Engs, Ruth CThe Health Concerns of Young American and Egyptian Women: A Cross Cultural Study. Int'l. Quarterly of Community Health Education, Vol. 4(1), 1983-84.
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THE HEALTH CONCERNS OF YOUNG AMERICAN AND EGYPTIAN WOMEN: A CROSS CULTURAL STUDY

Ruth C. Engs, R.N., Ed.D. Indiana University, Bloomington, Laila H.
Badr, M.P.H., H.S.D. Helwan University Cairo, Egypt.

ABSTRACT

The health concerns of 99 Egyptian and 135 American young women indicated that the Egyptian sample was significantly more concerned (p < .001) about most items compared to the American group, and that there was very little association ( r = .39) between the mean scores of the two groups. The top ten concerns of the Egyptian women ranked by mean score were Halitosis/Body Odor, Colds, Cancer, Poor Teeth, Population Explosion, Overweight, Birth Control, Water Pollution, Headaches, and Heart Disease. The top ten concerns of the American women ranked by mean score were Birth Control, What I'll be like in ten years, Auto Accidents, Overweight, Cancer, Use of Contraceptives, Death, Nuclear War, Childbirth, and Air Pollution. The differences in their health concerns have implications for community health education planning and promotion.

INTRODUCTION

Various international reports have indicated that health beliefs and behaviors often reflect the values and norms of a particular culture and can have ramifications for health education and care in that culture [1-7]. Over the past few years many Middle Eastern Muslim students have been preparing for health related professions in the United States. As part of their education they often learn about American health values and concerns which may be of little value to them when they return to their home countries as health educators. Moreover, there is a lack of information concerning the health beliefs or concerns of young Muslim adults, and in particular the concerns of young Muslim women.

It would be of interest to study the health concerns of young women in a Muslim culture, such as Egypt, in comparison to a similar American sample to

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determine cross cultural differences. This information could be used as a basis for community health programs and by professionals or consultants who have the potential for working in the Egyptian or other Muslim cultures.

Thus the purpose of this study was to determine the degree of concern women students, at an Egyptian and an American University, have about a variety of health issues which affect their physical, mental and social well-being. The purpose was also to provide information about health concerns which might be of interest to community health educators planning to work in Egypt or other Middle Eastern cultures.

METHODS

Instrument

The Health Concern Questionnaire was used for the study [8, 10]. The questionnaire consisted of fifty items. The respondents were asked to indicate their degree of concern for each item in terms of how it could affect their physical, social or mental well-being. A rating of 5 was given to "extremely concerned" down to 1 for "not concerned." The mean score for each item was then calculated for each respondent. For purposes of interpreting the results "extremely concerned," = 5.00-4.56, "very concerned," - 4.55-3.56, "moderately concerned," = 3.55-2.56, "mildy concerned," = 2.55-1.56, "not concerned," = 1.56 and lower.

Three items on the original questionnaire were changed to update the terminology. "Vietnam Combat" was changed to "Combat," "Atomic Warfare" to "Nuclear Warfare" and "Venereal Diseases," to "Sexually Transmitted Diseases." The instrument was translated into Arabic by the second author. The translation was checked for accuracy by two other native Arabic speaking individuals who were also fluent in English.

Due to the fact that three items were changed the reliability of the instrument was retested. The instrument was administered to 265 personal health students during fall semester 1981 and readministered two weeks after the first testing. Reliability was calculated by using the Pearson product-moment correlation. The test-retest reliability of each item ranged from .64 to .96 with a mean of .78 for 240 students who completed both testing situations.

A split half technique to test for internal reliability of the instrument was undertaken with the 265 students who completed the questionnaire on the first administration of the instrument. The Spearman-Brown technique indicated a reliability coefficient of .91. For the Arabic translated instrument the split half technique was tested on the ninety-nine women students who completed the questionnaire. The coefficient of reliability of this form of the instrument was .78. The lower reliability of the translated instrument may be due to cultural differences, translation errors and misinterpreting the meaning of the items due to a language structure and meaning differences.

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The Questionnaire was administered to all junior and senior female health, physical and recreation education students enrolled in the required health and physical education theory courses at Indiana University, spring term, 1982, and randomly to one half of the senior physical education female students at Helwan University, Cairo, Egypt during the same time period. All the women in both groups agreed to participate in the study.

RESULTS

The sample included 135 American and 99 Egyptian women with an age range of 19 to 27. The mean age of the Egyptian women was 22.9 and that of the American group was 21.2 Of the Egyptian sample 92 percent indicated their religious preference was Muslim. Of the American sample 74 percent indicated Christian and 22 percent indicated "none" or "other" as a religious preference.

When the mean score of each item for both groups was compared by the use of a t-test, the Egyptian sample had significantly (p < .05) higher mean scores on all but seven items for which there was no difference (see Table 1). The seven items were either environmental problems for which the individual in either culture has little personal control (airplane accidents, biological or chemical or nuclear warfare), concerns of a philosophical nature (death, what I'll be like in ten years), or diseases common to youth (mononucleosis).

Table 1. The Mean Scores of Each Item on the Health Concern Questionnaire of 99 Egyptian and 135 American Women in Alphabetical Order

Item  Egyptian American
1. Acne 

2. Airplane Accidents*

3. Air Pollution

4. Accs. Due to Elec Current

5. Alcohol Dependence*

6. Nuclear War*

7. Auto Accidents

8. Biol and Chem Warfare*

9. Birth Control

10. Being Burned

11. "Colds"

12. Cancer

13. Childbirth

14. Death*

15. Drowning

16. Drug Abuse

17. Eye Disorders and Blindness

18. Emphys. or Resp Disease

19. Firearm Accidents

20. Headaches

21. Heart Disease

22. Halitosis or Body Odor

23. Homosexuality

24. Kidney Diseases

25. Liver Diseases

26. Masturbation

27. Mental Illness

28. Moodiness

29. Mononucleosis ("Mono")*

3.26

2.67

3.79

3.85

2.93

3.00

4.11

3.16

4.25

4.14

4.56

4.45

4.03

3.50

3.61

3.24

4.15

3.92

3.42

4.20

4.14

4.60

3.11

3.56

3.28

3.11

3.69

4.13

2.51

2.73

2.54

2.93

2.15

2.43

3.01

3.38

2.65

3.54

2.49

2.45

3.27

2.96

3.02

2.36

2.32

2.75

2.34

2.33

2.46

2.56

2.64

1.34

2.07

1.98

1.69

2.21

2.83

2.10

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Table 1 (Continued)
 
Item Egyptian American
30. Nausea 

31. Nervousness

32. Overweight

33. Poor Teeth or Decay

34. Population Explosion

35. Pregnancy

36. Sex Behavior

37. Poisoning by Snakes

38. Radiation

39. Riots

40. Smoking and Disease

41. Starvation and Malnutrition

42. Sterility

43. Suicide

44. Tuberculosis (T.B.)

45. Use of Contraceptives

46. Sexually Trans. Disease

47. Varicose Veins

48. Combat

49. Water Pollution

50. What I'll be like in 10 years

3.39

3.50

4.27

4.35

4.33

3.69

3.47

3.41

3.18

3.60

4.07

4.02

3.92

3.61

3.93

4.03

4.12

3.61

3.51

4.23

3.89

2.07

2.69

3.27

2.8-

2.32

2.99

2.75

1.61

2.35

1.96

2.74

2.35

2.16

2.34

1.88

3.19

2.32

2.21

2.39

2.63

3.48

             *   ns = > .05
The top ten concerns of the American and Egyptian samples, ranked in order of mean score, are indicated in Table 2. The Egyptian women were "Extremely" or "very concerned" about all of their top ten items while the American sample, in contrast, were only "moderately" concerned about their top ten items.

The top ten concerns of the Egyptian women reflected items about personal hygiene and daily well being such as halitosis, body odor, poor teeth and decay, headaches and overweight. They also appeared to be concerned about chronic

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Table 2. Ranking of the Top Ten Health Concerns for the Egyptian and the American Women by Mean Score.

 Egyptian American
1.Halitosis/Body 

2. Colds 

3. Cancer 

4. Poor Teeth or Decay 

5. Population Explosion 

6. Overweight 

7. Birth Control 

8. Water Pollution 

9. Headaches 

10. Heart Disease

4.60 

4.56

4.45

4.35

4.33

4.27

4.25

4.23

4.20

4.17

Birth

What I'll be like in 10 years 

Auto Accidents 

Overweight 

Cancer 

Use of Contraceptives 

Death 

Nuclear War 

Childbirth 

Air Pollution 

3.54

3.45

3.38

3.28

3.27

3.19

3.02

3.01

2.96

2.93 

diseases (cancer, heart disease) and environmental problems (population explosion, water pollution). The American sample appeared to be primarily concerned about sexual matters such as birth control, use of contraceptives, and childbirth. They were also concerned about philosophical items such as death, what I'll be like in ten years, and environmental concerns.

The Pearson Correlation coefficient was used to test for the degree of association of the mean scores for all items on the instrument between the two groups. This resulted in a correlation coefficient ( r = .39) which indicated only a very slight positive association between the mean scores of the two cultures in this sample in terms of their concern about all of the health items.

DISCUSSION

There appeared to be a difference between the American and Egyptian women in this sample both in terms of the types of health items for which they were most concerned and to the degree of concern about the items.

The overall higher degree of concern for most of the items on the part of the Egyptian and lower concern on the part of the American women may have been caused by several reasons. First of all, an interpretation of what a "health concern" means might have a cultural difference leading to a higher mean score for the Egyptian sample. Or perhaps the American women felt they had more control over most of the health items in terms of prevention measures and treatment procedures and facilities and thus had less concern about them. The high degree of concern for personal hygiene and daily well-being items among the Egyptian sample may have reflected a lack of facilities or programs to cope with these problems.

It is interesting to note that overweight, birth control and cancer were among

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the top ten concerns of both groups. These are often considered as "Women's issues" in the North American culture and may indicate the cross cultural nature of these items.

There was no difference between the mean score of alcohol dependence. As it is not comon for Muslim women to drink, perhaps this indicates a growing concern about increased drinking among their friends or family members as these individuals begin to adopt "Western" customs. However, it should be noted that this item was considered a "mild" concern for the Egyptian in contrast to a "moderate" concern for the American women.

These results appeared to support and reinforce the notion that in the process of developing community health education programs that the needs of the individuals in a particular culture need to be taken into account and that health concerns which are important in one culture cannot be transposed to another.

Health students from Middle Eastern Muslim cultures studying in this country need to be encouraged to carry out surveys of their prospective clients, patients, students and communities to determine their needs and concerns before health education, prevention and treatment programs are developed. American educators need to be aware of differences in cultural backgrounds that might influence health concerns and attitudes and international students need to be encouraged to seek out information that will be useful to them when they return to their home countries. Finally, because of the marked differences found in this sample it is suggested that further cross-cultural studies be undertaken to determine how these different attitudes might affect prevention efforts in various parts of the world.

REFERENCES

1. R.C. Engs. The Drinking Patterns and Attitudes of Helping Professional Students in Queensland Australia, Journal of Studies on Alcohol, 43, pp. 517-531, 1982.

2. Z. Hoch, et al., Sexual Knowledge and Attitudes of Israeli Medical Students Compared to American Medical Students, Sex Education Therapy, 1, pp. 42-47, 1979.

3. F.B. Luckey, G.D. Nass, A Comparison of Sexual Attitudes and Behavior in an International Sample, Journal of Marriage and Family, 31, pp. 364-379, 1969.

4. A.I. Meleis, The Arab American in the Health Care System, American Journal of Nursing, pp. 1180-1183, June, 1981.

5. A.I. Meleis, The Health Care System of Kuwait: The Social Paradoxes, Social Science Medicine, 13, pp. 743-749, 1979.

6. R.S. Raben, J.A. Watson, Sexual Knowledge, Attitudes, and Behavior: A Cross Cultural Study of American and Israeli Women, Journal of Sex Education Therapy, 7, pp. 3-8, 1981.

7. M.E. Wegman, Public Health in China, American Journal of Public Health, 72, 978-979, 1982.

8. R.C. Engs, The Health Concern Questionnaire, 1970.

9. R. Schlaadt, R.C. Engs, Are We Teaching Them What They Want to Know? Journal of School Health, 41, pp. 426-427, 1971.

10. B. Goodrow, Does Time Change the Health Concerns of College Students? Health Education, pp. 34-35, May/June, 1977.

Direct reprint requests to: Ruth C. Engs, R.N., Ed.D. Health and Safety Education Department Poplars 615, Indiana University Bloomington, IN 47405-3085

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