1
|
Gutnik L, Msoka EF, Dwarampudi S, Hollis T, McLeod MC, Locke JE, Scarinci I, Rocque GB, Mremi A, Serventi F, Mmbaga BT. Meaningful engagement of people living with cancer: Leveraging breast cancer survivors in a stigma reduction intervention in Tanzania. World J Surg 2024. [PMID: 39289785 DOI: 10.1002/wjs.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Cancer-related stigma is a key driver of advanced breast cancer stage in Sub-Saharan Africa (SSA). We developed and tested the impact of a breast cancer survivor-led Stigma reduction intervention (SRI) on stigma and treatment adherence of newly diagnosed patients with breast cancer in Tanzania. METHODS Breast cancer survivors were trained on breast cancer knowledge and motivational interviewing. A total of 4 trained survivors delivered a SRI (standardized flipchart breast education talk, personal testimony, and motivational interviewing) to 30 newly diagnosed patients with breast cancer before treatment. Pre- and post-intervention knowledge surveys and stigma scale surveys were analyzed via Fisher's exact test and Wilcoxon rank-sum tests. A discussion was held with a group of survivors after the intervention period to elicit feedback on their intervention experience. RESULTS Among the 30 patients, breast cancer knowledge (median overall percent correct) increased from 28% (IQR: 18%-45%) to 85% (IQR: 79%-88%) (p < 0.001) and stigma (median score) decreased from 75 (IQR: 57-81) to 53 (IQR: 44-66) (p < 0.01) following the intervention. All participants were willing to pursue hospital-based treatment after undergoing the intervention. Eighty-seven percent (n = 26) initiated treatment at 8-week follow-up after the intervention. All survivors endorsed feeling empowered and valued in their role in this intervention. CONCLUSIONS Breast cancer survivors are a powerful group to combat the lack of knowledge and stigma in community and healthcare settings. Expanding the scope and scale of this intervention holds promise for improving treatment-seeking behavior and ultimately breast cancer outcomes in SSA.
Collapse
Affiliation(s)
- Lily Gutnik
- Department of Surgery, UAB Heersink School of Medicine, Birmingham, Alabama, USA
| | - Elizabeth F Msoka
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Sindhu Dwarampudi
- Department of Surgery, UAB Heersink School of Medicine, Birmingham, Alabama, USA
| | - Taylor Hollis
- Department of Surgery, UAB Heersink School of Medicine, Birmingham, Alabama, USA
| | - M Chandler McLeod
- Department of Surgery, UAB Heersink School of Medicine, Birmingham, Alabama, USA
| | - Jayme E Locke
- Department of Surgery, UAB Heersink School of Medicine, Birmingham, Alabama, USA
| | - Isabel Scarinci
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gabrielle B Rocque
- Department of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alex Mremi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Furuha Serventi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| |
Collapse
|
2
|
Bamodu OA, Chung CC. Cancer Care Disparities: Overcoming Barriers to Cancer Control in Low- and Middle-Income Countries. JCO Glob Oncol 2024; 10:e2300439. [PMID: 39173080 DOI: 10.1200/go.23.00439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/25/2024] [Accepted: 07/18/2024] [Indexed: 08/24/2024] Open
Abstract
The rising global burden of cancer disproportionately affects low- and middle-income countries (LMICs), which account for over half of new patients and cancer deaths worldwide. However, LMIC health systems face profound challenges in implementing comprehensive cancer control programs because of limited health care resources and infrastructure. This analytical review explores contemporary evidence on barriers undermining cancer control efforts in resource-constrained LMIC settings. We conducted a comprehensive literature review of peer-reviewed evidence on cancer control challenges and solutions tailored to resource-limited settings. We provide a conceptual framework categorizing these barriers across the cancer care continuum, from raising public awareness to palliative care. We also appraise evidence-based strategies proposed to overcome identified obstacles to cancer control in the published literature, including task-shifting to nonspecialist health workers, strategic prioritization of high-impact interventions, regional collaborations, patient navigation systems, and novel financing mechanisms. Developing strong primary care delivery platforms integrated with specialized oncology care, alongside flexible and resilient health system models tailored to local contexts, will be critical to curb the rising tide of cancer in resource-limited settings. Urgent global commitments and investments are needed to dismantle barriers and expand access to prevention, early detection, diagnosis, treatment, and palliation services for all patients with cancer residing in LMICs as an ethical imperative. The review elucidates priority areas for policy actions, health systems strengthening, and future research to guide international efforts toward more equitable cancer control globally.
Collapse
Affiliation(s)
- Oluwaseun Adebayo Bamodu
- Directorate of Postgraduate Studies, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Ilala District, Dar es Salaam, Tanzania
- Ocean Road Cancer Institute, Ilala District, Dar es Salaam, Tanzania
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington DC
| | - Chen-Chih Chung
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| |
Collapse
|
3
|
Mushosho EY, Muziringa MC, Radebe M, Nkosi PB. A model to enhance breast cancer screening among rural women aged 40-75 years in Sub-Saharan Africa (SSA): A scoping review. J Med Imaging Radiat Sci 2024; 55:109-124. [PMID: 38161135 DOI: 10.1016/j.jmir.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/20/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION AND BACKGROUND It is claimed that very little research has been done in Africa on breast cancer screening to identify the best method that can be adopted to have early detection of the malignancy. Breast cancer is a growing burden globally and in Sub-Saharan Africa (SSA). There is a rise in breast cancer mortality in SSA. This is caused by limited breast cancer screening or early detection practices due to limited resources which makes mammography unaffordable by the majority of women. This problem is more prevalent in elderly women living in rural areas where limited or no breast cancer screening is taking place. Downstaging which is context-specific is recommended for African countries but more studies are required to confirm its effectiveness. OBJECTIVES This review aims to identify the gaps in the literature focusing on strategies to enhance breast cancer screening among elderly women aged 40-75 years who reside in rural areas. INCLUSION CRITERIA The articles to be reviewed should focus on screening for the elderly women population that reside in rural areas and should fall within the age range of 40-75 years. Other phrases that can be included instead of breast cancer screening could be early detection measures, early diagnosis, or downstaging. METHODOLOGY The methodology was guided by the published manual for Joana Briggs Institute for scoping reviews. A search of the relevant studies was conducted on 4 October 2022 across PubMed, SCOPUS, Embase, and EBSCO Host databases. The systematic literature search strategy was developed and carried out using the Medical Subject Heading (MeSH) database. The eligibility criteria were developed using the Participants, Concept, and Context framework. Only articles written in English and published between 2010 and 2022 were considered. Removal of duplications was done first, followed by screening using the article title and abstract and then using full-text articles. The results of the search were profiled on the PRISMAScR flow chart diagram. Themes were identified from the conclusions of the reviewed studies. RESULTS After searching 78 citations were identified. These were screened and only 8 were left after the different stages of screening. The reviewed articles were published between 2010 and 2020. The majority (75%) of the studies were surveys except for two which were qualitative and all done in Kenya. No mixed methodology study was done. No study focused on developing a model to enhance breast cancer screening among rural women aged 40-75 years although there are very few countries in Africa with established nationwide breast cancer screening guidelines. CONCLUSION There are limited studies done on breast cancer screening of elderly rural women in SSA. No study was done to identify a model to enhance breast cancer screening among the rural elderly women population. None of the reviewed studies utilized the mixed methodology design to have an in-depth context-specific understanding to pave the way for the implementation of downstaging which is recommended for countries with limited resources. CONTRIBUTION The scoping review indicated the gap in research in terms of breast cancer screening among women aged 40-75 years who reside in rural areas and highlighted the future need for such studies to make downstaging effective.
Collapse
Affiliation(s)
- Eucaria Yemukayi Mushosho
- Durban University of Technology, Faculty of Health Sciences, Department of Radiography, Durban, South Africa; Harare Institute of Technology, School of Allied Health Sciences, Harare, Zimbabwe.
| | | | - Mbuyiselwa Radebe
- Durban University of Technology, Faculty of Health Sciences, Durban, South Africa
| | - Pauline Busisiwe Nkosi
- Durban University of Technology, Faculty of Health Sciences, Department of Radiography, Durban, South Africa
| |
Collapse
|
4
|
Suneja G, Kimani SM, Gill H, Painschab MS, Knettel BA, Watt MH. Addressing the Intersectional Stigma of Kaposi Sarcoma and HIV: A Call to Action. JCO Glob Oncol 2024; 10:e2300264. [PMID: 38301182 PMCID: PMC10846783 DOI: 10.1200/go.23.00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024] Open
Affiliation(s)
- Gita Suneja
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Radiation Oncology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Stephen M. Kimani
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Division of Oncology, Department of Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Hailie Gill
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Matthew S. Painschab
- Division of Hematology, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC
- UNC Project Malawi, Lilongwe, Malawi
| | - Brandon A. Knettel
- School of Nursing, Duke University, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Melissa H. Watt
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| |
Collapse
|
5
|
Magwesela FM, Msemakweli DO, Fearon D. Barriers and enablers of breast cancer screening among women in East Africa: a systematic review. BMC Public Health 2023; 23:1915. [PMID: 37794414 PMCID: PMC10548570 DOI: 10.1186/s12889-023-16831-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Breast cancer is among the most common cancers globally with a projected increase in incidence and mortality in low- and middle-income countries. The majority of the patients in East Africa present with advanced disease contributing to poor disease outcomes. Breast cancer screening enables earlier detection of the disease and therefore reduces the poor outcomes associated with the disease. This study aims to identify and synthesize the reported barriers and enablers of breast cancer screening among East African women. METHODS Medline, Embase, SCOPUS, and Cochrane library were searched for articles published on the subject from start to March 2022 using PRISMA guidelines. Also, forward citation, manual search of references and searching of relevant journals were done. A thematic synthesis was carried out on the "results/findings" sections of the identified qualitative papers followed by a multi-source synthesis with quantitative findings. RESULTS Of 4560 records identified, 51 were included in the review (5 qualitative and 46 quantitative), representing 33,523 women. Thematic synthesis identified two major themes - "Should I participate in breast cancer screening?" and "Is breast cancer screening worth it?". Knowledge of breast cancer and breast cancer screening among women was identified as the most influencing factor. CONCLUSION This review provides a rich description of factors influencing uptake of breast cancer screening among East African women. Findings from this review suggest that improving knowledge and awareness among both the public and providers may be the most effective strategy to improve breast cancer screening in Eastern Africa.
Collapse
Affiliation(s)
| | | | - David Fearon
- College of Medicine and Veterinary Medicine, University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL, UK
| |
Collapse
|
6
|
Agyemang LS, Wagland R, Foster C, McLean C, Fenlon D. To disclose or not to disclose: an ethnographic exploration of factors contributing to the (non) disclosure of Ghanaian women's breast cancer diagnosis to social networks. BMC Womens Health 2023; 23:366. [PMID: 37430247 DOI: 10.1186/s12905-023-02508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/24/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Although there may be theoretical support linking positive health outcomes with cancer disclosure to social networks, women from contexts such as Ghana where cancer is not openly talked about may have concerns around breast cancer disclosure. Women may not be able to share their experiences about their diagnosis, which may prevent them from receiving support. This study aimed to obtain the views of Ghanaian women diagnosed with breast cancer about factors contributing to (non) disclosure. METHODS This study is based on secondary findings from an ethnographic study that employed participant observation and semi-structured face to face interviews. The study was conducted at a breast clinic in a Teaching Hospital in southern Ghana. 16 women diagnosed with breast cancer (up to stage 3); five relatives nominated by these women and ten healthcare professionals (HCPs) participated in the study. Factors contributing to breast cancer (non) disclosure were explored. Data were analysed using a thematic approach. RESULTS The analysis indicated that most of the women and family members were very reticent about breast cancer disclosure and were secretive with distant relatives and wider social networks. Whilst remaining silent about their cancer diagnosis helped women protect their identities, prevented spiritual attack, and bad advice, the need for emotional and financial support for cancer treatment triggered disclosure to close family, friends, and pastors. Some women were discouraged from persevering with conventional treatment following disclosure to their close relatives. CONCLUSIONS Breast cancer stigma and fears around disclosure hindered women from disclosing to individuals in their social networks. Women disclosed to their close relatives for support, but this was not always safe. Health care professionals are well placed to explore women's concerns and facilitate disclosure within safe spaces to enhance engagement with breast cancer care services.
Collapse
Affiliation(s)
- Linda Serwaa Agyemang
- Department of Nursing Science, Faculty of Health and Social Science, Bournemouth University, Bournemouth, UK.
| | - Richard Wagland
- Centre for Psychosocial Research in Cancer, Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Claire Foster
- Centre for Psychosocial Research in Cancer, Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Chris McLean
- Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Deborah Fenlon
- Department of Nursing, College of Human and Health Science, University of Swansea, Swansea, UK
| |
Collapse
|
7
|
Estimation of Risk Factors Affecting Screening Outcomes of Prostate Cancer Using the Bayesian Ordinal Logistic Model. JOURNAL OF PROBABILITY AND STATISTICS 2023. [DOI: 10.1155/2023/4987764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Prostate cancer occurs when cells in the prostate gland grow out of control. Almost all prostate cancers are adenocarcinomas. The survival rate for prostate cancer patients depends on the screening outcome, which can be either no prostate cancer, early detection, and late detection or advanced stage detection. The main objective of this study was to estimate the risk factors affecting the screening outcome of prostate cancer. With ordinal outcomes, a generalized Bayesian ordinal logistic model was considered in the analysis. The generalized Bayesian ordinal logistic model helped in estimation of coefficient parameters of the risk factors affecting each level of prostate cancer-screening outcomes. In the study, positive coefficients, that is,
, indicated that the higher values on the explanatory variable increased the chances of the respondent being in a higher category of the dependent variable than the current one, while the negative coefficients, that is,
, signified that the higher values on the explanatory variable increased the likelihood of being in the current or lower category of prostate cancer. For instance, from the analysis, positive or negative outcomes of prostate cancer showed that an increase in weight lowered the chances of an individual having the disease.
Collapse
|
8
|
Watt MH, Suneja G, Zimba C, Westmoreland KD, Bula A, Cutler L, Khatri A, Painschab MS, Kimani S. Cancer-Related Stigma in Malawi: Narratives of Cancer Survivors. JCO Glob Oncol 2023; 9:e2200307. [PMID: 36795989 PMCID: PMC10166375 DOI: 10.1200/go.22.00307] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/08/2022] [Accepted: 01/19/2023] [Indexed: 02/18/2023] Open
Abstract
PURPOSE Stigma is an impediment across the cancer care continuum, leading to delayed presentation to care, elevated morbidity and mortality, and reduced quality of life. The goal of this study was to qualitatively examine the drivers, manifestations, and impacts of cancer-related stigma among individuals who received cancer treatment in Malawi, and to identify opportunities to address stigma. METHODS Individuals who had completed treatment for lymphoma (n = 20) or breast cancer (n = 9) were recruited from observational cancer cohorts in Lilongwe, Malawi. Interviews explored the individual's cancer journey, from first symptoms through diagnosis, treatment, and recovery. Interviews were audio-recorded and translated from Chichewa to English. Data were coded for content related to stigma, and thematically analyzed to describe the drivers, manifestations, and impacts of stigma along the cancer journey. RESULTS Drivers of cancer stigma included beliefs of cancer origin (cancer as infectious; cancer as a marker of HIV; cancer due to bewitchment), perceived changes in the individual with cancer (loss of social/economic role; physical changes), and expectations about the individual's future (cancer as death sentence). Cancer stigma manifested through gossip, isolation, and courtesy stigma toward family members. The impacts of cancer stigma included mental health distress, impediments to care engagement, lack of cancer disclosure, and self-isolation. Participants suggested the following programmatic needs: community education about cancer; counseling in health facilities; and peer support from cancer survivors. CONCLUSION The results highlight multifactorial drivers, manifestations, and impacts of cancer-related stigma in Malawi, which may affect success of cancer screening and treatment programs. There is a clear need for multilevel interventions to improve community attitudes toward people with cancer, and to support individuals along the continuum of cancer care.
Collapse
Affiliation(s)
- Melissa H. Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | | | - Katherine D. Westmoreland
- Department of Pediatric Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Lux Cutler
- Honors College, University of Utah, Salt Lake City, UT
| | - Abhilasha Khatri
- School of Biological Sciences and Honors College, University of Utah, Salt Lake City, UT
| | - Matthew S. Painschab
- Department of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen Kimani
- Department of Medicine, Division of Medical Oncology, University of Utah, Salt Lake City, UT
| |
Collapse
|
9
|
Iqbal MS, Ahmad W, Alizadehsani R, Hussain S, Rehman R. Breast Cancer Dataset, Classification and Detection Using Deep Learning. Healthcare (Basel) 2022; 10:2395. [PMID: 36553919 PMCID: PMC9778593 DOI: 10.3390/healthcare10122395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Incorporating scientific research into clinical practice via clinical informatics, which includes genomics, proteomics, bioinformatics, and biostatistics, improves patients' treatment. Computational pathology is a growing subspecialty with the potential to integrate whole slide images, multi-omics data, and health informatics. Pathology and laboratory medicine are critical to diagnosing cancer. This work will review existing computational and digital pathology methods for breast cancer diagnosis with a special focus on deep learning. The paper starts by reviewing public datasets related to breast cancer diagnosis. Additionally, existing deep learning methods for breast cancer diagnosis are reviewed. The publicly available code repositories are introduced as well. The paper is closed by highlighting challenges and future works for deep learning-based diagnosis.
Collapse
Affiliation(s)
- Muhammad Shahid Iqbal
- Department of Computer Science and Information Technology, Women University AJK, Bagh 12500, Pakistan
| | - Waqas Ahmad
- Higher Education Department Govt, AJK, Mirpur 10250, Pakistan
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Geelong, VIC 3216, Australia
| | - Sadiq Hussain
- Examination Branch, Dibrugarh University, Dibrugarh 786004, India
| | - Rizwan Rehman
- Centre for Computer Science and Applications, Dibrugarh University, Dibrugarh 786004, India
| |
Collapse
|
10
|
Ikhile D, Omodara D, Seymour-Smith S, Musoke D, Gibson L. “Some They Need Male, Some They Need Female”: A Gendered Approach for Breast Cancer Detection in Uganda. Front Glob Womens Health 2022; 3:746498. [PMID: 35400129 PMCID: PMC8989840 DOI: 10.3389/fgwh.2022.746498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction There are several challenges associated with breast cancer detection in Uganda and other low-and-middle-income countries. One of the identified challenges is attributed to the health workers' gender, which facilitates gender disparities in access to breast cancer detection services. Although this challenge is well acknowledged in existing literature, there are hardly any studies on how it can be addressed. Therefore, drawing on an intersectionality lens, our study examined how to address gender disparities facilitated by health workers' gender in accessing breast cancer detection services in Uganda. Materials and Methods We collected qualitative data through semi-structured interviews with twenty participants comprising community health workers, primary health care practitioners, non-governmental organizations, district health team, and the Ministry of Health. For the data analysis, thematic analysis was conducted on NVivo using Braun and Clarke's non-linear 6-step process to identify the themes presented in the results section. Results Four themes emerged from the data analysis: understanding a woman's gender constructions; health workers' approachability; focus on professionalism, not sex; and change in organizational culture. These themes revealed participants' perceptions regarding how to address gender disparities relating to the role health workers' gender play in breast cancer detection. Through the intersectionality lens, our findings showed how gender intersects with other social stratifiers such as religious beliefs, familial control, health worker's approachability, and professionalism within the health workforce. Conclusion Our findings show that the solutions to address gender disparities in breast cancer detection are individually and socially constructed. As such, we recommend a gendered approach to understand and redress the underlying power relations perpetuating such constructions. We conclude that taking a gendered approach will ensure that breast cancer detection programs are context-appropriate, cognizant of the prevailing cultural norms, and do not restrict women's access to breast cancer detection services.
Collapse
Affiliation(s)
- Deborah Ikhile
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
- *Correspondence: Deborah Ikhile
| | - Damilola Omodara
- Global Public Health, Institute of Population Health Science, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Sarah Seymour-Smith
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - David Musoke
- School of Public Health, Makerere University, Kampala, Uganda
| | - Linda Gibson
- Public Health, Institute of Health and Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| |
Collapse
|
11
|
McCutchan G, Weiss B, Quinn-Scoggins H, Dao A, Downs T, Deng Y, Ho H, Trung L, Emery J, Brain K. Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review. BMJ Glob Health 2021; 6:bmjgh-2020-004213. [PMID: 33531348 PMCID: PMC7868297 DOI: 10.1136/bmjgh-2020-004213] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Starting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment. Methods Mixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate. Results Of 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments. Conclusion Due to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.
Collapse
Affiliation(s)
- Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK .,Wales Cancer Research Centre, Cardiff University, Cardiff, UK
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,PRIME Centre Wales, Cardiff University, Cardiff, UK
| | - Anh Dao
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Tom Downs
- Department of Acute Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Yunfeng Deng
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Ha Ho
- Center for Research, Information and Services in Psychology, Vietnam National University, Hanoi, Vietnam
| | - Lam Trung
- Danang Psychiatric Hospital, Da Nang, Vietnam
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
12
|
Mascara M, Constantinou C. Global Perceptions of Women on Breast Cancer and Barriers to Screening. Curr Oncol Rep 2021; 23:74. [PMID: 33937940 DOI: 10.1007/s11912-021-01069-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Breast cancer (BC) is a public health dilemma across the globe and a leading cause of mortality for women. Approximately 2.1 million newly diagnosed female BC cases occurred in 2018, comprising nearly 1 in 4 cancer cases among women. When BC is recognized in its early stages, successful treatment results can be achieved. Therefore, screening for BC is of paramount significance and routine screening mammography has been shown to be effective in reducing mortality from BC. Despite being considered a global health issue, national screening programmes are offered only in developed countries and BC is still often diagnosed in advanced stages. RECENT FINDINGS Disparities in screening exist not only between different countries but also between local and immigrant populations within a particular country. Low screening is attributed to low public awareness as well as numerous social, psychological, and geographical barriers to screening. This review addresses (a) the differences in BC awareness and screening across the globe, (b) the most important barriers and facilitators to screening, and (c) the potential role of health education programmes to increase BC awareness and promote BC screening programmes with the ultimate goal to achieve earlier stage diagnosis of BC.
Collapse
Affiliation(s)
- Mariah Mascara
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, 21 Ilia Papakyriakou, 2414 Engomi, P.O. Box 24005, CY-1700, Nicosia, Cyprus
| | - Constantina Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, 21 Ilia Papakyriakou, 2414 Engomi, P.O. Box 24005, CY-1700, Nicosia, Cyprus.
| |
Collapse
|
13
|
Moodley J, Constant D, Mwaka AD, Scott SE, Walter FM. Mapping awareness of breast and cervical cancer risk factors, symptoms and lay beliefs in Uganda and South Africa. PLoS One 2020; 15:e0240788. [PMID: 33091035 PMCID: PMC7580973 DOI: 10.1371/journal.pone.0240788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/03/2020] [Indexed: 12/30/2022] Open
Abstract
Background Breast and cervical cancer are leading causes of cancer burden in Sub-Saharan Africa (SSA). We measured breast and cervical cancer symptom and risk factor awareness and lay beliefs in Uganda and South Africa (SA). Methods Between August and December 2018 we conducted a cross-sectional survey of women ≥18 years in one urban and one rural site per country. Households were selected using systematic random sampling, then one woman per household randomly selected to participate. Data were collected by interviewers using electronic tablets customised with the locally validated African Women Awareness of Cancer (AWACAN) tool. This has unprompted questions (testing recall) followed by prompted questions (testing recognition) on risk factor, symptom awareness and lay beliefs for breast and cervical cancer. Mann Whitney and Kruskal Wallis tests were used to compare the association between socio-demographic variables and outcomes. Poisson regression with robust variance was conducted to identify independent socio-demographic predictors. Results Of the 1758 women interviewed, 90.8% had heard of breast and 89.4% of cervical cancer. 8.7% recalled at least one breast risk factor and 38.1% recalled at least one cervical cancer risk factor. 78.0% and 57.7% recalled at least one breast/cervical cancer symptom respectively. Recognition of risk factors and symptoms was higher than recall. Many women were unaware that HPV, HIV, and not being screened were cervical cancer risk factors (23.7%, 46.8%, 26.5% respectively). In SA, urban compared to rural women had significantly higher symptom and risk factor awareness for both cancers. In Uganda married women/living with a partner had higher awareness of breast cancer risk factors and cervical cancer symptoms compared to women not living with a partner. Women mentioned several lay beliefs (e.g. putting money in their bra as a breast cancer risk factor). Conclusion We identified gaps in breast and cervical cancer symptom and risk factor awareness. Our results provide direction for locally targeted cancer awareness intervention programs and serve as a baseline measure against which to evaluate interventions in SSA.
Collapse
Affiliation(s)
- J. Moodley
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa
- South African Medical Research Council Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa
- * E-mail:
| | - D. Constant
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa
| | - A. D. Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - S. E. Scott
- Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, London, United Kingdom
| | - F. M. Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
14
|
Antabe R, Kansanga M, Sano Y, Kyeremeh E, Galaa Y. Utilization of breast cancer screening in Kenya: what are the determinants? BMC Health Serv Res 2020; 20:228. [PMID: 32183801 PMCID: PMC7079358 DOI: 10.1186/s12913-020-5073-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 03/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer accounts for 23% of all cancer cases among women in Kenya. Although breast cancer screening is important, we know little about the factors associated with women's breast cancer screening utilization in Kenya. Using the Andersen's behavioural model of health care utilization, we aim to address this void in the literature. METHODS We draw data on the Kenya Demographic and Health Survey and employ univariate, bivariate, and multivariate analyses. RESULTS We find that women's geographic location, specifically, living in a rural area (OR = 0.89; p < 0.001) and the North Eastern Province is associated with lower odds of women being screened for breast cancer. Moreover, compared to the more educated, richer and insured, women who are less educated, poorer, and uninsured (OR = 0.74; p < 0.001) are less likely to have been screened for breast cancer. CONCLUSION Based on these findings, we recommend place and group-specific education and interventions on increasing breast cancer screening in Kenya.
Collapse
Affiliation(s)
- Roger Antabe
- Department of Geography, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Moses Kansanga
- Department of Geography, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Yujiro Sano
- Department of Sociology, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Emmanuel Kyeremeh
- Department of Geography, Western University, 1151 Richmond Street, Social Science Building, London, Ontario, N6A 3K7, Canada
| | - Yvonne Galaa
- Department of Planning, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, KNUST, Kumasi, Ghana.
| |
Collapse
|
15
|
Torrorey-Sawe R, van der Merwe N, Mining SK, Kotze MJ. Pioneering Informed Consent for Return of Research Results to Breast Cancer Patients Facing Barriers to Implementation of Genomic Medicine: The Kenyan BRCA1/2 Testing Experience Using Whole Exome Sequencing. Front Genet 2020; 11:170. [PMID: 32231682 PMCID: PMC7089032 DOI: 10.3389/fgene.2020.00170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Obtaining informed consent from study participants and disseminating the findings responsibly is a key principle required for ethically conducted clinical and genetic research. Reports from African researchers providing feedback on insights gained during the return of whole exome sequencing (WES) results to breast cancer patients treated in resource-limited settings is lacking. AIM The empirical process used to fill this gap in relation to BRCA1/2 variant detection using WES provided unique insights incorporated into a pathology-supported genetic testing algorithm for return of research results to Kenyan breast cancer patients. METHODS The Informed consent form approved by the Moi Teaching and Referral Hospital in Kenya was adopted from a translational research study conducted in South Africa. Initially, the informed consent process was piloted in 16 Kenyan female patients referred for breast surgery, following a community-based awareness campaign. A total of 95 female and two male breast cancer patients were enrolled in the study from 2013 to 2016. Immunohistochemistry (IHC) results of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) status were obtained from hospital records. DNA of patients with a family history of cancer was extracted from saliva and screened for pathogenic variants in the BRCA1/2 genes as the first step using WES. RESULTS Ten patients approached for participation in this study declined to sign the informed consent form. Data on IHC used as a proxy for molecular subtype were available in 8 of 13 breast cancer patients (62%) with a family history of cancer. Five BRCA1/2 variants of uncertain clinical significance were detected, as well as a pathogenic BRCA2 variant (c.5159C > A; S1720∗) in a female patient eligible for return of WES results. CONCLUSION Experience gained during the qualitative pilot phase was essential to overcome challenges associated with the translation of sophisticated genetic terms into native African languages. Detection of a pathogenic BRCA2 variant in a patient with familial breast cancer, frequently associated with hormone receptor-positive breast carcinoma as reported in this case, led to a high level of confidence on which to base risk management in future. Implementation of new technologies alongside standard pathology provides a practical approach to the application of genomic medicine in Africa.
Collapse
Affiliation(s)
- Rispah Torrorey-Sawe
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Department of Immunology, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Nicole van der Merwe
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Simeon Kipkoech Mining
- Department of Immunology, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Maritha J Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| |
Collapse
|
16
|
Sayed S, Ngugi AK, Mahoney MR, Kurji J, Talib ZM, Macfarlane SB, Wynn TA, Saleh M, Lakhani A, Nderitu E, Agoi F, Premji Z, Zujewski JA, Moloo Z. Breast Cancer knowledge, perceptions and practices in a rural Community in Coastal Kenya. BMC Public Health 2019; 19:180. [PMID: 30755192 PMCID: PMC6373063 DOI: 10.1186/s12889-019-6464-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 01/21/2019] [Indexed: 11/13/2022] Open
Abstract
Background Data on breast healthcare knowledge, perceptions and practice among women in rural Kenya is limited. Furthermore, the role of the male head of household in influencing a woman’s breast health seeking behavior is also not known. The aim of this study was to assess the knowledge, perceptions and practice of breast cancer among women, male heads of households, opinion leaders and healthcare providers within a rural community in Kenya. Our secondary objective was to explore the role of male heads of households in influencing a woman’s breast health seeking behavior. Methods This was a mixed method cross-sectional study, conducted between Sept 1st 2015 Sept 30th 2016. We administered surveys to women and male heads of households. Outcomes of interest were analysed in Stata ver 13 and tabulated against gender. We conducted six focus group discussions (FGDs) and 22 key informant interviews (KIIs) with opinion leaders and health care providers, respectively. Elements of the Rapid Assessment Process (RAP) were used to guide analysis of the FGDs and the KIIs. Results A total of 442 women and 237 male heads of households participated in the survey. Although more than 80% of respondents had heard of breast cancer, fewer than 10% of women and male heads of households had knowledge of 2 or more of its risk factors. More than 85% of both men and women perceived breast cancer as a very serious illness. Over 90% of respondents would visit a health facility for a breast lump. Variable recognition of signs of breast cancer, limited decision- autonomy for women, a preference for traditional healers, lack of trust in the health care system, inadequate access to services, limited early-detection services were the six themes that emerged from the FGDs and the KIIs. There were discrepancies between the qualitative and quantitative data for the perceived role of the male head of household as a barrier to seeking breast health care. Conclusions Determining level of breast cancer knowledge, the characteristics of breast health seeking behavior and the perceived barriers to accessing breast health are the first steps in establishing locally relevant intervention programs. Electronic supplementary material The online version of this article (10.1186/s12889-019-6464-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Shahin Sayed
- Department of Pathology, Faculty of Health Sciences - East Africa, Aga, Khan University Nairobi, 3rd Parklands Avenue, P.O. Box 30270-00100, Nairobi, Kenya.
| | - Anthony K Ngugi
- Centre for Population, Faculty of Health Sciences - East Africa, Aga Khan University, Nairobi, 3rd Parklands Avenue, P.O. Box 30270-00100, Nairobi, Kenya
| | - Megan R Mahoney
- Department of Medicine General Medicines Discipline Stanford, University, Palo Alto-C, 291 Campus Dr.Palo Alto, California, CA, 94305, USA
| | - Jaameeta Kurji
- University of Ottawa, School of Epidemiology, Public Health & Preventive Medicine, Alta Vista Campus 600 Peter Morand Crescent,Ottawa, Ontario, K1G 5Z3, Canada
| | - Zohray M Talib
- Department of Medicine and of Health Policy and Management, The George Washington University (GWU) Medical School, Ross Hall, 2300 Eye Street, Washington D.C., NW, 20037, USA
| | - Sarah B Macfarlane
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, Mission Hall: Global Health & Clinical Sciences Building 550 16th Street, 2nd Floor Box #0560, San Francisco, CA, 94158-2549, USA
| | - Theresa A Wynn
- University of Alabama at Birmingham, School of Medicine, Division of Preventive Medicine, University of Alabama, Medical Towers, MT-621. 1720 2nd Ave South, Birmingham, AL, 35294-4410, USA
| | - Mansoor Saleh
- Department of Medicine, University of Alabama Comprehensive Cancer Center, Birmingham, Alabama, USA Wallace Tumor Institute, WTI 202. 1720 2nd Ave South, Birmingham, AL, 35294-3300, USA
| | - Amyn Lakhani
- Mombasa Research Office, Faculty of Health Sciences - East Africa, Aga Khan University, 3rd Parklands Avenue, P.O. Box 30270-00100, Nairobi, Kenya
| | - Esther Nderitu
- School of Nursing and Midwifery, Aga Khan University Nairobi Kenya, 3rd Parklands Avenue, P.O. Box 30270-00100, Nairobi, Kenya
| | - Felix Agoi
- Mombasa Research Office, Faculty of Health Sciences - East Africa, Aga Khan University, 3rd Parklands Avenue, P.O. Box 30270-00100, Nairobi, Kenya
| | - Zul Premji
- Department of Pathology, Faculty of Health Sciences - East Africa, Aga, Khan University Nairobi, 3rd Parklands Avenue, P.O. Box 30270-00100, Nairobi, Kenya
| | - Jo Anne Zujewski
- JZ Oncology, JZ Oncology , 4525 North Chelsea Lane, Bethesda, MD, 20814, USA
| | - Zahir Moloo
- Department of Pathology, Faculty of Health Sciences - East Africa, Aga, Khan University Nairobi, 3rd Parklands Avenue, P.O. Box 30270-00100, Nairobi, Kenya
| |
Collapse
|
17
|
Sharifikia I, Rohani C, Estebsari F, Matbouei M, Salmani F, Hossein-Nejad A. Health Belief Model-based Intervention on Women's Knowledge and Perceived Beliefs about Warning Signs of Cancer. Asia Pac J Oncol Nurs 2019; 6:431-439. [PMID: 31572765 PMCID: PMC6696815 DOI: 10.4103/apjon.apjon_32_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: Early detection of cancers essentially depends on knowledge of the warning signs. This study, therefore, aimed at investigating the effect of Health Belief Model (HBM)-based educational intervention on the knowledge and perceived beliefs of women about the warning signs of cancer. Methods: This experimental study with intervention (n = 80) and control (n = 80) groups was performed at four urban health centers affiliated to the university. Data collection was done in two phases, before and one month after the educational intervention, using three instruments, a demographic-clinical information questionnaire, the awareness questionnaire on cancer warning signs, and the cancer warning signs-HBM questionnaire. Results: The results of the multivariate repeated-measures analyses of variance indicated that the hypothesis of this study was confirmed. It means that “women's knowledge and their perceived beliefs of cancer warning signs” improved after HBM-based educational intervention in the intervention group, compared to the controls over time. Thus, the “level of knowledge” and perceived beliefs of the women in the intervention group compared to the controls increased, in terms of perceived “sensitivity,” “severity,” “benefits,” “barriers,” “cue to action,” and “self-efficacy” over time (P < 0.001). Conclusions: It could be hoped that this intervention would be effective for improving the performance of women in health-promoting behaviors of cancer prevention. It is recommended that health-care providers plan for HBM-based educational interventions, based on educational needs of the target groups at different community levels.
Collapse
Affiliation(s)
- Iman Sharifikia
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Camelia Rohani
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Estebsari
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Matbouei
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Salmani
- Department of Epidemiology and Biostatistics, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Azam Hossein-Nejad
- Department of Nursing, School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran
| |
Collapse
|
18
|
Ginsburg O, Rositch AF, Conteh L, Mutebi M, Paskett ED, Subramanian S. Breast Cancer Disparities Among Women in Low- and Middle-Income Countries. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0286-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
19
|
Factors Contributing to Late-Stage Breast Cancer Presentation in sub-Saharan Africa. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0278-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
20
|
Martei YM, Vanderpuye V, Jones BA. Fear of Mastectomy Associated with Delayed Breast Cancer Presentation Among Ghanaian Women. Oncologist 2018; 23:1446-1452. [PMID: 29959283 DOI: 10.1634/theoncologist.2017-0409] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/17/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Breast cancer is the leading cause of cancer mortality among women globally. Most women in Ghana present with advanced stage disease. The aim of this study is to characterize sociocultural factors associated with delayed presentation. MATERIALS AND METHODS Qualitative study (grounded theory, constant comparative method) using individual in-depth interviews with breast cancer patients seen at the Korle Bu Teaching Hospital in Accra, Ghana. Interviews were conducted in English and three local languages. We achieved theoretical saturation with 31 participants. RESULTS The mean length of delay reported by patients was approximately 1 year. Five recurrent themes were related to delayed presentation: (a) Women with a confirmed breast cancer diagnosis delay treatment because of the fear of mastectomy due to self and societal stigma; (b) role of the church as a social support system given the societal stigma associated with breast cancer; (c) study participants expressed some awareness of breast cancer, but with varying depths of breast cancer knowledge encompassing both myths and misconceptions about breast cancer; (d) most patients present late because they do not associate a "painless" breast lump with possible breast malignancy; and (e) delayed presentation linked to significant financial burden associated with breast cancer treatment. CONCLUSION Despite current efforts to increase breast cancer awareness, the fear of mastectomy remains one of the main reasons for delayed presentation. Successful breast cancer education programs will need to be framed within the broader sociocultural dimensions of femininity that address some of the stigma associated with mastectomy reported in the Ghanaian context. IMPLICATIONS FOR PRACTICE Most women in Ghana present with advanced-stage disease. The aim of this study was to characterize sociocultural factors associated with delayed presentation. Although several quantitative studies have been conducted on delays in presentation in sub-Saharan Africa (SSA), this study is one of the few to identify fear of mastectomy as a reason for delayed presentation. Anecdotal data from current clinical experiences in SSA suggest that this is still an issue that has not been adequately reported and addressed in most SSA countries. The research results presented here will hopefully guide health providers and national organizations in designing breast cancer education programs in Ghana and other parts of SSA.
Collapse
Affiliation(s)
- Yehoda M Martei
- Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Verna Vanderpuye
- National Center for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Beth A Jones
- Yale School of Public Health, Yale Comprehensive Cancer Center, New Haven, Connecticut, USA
| |
Collapse
|
21
|
Kisiangani J, Baliddawa J, Marinda P, Mabeya H, Choge JK, Adino EO, Khayeka-Wandabwa C. Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya. BMC WOMENS HEALTH 2018; 18:81. [PMID: 29859095 PMCID: PMC5984781 DOI: 10.1186/s12905-018-0571-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/18/2018] [Indexed: 01/24/2023]
Abstract
Background Estimately, 70–80% of cancer cases are diagnosed in late stages in Kenya with breast cancer being a common cause of mortality among women where late diagnosis is the major ubiquitous concern. Numerous studies have focused on epidemiological and health policy dynamics essentially underestimating the determining factors that shape people’s choices and cues to health care service uptake. The study sought to evaluate the knowledge, attitude and health seeking behavior towards breast cancer and its screening in a quest to explain why women present for prognosis and treatment when symptomatic pointers are in advanced stages, impeding primary prevention strategies. Methods Eight focus groups (6–10 members per group) and four key informant interviews were conducted among adult participants from rural and urban settings. Sessions were audio-recorded and transcribed. A thematic analysis of the data was based on the concepts of the health belief model. Data analysis was conducted using NVIVO10. Results Most women perceived breast cancer as a fatal disease and conveyed fear of having early screening. Rural women preferred self-prescribed medications and the use of alternative medicine for long periods before presenting for professional care on suspicion that the lump is cancerous. Accessibility to equipped health facilities, lack of information to establish effective follow-up treatment and low-income status were underscored as their major health seeking behavior barriers whereas, urban women identified marital status as their main barrier. Key informant interviews revealed that health communication programs emphasized more on communicable diseases. This could in part explain why there is a high rate of misconception and suspicion about breast cancer among rural and urban women in the study setting. Conclusions Creating breast cancer awareness alongside clear guidelines on accessing screening and treatment infrastructure is critical. It was evident, a diagnosis of breast cancer or lump brings unexpected confrontation with mortality; fear, pain, cultural barriers, emotional and financial distress. Without clear referral channels to enable those with suspicious lumps or early stage disease to get prompt diagnosis and treatment, then well-meaning awareness will not necessarily contribute to reducing morbidity and mortality. Electronic supplementary material The online version of this article (10.1186/s12905-018-0571-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joyce Kisiangani
- The Aquaya Institute, Nairobi, 00505, Kenya.,School of Public Health, Department of Epidemiology and disease control, Moi University, P.O. Box 3900, Eldoret, Kenya
| | - Joyce Baliddawa
- School of Public Health, Department of Epidemiology and disease control, Moi University, P.O. Box 3900, Eldoret, Kenya
| | - Pamela Marinda
- Department of Food Science and Nutrition, School of Agricultural Sciences, The University of Zambia, Lusaka, Zambia
| | - Hillary Mabeya
- Gynocare Fistula Centre, Eldoret Hospital Lane, P.O. BOX 2326-30100, Eldoret, Kenya
| | - Joseph K Choge
- University of Kabianga, P.O. Box 2030-20200, Kericho, Kenya
| | | | - Christopher Khayeka-Wandabwa
- School of Pharmaceutical Science and Technology (SPST), Health Science Platform, Tianjin University, 92 Weijin road, Nankai District, Tianjin, 300072, People's Republic of China. .,African Population and Health Research Center (APHRC), P .O. Box 10787-00100, Nairobi, Kenya.
| |
Collapse
|
22
|
Perceived barriers to early detection of breast cancer in Wakiso District, Uganda using a socioecological approach. Global Health 2018; 14:9. [PMID: 29361954 PMCID: PMC5781279 DOI: 10.1186/s12992-018-0326-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 01/09/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Early detection of breast cancer is known to improve its prognosis. However, women in most low and middle income countries, including Uganda, do not detect it early hence present at an advanced stage. This study investigated the perceived barriers to early detection of breast cancer in Wakiso district, Uganda using a multilevel approach focused through a socioecological framework. METHODS Using qualitative methods, participants were purposively selected to take part in the study. 5 semi-structured interviews were conducted among the community members while two focus groups were conducted amongst women's group and community health workers (CHWs) in Ssisa sub county, Wakiso district. In addition, 7 key informant interviews with health professionals, policy makers and public health researchers were carried out. RESULTS Findings from the study revealed that barriers to early detection of breast cancer are multifaceted and complex, cutting across individual, interpersonal, organizational, community and policy barriers. The major themes that emerged from the study included: knowledge, attitudes, beliefs and practices (KABP); health system and policy constraints; and structural barriers. Prominent barriers associated with KABP were low knowledge, apathy, fear and poor health seeking behaviours. Barriers within the health systems and policy arenas were mostly centred around competing health care burdens within the country, lack of a cancer policy and weak primary health care capacity in Wakiso district. Distance, poverty and limited access to media were identified as the most prominent structural barriers. CONCLUSION Barriers to early detection of breast cancer are complex and go beyond individual behaviours. These barriers interact across multiple levels of influence such as organizational, community and policy. The findings of this study could provide opportunities for investment in multi-level interventions.
Collapse
|
23
|
Kohler RE, Gopal S, Lee CN, Weiner BJ, Reeve BB, Wheeler SB. Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment. J Glob Oncol 2017; 3:480-489. [PMID: 29094086 PMCID: PMC5646878 DOI: 10.1200/jgo.2016.005371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge. METHODS We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software. RESULTS Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time. CONCLUSION Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women's preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.
Collapse
Affiliation(s)
- Racquel E. Kohler
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Satish Gopal
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Clara N. Lee
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Bryan J. Weiner
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Bryce B. Reeve
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| | - Stephanie B. Wheeler
- Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Racquel E. Kohler and Satish Gopal, UNC Project Malawi, Lilongwe, Malawi
| |
Collapse
|
24
|
Ragan KR, Buchanan Lunsford N, Lee Smith J, Saraiya M, Aketch M. Perspectives of Screening-Eligible Women and Male Partners on Benefits of and Barriers to Treatment for Precancerous Lesions and Cervical Cancer in Kenya. Oncologist 2017; 23:35-43. [PMID: 28798272 PMCID: PMC5759810 DOI: 10.1634/theoncologist.2017-0053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/14/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of female cancer mortality in Kenya. Kenya's National Cervical Cancer Prevention Program Strategic Plan outlines efforts to reduce the burden; however, treatment services remain limited. This study identified male and female perspectives regarding benefits, facilitators, and barriers to treatment for precancerous lesions and cervical cancer. MATERIALS AND METHODS Ten focus groups were conducted in Nairobi and Nyanza in 2014 with females aged 25-49 years (n = 60) and male partners (n = 40). Participants were divided into groups dependent on screening status, sex, language, and geographic location. Qualitative analytic software was used to analyze transcribed and translated data. RESULTS Treatment was endorsed as beneficial for the prevention of death and the improvement of wellness, quality of life, symptoms, and family life. Barriers reported by males and females included the following: (a) concerns about side effects; (b) treatment-related fear and stigma; (c) marital discord; (d) financial and access issues; (e) religious and cultural beliefs; and (f) limited knowledge. Male endorsement of wanting to improve knowledge and communication with their partners, in spite of stigmatizing beliefs and misperceptions regarding females with abnormal screening results or those who have been diagnosed with cancer, was novel. CONCLUSION Incorporating qualitative data on benefits of and barriers to treatment for precancerous lesions and cervical cancer into Kenya's national priorities and activities is important. These findings can be used to inform the development and successful implementation of targeted, region-specific community outreach and health messaging campaigns focused on alleviating the country's cervical cancer burden. IMPLICATIONS FOR PRACTICE This article provides important insight into female and male partner perspectives regarding benefits, facilitators, and barriers to treatment for precancerous lesions and cervical cancer. These novel research findings can inform the development of targeted community health interventions, educational messages, and resources and aid stakeholders in strengthening strategic plans regarding treatment coverage and cervical cancer prevention. Because several treatment barriers identified in this study are similar to barriers associated with cervical cancer screening in low- and middle-resourced countries, effective messaging interventions could address barriers to receipt of both screening and treatment.
Collapse
Affiliation(s)
- Kathleen R Ragan
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia, USA
| | - Natasha Buchanan Lunsford
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia, USA
| | - Judith Lee Smith
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia, USA
| | - Mona Saraiya
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, Georgia, USA
| | | |
Collapse
|
25
|
Scheel JR, Molina Y, Anderson BO, Patrick DL, Nakigudde G, Gralow JR, Lehman CD, Thompson B. Breast Cancer Beliefs as Potential Targets for Breast Cancer Awareness Efforts to Decrease Late-Stage Presentation in Uganda. J Glob Oncol 2017; 4:1-9. [PMID: 30241166 PMCID: PMC6180808 DOI: 10.1200/jgo.2016.008748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose To assess breast cancer beliefs in Uganda and determine whether these beliefs
are associated with factors potentially related to nonparticipation in early
detection. Methods A survey with open- and close-ended items was conducted in a community sample
of Ugandan women to assess their beliefs about breast cancer. Linear
regression was used to ascertain associations between breast cancer beliefs
and demographic factors potentially associated with early detection,
including socioeconomic factors, health care access, prior breast cancer
knowledge, and personal detection practices. Results Of the 401 Ugandan women surveyed, most had less than a primary school
education and received medical care at community health centers. Most women
either believed in or were unsure about cultural explanatory models for
developing breast cancer (> 82%), and the majority listed these
beliefs as the most important causes of breast cancer (69%). By comparison,
≤ 45% of women believed in scientific explanatory risks for
developing breast cancer. Although most believed that regular screening and
early detection would find breast cancer when it is easy to treat (88% and
80%, respectively), they simultaneously held fatalistic attitudes toward
their own detection efforts, including belief or uncertainty that a cure is
impossible once they could self-detect a lump (54%). Individual beliefs were
largely independent of demographic factors. Conclusion Misconceptions about breast cancer risks and benefits of early detection are
widespread in Uganda and must be addressed in future breast cancer awareness
efforts. Until screening programs exist, most breast cancer will be
self-detected. Unless addressed by future awareness efforts, the high
frequency of fatalistic attitudes held by women toward their own detection
efforts will continue to be deleterious to breast cancer early detection in
sub-Saharan countries like Uganda.
Collapse
Affiliation(s)
- John R Scheel
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Yamile Molina
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Benjamin O Anderson
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Donald L Patrick
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Gertrude Nakigudde
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Julie R Gralow
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Constance D Lehman
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Beti Thompson
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
26
|
Lin TTC, Li L, Bautista JR. Examining How Communication and Knowledge Relate to Singaporean Youths' Perceived Risk of Haze and Intentions to Take Preventive Behaviors. HEALTH COMMUNICATION 2017; 32:749-758. [PMID: 27392280 DOI: 10.1080/10410236.2016.1172288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
As Southeast Asia has experienced haze crises in recent years, encouraging Singaporeans to take preventive measures against negative health outcomes during haze is a growing concern. This study examines how communication factors (i.e., attention to traditional media and new media, interpersonal discussion, and knowledge) can inform Singaporeans about haze and influence their risk perceptions and intentions to undertake self-protective measures. The web survey of 410 respondents shows that attention to traditional media, attention to new media, interpersonal discussion, knowledge, and risk perception are positively associated with intention to take preventive measures. However, only interpersonal discussion is related to risk perception. Theoretical as well as practical implications of the findings are discussed.
Collapse
Affiliation(s)
- Trisha T C Lin
- a Wee Kim Wee School of Communication and Information , Nanyang Technological University
| | - Li Li
- a Wee Kim Wee School of Communication and Information , Nanyang Technological University
| | - John Robert Bautista
- a Wee Kim Wee School of Communication and Information , Nanyang Technological University
| |
Collapse
|
27
|
Githaiga JN, Swartz L. 'You have a swelling': The language of cancer diagnosis and implications for cancer management in Kenya. PATIENT EDUCATION AND COUNSELING 2017; 100:836-838. [PMID: 28089133 DOI: 10.1016/j.pec.2017.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/19/2016] [Accepted: 01/07/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the ramifications of language as a vehicle of communication in the Kenyan healthcare system. METHODS (1) A review of literature search on language access and health care in Kenya, using Scopus, Web of Science, Ebscohost, ProQuest and Google Scholar electronic databases. (2) Two illustrative case studies from a Nairobi based qualitative research project on family cancer caregivers' experiences. RESULTS Evidence from the case studies shows that language barriers may hinder understanding of cancer diagnoses and consequently, the nature of interventions sought by family members as informal caregivers of cancer patients. CONCLUSION Findings demonstrate the significance of language in understanding cancer diagnosis as a basis for treatment seeking behaviour and specifically in light of the critical role played by informal caregivers in under resourced health care contexts. PRACTICE IMPLICATIONS (1) The assumption that English and Swahili are adequate in communication in Kenyan health care contexts ought to be reviewed. (2) Further research and assessment of language needs as a basis for training of language interpreters in the Kenyan health care system is a necessity.
Collapse
Affiliation(s)
- Jennifer Nyawira Githaiga
- Department of Psychology, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland, 7602, South Africa.
| | - Leslie Swartz
- Alan J. Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland, 7602, South Africa
| |
Collapse
|
28
|
Rakkapao N, Promthet S, Moore MA, Solikhah S, Hurst C. Assessing Breast Cancer Awareness in Thai Women: Validation of the Breast Cancer Awareness Scale (B-CAS). Asian Pac J Cancer Prev 2017; 18:995-1005. [PMID: 28545198 PMCID: PMC5494250 DOI: 10.22034/apjcp.2017.18.4.995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Raising breast cancer awareness is a well-established first line strategy to reduce breast cancer mortality. A properly validated instrument is needed to gain a better understanding of breast cancer awareness. Objective: The objective of this study was to develop and validate an instrument to assess breast cancer awareness in Thai women. Methods: In this study, we develop and evaluate the validity of the Breast Cancer Awareness Scale (B-CAS). Construct validity was evaluated by using exploratory factor analysis and confirmatory factor analysis, and criterion validity was investigated using ROC curves to examine the associations between B-CAS subscales and breast self-examination. Internal consistency and test-retest reliability were also investigated. This validation process employed two independent samples of Thai women aged 20-64 years collected from communities in southern Thailand. Results: In total, 660 Thai women (mean age 41 years) participated in this study. Confirmatory factor analysis demonstrated the construct validity of B-CAS (CFI =0.91; NNFI=0.90; GFI=0.95; AGFI= 0.95; RMSEA=0.044, 95%CI 0.041 to 0.047; P< 0.05). Several of the B-CAS subscales demonstrated strong utility in discriminating between women who do and do not regularly conduct breast self-examination. B-CAS also demonstrated strong internal consistency (Cronbach’s α=0.86) and test-retest reliability. The final version of B-CAS contains 35 items across five domains: knowledge of risk factors, knowledge of signs and symptoms, attitude to breast cancer prevention, barriers of breast screening, and health behaviour related to breast cancer awareness. Conclusion: The breast cancer awareness scale (B-CAS) was shown to have good psychometric properties in Thai women, and is likely to prove useful in studying the epidemiology of breast cancer awareness in Thai women, and evaluating breast cancer prevention programs for raising awareness.
Collapse
Affiliation(s)
- Nitchamon Rakkapao
- Faculty of Public Health, Thammasat University Lampang Center, Thailand.
| | | | | | | | | |
Collapse
|
29
|
Akuoko CP, Armah E, Sarpong T, Quansah DY, Amankwaa I, Boateng D. Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa. PLoS One 2017; 12:e0171024. [PMID: 28192444 PMCID: PMC5305236 DOI: 10.1371/journal.pone.0171024] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/13/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Breast cancer (BC) has been described as the leading cause of cancer deaths among women especially in the developing world including sub Saharan Africa (SSA). Delayed presentation and late diagnosis at health facilities are parts of the contributing factors of high BC mortality in Africa. This review aimed to appraise the contributing factors to delayed breast cancer presentation and diagnosis among SSA women. METHODS Five databases encompassing medical and social sciences were systematically searched using predefined search terms linked with breast cancer presentation and diagnosis and sub Saharan Africa. Reference lists of relevant papers were also hand searched. Quality of quantitative and qualitative articles were assessed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Critical Appraisal Skills Programme (CASP) quality appraisal checklist. Thematic analysis was used to synthesize the qualitative studies to integrate findings. RESULTS Fourteen (14) quantitative studies, two (2) qualitative studies and one (1) mixed method study merited inclusion for analysis. This review identified low knowledge of breast cancer among SSA women. This review also found lack of awareness of early detection treatment, poor perception of BC, socio-cultural factors such as belief, traditions and fear as factors impacting African women's health seeking behavior in relation to breast cancer. CONCLUSION Improving African women's knowledge and understanding will improve behaviors related to breast cancer and facilitate early presentation and detection and enhance proper management and treatment of breast cancer.
Collapse
Affiliation(s)
| | | | | | - Dan Yedu Quansah
- Graduate School of Public health, Seoul National University, Seoul, South Korea
| | | | - Daniel Boateng
- Julius Global Health, University Medical Center, Utrecht University, the Netherlands
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
30
|
Buchanan Lunsford N, Ragan K, Lee Smith J, Saraiya M, Aketch M. Environmental and Psychosocial Barriers to and Benefits of Cervical Cancer Screening in Kenya. Oncologist 2017; 22:173-181. [PMID: 28167567 DOI: 10.1634/theoncologist.2016-0213] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/09/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cancer is the second most commonly diagnosed cancer in females and is a leading cause of cancer-related mortality in Kenya; limited cervical cancer screening services may be a factor. Few studies have examined men's and women's perceptions on environmental and psychosocial barriers and benefits related to screening. MATERIALS AND METHODS In 2014, 60 women aged 25-49 years and 40 male partners participated in 10 focus groups (6 female and 4 male), in both rural and urban settings (Nairobi and Nyanza, Kenya), to explore perceptions about barriers to and benefits of cervical cancer screening. Focus groups were segmented by sex, language, geographic location, and screening status. Data were transcribed, translated into English, and analyzed by using qualitative software. RESULTS Participants identified screening as beneficial for initiating provider discussions about cancer but did not report it as a beneficial method for detecting precancers. Perceived screening barriers included access (transportation, cost), spousal approval, stigma, embarrassment during screening, concerns about speculum use causing infertility, fear of residual effects of test results, lack of knowledge, and religious or cultural beliefs. All participants reported concerns with having a male doctor perform screening tests; however, men uniquely reported the young age of a doctor as a barrier. CONCLUSION Identifying perceived barriers and benefits among people in low- and middle-income countries is important to successfully implementing emerging screening programs. The novel findings on barriers and benefits from this study can inform the development of targeted community outreach activities, communication strategies, and educational messages for patients, families, and providers. The Oncologist 2017;22: 173-181Implications for Practice: This article provides important information for stakeholders in clinical practice and research when assessing knowledge, beliefs, and acceptability of cervical cancer screening and treatment services in low- and middle-resourced countries. Formative research findings provide information that could be used in the development of health interventions, community education messages, and materials. Additionally, this study illuminates the importance of understanding psychosocial barriers and facilitators to cervical cancer screening, community education, and reduction of stigma as important methods of improving prevention programs and increasing rates of screening among women.
Collapse
Affiliation(s)
- Natasha Buchanan Lunsford
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathleen Ragan
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Judith Lee Smith
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | |
Collapse
|
31
|
Meacham E, Orem J, Nakigudde G, Zujewski JA, Rao D. Exploring stigma as a barrier to cancer service engagement with breast cancer survivors in Kampala, Uganda. Psychooncology 2016; 25:1206-1211. [PMID: 27421234 DOI: 10.1002/pon.4215] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 05/12/2016] [Accepted: 07/07/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand the role of stigma in the delay of cancer service engagement by women with breast cancer in Kampala, Uganda. BACKGROUND Women in Sub-Saharan African countries are twice as likely to die from cancer as women in high-income countries, which is largely attributable to late diagnosis. While breast cancer-related stigma has been identified in Sub-Saharan Africa, limited research focuses on how stigma impacts the behavior of breast cancer patients in Uganda. METHODS This qualitative study used a grounded theory approach to examine illness narratives from 20 breast cancer survivors in Uganda, gathered through semistructured interviews. RESULTS Thematic analysis showed that perceived and internalized stigma associated with breast cancer influenced care engagement throughout illness, delaying engagement and inhibiting treatment completion. Women identified key factors for overcoming stigma including acceptance of diagnosis, social support, and understanding of breast cancer. CONCLUSION The growing burden of mortality associated with breast cancer in Uganda can be mitigated by improving early detection and treatment engagement through interventions which account for key psychosocial barriers such as stigma.
Collapse
Affiliation(s)
- Elizabeth Meacham
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | | | | | | | - Deepa Rao
- Department of Global Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
32
|
Kwok C, Ogunsiji O, Lee CF. Validation of the Breast Cancer Screening Beliefs Questionnaire among African Australian women. BMC Public Health 2016; 16:117. [PMID: 26846341 PMCID: PMC4743245 DOI: 10.1186/s12889-016-2793-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/27/2016] [Indexed: 11/11/2022] Open
Abstract
Background The Breast Cancer Screening Beliefs Questionnaire (BCSBQ) has been designed as a culturally appropriate instrument for assessing women’s beliefs, knowledge and attitudes to breast cancer and breast cancer screening practices. While it has proved to be a reliable instrument when applied to women of Chinese, Arabic and Korean origin living in Australia, its psychometric properties among women from African backgrounds have not been tested. The aim of this study is to examine the psychometric properties of the BCSBQ among African Australian women. Methods The BCSBQ was administered to 284 African Australian women who were recruited from a number of African community organizations and churches. Factor analysis was conducted to study the factor structure. Construct validity was examined using Cuzick’s non-parametric test while Cronbach alpha was used to assess internal consistency reliability. Results Exploratory factor analysis results demonstrated that the African-Australian BCSBQ can be conceptualized as a 4-factor model. The third factor, viz. “barriers to mammography”, was split into two separate factors namely, “psychological” and “practical” barriers. The results indicated that the African-Australian BCSBQ had both satisfactory validity and internal consistency. The Cronbach’s alpha of the three subscales ranged between 0.84-0.92. The frequency of breast cancer screening practices (breast awareness, clinical breast-examination and mammography) were significantly associated with attitudes towards general health check-ups and perceived barriers to mammographic screening. Conclusions Our study provided evidence to support the psychometric properties of the BCSBQ.in African Australian women. The study moreover demonstrated that the use of the instrument can help health professionals to understand the beliefs, knowledge and attitudes to breast cancer among African Australian women and also the factors that impact on their breast cancer screening practices.
Collapse
Affiliation(s)
- Cannas Kwok
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.
| | - Olayide Ogunsiji
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.
| | - Chun Fan Lee
- Department of Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore.
| |
Collapse
|
33
|
Tetteh DA, Faulkner SL. Sociocultural factors and breast cancer in sub-Saharan Africa: implications for diagnosis and management. ACTA ACUST UNITED AC 2016; 12:147-56. [PMID: 26757491 DOI: 10.2217/whe.15.76] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The incidence of breast cancer is on the rise in sub-Saharan Africa (SSA) and efforts at early diagnosis have not been very successful because the public has scant knowledge about the disease, a large percentage of breast cancer cases are diagnosed late and mainly rural SSA women's practice of breast self-examination is poor. In this paper, we argue that an examination of the social and cultural contexts of SSA that influence breast cancer diagnosis and management in the region is needed. We discuss the implications of sociocultural factors, such as gender roles and spirituality, on breast cancer diagnosis and management in SSA.
Collapse
Affiliation(s)
- Dinah A Tetteh
- Bowling Green State University, School of Media & Communication, 302 West Hall, Bowling Green, OH 43403, USA
| | - Sandra L Faulkner
- Bowling Green State University, School of Media & Communication, 302 West Hall, Bowling Green, OH 43403, USA.,Bowling Green State University, Women's Gender & Sexuality Studies, 236 Shatzel Hall, Bowling Green, OH 43403, USA
| |
Collapse
|
34
|
Naanyu V, Asirwa CF, Wachira J, Busakhala N, Kisuya J, Otieno G, Keter A, Mwangi A, Omenge OE, Inui T. Lay perceptions of breast cancer in Western Kenya. World J Clin Oncol 2015; 6:147-155. [PMID: 26468451 PMCID: PMC4600189 DOI: 10.5306/wjco.v6.i5.147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/11/2015] [Accepted: 06/11/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cancer.
METHODS: In October-November 2012, we recruited men and women (18 years and older) from households and health facilities in three different parts of Western Kenya, chosen for variations in their documented burdens of breast cancer. A standardized and validated tool, the breast cancer awareness measure (BCAM), was administered in face-to-face interviews. Survey domains covered included socio-demographics, opinions about causes, symptoms, severity, and treatment of breast cancer. Descriptive analyses were done on quantitative data while open-ended answers were coded, and emerging themes were integrated into larger categories in a qualitative analysis. The open-ended questions had been added to the standard BCAM for the purposes of learning as much as the investigators could about underlying lay beliefs and perceptions.
RESULTS: Most respondents were female, middle-aged (mean age 36.9 years), married, and poorly educated. Misconceptions and lack of knowledge about causes of breast cancer were reported. The following (in order of higher to lower prevalence) were cited as potential causes of the condition: Genetic factors or heredity (n = 193, 12.3%); types of food consumed (n = 187, 11.9%); witchcraft and curses (n = 108, 6.9%); some family planning methods (n = 56, 3.6%); and use of alcohol and tobacco (n = 46, 2.9%). When asked what they thought of breast cancer’s severity, the most popular response was “it is a killer disease” (n = 266, 19.7%) a lethal condition about which little or nothing can be done. While opinions about presenting symptoms and signs of breast cancer were able to be elicited, such as an increase in breast size and painful breasts, early-stage symptoms and signs were not widely recognized. Some respondents (14%) were ignorant of available treatment altogether while others felt breast cancer treatment is both dangerous and expensive. A minority reported alternative medicine as providing relief to patients.
CONCLUSION: The impoverished knowledge in these surveys suggests that lay education as well as better screening and treatment should be part of breast cancer control in Kenya.
Collapse
|
35
|
Hill JA, Lee SY, Njambi L, Corson TW, Dimaras H. Cancer genetics education in a low- to middle-income country: evaluation of an interactive workshop for clinicians in Kenya. PLoS One 2015; 10:e0129852. [PMID: 26035834 PMCID: PMC4452713 DOI: 10.1371/journal.pone.0129852] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/12/2015] [Indexed: 11/21/2022] Open
Abstract
Background Clinical genetic testing is becoming an integral part of medical care for inherited disorders. While genetic testing and counseling are readily available in high-income countries, in low- and middle-income countries like Kenya genetic testing is limited and genetic counseling is virtually non-existent. Genetic testing is likely to become widespread in Kenya within the next decade, yet there has not been a concomitant increase in genetic counseling resources. To address this gap, we designed an interactive workshop for clinicians in Kenya focused on the genetics of the childhood eye cancer retinoblastoma. The objectives were to increase retinoblastoma genetics knowledge, build genetic counseling skills and increase confidence in those skills. Methods The workshop was conducted at the 2013 Kenyan National Retinoblastoma Strategy meeting. It included a retinoblastoma genetics presentation, small group discussion of case studies and genetic counseling role-play. Knowledge was assessed by standardized test, and genetic counseling skills and confidence by questionnaire. Results Knowledge increased significantly post-workshop, driven by increased knowledge of retinoblastoma causative genetics. One-year post-workshop, participant knowledge had returned to baseline, indicating that knowledge retention requires more frequent reinforcement. Participants reported feeling more confident discussing genetics with patients, and had integrated more genetic counseling into patient interactions. Conclusion A comprehensive retinoblastoma genetics workshop can increase the knowledge and skills necessary for effective retinoblastoma genetic counseling.
Collapse
Affiliation(s)
- Jessica A Hill
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Su Yeon Lee
- Laboratory Medicine and Pathobiology Program, University of Toronto, Toronto, Canada
| | - Lucy Njambi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Timothy W Corson
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America; Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada; Department of Human Pathology, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
36
|
Norlaili AA, Fatihah MA, Daliana NFN, Maznah D. Breast cancer awareness of rural women in Malaysia: is it the same as in the cities? Asian Pac J Cancer Prev 2015; 14:7161-4. [PMID: 24460269 DOI: 10.7314/apjcp.2013.14.12.7161] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Breast cancer is the most common cancer among women globally. This study was conducted to compare the awareness of breast cancer and the practice of breast self-examination (BSE), clinical breast examination (CBE) and mammography screening among rural females in Pahang and Perak. A cross-sectional study was carried out in five selected rural districts of Pahang and Perak. Two hundred and fifty households were randomly selected and interviewed face to face using a semi-structured questionnaire. The majority of residents from both states were Malay, aged between 50 and 60 years and had a secondary level of education. Malay women aged 40-49 years and women with a higher level of education were significantly more aware of breast cancer (p<0.05). About half of these women practiced BSE (60.7%) and CBE (56.1%), and 7% had underwent mammography screening. The results of this study suggest that women in Pahang and Perak have good awareness of breast cancer and that more than half practice BSE and CBE. The women's level of education appears to contribute to their level of knowledge and health behaviour. However, more effort is needed to encourage all women in rural areas to acquire further knowledge on breast cancer.
Collapse
Affiliation(s)
- Abdul Aziz Norlaili
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia E-mail :
| | | | | | | |
Collapse
|
37
|
Rahaei Z, Ghofranipour F, Morowatisharifabad MA, Mohammadi E. Determinants of Cancer Early Detection Behaviors:Application of Protection Motivation Theory. Health Promot Perspect 2015; 5:138-46. [PMID: 26290829 PMCID: PMC4539052 DOI: 10.15171/hpp.2015.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/10/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cancer is account for 13% of all deaths around the world and is the third cause of mortality in Iran. More than one third of these cases are pre-ventable and about 33% are curable with early detection. The aim of this study was to determine the predictors of cancer early detection (CED) behaviors applying Protection Motivation Theory (PMT). METHODS In this cross-sectional study, cluster sampling method was employed to recruit 260 individuals of above 20 years old in Yazd, Iran and a researcher designed questionnaire was completed through interviews for each of the respondents. PMT theoretical variables and CED behaviors were the basis of data collection procedure. RESULTS Participants acquired 64.47% of the protection motivation, 30.97% of the passive and 45.64% of the active behaviors‟ possible scores. Theory constructs predicted 19.8%, 15.6% and 9.6% of the variations for protection motivation, passive and active behavior respectively. Protection motivation was responsible for 3.6% of passive and 8% of active behaviors‟ variations. CONCLUSION Considering the scarceness of CED behaviors and the applicability of PMT in predicting these behaviors, utilization of the PMT‟s constructs in any interventional programs to accelerate CED behaviors could be an alternate methodological choice in the cancer control initiatives.
Collapse
Affiliation(s)
- Zohreh Rahaei
- Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Fazlollah Ghofranipour
- Department of Health Education, Tarbiat Modares University, Tehran, Iran
- Corresponding Author: Ghofranipour Fazlollah Tel: +98 21 82883869;
| | | | - Eesa Mohammadi
- Department of Nursing, Tarbiat Modares University, Tehran, Iran
| |
Collapse
|
38
|
Kohler RE, Lee CN, Gopal S, Reeve BB, Weiner BJ, Wheeler SB. Developing a discrete choice experiment in Malawi: eliciting preferences for breast cancer early detection services. Patient Prefer Adherence 2015; 9:1459-72. [PMID: 26508842 PMCID: PMC4612134 DOI: 10.2147/ppa.s87341] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In Malawi, routine breast cancer screening is not available and little is known about women's preferences regarding early detection services. Discrete choice experiments are increasingly used to reveal preferences about new health services; however, selecting appropriate attributes that describe a new health service is imperative to ensure validity of the choice experiment. OBJECTIVE To identify important factors that are relevant to Malawian women's preferences for breast cancer detection services and to select attributes and levels for a discrete choice experiment in a setting where both breast cancer early detection and choice experiments are rare. METHODS We reviewed the literature to establish an initial list of potential attributes and levels for a discrete choice experiment and conducted qualitative interviews with health workers and community women to explore relevant local factors affecting decisions to use cancer detection services. We tested the design through cognitive interviews and refined the levels, descriptions, and designs. RESULTS Themes that emerged from interviews provided critical information about breast cancer detection services, specifically, that breast cancer interventions should be integrated into other health services because asymptomatic screening may not be practical as an individual service. Based on participants' responses, the final attributes of the choice experiment included travel time, health encounter, health worker type and sex, and breast cancer early detection strategy. Cognitive testing confirmed the acceptability of the final attributes, comprehension of choice tasks, and women's abilities to make trade-offs. CONCLUSION Applying a discrete choice experiment for breast cancer early detection was feasible with appropriate tailoring for a low-income, low-literacy African setting.
Collapse
Affiliation(s)
- Racquel E Kohler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Correspondence: Racquel E Kohler, University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599-7411, USA, Tel +1 919 966 7374, Fax +1 919 966 3671, Email
| | - Clara N Lee
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Satish Gopal
- UNC Project-Malawi, Tidziwe Center, Lilongwe, Malawi
| | - Bryce B Reeve
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bryan J Weiner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
39
|
Galukande M, Wabinga H, Mirembe F, Karamagi C, Asea A. Molecular breast cancer subtypes prevalence in an indigenous Sub Saharan African population. Pan Afr Med J 2014; 17:249. [PMID: 25309649 PMCID: PMC4189896 DOI: 10.11604/pamj.2014.17.249.330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/26/2014] [Indexed: 12/19/2022] Open
Abstract
Introduction Sub-Saharan Africa is predicted to face an unprecedented growth of cancers including breast cancer. There are indications of a significant burden of aggressive and late stage breast disease among premenopausal women in sub-Saharan Africa; because hormonal status tests are not routinely done, many women are given anti-hormonal therapy empirically. There is paucity of data on breast cancer molecular subtypes and their characteristics among women in sub Saharan Africa. The objective is to determine the prevalence of breast cancer molecular phenotypes among Ugandan women. Methods This was a cross sectional descriptive study, conducted at a tertiary hospital in Africa. Eligible participants’ formalin fixed and paraffin embedded sections were evaluated. H & E stains and Immunochemistry (Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal growth factor Receptor (HER2)) were performed. Ethical approval was obtained. Results A total of 226 patient samples were evaluated. The mean age was 45 years (SD 14);the prevalence of Triple Negative Breast Cancer (TNBC) was 34% (77/226), Luminal A 38% (83/226), HER2 positive was 22% (49/226), and Luminal B was 5% (13/226). High-grade (III) tumors were 68%, stage III and IV constituted 75% of presentations. Histological type was mostly invasive ductal carcinoma. Most patients (55%) were from rural areas. Conclusion Ugandan women had an over representation of TNBC and high-grade breast tumors. Underlying reasons ought to be investigated. The empirical use of tamoxifen (anti-hormonal therapy) should be reexamined.
Collapse
Affiliation(s)
- Moses Galukande
- Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Florence Mirembe
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alexzander Asea
- The Texas A & M Health Science Center College of Medicine, USA
| |
Collapse
|
40
|
Khalil A, Abdalrahim M. Knowledge, attitudes, and practices towards prevention and early detection of chronic kidney disease. Int Nurs Rev 2014; 61:237-45. [PMID: 24571391 DOI: 10.1111/inr.12085] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the knowledge, attitudes and practices of Jordanian patients with chronic illnesses towards prevention and early detection of chronic kidney disease. BACKGROUND Patients with chronic illnesses such as hypertension and diabetes need to adopt healthy attitudes and practices and gain knowledge regarding prevention and early detection of kidney disease to decrease the prevalence of dialysis-related complications and costs. METHODS A total of 740 patients were recruited from out-patients clinics in Jordan. Knowledge, attitudes and practices about kidney disease prevention and early detection were measured using the Chronic Kidney Disease Screening Index which was developed by the researcher and tested for validity and reliability. RESULTS The results revealed that most of the participants have knowledge about kidney disease; however, half of them had wrong information related to signs and symptoms of chronic kidney disease. The majority of the participants were not aware about the importance of discovering health problems at early stages. CONCLUSION AND IMPLICATIONS Improvement in population understanding about chronic kidney disease is needed to advance their awareness and practices to make appropriate decisions towards health promotion and better quality of life. IMPLICATION FOR POLICY DEVELOPMENT Nurses need to be involved in development of protocols for screening and intervention programmes, taking into consideration the cultural issues and the financial status of individuals at risk for kidney disease. Governments should adopt a public health policy for chronic kidney disease that supports programmes for screening and programmes for improving public awareness for kidney disease prevention.
Collapse
Affiliation(s)
- A Khalil
- Faculty of Nursing, The University of Jordan, Amman, Jordan
| | | |
Collapse
|
41
|
Jones CEL, Maben J, Jack RH, Davies EA, Forbes LJL, Lucas G, Ream E. A systematic review of barriers to early presentation and diagnosis with breast cancer among black women. BMJ Open 2014; 4:e004076. [PMID: 24523424 PMCID: PMC3927711 DOI: 10.1136/bmjopen-2013-004076] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To explore barriers to early presentation and diagnosis with breast cancer among black women. DESIGN Systematic review. METHODS We searched multiple bibliographic databases (January 1991-February 2013) for primary research, published in English, conducted in developed countries and investigating barriers to early presentation and diagnosis with symptomatic breast cancer among black women (≥18 years). Studies were excluded if they did not report separate findings by ethnic group or gender, only reported differences in time to presentation/diagnosis, or reported on interventions and barriers to cancer screening. We followed Cochrane and PRISMA guidance to identify relevant research. Findings were integrated through thematic synthesis. Designs of quantitative studies made meta-analysis impossible. RESULTS We identified 18 studies (6183 participants). Delay was multifactorial, individual and complex. Factors contributing to delay included: poor symptom and risk factor knowledge; fear of detecting breast abnormality; fear of cancer treatments; fear of partner abandonment; embarrassment disclosing symptoms to healthcare professionals; taboo and stigmatism. Presentation appears quicker following disclosure. Influence of fatalism and religiosity on delay is unclear from evidence in these studies. We compared older studies (≥10 years) with newer ones (<10 years) to determine changes over time. In older studies, delaying factors included: inaccessibility of healthcare services; competing priorities and concerns about partner abandonment. Partner abandonment was studied in older studies but not in newer ones. Comparisons of healthy women and cancer populations revealed differences between how people perceive they would behave, and actually behave, on finding breast abnormality. CONCLUSIONS Strategies to improve early presentation and diagnosis with breast cancer among black women need to address symptom recognition and interpretation of risk, as well as fears of the consequences of cancer. The review is limited by the paucity of studies conducted outside the USA and limited detail reported by published studies preventing comparison between ethnic groups.
Collapse
Affiliation(s)
- Claire EL Jones
- King's College London, Florence Nightingale School of Nursing and Midwifery, London, UK
| | - Jill Maben
- King's College London, Florence Nightingale School of Nursing and Midwifery, London, UK
| | - Ruth H Jack
- Knowledge and Intelligence Team, Public Health England, London, UK
| | - Elizabeth A Davies
- Cancer Epidemiology and Public Health, King's College London, London, UK
| | - Lindsay JL Forbes
- Promoting Early Presentation Group, King's College London, London, UK
| | - Grace Lucas
- King's College London, Florence Nightingale School of Nursing and Midwifery, London, UK
| | - Emma Ream
- King's College London, Florence Nightingale School of Nursing and Midwifery, London, UK
| |
Collapse
|