a new conceptual model that comprehensively captures these sociodemographic; cultural; knowledge, attitude, and perception; health history; health care accessibility and availability; and intervention factors, including components and mode of intervention. This conceptual model can be used to guide development of interventions that effectively promote mammography screening. Future research should focus on the effect of acculturation on screening behaviors and the importance of culturally tailored intervention and information-sharing elements to improving mammography screening among Asian Americans.
... A Muslim participant expressing modesty concerns when viewing a graphic depiction of a colonoscope being inserted illustrated this point. Upholding modesty in dressing is strongly advocated in certain Asian cultures, especially those of Muslim faith who may consider exposure of the body a barrier to seeking healthcare [32]33. In multi-ethnic Singapore, it is vital for healthcare providers to be culturally sensitive to avoid compromising the quality of care rendered to specific ethnic groups. ...
Article
Full-text available
Background Colorectal cancer (CRC) is a common malignancy worldwide. Despite being the most common cancer in Singapore, CRC screening rate remains low due to knowledge deficits, social reasons such as inconvenience and a lack of reminder or recommendation. A decision aid (DA) may facilitate an individual’s decision-making to undertake CRC screening by addressing misconceptions and barriers. We postulate that a more person-centred and culturally adapted DA will better serve the local population. The views of the target users are thus needed to develop such a DA. A CRC screening DA prototype has been adapted from an American DA to cater to the Asian users. This study aimed to explore user perspectives on an adapted CRC screening DA-prototype in terms of the design, content and perceived utility. Methods The study used in-depth interviews (IDIs) and focus group discussions (FGDs) to gather qualitative data from English-literate multi-ethnic Asian adults aged 50 years old and above. They had yet to screen for CRC before they were recruited from a public primary care clinic in Singapore. The interviews were audio-recorded, transcribed and analysed to identify emergent themes via thematic analysis. Results This study included 27 participants involved in 5 IDI and 5 FGDs. Participants found the DA easily comprehensible and of appropriate length. They appreciated information about the options and proposed having multi-lingual DAs. The design, in terms of the layout, size and font, was well-accepted but there were suggestions to digitalize the DA. Participants felt that the visuals were useful but there were concerns about modesty due to the realism of the illustration. They would use the DA for information-sharing with their family and for discussion with their doctor for decision making. They preferred the doctor’s recommendation for CRC screening and initiating the use of the DA. Conclusions Participants generally had favourable perceptions of the DA-prototype. A revised DA will be developed based on their feedback. Further input from doctors on the revised DA will be obtained before assessing its effectiveness to increase CRC screening rate in a randomized controlled trial.
... In Jewish culture, notions of modesty are reflected in one's relationship to religious laws governing cross-gender interaction and dress code, as well as in the way one discusses him or herself and others (Andrews 2011). Thus, while alike (Andrews 2006;Austin et al. 2002;Carteret 2011;Hasnain et al. 2011;Isa Modibbo 2016;Lee and Vang 2010;Vahabi and Lofters 2016;Vu et al. 2016;Yosef 2008). While these and other studies use a variety of qualitative methods and survey tools to assess the impacts of modesty, none used a tool specific to Muslim notions of modesty. ...
Article
Full-text available
This paper reports on the multi-phase development of an English-language modesty measure for use among Muslim populations. The process yielded a 10-item measure that has high levels of internal consistency reliability (Cronbach’s α of 0.83), and has acceptable discriminant and predictive validity. Specifically although our modesty measure for Muslim women was found to be significantly correlated with measures of positive and negative religious (Islamic) coping, it was not significantly correlated with religious practice-based religiosity (discriminant validity). Further logistic modeling revealed higher modesty levels positively associated with forgoing mammography because of concerns about lack of same-sex providers (predictive validity).
... A provider who takes cultural modesty into account is someone who shows respect and caring in the highest degree. [10] Modesty may influence health-care utilization. Chinese and Islamic Editorial women have cited modesty as the reason they do not obtain cervical cancer screening or mammography for cancer care. ...
... Furthermore, Davidson's equations require skinfold measurement at four locations (biceps, triceps, subscapular, and suprailiac), some of which may be challenging to acquire due to cultural constraints surrounding exposure of female body parts, notably suprailiac and subscapular skinfolds, to strangers. 12 Therefore, the objective of this study was to develop simple prediction equations of percentage body fat in Chinese subjects using easily accessible anthropometric measurements in a clinical setting, such as skinfold thicknesses at biceps and triceps, height, and waist circumference along with age. ...
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Background: Adiposity is an independent predictor of metabolic disease. However, highly accurate body fat assessment is not routinely done due to limited access to expensive and labor-intensive methods. Objective: The aim of the study was to develop body fat prediction equations for Asian-Chinese adults using easily attainable anthropometric measurements. Design: Prediction equations of body fat were developed using anthropometric and skinfold thickness measurements obtained from a cross-sectional study. These new equations were then validated using baseline data from an independent randomized controlled study. Participants/setting: Healthy participants with no major diseases and not taking long-term medications were recruited in an ongoing cross-sectional study that began in June 2014 (n=439, 170 males, 269 females), as well as a randomized controlled trial (n=108, 58 males, 50 females) conducted from January 2013 to October 2014. Both the studies were conducted at Clinical Nutrition Research Center located in Singapore. Main outcome measures: Data used to develop and validate equations were from two original studies that assessed body fat by dual-energy x-ray absorptiometry, age, waist circumference, height, and biceps and triceps skinfolds. Statistical analysis performed: Sex-specific percent body fat prediction equations were developed using stepwise regression with Akaike Information Criterion on the cross-sectional data. The equations were then validated using data from the randomized controlled study and also compared against Asian-specific Davidson equations. Results: The best body fat prediction model (R2=0.722, standard error of estimation=2.97 for females; R2=0.815, standard error of estimation=2.49 for males) for both sexes included biceps and triceps skinfolds, waist circumference, age, and height. The new equations developed resulted in modest discrepancies in body fat of 1.8%±2.7% in males (P<0.001) and 0.7%±3.1% in females (P=0.125; not significant) compared with the Asian-specific Davidson equations (-7.4%±3.2% [P<0.001] and -7.4%±2.7% [P<0.001], respectively). Conclusions: Sex-specific equations to predict the percent body fat of Asian-Chinese adults with a higher degree of accuracy were developed. Ease of use in both field and clinical settings will be a major advantage.
... Women in some culture advised covering their hair, body, arms, and legs at any time she meets stranger men. That is including physical contact with opposite gender medical care providers, except in cases of medical emergencies [16]. This framework explains why many prefer to see a same-sex physician, particularly in consultations necessitating examination of the genitalia despite the standard practice calls for chaperones when conducting opposite sex examinations [17]. ...
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Background: Culturally conservative patients may feel uncomfortable when examined by opposite sex of EP (Emergency Physician). Objective: To determine the preferred EP gender among ED (Emergency Department) patients and investigate which characteristics affect their choice Design: Observational cross-sectional study. Setting: Four major emergency departments. Patients: Adults patients attending emergency departments. Main outcome measures: Randomly selected patients answered a structured questionnaire detailing socio-demographic information and cultural status. Patients were asked about the preferred gender of EP in critical and non-critical presentation and the diverse characteristics of EP. Categorical variables were summarized as frequencies, percentages and compared by Chi-square test. Univariate and multivariate logistic regression was used to assess the impact of important variables over gender preferences. The level of statistical significance was set at P <.05. Results: The interviewed 407 patients (56% females) reflected a wide range of age, educational level, marital status, and occupation. In non-critical conditions, 41% of female patients preferred female EP which was statistically significant (p<0.004). In critical conditions, 27% of female patients preferred female EP. Experience, concerning, trustfulness and making the patient comfortable were the major characteristic features among EP. Using univariate logistic regression in non-critical conditions for female EP preference; the significant factors are: origin (P=.02), gender (P <.0001), age (p=0.006), and occupation (P=.01). While in multivariate logistic regression only gender and age was found to be significant (p<.0001), (P =.01) respectively. Univariate logistic regression in critical conditions for female EP preference found the significant factors are: gender (P<.0001), occupation (P<.0001), and cultural commitment (P=.03). While in multivariate logistic regression only gender and occupation were found to be significant (P<.0001), (P=.004) respectively. Conclusions: Both genders of EP are needed in emergency departments, however, more female EPs are needed for the delivery of high-quality gender-sensitive healthcare in ED.
... It has has been suggested to influence healthcare practices when it comes to breast cancer, many women "…have cited modesty as the reason they do not obtain cervical cancer screening or mammography." (Andrews, 2006). ...
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